Coming Clean

Overcoming Addiction Without Treatment

Robert Granfield, William Cloud

• Editore: NYU Press
• Anno: 1999
• ISBN:
  9780814738665
• Argomento: Psicología
• Categoria: Adicción en psicología

Despite the widely accepted view that formal treatment and twelve-step groups are essential for overcoming dependencies on alcohol and drugs, each year large numbers of former addicts quietly recover on their own, without any formal treatment or participation in self-help groups at all.

Coming Clean explores the untold stories of untreated addicts who have recovered from a lifestyle of excessive and compulsive substance use without professional assistance. Based on 46 in-depth interviews with formerly addicted individuals, this controversial volume examines their reasons for avoiding treatment, the strategies they employed to break away from their dependencies, the circumstances that facilitated untreated recovery, and the implications of recovery without treatment for treatment professionals as well as for prevention and drug policy.

Because of the pervasive belief that addiction is a disease requiring formal intervention, few training programs for physicians, social workers, psychologists, and other health professionals explore the phenomenon of natural recovery from addiction. Coming Clean offers insights for treatment professionals of how recovery without treatment can work and how candidates for this approach can be identified. A detailed appendix outlines specific strategies which will be of interest to addicted individuals themselves who wish to attempt the process of recovery without treatment.

Chapter One
RECOVERY WITHOUT TREATMENT
An Introduction

“Addiction is just an opinion to me!” These were the words John used to describe his ten-year bout with alcohol dependency. Having consumed alcohol excessively on a daily basis for this decade-long period, John had become fed up with the constant hangovers, blackouts, fist fights, and other problems that resulted from his alcohol-induced anger. The child of an alcoholic father who had died of an alcohol-related illness, John was being counseled by his friends to admit that he was an alcoholic. Realizing he was desperately out of control, John concluded that he needed to take charge of his life. On New Year’s Day in 1982, he made a monumental decision that significantly transformed his life. That morning, he stopped drinking and embarked on what he called a new “adventure” of abstinence from alcohol. When we interviewed John more than ten years after his New Year’s resolution, he was reaping the benefits of that “adventure,” having reestablished himself financially, socially, and spiritually.

On the surface, John’s experiences with alcohol, his decision to quit, and his success at overcoming dependency would appear rather prosaic. Each year, thousands of people like him reach a point in their substance-abusing careers where they enter treatment facilities for addiction and set out on the road to recovery. John’s case would be considered rather routine were it not for one exception: he never sought professional assistance for his ten-year alcohol problem, nor did he affiliate with the most common 12-step group, Alcoholics Anonymous. After resolving to stop drinking, John did so—on his own. Now, more than ten years later, his alcohol dependency is merely a period of his past life from which he feels removed. When asked about his erstwhile dependency, John replies dispassionately, “I used to drink a lot, now I don’t.”

This book is about John and numerous others like him who overcame serious dependencies on alcohol and drugs without recourse to formal addiction treatment or 12-step group involvement. Our study closely explores the social lives of untreated former alcoholics and former addicts who have “spontaneously” or “naturally” recovered from a lifestyle of addicted and compulsive substance use. The stories of these untreated individuals and the legions of other self-remitters have remained relatively obscure to all but a small group of researchers who have studied the phenomenon of untreated recovery for more than twenty years. While these researchers have elucidated the multiple pathways or routes to recovery, including recovery without treatment, their writings have been limited to scholarly journals for a specialist audience; in general, little attention has been paid to individuals like John who overcome their addictions without treatment.¹ Despite this relative disregard, however, we cannot deny the existence of recovery without treatment, for as David Lewis of the Brown University Center for Alcohol and Addiction Studies has declared, “[T]here can be no doubt that spontaneous remission occurs.”²

Because individuals like John are successful in overcoming their addictions without treatment they represent an important subject of study. By closely examining their social lives this book seeks to expand the discourse on natural recovery. We wish to uncover the social dynamics within these individuals’ lives that facilitated their triumph over addiction. We intentionally adopt a sociological perspective because we firmly believe that natural recovery can be best understood through a close inspection of the social lives of self-remitters. In being mindful of their social lives we hope to breathe life into the stories of those who overcome addiction without treatment. Not only will we thereby enhance the understanding of natural recovery, but we will also have provided a sound basis from which to consider the implications of natural recovery for treatment, prevention, and drug policy.

Currently, there is an enormous literature that describes how addiction can be overcome through treatment or participation in 12-step groups. The essential problem with much of this recovery literature is that we are exposed to a battalion of voices which, almost without exception, offers recovery narratives that mirror the reigning disease model of addiction. All too often this literature takes for granted a set conception of the multiple and variegated pathways into and out of addiction. In an almost mantralike cadence, we read that people are hopelessly and permanently addicted, that they are powerless over the substances they use, that they must “hit bottom,” and that their sanity is restored only through formal treatment interventions or 12-step group involvement. This literature, much of which is promoted by the addiction industry itself, would have us believe that treatment and 12-step groups are a necessary prelude to meaningful recovery and that anything short of this is a prescription for self-delusion, continued dependency, further deterioration, and possibly even death. This potent ideology not only dominates the health and wellness sections of our bookstores but has also influenced Hollywood films and television programs, which typically portray addicts as transforming their lives only after they have entered treatment. Even the recent PBS special on addiction hosted by Bill Moyers made strong, passionate claims about the imperative of treatment and 12-step groups in overcoming dependencies on alcohol and drugs.³

The popularity of this disease-oriented view must not be underestimated. Ninety percent of the American public accept the view that addiction is a disease that must be treated.⁴ However, this widely-held view of addiction, with its associated intervention mandates and disease-based ideology, does not comport with the experiences of those who discontinue their dependencies without treatment. Although it is impossible to estimate the size of the self-remitter population, the available research as well as the interviews conducted for this book, convince us that such individuals are ubiquitous in our society. Researchers have maintained that their numbers are large and even assert that they substantially outnumber those choosing treatment facilities or 12-step programs.⁵ Some have estimated that as many as 80 percent of problem drinkers never enter treatment and suspend problematic use without it.⁶ Untreated remitters are our next-door neighbors, our colleagues at work, and our relatives. They are our teachers, our doctors, our lawyers, and our social workers. They build our houses and they figure our taxes. They sell us commodities, teach us to ski, write the software we use, and wait on tables. We are convinced that such people are pervasive throughout society, and yet for the most part their success in overcoming their addictions has gone largely unnoticed. In a very real sense, they are hidden from our view.⁷ They appear neither at Alcoholics or Narcotics Anonymous groups, nor on treatment rosters. They have not enrolled in therapeutic communities or outpatient counseling programs. They generally do not present themselves to others as being addicted, in recovery, or in any way diseased. In effect, they are the proverbial elephants in the room that no one sees.⁸ They are hidden from our gaze because they do not fit into commonly accepted definitions of what it means to be addicted and “in recovery,” and, as we shall see, most prefer to remain in the shadows.

While stalwart advocates of the disease concept consider the thought of natural recovery from addiction heretical, the general concept of natural or spontaneous recovery is well known in the medical literature. People who have been diagnosed with terminal conditions or who have been severely disabled have sometimes experienced complete reversals, referred to by Caryle Hirshberg and Marc Ian Barasch as “remarkable recoveries.”⁹ Such recoveries have bewildered the medical community for years. Although they are treated “like orphans in the annals of medical investigation,” they nonetheless call into question the limits of Western medicine.¹⁰ In their work on remarkable recoveries, Hirshberg and Barasch “discovered people who had the unyielding courage to confront multifarious demons, the strength to transform their lives in the face of wearying and terrifying circumstances, the conviction that doctors often sought to undermine, and the spirit to cherish loved ones as they never had before.”¹¹

Consistent with Hirshberg and Barasch’s narratives of remarkable recoveries, Norman Cousins, in his widely acclaimed book Anatomy of an Illness, found that laughter was indeed the best medicine in overcoming a life-threatening disease.¹² Diagnosed with a terminal condition known as ankylosing spondylitis, a degenerative spinal disease, Cousins placed himself on a strict regime of laughter during which he read joke books and watched film comedies such as the Marx Brothers that left him roaring with laughter. While the medical reasons for his “natural” recovery remain unclear, Cousins adamantly maintained that his participation and belief in his own treatment plan were integral to his recovery.

Experiences such as these lend support to Andrew Weil’s provocative observations concerning natural recovery in his best-selling book Spontaneous Healing.¹³ Weil, who trained at Harvard Medical School, became profoundly disenchanted with conventional medicine’s methodology of healing. In his numerous books and lectures, Weil maintains that Western medical wisdom posits that illness and its treatment originate outside the body. From this perspective, the human body is seen as being under attack by external disease agents that require chemical, surgical, or other therapeutic weapons to be brought to bear in the fight to restore health. For Weil, however, this implies a dangerous passivity on the part of the patient that potentially increases the chances of illness and may delay or even inhibit the body’s natural healing processes. Rather than rely solely on the external sources of healing associated with medical interventions, Weil proposes that people have the innate and intrinsic capacity within themselves to experience spontaneous healing. By documenting the spontaneous recoveries of people with an assortment of medical conditions, Weil reaches the provocative conclusion that “spontaneous healing is a common occurrence, not a rare event.” In our book, we shall present and analyze the social lives of individuals who recovered from their addictions to alcohol and drugs without treatment. In so doing, we shall demonstrate that such “recoveries” are anything but remarkable. Rather, they are, as Weil suggests, commonplace.

Recovery from Addiction without Treatment

The resolution of alcohol and drug addiction without formal treatment has been referred to as natural recovery,¹⁴ maturing out,¹⁵ autoremission,¹⁶ spontaneous remission,¹⁷ and spontaneous recovery.¹⁸ Although a number of different terms are prevalent in the literature, they all subscribe to the basic principle that people overcome substance-abuse problems without recourse to treatment.¹⁹ In this book we use these terms interchangeably.

While researchers have explored the dynamics of recovery without treatment for quite some time, the concepts they have developed and the implications associated with them have been largely ignored by professionals and the general public. This is not because knowledge of such recoveries is recent. Indeed, the evidence of such recoveries is more than two hundred years old. Recovery without treatment was first documented by Dr. Benjamin Rush—the only physician to sign the Declaration of Independence—who is often credited with developing an early understanding of alcoholism as a disease and who wrote extensively about such recoveries. In one of his reported cases, Rush cited the profound effect that a child’s observation could have on an alcoholic parent:

A farmer in England, who had been many years in the practice of coming home intoxicated, from a market town, one day observed appearances of rain, while he was in market. His hay was cut, and ready to be housed. To save it, he returned in haste to his farm, before he had taken his customary dose of grog. Upon coming into his house, one of his children, a boy of six years old, ran to his mother, and cried out, “O mother, father is come home, and he is not drunk.” The father, who heard this exclamation, was so severely rebuked by it, that he suddenly became a sober man.²⁰

The fact that Rush documented many such cases long before the emergence of addiction treatment and self-help suggests that natural recovery has had a lengthy history.

Natural Recovery: A Disregarded Perspective

While evidence of natural recovery from addictions has existed for years, it has been ignored by most. There are several reasons for the lack of attention accorded to natural recovery, particularly among clinicians. One reason for this is that clinicians, like most people in society, have been socialized into the dominant disease-based theory of addiction. Moreover, clinicians’ training programs seldom discuss alternative approaches to understanding and responding to addiction. Addiction professionals are generally socialized into what Anthony Giddens calls a “practical consciousness,” that is, a tacit or taken-for-granted assumption of the presumed naturalness of everyday life.²¹ As a non-conscious activity, this practical consciousness marginalizes and censors alternative realities. It separates the thinkable from the unthinkable. It simultaneously creates the possibility of awareness and restricts the development of alternative insights. Practical consciousness acts as a kind of “working consensus” that embodies the socialized mind, or what the French sociologist Pierre Bourdieu has characterized as the “habitus,” namely, the largely unreflective set of dispositions, values, and beliefs that individuals willingly accept.²² This marginalization of alternative perspectives associated with the habitus of addiction is further exacerbated by the fact that a high percentage of addiction clinicians are themselves “in recovery.” It has been estimated that over 70 percent of professional counselors working in substance abuse treatment centers across the country have personally experienced substance abuse problems.²³ Most of them have been presocialized into their occupational roles through their participation in formal treatment programs, self-help groups, or both. Consequently, they are frequently reluctant to entertain the possibility of untreated recovery.

A second reason for the paucity of attention accorded to natural recovery has to do with the lack of organized efforts to see untreated recovery as a viable recovery option. Concepts such as addiction, alcoholism, and treatment do not emerge full-blown in the public consciousness. Rather, they are constructed by individuals and groups who lobby in their favor.²⁴ Sometimes such classifications are based more on historical circumstance than on scientific credibility. Enoch Gordis, Director of the National Institute on Alcohol Abuse and Alcoholism, acknowledged this point a number of years ago. According to Gordis,

[I]n the case of alcoholism, our whole treatment system, with its innumerable therapies, armies of therapists, large and expensive programs, endless conferences and public relation...