In addition to the facts arising from the science of addiction treatment, there is another compelling and relevant aspect of addiction: Natural recovery. Most who recover from addictive behavior do so without attending treatment or a support group. Recovery is thus a broader concept than treatment. In daily life natural recovery is easily visible in how people quit smoking. Although for most quitting smoking involves multiple attempts and a major expenditure of effort, very few individuals attend treatment or a support group to quit. Nevertheless, in the US millions of individuals have quit smoking, especially since the widespread recognition in the mid-20th century that smoking was seriously harmful.
Large scale population studies have confirmed that even for the substances of abuse often dealt with in treatment facilities (such as alcohol and heroin), most who recover do so without treatment or a support group. This does not mean that of 100 individuals with drinking problems most will recover on their own—what will happen for them is anybody’s guess. Rather, it means that of 100 individuals with previous problems, the majority will have resolved those problems without treatment or a support group.
Natural recovery may often involve outside support (e.g., from friends or family), but we are still learning about the myriad ways that support is expressed and received. Unfortunately, just as evidence-based treatment is not widely available, natural recovery is not widely recognized. When we hear professionals state “I’ve never seen a solid recovery that did not involve treatment and support group attendance,” we should believe them. That is, we should believe that this professional needs an expanded awareness of how recovery happens.
A review of the relationship between recovery and treatment, and the incredible diversity of recovery (with or without treatment) is available in Recovery Management, by White, Kurtz and Sanders (Chicago: Great Lakes Addiction Technology Transfer Center, 2006). A review of the research on natural recovery is available in Promoting Self-Change From Addictive Behaviors: Practical Implications for Policy Prevention, and Treatment, edited by Klingemann and Sobell (New York: Springer, 2007).
Arising out of the awareness of natural recovery has been the related awareness that self-change typically begins when the individual realizes that the costs of the addictive behavior outweigh the benefits. The individual reviews “the pros and cons” and makes a decision to change. In my own discussions with self-changers I typically hear statements like: “I just realized I’d had enough. It was time to do something different with my life. I was missing out on too much. I didn’t like the side effects anymore.”
By comparison, there are occasions when substance use may cause significant harm, but that harm is exceeded by the benefits of use. An example of this situation is morphine dependence during terminal illness. Contrasting this example with what we normally mean by “addiction” suggests that “costs exceeding benefits” is the defining element of addiction. Ultimately, the beginning of addiction recovery is the user’s own conclusion that costs exceed benefits. If the user by himself or herself does not reach this conclusion, and maintain it, reaching this conclusion becomes the primary task of addiction treatment (if the user will stay put long enough).