Resolution of drinking problems without formal treatment.

TOPIC. Self-resolution of alcohol abuse among individuals with mild to moderate drinking problems. PURPOSE. To examine self-resolution of drinking problems and clinical/research implications. SOURCE. Review of the literature. CONCLUSION. Two pathways toward self-resolution of alcohol problems have been proposed. One appears to be relatively spontaneous, the other involves ongoing cognitive appraisals and a conscious effort to change. Nurses have the potential to play an important role in encouraging self-change by conducting screenings, implementing brief interventions, and promoting the use of self-help materials. Opportunities also exist for nurses to spearhead research efforts in this long-neglected area. Key words: Alcoholism, drinking problems, natural recovery, self-change, self-help, spontaneous remission Until recently, little attention has been paid to individuals who experience problem drinking behaviors and go on to abstain or moderate their drinking without formal treatment (Sobell, Cunningham, Sobell, Agrawal et al., 1996). This topic has been ignored, in large part, owing to the perspective that alcoholism is an insidious and progressive disease that cannot be managed without formal intervention (Jellinek, 1952). Another view that has diminished interest in this area is that alcohol problems constitute a moral deviation that can be solved only through total abstinence. Today, prominent Christian and Islamic groups advocate total abstinence from alcohol, regardless of whether any physical or psychosocial problems result from its use (Fox, 1993). In spite of these influences, experts in the field of alcohol abuse are beginning to demonstrate considerable interest in individuals who have successfully moderated problem drinking habits or abstained from using alcohol without the aid of formal treatment. Interest in this topic stems from several factors. First, research suggests that alcohol problems do not necessarily constitute a progressive disease that requires total abstinence (Nordstrom & Berglund, 1987; Roizen, Cahalan, & Shanks, 1978; Sanchez-Craig & Wilkinson, 1987; Sanchez-Craig, Wilkinson, & Davila, 1995). Second, findings from several studies indicate that alcohol problems can be self-limiting (Cahalan, 1970; Drew, 1968; Lemere, 1953; Roizen et al.; Saunders & Kershaw, 1979; Sobell, Cunningham, & Sobell, 1996; Sobell, Cunningham, Sobell, & Toneatto, 1993; Sobell, Sobell, & Toneatto, 1992; Sobell, Sobell, Toneatto, & Leo, 1993; Stall, 1983). In fact, Sobell, Sobell et al. (1993) indicate that as many as 82% of individuals who recover from alcohol problems for a year or more do so without treatment. Third, there is growing evidence that alcohol problems range from mild to severe (Institute of Medicine [IOM], 1990; Sobell, Cunningham, Sobell, Agrawal et al., 1996; Wilson, 1995) and that mild to moderate problems outnumber severe cases 4-to-1 (Wilson). Finally, it appears that there are multiple routes to recovery, and long-term treatment programs may not be needed or be appropriate for all individuals (IOM, 1990; Sobell, Cunningham, Sobell, Agrawal et al., 1996; Sobell, Cunningham et al., 1993). The intent of this article is to explore these perspectives, discuss implications for clinical practice, and offer ideas for future research. Paths Toward Self-Resolution Resolution of problem drinking behaviors without formal treatment has been referred to as self-change (Sobell, Cunningham, Sobell, Agrawal et al., 1996; Sobell, Cunningham et al., 1993), natural recovery (Sobell, Cunningham et al., 1993), maturing out (IOM, 1990; Klingemann, 1992; Miller-Tutzauer, Leonard, & Windle, 1991), autoremission (Klingemann, 1992), and spontaneous remission (Roizen et al., 1978; Saunders & Kershaw, 1979; Stall, 1983; Stall & Biernacki, 1986; Tuchfeld, 1981). These labels imply differing perspectives of the phenomenon in question. …