Alcohol Recovery Study Finds More Than 75% Recover Without Treatment

TREATMENT SUMMER 1996

A majority of individuals who maintained recovery from alcohol problems for one year or more did so without help or treatment (natural recovery) according to a recent study of two population surveys. The study also shows that a significant percentage of the survey respondents reported drinking moderately after recovering from their problem (Linda C. Sobell, PhD, John A. Cunningham, PhD, and Mark B. Sobell, PhD, "Recovery from Alcohol Problems with and without Treatment: Prevalence in Two Population Surveys," American Journal of Public Health, July 1996, p. 966).

The study was designed "to determine the prevalence of recovery from alcohol problems with and without treatment, including whether such recoveries involved abstinence or moderate drinking."

Data analyzed for the study originated from two surveys: the National Alcohol and Drugs Survey ("National Survey"), conducted by Statistics Canada in March 1989, and the Ontario Alcohol and Drug Opinion Survey ("Ontario Survey"), conducted by the Institute of Social Research at York University (Toronto) in April and May 1993. These surveys of randomly selected adults used telephone interviews (using random-digit dialing).

Survey respondents were asked questions to detect past or current drinking problems, abstinence or nonabstinence (moderate drinking) in those who had resolved their drinking problem, and whether they had received any formal services or treatment (including Alcoholics Anonymous) for an alcohol-related problem. Respondents were classified as having drinking problems if they reported any of these past problems related to their alcohol use: problems that (1) affected their work, studies, or employment opportunities, (2) interfered with their family or home life, (3) affected their physical health, (4) affected their social life or friendships and/or (5) affected their financial position. These criteria for an alcohol abuse diagnosis are consistent with the definition in the DSM-IV. Resolution of a drinking problem was defined as not having a recurrence of any of these problems for one year or more.

The study shows 77.5% of respondents in the National Survey and 77.7% or respondents in the Ontario Survey reported resolving an alcohol problem without treatment. Furthermore, 38% and 62.7% of respondents in the National Survey and Ontario Survey, respectively, drank moderately after resolution while 62% and 37.3% abstained from drinking. Among the abstinent recoveries, 65.7% and 56%, respectively, reported resolution without treatment. Furthermore, almost all (96.7% and 90.6%, respectively) of the moderate drinking recoveries did not involve treatment.

There was a large disparity between the two surveys in terms of the prevalence of abstinence recoveries. However, abstinence prevalence rates of 50.8% of recoveries for Ontario respondents in the National Survey reveal no significant difference in comparison to the percentages in the Ontario Survey. The appearance of higher nonabstinence recovery rates in Ontario was not expected, but according to the report, "studies have shown that sociocultural factors not only are related to problem severity but also appear to be associated with recovery type."

Comparisons were made of sociodemographic factors and alcohol-related variables of three groups in the two surveys: resolved abstinent-treatment, resolved abstinent-no treatment, and resolved nonabstinent-no treatment. A resolved nonabstinent-treatment group was excluded from further analysis due to its very small number of cases. Respondents who returned to moderate drinking in their recovery, in comparison with those who were abstinent, were more likely "to be female, to be younger, to have some postsecondary education, to have higher incomes, and to have stopped smoking (among those who ever smoked) ... and fewer had two or more alcohol problems prior to their resolution."

Although limited by methodological problems such as self-reported data, anonymity of respondents (which may make them more honest), retrospective reports, and drinking assessments involving a short time frame, the study is substantiated by several factors. First, although the two different surveys analyzed were conducted in different years by different organizations, the results were consistent. Also, the results were similar to prevalence figures in other major studies.

The findings support a growing body of evidence that many individuals with alcohol problems recover on their own. The Institute of Medicine in the U.S. and the American Psychiatric Association have recognized that natural recoveries constitute "a significant pathway to recovery from alcohol problems." However, the study's authors acknowledge "it is unclear whether we have identified multiple pathways out of the same kind of alcohol problem or different types of alcohol problems."

Persons with severe alcohol problems represent the majority of cases observed in clinical or treatment programs, but they only represent a minority of the people with alcohol problems. According to the report, most alcohol related-costs to society (e.g., drunk driving, missed work, domestic violence) stem from the vast majority of "problem drinkers" with milder alcohol dependence. Consequently, the study deems it important to broaden the viewpoint on alcohol problems from a clinical phenomenon to an issue of public health.