Recovery from Alcohol Problems with and without Treatment: Prevalence in Two Population Surveys Linda C. Sobell, PhD, John A. Cunningham, PhD, and Mark B. Sobell, PhD Introduction Even though estimates of the ratio of untreated to treated individuals with alcohol problems in the general popula- tion range from 3:1 to 13:1,1 there has been little interest in the fates of un- treated individuals, including whether they can recover without treatment (natu- ral recovery).2- Recently, prominent orga- nizations such as the Institute of Medi- cine5 and the American Psychiatric Association6 have acknowledged that natu- ral recoveries constitute a significant pathway to recovery from alcohol prob- lems. However, while epidemiological and longitudinal studies of alcohol prob- lems in the general population have led to speculation about the prevalence of un- treated recoveries, these studies have not directly assessed recovery rates for both treated and untreated individuals or whether drinking outcomes involved absti- nence or moderate drinking." 4'7-9 Traditionally, alcohol problems have been viewed from the context of individu- als who are severely dependent on alco- hol.10 However, epidemiological studies show that while persons with severe alcohol problems constitute the majority of individuals in treatment programs, they represent a minority of those with alcohol problems.1011 It has been estimated that the ratio of problem drinkers (i.e., mild alcohol dependence) to those severely dependent on alcohol is about 4:1.5 Although severely dependent alcohol abusers have more serious problems, most alcohol-related costs to society stem from the large numbers of problem drinkers (e.g., drunk driving, days of missed work, domestic violence).5'12 From a public health perspective, the fate of all individu- als with alcohol problems is important. In two recent surveys, randomly selected adults in the general population were asked a broad range of questions about their past and present use of alcohol. Using data from these surveys, this report examines the prevalence of treated and untreated recoveries from alcohol problems. Because research indi- cates that individuals with low-severity problems often recover by reducing rather than stopping drinking, recoveries were also classified as involving abstinence or moderate drinking. Methods Data were derived from two surveys: the National Alcohol and Drugs Survey ("National Survey"), conducted by Statis- tics Canada in March 1989,13 and the Ontario Alcohol and Drug Opinion Sur- vey ("Ontario Survey"), conducted by the Institute of Social Research at York University (Toronto) in April and May 1993.14 In both surveys, persons living in institutions (e.g., those in hospitals) were excluded. All respondents were assured of anonymity (i.e., names were never asked). Random-digit dialing was the sampling method used in both surveys.14"5 Households without telephones (<2%) could not be covered by this sampling method. Linda C. Sobell is with the Addiction Research Foundation and the Departments of Psychol- ogy, Family and Community Medicine, and Behavioural Science, University of Toronto, Toronto, Ontario, Canada. John A. Cunning- ham is with the Addiction Research Founda- tion and the Department of Psychology, Univer- sity of Toronto. Mark B. Sobell is with Nova Southeastern University, Ft. Lauderdale, Fla. Requests for reprints should be sent to Linda C. Sobell, PhD, Center for Psychological Studies, Nova Southeastern University, 3301 College Ave, Ft. Lauderdale, FL 33314. This paper was accepted February 1, 1996. July 1996, Vol. 86, No. 7