0145-6008/93/1702-02 17$3.00/0 ALCOHOLISM: CLINICAL AND EXPERIMENTAL RESEARCH zyxwvutsrqpo Vol. 17, No. 2 March/April 1993 What Triggers the Resolution of Alcohol Problems Without Treatment?* zy Linda C. Sobell, Mark B. Sobell, Tony Toneatto, and Gloria I. Leo This study investigated natural recoveries (self-change) from alcohol problems, and overcame several methodological problems that af- fected the few previous studies of this phenomenon. Three groups of individuals who had resolved an alcohol problem without treatment were interviewed about their drinking history, life events that oc- curred during the year prior to their resolution, and factors that helped maintain their resolution. As a control for prevalence of life events, a control group of nonresolved, nontreated alcohol abusers were interviewed about events in a randomly selected year. Collat- erals were interviewed for all subjects. No life event or constellation of events was differentially associated with the resolutions across the three resolved groups or differentiated the resolved and nonre- solved groups. Interviews with resolved subjects were qualitatively analyzed-the majority (57%) of recoveries were characterized as involving a "cognitive evaluation" or appraisal of the pros and cons of drinking. Spousal support was reported by the greatest number of resolved subjects as having helped them maintain their resolution. Findings from this study may provide direction for developing new treatment strategies and for accelerating self-change among prob- lem drinkers in the community. The study also demonstrates the importance of using a control group, without which very different conclusions might have been drawn. Key Words: Natural Recovery, Spontaneous Remission, Self- Change, Alcohol Problems, Alcohol Abuse. VER A QUARTER of a century ago, Becker' in his 0 classic treatise on the study of deviants, cautioned against studying only extreme cases. He urged researchers to consider "those who have a more fleeting contact with deviance, whose careers lead them away from it into conventional ways of life" (p. 24-25). This same point is relevant to the study of alcohol abusers, where the vast majority of individuals with alcohol problems do not seek treatment (i.e., the ratio of untreated to treated alcohol abusers ranges from a conservative estimate of 3:l to a liberal estimate of 13: I).' It has been suggested that our understanding of the disorder might be highly biased or zyxwvu From the Addiction Research Foundation and the Departments of Psychology and Behavioural Science, University zyxwvuts of Toronto, Toronto. Ontario, Canada. Received for publication June 9, 1992; accepted September 2, I992 * The views expressed in this paper are those of the authors and do not necessarily reflect those of the Addiction Research Foundation. The research presented in this paper was supported in part, by a grant (AA08593)from the National Institute on Alcohol Abuse and Alcoholism. Portions of the paper were presented at the 5th International Confer- ence on Treatment of Addictive Behaviors, Sydney, Australia, January 1990, and zyxwvutsrqp at the Banf International Conference on Behavioral Science, Banff; Canada, March 1991, Reprint requests: Dr. zyxwvutsrqpo L. C. Sobell, Addiction Research Foundation, 33 Russell St., Toronto. Ontario, MSS 2.91, Canada. Copyright zyxwvutsrqpo 0 1993 by The Research Society on Alcoholism. Alcohol Clin Exp Res, Val 17, No 2, 1993: pp 211-224 circumscribed if research is limited to the study of clinical case^.^-^ Because most alcohol abusers do not seek treatment, what are their fates? Do they all go on to a violent, degrading death zyxw as some have suggested,6 or do some recover on their own? Until recently, the possibility that alcohol abusers might recover without treatment received little attention. Now, however, there is a growing recog- nition that natural recovery is not only a pathway to recovery from alcohol pr~blerns,**~-'~ but that the study of natural recovery processes is a significant and important area of inq~iry.~."-'~ Reports of natural recoveries from alcohol problems are not new. In the early 19th century Benjamin Rush,I4 a distinguished physician and author of one of the earliest scientific treatises on inebriety, described several individ- uals who recovered from alcohol problems on their own (alcohol treatment as we know it today was nonexistent in the 18OOs), some of whom appeared to have become moderate drinkers (i.e., they gave up the evils of "spiri- tuous liquors"). A century after Rush's publication, but before the advent of modern treatment or Alcoholics Anonymous, a little known but well-documented study of individuals' changes in drinking patterns also revealed many cases of self-change where heavy drinkers either became long-term abstainers or returned to more moder- ate drinking. In addition to these early reports, there is now a sizable body of epidemiological and longitudinal studies of alco- hol problems in the general population' that demonstrates that the prevalence of natural recoveries is greater than previously suggested.* For example, a recent Canadian national survey has shown that natural recoveries from alcohol problems seem to be the predominant pathway to recovery.l6 Of alcohol abusers who were recovered for a year or more, 82% (n = 406) recovered without treatment compared to 18% (n = 89) who reported using alcohol- related treatment, including Alcoholics Anonymous. Although we know that natural recoveries from alcohol problems occur, studies to date tell us little about what triggers and maintains the re~overies.'~~'~~'' Because so little is known about natural recovery processes, the present study was designed to be exploratory, generating rather than testing hypotheses. A major concern was to avoid traditional models of alcohol use, stereotypes, and nonempirical conceptualizations that might inhibit dis- covery.'9-2' The present study was designed to overcome several z 21 7