Natural Remission Has Had on the Addiction

¶ … Natural Remission Has Had on the Addiction Field

Spontaneous remission from addiction is often referred to under different titles. These include, natural recovery, maturing out, and unassisted change. All of these titles refer to the process of recovering or being in remission from an addiction without the intervention of conventional methods and techniques of addiction treatment. Until fairly recently the idea of spontaneous remission had been vilified in the medical profession as being misleading and even dangerous. A paper by Chiauzzi and Liljegren ( 1993) entitled Taboo topics in addiction treatment: an empirical review of clinical folklore, stated that the concept of natural recovery was identified as a ... Taboo topic, stating that disease model advocates had put forth a tautological argument that an ability to cease addictive behaviors on one's own suggests that the individual was not addicted in the first place, .the failure to seek treatment for a substance abuse problem will have fatal consequences. ( Sobell L. et al. 2000. pp. 749- 750)

Therefore there has been a strong reaction from the academic and professional community which sees the non-formal treatment of addiction as illusionary and deceptive.

On the other hand there have more recently been an increasing number of research studies which indicate that natural or non-formal treatment of addictive complexes have resulted in positive results. A study by Sobell et al. ( 2000) states that "... The recent increase in research has lead to natural recovery from substance abuse gaining recognition and acceptance." ( Sobell L. et al. 2000. p. 750) The study goes on to state that, " Prestigious bodies such as the Institute of Medicine (1990) and the American Psychiatric Association (1994) have acknowledged that natural recovery is a legitimate and documented route of recovery." ( ibid p. 750/1) There are also numerous studies which add quantitative evidence attesting to these assertions that natural recovery is a verifiable fact and not just conjecture. " ... reports of natural recovery studies have been increasing dramatically in recent years, with half ( 52.6%) published in the last 8 years." ( ibid)

A further aspect which adds to the plethora of studies on natural remission, and which also acts as a viable starting point for the acceptance of theories of spontaneous remission in cases of addiction, is ' informed eclecticism." This is a strategy influencing not only medicine but other disciplines as well. Informed eclecticism is a term coined by Spackman, Barker and Nancarrow (2000) to " ... describe a broad and eclectic approach ... (qualitative and quantitative), involving the use of theories, methods and researchers drawn from a wide range of disciplines." (Informed eclecticism) In essence informed eclecticism is the openness to other approaches that may not initially be condoned by the more formal canons of medical treatment.

Informed eclecticism seeks a position beyond the hollow dogmatism that only one method works, and also beyond the naive optimism that everything works equally well. The clinician's attitude should be one of openness to a variety of approaches, guided by scientific evidence.

(Hester R. et al. 1995).

From the perspective of informed eclecticism the issue of natural remission in addiction becomes a viable possibility which can be investigated and accepted outside of the more formal parameters of medical treatment orthodoxy.

This theory, as well as the various arguments for and against natural remission, will be discussed in this paper in an attempt to ascertain the effect of natural remission on addiction treatment and therapy.

2. Methodological problems

As many research studies point out, one of the central problems facing medical science with regard to the issue of natural remission is that within the ambit of objective and scientific methods of verifiability, the theory and praxis of spontaneous remission is both difficult to explain and to prove.. As Walters in his study Spontaneous Remission from Alcohol, Tobacco, and Other Drug Abuse: Seeking Quantitative Answers to Qualitative Questions, states, " ... this process is as difficult to understand as it is to define."

One of the central problems with regard to the definition and proof of natural remission is that much of the empirical evidence for the phenomenon has been garnered by qualitative rather than quantitative sources and methods. The formal criticism of natural remission has been based mainly on this aspect. Walters states that skepticism in this regard " ... may be attributable, in part, to the fact that studies investigating spontaneous remission have often relied on impressionistic and qualitative measures that defy unambiguous interpretation."

(Walters Glenn D. 2000) This aspect therefore " ... raises serious questions about the reliability and validity of the results obtained in research on spontaneous remission in substance-abusing populations. ( ibid)

As a working definition the following is commonly accepted when referring to natural or spontaneous remission in terms of addiction treatments. "spontaneous remission is the term used here to identify desistance from substance abuse in the absence of formal intervention. " ( ibid)

However it is not always the case that qualitative reports from the subject can be discounted. Many researchers see the critique of qualitative reports as an unnecessary bias. A number of research studies have found that there is a large degree of reliability in personal accounts of natural remission from subjects.

" .... In a study that examined the reliability and validity of self-reports of spontaneous remission from alcohol abuse, it was determined that subjects achieved good reliability in their drinking reports over 2 weeks and attained reasonably good concordance with the reports of collateral observers for variables the collaterals could readily observe ( ibid)

As Walters's states:

Therefore, while collateral reports and physiological verification (e.g., carbon monoxide testing to verify cessation of tobacco smoking) have been employed in research on spontaneous remission, they were not required of all studies because self-report measures have proven sufficiently reliable and valid to serve as criterion measures for a preliminary quantitative analysis of the spontaneous remission literature. (ibid)

The results from the Walters study also concur with various other studies. These studies have tended to indicate that there is a large degree of congruence between qualitative and quantitative research; which indicates that spontaneous remission is a fact a reality and therefore has an important part to play in the understanding and treatment of addiction.

3. Formal and non-formal approaches

The formal treatment of addiction is defined by Stall as being "received through a generally recognized organization which has as a primary goal the resolution of alcohol (or other drug) related problems" (Stall, R., and Biernacki, P. 1886. p. 194). Therefore, formal intervention is usually accessed through medical, psychiatric, private, and public rehabilitative and self-help (e.g., Alcoholics Anonymous, AA) channels. (Walters Glenn D. 2000) However, as stated, spontaneous or natural remission is a form of intervention or treatment that takes place essentially outside of formal modes of intervention.

" ... spontaneous remission is defined as cessation of alcohol, tobacco, or other drug abuse without formal intervention or a statement by the subject that formal intervention had no effect on his or her decision to desist from the abuse of one or more of these substances." ( ibid)

An increasing number of researchers have begun to question the formal praxis related to addiction treatment. The criticism revolves mainly around the formal disease model of addiction. This model is an important aspect of the present discussion, as it views addiction essentially as a disease and therefore not as something that can be dealt with outside of formal medical treatment procedures. As Candice Nelson ( 2004) states in her study on Natural Recovery from Alcohol Problems and its Implications on the Disease Model of Addiction,

The Diagnostic Statistical Manual (DSM-IV-TR, 2000) dictates that certain criteria must be met in order to diagnose a person with alcohol dependence. The DSM-IV criteria for substance dependence support the disease model of addiction, in that the person is viewed as a passive recipient of a disease, over which he or she has no control. Gorski (1996) proposed that "it is appropriate to describe people with severe alcohol problems that meet the DSM-IV criteria of substance dependence as having a disease.

( Nelson C. 2004)

Many researchers like Nelson argue against the classification of addiction as a disease and view addiction rather as a temporary impediment that can be remedied by other means. "It seems irrational to classify dependence on alcohol as a disease ... Instead, "alcoholism" may be viewed as ... A disruption in the person's functioning, but may not be a lifelong pathological condition. ( ibid)

What researchers like Nelson object to is the classification of addictions such as alcohol as a disease and a lifelong and irrevocable condition. They also question the assumption " ... that the person would need treatment in order to recover from their disease. " ( ibid) Nelson also states that in many cases there is a certain irony in the fact that formal treatment may in fact exacerbate the problem, rather than solve it. She refers to the fact that in traditional treatment for alcohol addiction there is an ambiguity in formal treatment which is essentially unproductive. In the first instance the subjects are "told that they must enter treatment to recover." However in the traditional 12 step-based treatment patients are informed that they will never fully recover. "This duality seems to be therapeutically unproductive, and largely unnecessary." ( ibid)

Nelson also states that there is ample evidence from various studies that reveal that "... successful natural recoverers fuel their change process with personal, unique motivational themes, and utilize their social networks to gain support." ( ibid) This evidence goes against the formal disease model and the postulation that alcohol and other dependent addictions are necessity lifelong and uncontrollable without formal treatment. Importantly, she also argues against the reliability of the DSM-IV-TR criteria which suggests that social or occupational impairment is a result, rather than a cause of substance dependence. ( ibid)

Many researchers state that there is a strong and growing body of evidence, both qualitative and quantitative, that suggests that addictions such as alcoholism can be cured through spontaneous remission and self treatment. These research findings indicate that natural remission is an area which has been neglected in the past. This is one of the main reasons, among others, for the recent criticisms of the formal disease model of addiction. For example, in a study by Russell ( 2001) it was found that there was no indication that biological association within a family had any impact on addiction recovery; which suggests that natural recovery is a distinct possibility. In other words, biological or genetic predisposition to an addiction is not an indication of lifelong addiction. Burman (1997) also states that subjects are capable of finding personal motivation to enable their recovery from addiction. There are numerous studies that point out that maturity and age may in itself be a factor in the recovery and remission of addictions. In the study by Russell et al. ( 2001) it is suggested that many older subjects " mature out ' of their addictive behavior.

Furthermore, many studies point out that accepted formal procedures may in fact be counterproductive for remission. This relates particularly to the important area of the correct type of treatment for the specific individual. Hester and Miller (1995) state that,

"It is clear that inappropriately matched clients can be harmed, faring worse than if they had received no treatment at all. Individuals matched to the right treatment the first time can be spared years of needless suffering and impairment. A common concern for those who suffer from alcohol problems should, in the end, be the most persuasive ground for agreement and cooperation toward a comprehensive system of informed eclecticism." (Hester, Reid K. Miller William R, 1995 p. 10)

4. The Informed Eclectic approach

The above theories and studies are suggestive of a new approach to addiction theory and praxis. As mentioned, the eclectic approach is seen by many researchers as a better alternative to the strictly formal method of dealing with addictive behavior. Informed eclecticism tends to combine the various possibilities of both qualitative and quantitative theories of addiction treatment.

This approach emphasizes a number of central principles. These include the view that there is no single treatment or approach which is superior for all subjects. (Reid K. Hester, William R. Miller. 1995) In other words there is no single method for the treatment of addiction but "an array of empirically supported treatment options." ( ibid) Informed eclecticism also states that treatment programs should offer a number of different options. There is also the emphasis on different treatments to suit various individual types. Those who suggest the eclectic approach are strongly cognizant that different types of people respond to different approaches to treatment. ( ibid) One of the most important aspects is that "The art of the clinician lies in matching the right treatment to the right patient the first time around." ( ibid)

Advocates of the informed eclectic approach are aware that at present the natural remission approach is problematic, with existing treatment programs offering little in the way of treatment alternatives. One of the main obstacles lies in the full acceptance of alternative approaches. Researchers have found that in most instances formal and empirically-based treatment programs still tend to dominate. "There is no tried and true, 'state-of-the-art' treatment of choice for alcohol problems. Rather, the state of the art is an array of empirically supported treatment options." (ibid) Furthermore there is also the realization that the matching of treatment to patients is an important aspect that needs to be developed.