Here hezus, let me help;
Estimates of Recovery From
Prospective Studies
Prospective studies tend to be limited
by small sample size because of cost,
but they have the important advantages
of minimizing recall error and account*
ing for attrition due to mortality. In a
community sample of 96 Swedish alco*
holics, Ojesjo (1981) found that 41
percent of those who survived to the
15-year followup were either abstainers
or asymptomatic drinkers. Vaillant
(1995, 1996, 2003) followed two com*
munity samples of U.S. male alcohol
abusers for up to six decades. In his
sample of 150 inner-city residents, 59
percent of those who survived to age
60 had achieved remission of alcohol
use disorders. Controlled drinkers
accounted for about one-third of the
recoveries. In his sample of 55 college
alcohol abusers, remission rates among
survivors were 27 percent at age 60 and
47 percent at age 70. In another com*
munity sample of outpatient health
care recipients (n = 704), 30 percent of
the individuals who had survived to the
10-year interval had been in remission
at both the 4-year and 10-year followups
(Schutte et al. 2001, 2003). Prospective
studies of treated alcoholics with fol*
lowup intervals of 8 years or more have
Laboratory of Epidemiology and Biometry, Division of
Intramural Clinical and Biological Research, National
Institute on Alcohol Abuse and Alcoholism, National
Institutes of Health, Bethesda, MD.
132
reported remission rates of 21 percent
to 83 percent (Vaillant 1998; Finney et
al. 1999). In a study that compared
alcohol-dependent adults identified in
a general population sample (n = 111)
with those admitted to substance abuse
programs (n = 371), Weisner and colleagues
(2003) found that 30-day abstinence
rates 1 year after baseline were 57 percent
for the treatment sample and 12 percent
for the population sample. The rates of
nonproblematic drinking at followup
were 40 percent and 23 percent.
Estimates of Recovery From
Retrospective Surveys
In retrospective surveys, the assessment
of recovery generally is based on the
current diagnostic status of cases with
prior-to-past-year or lifetime alcohol
use disorders, relying on respondent
recall of ages at onset and remission.
Although limited potentially by selec*
tive survival and recall problems, this
approach has yielded the only national
estimates of recovery from alcohol
dependence in the United States. Based
on data collected in the 1992 National
Longitudinal Alcohol Epidemiologic
Survey (NLAES), only 27.8 percent of
U.S. adults with PPY alcohol dependence
were still classified with dependence or
abuse in the year preceding interview.
Half (49.9 percent) were drinkers who
did not meet the criteria for abuse or
dependence, including heavy drinkers
and individuals with subclinical symp*
toms of dependence, and 22.3 percent
were abstinent (Dawson 1996). Rates
of recovery increased over time since onset
of dependence, and treatment increased
the likelihood of abstinent recovery.
In both the 1989 National Alcohol
and Drugs Survey and the 1993
Ontario Alcohol and Drug Opinion
Survey, more than three-quarters of the
individuals who reported recovering
from alcohol problems (social and legal
consequences of drinking comparable
to alcohol abuse) did so without treat*
ment (Sobell et al. 1996). Nonproblem*
atic drinking accounted for 38 percent
of all recovery in the 1989 survey
(n = 437) and 63 percent in the 1993
survey (n = 87). Both surveys excluded
from their estimates of recovery those
asymptomatic drinkers whose levels of
intake were considered to pose a risk to
their health: a usual quantity of four or
more drinks for men (three or more for
women), having consumed five to seven
drinks on a single occasion more than
twice in the past year, or drinking eight
or more drinks on any occasion in the
past year.
Using data from the 1990–1991
Mental Health Supplement to the
Ontario Health Survey, Cunningham
and colleagues (2000) reported that 50
percent of remitted alcoholics and alco*
hol abusers had accessed treatment at
some time (although not necessarily
prior to remission) and that 58 percent
were drinking moderately at the time
of interview. Asymptomatic past-year
drinkers were excluded from classifica*
tion of remission if they reported ever
drinking five or more drinks in the past
year or if they drank one to four drinks
more than twice a week. Notably, this
group of asymptomatic risk drinkers was
more than three times as large as the
group of remitted “moderate” drinkers.
Correlates of Recovery
Past research has sought not only to
document rates of recovery but also to
identify factors that promote or impede
the recovery process and examine whether
these differ for treated versus untreated
and abstinent versus nonabstinent
recovery. Much of the information on
correlates of recovery has come from
media-solicited samples of individuals
who have overcome alcohol problems
(Tucker & Gladsjo 1993; Burman
1997; King & Tucker 2000; Bischof et
al. 2001, 2003; Rumpf et al. 2002).
Although useful in identifying factors
that distinguish abstinent from nonab*
stinent and treated from untreated
recovery, these studies cannot identify
predictors of recovery per se, in that
there is no control group of individuals
who have not recovered.
In studies of community and nation*
ally representative samples, factors that
have been associated positively with
recovery include female gender and
being married (Dawson 1996; Bischof
et al. 2001; Schutte et al. 2001, 2003).
Education has been associated positively
Alcohol Research & Health
pubs.niaaa.nih.gov/publications/arh29-2/131-142.pdf
Now Heroin;
The first evidence to suggest natural recovery came from Charles Winick's famous "maturing out" study published in 1962. Winick traced the official records of addicts in files of the Federal Bureau of Narcotics and found that age was associated with such traces. As addicts approached ages 35-40 years they tended to drop out of the files which suggested to Winick that some life cycle processes were involved. He postulated that addicts gave up their addiction just as some adolescents matured out of juvenile delinquency. There are, however, problems with Winick's study; he did not know exactly what happened to persons who were no longer in the file and assumed that they had given up their addiction. A 1973 report of George Vaillant's longitudinal study of 100 New York addicts (originally admitted to Lexington Hospital and followed for 20 years) questions Winick's assumption of recovery. Vaillant found that " . . . more than half of the actively addicted men of [his] study [were] able to go for five years or more without being reported to the Federal Bureau of Narcotics and Dangerous Drugs," and that "Over 25% of active addicts went for five years without being reported to the New York Narcotics Register." (Vaillant, 1973) These data suggest that Winick's assumption of recovery may not be completely justified. The next study to suggest natural recovery was conducted in 1964 and 1965 and published in 1966. Robert Scharse working in the East Los Angeles Halfway House asked known addicts in the program to identify and locate friends who had used heroin with them but had since given it up. Scharse identified 71 ex-users by this means and interviewed 40 of them in a dual interview situation (both the addict and the ex-user). He found that at least 9 of the 40 interviewed reported that they had experienced physical dependence from heroin and had recovered without going to treatment. (Scharse, 1966)
Social survey data amplified the exploratory studies of Scharse and Winick in 1967. Lee Robins working out of Washington University in St. Louis published the results of a social survey of a sample of black males born during 1930-1934 in St. Louis and who attended schools in that city. This was the first study of drug use of a non-treatment sample (called "normal" by Robins) and she found that 10% (22) of the 235 men interviewed had been addicted to heroin while 4% (9) had been to Lexington and Ft. Worth Hospitals for drug treatment (at that time there were few other treatments available). Of the 22 persons reporting heroin addiction only 16% (4) reported heroin ule during the previous year (1964-1965); 2 of the 4 had been to treatments (or 22% of the 13) and the remaining (15% of the 13) had not been treated. Put another way, 78% of the treated and 85% of the untreated addicts reported no heroin use for the previous year. (Robins, 1967) These findings were so unusual and so much at odds with the accepted knowledge of addiction at the time that many persons were cautiously skeptical.
This skepticism subsided somewhat in 1973 when Robins published her milestone study of returned Vietnam veterans. Startled by reports of widespread heroin use in Vietnam during the war, the federal agencies (more specifically the Special Action Office for Drug Abuse Prevention) commissioned a study of returned veterans in 1972 to learn more about their drug use in Vietnam and also since returning. A sample of 898 men who had returned from Vietnam during September 1971 were interviewed in 1972 from 8-12 months after their return. Of the 898 it was found that nearly one in two had used narcotics in Vietnam (45%) and one in five (20%) had been addicted to heroin. After returning only 10% reported using narcotics between the time of their return and the interview and only 1% had been re-addicted. At the time of the interview only 2% (8% of those addicted in Vietnam) reported to have been currently using narcotics and 1% were detected to have used opiates through urine analyses.
Research findings concerning the differences between treated and untreated addicts were not as expected. Veterans who did not get treatment for their addiction did just as well upon return as those treated. More specifically the study found that:
37% of the treated and 49% of the untreated veterans who were dependent and detected (DEROS urine samples) narcotics users (186) were drug positive at the interview. 48% of the treated and 24% of the untreated veterans who were dependent but not detected narcotic users (76) were drug positive and;
13% of the treated and 16% of the untreated persons who claimed never to have been dependent in Vietnam (12) were drug positive.
These findings were even more startling than those of the first Robins study. The idea that addiction was nearly always a long lasting phenomena and the old myth 11 once an addict, always an addict" had to be abandoned in the face of these findings. Very clearly, the natural history of addiction had to be re-thought to account for these new data. Discussing the findings in 1975 she and her co-authors said:
... it does seem clear that the opiates are not so addictive that use is necessarily followed by addiction nor that once addicted, an individual is necessarily addicted permanently. At least in certain circumstances, individuals can use narcotics and even become addicted to them but yet be able to avoid use in other social circumstances. (Robins, Helzer and Davis, 1975)* Still another large scale survey also lends support to the findings of the two Robins' studies. In 1976 John O'Donnell and researchers from the Universities of Kentucky and California (at Berkeley) published preliminary results from a survey of 2,510 males taken in 1974 and 1975. (O'Donnell, Voss, Clayton, Slatin and Room, 1976). From a sample of all the males in the United States born between 1944-1954 and known to draft boards, O'Donnell and his associates found that 6% of the sample had used heroin and 2% were considered heavy users (using 100 times or more). Only 20 of the heroin users reported going to treatment; this number constituted 13% of all the heroin users. Half the heavy heroin users had been to treatment. Comparing those who had been to treatment with those who had not the authors found major differences in current heroin use (use during 1974 and 1975):
... 65 percent of the men who had been treated for heroin use were currently using it, in contrast with 27 percent of the men who had never been treated for use of heroin. These data suggest that users who enter treatment comprise those least likely to succeed in terminating the use of heroin. (O'Donnell, Voss, Clayton, Slatin and Room, 1976)
http://www.umsl.edu/~keelr/180/narehead.htm
Hmm, seems you are quite incorrect. How unsurprising.