American Addiction Treatment and Policy
How have findings of natural recovery affected American addiction treatment and policy?
Dear Stanton Peele:
I have always admired your work and agreed with it. But there’s one question I’m very interested in finding an answer to. I have got a number of opinions on this subject but I’d like to hear your opinion: What is the impact that research into the phenomenon of natural remission has had on the addictions field?
Natural remission runs counter to everything we are told about drugs and alcohol — see the February 12 (2001) Newsweek cover story, where the director of the NIDA, Alan Leshner, said: “Drugs of abuse change the brain, hijack its motivational systems and even change how its genes function. . . .This is why addiction is a brain disease. . . . It may start with the voluntary act of taking drugs, but once you’ve got it, you can’t just tell the addict, ‘Stop,’ any more than you can tell the smoker ‘Don’t have emphysema.’ Starting may be volitional. Stopping isn’t.”
I said in response:
And what, exactly, supports Leshner’s claim that: “Starting may be volitional. Stopping isn’t”? Let’s first consider the most universally addicting substance known to Americans — cigarettes. Surveys of multiple substance abusers tell us that nicotine is at the top of the list of addictive substances that are hard to quit — harder than crack or alcohol. Yet, national surveys have revealed what most of us could ascertain by surveying our co-workers and dinner companions — a large percentage (half or more) of people ever addicted to smoking have quit. Moreover, in the 1980s, these surveys showed, from 90% to 95% quit smoking without formal treatment of any kind (although current research will reveal that more people — although still a minority — quit smoking through relying on widely marketed pharmacological aids). To say that quitting smoking is the same as willing away emphysema distorts the data so badly that, if not intentionally meant to be misleading, it can only indicate that the speaker is psychotic.
Consider the results of the largest survey of drinking ever conducted — involving face-to-face interviews with nearly 45,000 Americans (this study, called the National Longitudinal Alcohol Epidemiologic Survey, was conducted by the National Institute on Alcohol Abuse and Alcoholism). Of all Americans who were ever dependent on (addicted to) alcohol, about a quarter had been treated. Nonetheless, a large majority of untreated alcoholics (a higher percentage than of those who were treated) were no longer alcoholic, even though more than half continued to drink!
National Longitudinal Alcohol Epidemiologic
Survey Data on Alcohol Dependent Subjects
Drinking over prior year Treated (n=1,233) Untreated (n=3,309) Total (n=4,585) % drinking with abuse/dependence 33 26 28 % abstinent 39 16 22 % drinking w/o abuse/dependence 28 58 50 From “Correlates of past-year status among treated and untreated person with former alcohol dependence: United States, 1992” by D. A. Dawson (1996) Alcoholism: Clinical and Experimental Research, 20, p. 773. Adopted with permission.
Finally, think of the Vietnam experience, where, among those GIs found to have been addicted in Vietnam, only one in eight became readdicted in the U.S., although half used narcotics at some point stateside.
Of course, to answer your question, “What is the impact that research into the phenomenon of natural remission has had on the addictions field?” — virtually none!
I participated in a conference in Switzerland on natural remission in 1999, from which a book has been produced.* The book describes a public education campaign undertaken in Switzerland, where the public is well-educated about alcoholism, and the medical view of alcoholism (the American view) has begun to proliferate. But this view was unnecessarily pessimistic and could discourage people from trying, and succeeding, at quitting drugs. Based on national survey data on drug addicts, the federal government initiated a campaign ” ‘A sober look at drugs’ . . . to change the attitude ‘once an addict always an addict’ ” by informing users and others that most drug users succeed at quitting their drug habits. The purpose was “to strengthen hope and optimism” that people could stop using drugs. Can you imagine such a campaign here?
*Klingemann et al. (in press/2001). Promoting Self-Change from Problem Substance Use: Practical Implications for Prevention, Policy and Treatment. The Hague, NL: Kluwer.