Stanton Peele and Natural Recovery

Natural recovery is the most common outcome of addiction, as Stanton has been showing for four decades, while being roundly ignored. Here is a listing of his many efforts to expose the best kept secret in the addiction field.

From the beginning, I have never accepted that addiction (alcoholism) is a disease, and I have always referenced the typicality of natural recovery as the opposite point of view. This begins with my theoretical work on addiction, including Love and Addiction (1975) and The Meaning of Addiction (1985)
My alternative view of addiction has always focused on personal stories of natural recovery (e.g., Bing Crosby, Steve Martin, Drew Barrymore), and on epidemiological literature. In L&A I used Charles Winick’s “Maturing Out of Narcotic Addiction” and the just-in Vietnam data. In the alcohol field, I tuned into epi data – the Alcohol Research Group national surveys, NLAES, and NESARC – as well as theoreticians like Harold Mulford who recognized the natural recovery parabola.
I have divided my work into five areas to review my treatment of natural recovery: I. Theoretical books on the nature of addiction; II. Popular articles on addiction/alcoholism: III. Academic articles; IV. Self-help books; V. Blog posts. I also include an excerpt for my interview with Bill White

I. Books About Addiction

A. Love and Addiction (1975)
Love and Addiction was a self-help book, and theoretical treatise, on addiction, which assumed and asserted that people could overcome addictions without treatment.

Chapter 2 in L&A is titled, "What Addiction Is, and What It Has to Do with Drugs"

Among my main evidentiary points, the Vietnam results were just becoming evident then, which I focused on back in 1975. My first point in my list is this:

Vietnam veterans, hospital patients. After it became known that perhaps one-fourth of all American soldiers in Vietnam were using heroin, there was widespread concern that returning veterans would trigger an epidemic of addiction in the United States. Nothing of the sort happened. Jerome Jaffe, the physician who headed the Government’s rehabilitation program for drug-dependent veterans, explained why in an article in Psychology Today entitled “As Far as Heroin Is Concerned, the Worst Is Over.” Dr. Jaffe found that most of the G.I.s used heroin in response to the unbearable conditions they faced in Vietnam. As they prepared to return to America, where they would be able to resume their normal lives, they withdrew from the drug with little difficulty and apparently showed no further interest in it. Dr. Richard S. Wilbur, then Assistant Secretary of Defense for Health and Environment, said that this conclusion to the heroin experience in Vietnam amazed him, and caused him to revise the notions about addiction that he had learned in medical school, where he “was taught that anyone who ever tried heroin was instantly, totally, and perpetually hooked.”

And, of course, I cited Winick:

Maturing out of addiction. By going over the Federal Bureau of Narcotics’ lists of addicts, and comparing the names which appeared on the lists at five-year intervals, Charles Winick discovered that street addicts commonly grow out of their dependency on heroin. In his study, entitled “Maturing Out of Narcotic Addiction,” Winick demonstrated that one-fourth of all known addicts become inactive by the age of 26, and three-fourths by 36. He concluded from these findings that heroin addiction is largely an adolescent habit, one which most people get over at some point in their adulthood.

B. The Meaning of Addiction, 1985
http://lifeprocessprogram.com/the-meaning-of-addiction-1-the-concept-of-addiction/

Meaning is a book that refuted the disease theory of addiction:

The conventional concept and meaning of addiction —the one accepted not only by the media and popular audiences, but by researchers whose work does little to support it—derives more from magic than from science. The core of this concept is that an entire set of feelings and behaviors is the unique result of one biological process. No other scientific formulation attributes a complex human phenomenon to the nature of a particular stimulus: statements such as “He ate all the ice cream because it was so good” or “She watches so much television because it’s fun” are understood to call for a greater understanding of the actors’ motivations (except, ironically, as these activities are now considered analogous to narcotic addiction). Even reductionist theories of mental illness such as of depression and schizophrenia (Peele 1981b) seek to account for a general state of mind, not specific behavior. Only compulsive consumption of narcotics and alcohol—conceived of as addictions (and now, other addictions that are seen to operate in the same way)—is believed to be the result of a spell that no effort of will can break.

To make my case, I reviewed the extensive lit on natural recovery, starting with narcotic addiction:

If life circumstances affect people’s drug use, we would expect patterns of use to vary over time. Every naturalistic study of heroin use has confirmed such fluctuations, including switching among drugs, voluntary and involuntary periods of abstinence, and spontaneous remission of heroin addiction (Maddux and Desmond 1981; Nurco et al. 1981; Robins and Murphy 1967; Waldorf 1973, 1983; Zinberg and Jacobson 1976). In these studies, heroin does not appear to differ significantly in the potential range of its use from other types of involvements, and even compulsive users cannot be distinguished from those given to other habitual involvements in the ease with which they desist or shift their patterns of use.

This is still a radical idea. Indeed, even the people who themselves speak of natural remission don’t believe this. But, if you don’t believe in natural recovery re narcotics, then you don’t believe in natural recovery!

II. Popular Articles

A. "Out of the Habit Trap," American Health (1983)

George Harris, whom I knew from his founding Psychology Today, created a highly successful competing publication, the first popular general health magazine, American Health. George had me write a piece on natural recovery. The running head was: "Update from a top addiction researcher: People who quit drug abuse, smoking and other habits do best if they do it themselves.” George sold it to Readers Digest, but since he sold it first to the Eastern Airlines in-flight magazine, that deal was voided. It was translated into French for the first volume of the leading European addiction journal, Psychotropes (1984). Richard Lazarus included it in his book of readings, Stress and Coping (1985).

B. “Hungry for the Next Fix,” Reason (2002)

I evaluate our never-ending search for a magic bullet solution for addiction in light of the NLAES natural recovery results. In this article, I refute (what was then) the crux of the chronic brain disease model: First, certain drugs are inherently addictive. Second, scientists have discovered the neurochemical processes through which these drugs cause addiction. Third, that understanding will make it possible to develop drugs that cure or prevent addiction.

C. “The Surprising Truth About Addiction,” Psychology Today (2004)

In this article, I popularized the results of NESARC, showing that most people recovered from alcohol dependence, that—by far—most people did so without treatment, and that they mainly did it without abstaining. This article was picked up both popularly and by academic sources.

III. Academic Articles

A. “The Cultural Context of Psychological Approaches to Alcoholism
Can We Control the Effects of Alcohol?” American Psychologist (1984)

In this academic piece, I brought together the clinical and epidemiological literature:

Field investigations of the natural course of drinking problems have evolved separately from the behavioral models of alcoholism generated in laboratory studies. Generally sociological in nature, such field research has agreed with laboratory studies in finding alcoholism to be malleable and situationally determined. In this view, people's alcohol-related problems are so diverse, fluctuate so much with time, and are so strongly influenced by social context that such problems are best conceived of as problem drinking rather than as a disease state of alcoholism (Cahalan, 1970; Cahalan & Room, 1974; Clark & Cahalan, 1976).

B. “Ten Radical Things NIAAA Research Shows About Alcoholism,” The Addictions Newsletter (The American Psychological Association, Division 50), (1998)

(4) Alcoholism treatment in the United States is not notable for its success.
The NIAAA's Deborah Dawson (1996) analyzed over 4,500 NLAES subjects whose drinking at some point in their lives qualified for a diagnosis for alcohol dependence (DSM-IV). Treated alcoholics were more heavily alcohol dependent on average than untreated alcoholics and, according to the NIAAA's Bridget Grant (1996) in the same journal volume, to also have a drug problem (thereby distinguishing these from MATCH subjects). NLAES found that a third of treated (and 26% of untreated) subjects were abusing or dependent on alcohol in the past year.
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(8) Elaborate alcoholism treatment is not necessary for recovery; most alcoholics in the United States recover without treatment. MATCH indicated that people who seek to overcome alcoholism and have a supportive social environment can well do so with brief therapeutic interactions that focus their motivation and resources on improving their lives. The NLAES analysis of untreated alcoholics shows (a) that most alcoholics do not seek treatment and (b) that most of these stop abusing alcohol (Dawson, 1996).
(9) Nonabstinent remission is standard for American alcoholics. Not only do most alcoholics improve significantly without treatment, but they typically do so without quitting drinking. According to NLAES, from five years following a dependence diagnosis on, a majority of ever-alcohol-dependent people in the US are drinking without manifesting alcohol abuse/dependence. Untreated alcoholics are more likely to be in remission than treated alcoholics at all points since dependence onset because, although they are less likely to abstain, they are far more likely to drink without diagnosed problems.

C. Addiction as Disease: Policy, Epidemiology, and Treatment Consequences of a Bad Idea. In J. Henningfield, W. Bickel, and P. Santora (Eds.), Addiction Treatment in the 21st Century: Science and Policy Issues. (2007, pp. 153-163).

In this prestige compilation on addiction, I detail step-by-step what NESARC and NLAES tell us and their crucial implications. Its opening words are these:

The effect of conceptualizing addiction as a disease on policy and treatment has been predictably disastrous. The disease conception that addiction can only become progressively worse and never self-ameliorate is decisively wrong. Accepting this misconception leads to the belief that addictions can be remedied only through treatment when, in fact, natural recovery is typical.

IV. Self-Help Books

I have written four self-help books (with assistance from others). Three are oriented to adults: The Truth About Addiction and Recovery (1991); 7 Tools to Beat Addiction (2004); Recover! An Empowering Program to Help You Stop Thinking Like an Addict and Reclaim Your Life (2014). The other, Addiction-Proof Your Child (2007), is youth-focused. The first, Truth, has sold steadily for decades (it was made an e-book this year); the second, Tools, for a decade. All are built on the primary concept that people’s natural drive is towards recovery.

A. The Truth About Addiction and Recovery (1991)

Truth details “Why it doesn’t make sense to call addiction a disease.” Up front, Truth says the disease theory fails because it maintains that “Addictions are forever.” This furthermore “stigmatizes people—in their own minds—for life.” Instead, Truth makes clear, “Addiction usually does not last a lifetime.” The book outlines The Life Process Program, which involves drawing “connections between the normal maturing process” and recovery from addiction. At the end of this process, “You eventually develop a new self-image, a view of yourself as a former addict.” I was indebted in this formulation to Harold Mulford’s “natural processes model.”

B. 7 Tools to Beat Addiction (2004)

Tools is built on refuting Alan Leshner’s assertion “It’s a myth that millions of people get better (from addiction) by themselves” and from the NIDA’s efforts—along with those of ‘’’industry, government, and faith-based organizations. . .to drive home the same erroneous point.” From the opening words of its introduction Tools asserts that, “In the United States, tens of millions of people have quit smoking without treatment, about half of those who have ever smoked. Surprisingly, the percentage of former heroin, cocaine and alcohol addicts who have quit on their own is even higher.”

At this point, I should recall an exercise that I always do (and that I believe you have seen me do, Andrew) where I ask an assembled audience what the hardest substance addiction to quit is. People uniformly shout out “smoking.” I then ask whether anyone in the audience has quit smoking. In a group of recovered counselors, often more than half of the audience indicate they have done so—hundreds of people. I then ask, “How many of you relied on a support group or medical treatment, like nicorettes or a nicotine batch?” Never more than a handful—and often just a couple, or even no one—raises their hand.

C. Recover! An Empowering Program to Help You Stop Thinking Like an Addict and Reclaim Your Life (2014)

Once again, my launching point of my book with Ilse Thompson is the reality of natural recovery, and the crucial message this gives people who are addicted about themselves.

The truth is, however, that the qualities that make you you are much more powerful and abiding than any addiction. When people overcome addiction, it’s because they align their behavior with who they really are. When people recognize that something they are doing interferes with their deepest values or goals, they can leave destructive compulsions behind. It’s a natural life process.

This is the essence of the self-efficacy message that we convey:

You have forgotten how to imagine yourself living without it. You would be empty inside or a complete stranger to yourself, someone without an identity or soul, you may now believe. This is not true. The real you is, in fact, able to reassert itself and to take charge.

D. Addiction-Proof Your Child (2007)

Of course, Proof focuses parents on the fact that adolescence and young adulthood are peak periods for substance abuse (the term DSM-IV used) and dependence. “Peak” period indicates that use, abuse, and dependence decline thereafter. Once again, in a pamphlet I have lately produced with Kevin Gallagher, Addiction-Proofing Your Family, summarizing Proof, we begin with this assertion:

Today’s conception of addiction is known as the “medical” or “disease” model. This is the view that addiction is the result of genetic, chemical, and biological factors that create a disease in the individual. In this view addiction is the same as cancer or diabetes. The brain goes “haywire” so that people can’t control themselves: they are powerless.

Before going any further, you need to know that this isn’t true. You should see your doctor when you or your child is sick. But no doctor or disease treatment based on a medical model can prevent or solve addiction for you or your child. Sorry.

The disease theory is good at removing the stigma from addiction. But it creates more questions than answers. For example, if the problem is locked in biology, how can talking about it help? If it is progressive and chronic, how can some people go in and out of addictive behaviors? (Do you know anyone who has – or have you yourself – quit smoking?)

Although the disease theory is well meaning, it also confuses issues. People taught this model learn that they are powerless to change themselves. They believe that their whole life will be lived in addicted hell, even though research shows that most people outgrow addiction.

V. Blogs

Of course, lately I often communicate through blogposts. Throughout my blogging career, I have emphasized and re-emphasized natural recovery.

A. How have findings of natural recovery affected American addiction treatment and policy? Peele.net (2001). I drive home the NLAES data, and how these are ignored.

B. United States Changes Its Mind on Addiction - It's Not a Chronic Brain Disease After All. Psychology Today Blogs (2009). Of course, I promoted the results of NESARC when these appeared.

C. Government Says You Can’t Overcome Addiction, Contrary to What Government Research Shows. Reason (2014). As findings have multiplied on findings of natural recovery (including a major review of natural recovery research by Bill White), I announced the meaning of this discovery for a Web site with a million independent hits a month.

Interview with Bill White

The fact that people tend, in general, to recover from addiction is so crucial that it needs to inform our whole view of addiction, including how we treat it. Of course, it is a fundamental refutation of the disease theory, which claims the exact opposite as a basic tenet. I see people cite to the fact of natural recovery without being able to comprehend or acknowledge its significance and treatment implications. Here's how I answered a question about that in my interview with Bill White:

Bill White: You have championed the natural resolution of AOD problems (without professional or mutual aid support). What are the implications of research on natural recovery for the design and practice of addiction treatment?

Stanton Peele: From the start, I have always incorporated epidemiological, community-based, and life-history visions of addiction. These regularly show us that people tend to recover naturally. You noted that finding yourself, Bill, based on a literature review, although I don’t believe you have delved enough into what that tells us.

Let me jump to the “evidence-based-treatment” era we are in, where every documentary and popular article now says we don’t use treatments that have empirical support for their effectiveness. The people who promote that “evidence-based” concept are CBTers intent on putting down AA and the 12 steps. I realize that Bill Miller, who has found that AA is ineffective and that belief in the disease theory leads to relapse, and yet supports AA, is hard to fit on that continuum. But you and Keith and others have shown that, looked at from some angles, the evidence is as good for traditional approaches as anything else.

When you questioned Bill about what he learned from Project MATCH, he said it was our arrogance in thinking we could match people with the treatments that would work best for them. What that actually means is that people do best when they find their own ways to recovery! That’s a natural recovery outcome, really. Project MATCH actually showed that all treatments were equally effective for a highly selected population of alcoholics, that is, those who were socially stable, had no co-occurring mental illnesses, and were not mired in the criminal justice system.

But those are the people most likely to recover in any case, treatment or no. And, of course, there wasn’t a no-treatment control group in Project MATCH. Cutler’s analysis of the MATCH results showed that all the improvement occurred up front, as soon as people signed on. Along with that came follow-up assessments. Project MATCH was a giant brief intervention demonstration with follow-up contacts. That process accounted for virtually all of the subjects’ improvement in what was supposed to be a treatment trial.

I have repeatedly written that we will never treat our way out of addiction or mental illness. Not enough people enter treatment, stay in treatment, succeed at treatment, and avoid relapse to make a difference. And all the while, more and more people are developing the syndromes that supposedly require treatment. I know that you are a great AA booster, Bill. But the simplest back-of-the-envelope calculation shows how futile that whole operation is. According to NESARC, 1 in 12 alcohol dependent people enter formal alcohol treatment or AA. And, while you can quibble with Lance, he cites the data showing that 5-10 percent of people stay with and succeed at AA. Taken together, that’s one in a hundred alcoholics who benefit from AA or 12-step treatment!

Of course, I have created a treatment package myself, the Life Process Program, and my later books are all self-help oriented. That’s because I can read which way the wind blows in America, and I need to make a living. But I at least tell people the truth in my books and my program, that recovery requires people to exercise their own initiative, so that they can recognize what they must do, as well as having the research-based support and faith to know that it can be done, examples from history and popular culture showing that it is done all the time, and signposts taken from the data and these examples for how they might do it for themselves.

Summary

So, Andrew, as you can see, I am preoccupied with natural recovery—it has fueled my views of and approaches to addictions throughout my career. It is impossible to maintain current disease myths about addiction and simultaneously to acknowledge the prevalence of natural recovery outcomes—although we continue to attempt this psychotic squaring of the circle. Both you and I know people who build their careers on doing so.

Nonetheless, as I say yet again at Reason.com, in explicating how the latest NESARC results show a 50% growth in AUDs in the last decade, despite—nay, due to—our broadcasting to Americans, at earlier and earlier ages, the disease concept of no return from addiction, “Are We Creating Our Own Addiction Surge”: “Needless to say, such maturing out refutes both Alcoholics Anonymous' and the chronic brain disease model's view of addiction and alcoholism as progressive diseases.”