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One population that remains hidden due to the fact that they deviate from socially constructed categories regarding addiction are middle-class drug addicts and alcoholics who terminate their addictive use of substances without treatment. Research exploring the phenomena of natural recovery has found that significant numbers of people discontinue their excessive intake of addictive substances without formal or lay treatment. While it is difficult to estimate the actual size of this hidden population because they are largely invisible (Lee 1993), researchers agree that their numbers are large (Goodwin et al. 1971) and some even contend that they are substantially larger than those choosing to enter treatment facilities or self-help groups (Sobell et al. 1993; Peele 1989; Biernacki 1986). Some have estimated that as many as 90% of problem drinkers never enter treatment and many suspend problematic use without it (Hingson et ai. 1980; Roizen et al. 1978; Stall and Biernacki 1986). Research in Canada has shown that 82% of alcoholics who terminated their addiction reported using natural recovery (Sobell et al. 1993).
While the sample within the present study is small, there is considerable evidence from additional research to suggest that the population of self-healers is quite substantial (Sobell et al. 1992; Waldorf et al. 1991). Despite empirical evidence, many in the treatment field continue to deny the existence of such a population. The therapeutic "field" possesses considerable power to construct reality in ways that exclude alternative and perhaps challenging paradigms. As Bourdieu (1991) has recently pointed out, such fields reproduce themselves through their ability to normalize arbitrary world views. The power of the therapeutic field lies in its ability to not only medicalize behavior, but also in the ability to exclude the experiences and world views of those who do not fit into conventional models of addiction and treatment (Skoll 1992).
Finding empirical support for natural recovery does not imply that we devalue the importance of treatment programs or even self-help groups. Such programs have proven beneficial to addicts, particularly those in advanced stages. However, the experiences of our respondents have important implications for the way in which addiction and recovery are typically conceptualized. First, denying the existence of this population, as many do, discounts the version of reality held by those who terminate their addictions naturally. Natural recovery is simply not recognized as a viable option. This is increasingly the case as media has reified dominant notions of addiction and recovery. Similarly, there is an industry of self-help literature that unquestionably accepts and reproduces these views. Denying the experience of natural recovery allows treatment agencies and self-help groups to continue to impose their particular view of reality on society.
Related to this is the possibility that many of those experiencing addictions may be extremely reluctant to enter treatment or attend self-help meetings. Their resistance may stem from a variety of factors such as the stigma associated with these programs, discomfort with the therapeutic process, or lack of support from significant others. Whatever the reason, such programs do not appeal to everyone, For such people, natural recovery may be a viable option. Since natural recovery demystifies the addiction and recovery experience, it may offer a way for people to take control of their own lives without needing to rely exclusively on experts. Such an alternative approach offers a low-cost supplement to an already costly system of formal addiction treatment.
A third implication concerns the consequences of adopting an addict identity. While the disease metaphor is thought to be a humanistic one in that it allows for the successful social reintegration of deviant drinkers or drug users, it nevertheless constitutes a deviant identity. Basing one’s identity on past addiction experiences may actually limit social reintegration. The respondents in our sample placed a great deal of emphasis on their immediate social roles as opposed to constantly referring to their drug-addict pasts. Although there is no way of knowing, such present-centeredness may, in the long run, prove more beneficial than a continual focusing on the past.
Fourth, for drug and alcohol treatment professionals, as well as those who are likely to refer individuals to drug and alcohol treatment programs, this research raises several important considerations. It reaffirms the necessity for individual treatment matching (Lewis et al. 1994). It also suggests that individuals whose profiles are similar to these middle-class respondents are likely to be receptive to and benefit from less intrusive, short-term types of interventions. Given the extent of the various concerns expressed by these respondents around some of the possible long-term negative consequences of undergoing traditional treatment and related participation in self-help programs, the decision to specifically recommend drug and alcohol treatment is a profoundly serious one. It should not be made capriciously or simply because it is expected and available. A careful assessment of the person’s entire life is warranted, including whether or not the condition is so severe and the absence of supportive resources so great that the possible lifelong identity of addict or related internalized beliefs are reasonable risks to take in pursuing recovery. Overall, the findings of this study as well as previous research on natural recovery could be instructive in designing more effective treatment programs (Sobell etal. 1992; Fillmore 1988; Stall and Biernacki 1986).
Finally, the experiences of our respondents may have important social policy implications. If our respondents are any guide, the following hypothesis might be considered: those with the greatest number of resources and who consequently have a great deal to lose by their addiction are the ones most likely to terminate their addictions naturally. While addiction is not reducible to social class alone, it is certainly related to it (Waldorf et al. 1991). The respondents in our sample had relatively stable lives: they had jobs, supportive families, high school and college credentials, and other social supports that gave them reasons to alter their drug-taking behavior. Having much to lose gave our respondents incentives to transform their lives. However, when there is little to lose from heavy alcohol or drug use, there may be little to gain by quitting. Social policies that attempt to increase a person’s stake in conventional life could not only act to prevent future alcohol and drug addiction, they could also provide an anchor for those who become dependent on these substances.
12-Step Interventions and Mutual Support Programs
- Donovan, D. M., Ingalsbe, M. H., Benbow, J., & Daley, D. C. (2013). 12-Step Interventions and Mutual Support Programs for Substance Use Disorders: An Overview. Social Work in Public Health, 28(3-4), 313-332.
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