Self-resolution of drinking problems as a process of reinvesting in self.

PROBLEM. Resolution of alcohol problems without formal treatment or participation in self-help groups. METHODS. Qualitative study using grounded theory (N = 11). FINDINGS. The onset of alcohol problems begins with negligible penalties. Over time, the cost-benefit ratio of drinking habits continues to rise and the risks become too great. Individuals find it necessary to change their drinking patterns by reinvesting in themselves. Assets such as the ongoing availability of information, life-management skills, and self-confidence promote the change process; cultural mores and behaviors of some healthcare providers serve as liabilities. The dividends of self-resolving alcohol problems include self-pride, mental and physical health, conscientious work performance, rewarding relationships, enhancement of creative talents, and spiritual well-being. CONCLUSIONS. Nurses can play an important role in promoting, self-resolution of alcohol problems by providing accurate information and encouraging clients to reinvest in long-standing priorities and values. Key words: Alcoholism, drinking problems, natural recovery, self-change, self-help, self-resolution, spontaneous, remission Historically, little attention has been paid to individuals who resolve drinking problems without engaging in formal treatment or participating in self-help groups such as Alcoholics Anonymous (AA) (Sobell, Sobell, & Toneatto 1992; Stall & Biernacki, 1986). This is because many believe alcohol misuse constitutes a long-term progressive problem that cannot be altered without formal intervention (Jellinek, 1952). Interest in self-resolution of drinking problems is increasing, however, as conventional treatment options remain inaccessible to some of because prohibitive costs and the uneven distribution of treatment facilities. Some people with drinking problems fear the potential stigma of participating in rehabilitation programs. Questions persist regarding the effectiveness of traditional interventions, and new research findings continue to substantiate that people can resolve problem drinking behaviors on their own (Institute Medicine [IOM], 1990). Background As early as 1953, Lemere studied the the histories of 500 alcoholics. Of those, 10% eventually moderated their drinking and 33% became abstainers at a time when treatment programs for alcohol problems were virtually nonexistent. More recently, Sobell, Sobell, Toneatto, & Leo (1993) estimated that as many as 82% of those who recover from alcohol problems for a year or more do so without intervention. Additional studies also have substantiated that alcohol problems can be self-limiting (Sobell, Cunningham, & Sobell, 1996; Sobell, Cunningham, Sobell, & Toneatto, 1993; Sobell et al., 1992; Stall, 1983), and that some individuals go on to drink small amounts occasionally on selective occasions without drinking excessively (Nordstrom & Berglund, 1987; Sanchez-Craig & Wilkinson, 1987; Sanchez-Craig, Wilkinson, & Davila, 1995) It has been suggested that for some individuals, self-change of alcohol problems may occur in a natural and somewhat spontaneous manner. This type of change is attributed to becoming more mature (Chen & Kandel, 1995; IOM, 1990) or having a life-altering experience, such as a religious conversion (Klingemann, 1992). For others, self-resolution of alcohol misuse has been characterized as a deliberate cognitive effort to change, which requires the employment of identifiable coping strategies and does not necessarily coincide with a dramatic life event. For a detailed review of the literature in this area, see Finfgeld (1997). Tuchfeld (1981) made an initial attempt to develop a conceptual model to help explain the self-resolution process. To date, however, no formal theory has been explicated. Thus, based on mounting evidence that individuals can resolve alcohol problems successfully without treatment or participation in self-help groups, this study was conducted to develop a substantive theory of self-resolution of alcohol problems. …