ArticlePDF Available

Abstract

Studies of natural recoveries from alcohol, heroin, and cocaine abuse have indicated that many individuals are able to change their drug or alcohol use when the benefits of using the drug are outweighed by the negatives. The present study investigated the recovery process using 50 abstinent (≥ year) untreated former cocaine users and 21 untreated and nonrecovered cocaine users. The recovered group did not differ from the untreated, active cocaine users in terms of demographic variables, lifetime substance use history, psychiatric history, or cocaine-related consequences. Recovery was most frequently related to a cognitive evaluation of the pros and cons of continued cocaine use. Discrete life events triggering cessation were less frequently reported by the recovered respondents. Implications of this research for the treatment of cocaine dependence are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
A preview of the PDF is not available
... 16 However, given the growth in the number of studies on this topic over the last two decades showing several converging lines of evidence, it is clear that attempts at self-managed change are quite common. [15][16][17][18][19][20][21] bulletin series 12 -September 2010 bulletin Evidence for the efficacy of self-managed change lies in the fact that population surveys show that a large majority of people with alcohol and other drug problems can and do resolve them without formal treatment or self-help groups. 22 There is a wealth of evidence for the effectiveness of self-managed change from problematic alcohol use. ...
... Benefits of substance use are complexly determined and maintained. Examples of models include the Health Belief Model, 20,28,29 Biernacki's model of Natural Recovery 31 and Prochaska and DiClemete's (1982) Transtheroetical Model of Change, 32 commonly known as the 'Stages of Change Model'. ...
... Side effects: includes reduced sleep, increased anxiety, mood swings, cravings, withdrawal/ increased use of other drugs (20). ...
... Very few studies have looked into why cocaine users quit and how they quit. One exception is a study by Toneatto et al. (1999). They interviewed 50 untreated cocaine users who had quit cocaine and had been abstinent at least a year; the mean time abstinent was 3.7 years; the mean age was 29 years; the mean duration of use was 10.3 years. ...
... Many participants (50%) said it was somewhat or extremely difficult to quit, but 38 percent said it was somewhat or extremely easy. The mean drinking per day reported was 8.5 drinks, so many people may quit by switching to alcohol, even though 35% reported that alcohol was a trigger (Toneatto et al., 1999). One study suggests that many older, dually diagnosed adults do not recover without treatment (Searby et al., 2015). ...
... In contrast, Cunningham (2000) found that 91 percent of those who had met criteria for drug dependence had sought some kind of treatment. Strang et al. (1998) followed up on 32 opiate addicts (41% using heroin and 56%, Diconal) who also sought Table 3. Summary of reasons and strategies for change and maintenance of change for cocaine misuse, based on Toneatto et al. (1999) and Flynn et al. (2003a). ...
Article
Full-text available
Millions of people change risky, health-related behaviors and maintain those changes. However, they often take years to change, and their unhealthy behaviors may harm themselves and others and constitute a significant cost to society. A review—similar in nature to a scoping review—was done of the literature related to long-term health behavior change in six areas: alcohol, cocaine and heroin misuse, gambling, smoking, and overeating. Based on the limited research available, reasons for change and strategies for changing and for maintaining change were also reviewed. Fifty years of research clearly indicate that as people age, in the case of alcohol, heroin and cocaine misuse, smoking, and gambling, 80–90 percent moderate or stop their unhealthy behaviors. The one exception is overeating; only 20 percent maintain their weight loss. Most of these changes, when they occur, appear to be the result of self-guided change. More ways to accelerate self-guided, health-related behavior change need to be developed and disseminated.
... Entre las razones que refieren los consumidores de cannabis para no solicitar tratamiento están el no creer que necesiten tratamiento y el deseo de recuperarse por sí mismos. Toneatto et al. (1999), por su parte, estudiaron los factores que influyen en la recuperación natural en sujetos adictos a la cocaína. Estos autores encontraron un perfil adictivo moderado grave, en términos de dependecia y comorbilidad psiquiátrica entre estos autocambiadores (Toneatto, Sobell, Sobell, & Rubel, 1999). ...
... Toneatto et al. (1999), por su parte, estudiaron los factores que influyen en la recuperación natural en sujetos adictos a la cocaína. Estos autores encontraron un perfil adictivo moderado grave, en términos de dependecia y comorbilidad psiquiátrica entre estos autocambiadores (Toneatto, Sobell, Sobell, & Rubel, 1999). Además, se encontró que la evaluación cognitiva de pros y contras era un aspecto fundamental a la hora de iniciar la recuperación. ...
... Este instrumento consta de 4 factores bien diferenciados (pensamiento positivo, pensamiento negativo, distracción y evitación) y ha mostrado una buena consistencia interna y validez de constructo,. Además, se incluyó un instrumento de 23 ítems, Maintenance factors (Factores de Mantenimiento), que se corresponden con los factores que más influyen en el mantenimiento del cambio en la recuperación natural según estudios previos de recuperación natural como cambios en fac-tores familiares, de salud, laborales o legales (Blomqvist, 1999;Sobell, Sobell, & Toneatto, 1992;Sobell, Sobell, Toneatto, & Leo, 1993;Toneatto et al., 1999). Los ítems de esta escala fueron agrupados en 5 factores con puntuaciones que van de 0 a 10 para cada factor: Cambios relacionados con la salud, con el autocontrol, con el estilo de vida, con la influencia religiosa y con el apoyo social y familiar. ...
Article
Los que abandonan o reducen el consumo de alcohol y otras sustancias. El objetivo de este trabajo fue analizar en población hispanohablante, los procesos, las circunstancias y las características que explican cómo y porqué los adictos a sustancias (alcohol y otras drogas) se recuperan sin solicitar ayuda profesional. Utilizando fundamentalmente anuncios de prensa, se reclutaron 54 autocambiadores hispanohablantes que llevabanal menos 1 año recuperados, de los cuales 29 fueron reclutados en España y 25 en el Sur de Florida (EEUU). A todos ellos se les evaluó en una única sesión en aspectos relacionados con la adicción y la recuperación.Los resultados mostraron que el autocambiador hispanohablante es fundamentalmente un varón de mediana edad, que ha tenido problemas en el pasado con el alcohol y que ha abandonado el consumo por razones de salud, sin acudir a tratamiento por no considerar su problema de gravedad. El perfil encontrado en este estudio de los participantes hispanohablantes es muy similar al encontrado en estudios previos con población no hispanohablante. Abstract Natural recovery has shown itself to be the most common form of recovery among those who give up or reduce the use of alcohol and other substances. The goal of the present work was to analyze in Spanish-speaking population the processes, circumstances and characteristics that explain how and why addicts to substances (alcohol and other drugs) recover without seeking professional help. Using mainly press advertisements, we recruited 54 Spanish-speaking self-changers who had recovered at least 1 year previously, 29 from Spain and 25 from southern Florida (USA). All participants were assessed in a single session on aspects related to addiction and recovery. The results showed that the Spanish-speaking self-changer is basically a middle-aged male, who has had problems in the past with alcohol and who has given it up for health reasons, without seeking treatment since he does not consider it a serious problem. The profile found in this study with Spanish-speaking participants is very similar to that found in previous studies with non-Spanish-speaking populations.
... The two groups differed significantly regarding crime, SU, CAN, and psychiatric problems. This contradicts previous research, which revealed only small differences between treated and untreated individuals with regard to background characteristics, history of SU, and criminal activity (Bischof et al. 2003;Blomqvist 2002;Toneatto et al. 1999). The TC reported a greater number of imprisonments and were significantly more involved in SU crimes than the SC were. ...
Article
The aims of the current study were to examine differences between self-changers (SC) and treatment-changers (TC) in sociodemographic, personal characteristics, severity of substance use disorders (SUDs), and psychiatric problems, and to predict the severity of SUDs, psychiatric problems, and belonging to the SC group. The sample included 229 Israeli respondents (134 SC and 95 TC). Significant differences between the two groups were found. The SC were younger, had a higher sense of coherence, and reported more cannabis use. The TC were involved more in crime and had experienced more child abuse and severe psychiatric problems compared with the SC. No significant group differences were found in the severity of substance dependence. The findings suggested that severity of SUDs did not differentiate between the groups, but the severity of psychiatric problems and history of child abuse did. This indicates a need for treatment interventions targeting all three issues of childhood trauma, SUDs, and psychiatric problems.
... Indeed, many addicts have regular or part-time jobs and families that they tend to (e.g., Courtwright et al. 1989;Hanson 1985). Thus, addicts are not without opportunities for non-intoxicated reflection on whether to continue using drugs (e.g., Toneatto et al. 1999). ...
Chapter
Full-text available
Individuals make choices according to quantifiable behavioral principles. Depending on specifiable conditions, these principles produce optimal outcomes, near optimal outcomes, or seriously sub-optimal outcomes, which involve compulsive-like, excessive levels of consumption of a highly preferred substance or activity (Heyman 2009). In this chapter, I focus on three elementary features of how people make choices. Although they are perfectly ordinary and are active in all decision making, they can result in drug binges, excessive drug use, and the pattern of remission and relapse that characterizes addiction. By analogy meteorology textbooks teach us that the physics that governs everyday weather is the same physics that foments typhoons. My analysis begins with a brief overview of the topic to be explained: addiction. http://geneheyman.com/wordpress/wp-content/uploads/2013/06/DerivingAddiction2018gmh.pdf
... Research into how difficult drinkers find reducing alcohol misuse does not appear to exist, but many respondents in this study said that they found it somewhat or very difficult to do so. These findings are consistent with what Toneatto et al. (1999) found in their study of untreated former cocaine users; half had found it somewhat or extremely difficult to stop. Research into the dynamics of self-change reflects significant individual differences (Littlefield et al., 2010;Reich et al., 2015;Vergés et al., 2012). ...
Article
Full-text available
Approximately 64,000,000 people in the United States report binge drinking at least once in the past month. Unlike overeating and oversleeping, “overdrinking”—defined as drinking more than a person intends to drink—does not exist in the literature. Terms such as binge and problem drinking do not consider the intent of the drinker. The results of this pilot study suggest that most people drink more than they intend to drink. Moreover, they also report often being surprised that they overdrank. Smartphones may help overdrinkers be less often surprised by overdrinking and may prevent drinkers from developing an alcohol use disorder.
... Así, parecen existir diferencias significativas entre los recuperados del hábito del juego y las personas adictas a sustancias que se han rehabilitado naturalmente, como, por ejemplo, el alcohol. En el caso del alcohol, uno de los aspectos que más se han observado en las distintas investigaciones es la evaluación cognitiva de pros y contras (Sobell, Klingemann, Toneatto, Sobell, Agrawal y Leo, 2001;Sobell, Sobell, Toneatto y Leo, 1993;Toneatto, Sobell, Sobell y Rubel, 1999), y, sin embargo, esta evaluación no es habitualmente citada por los jugadores patológicos . Koski-Jännes et al. (1999) compararon estrategias de auto-cambio en distintas adicciones; en concreto, alcohol, consumo de múltiples sustancias, nicotina, comedores compulsivos y otros (jugadores patológicos, adictos al sexo y adictos a las benzodiacepinas). ...
Article
Full-text available
Los estudios señalan que sólo un porcentaje muy pequeño de los jugadores patológicos acude alguna vez a tratamiento profesional y que la forma más habitual de abandono del juego patológico es la recuperación natural. En general, los jugadores que acuden a los programas de tratamiento presentan una mayor severidad del problema que los que no acuden a estos programas. No parecen existir excesivas diferencias en los factores relacionados con el cambio entre aquellos que acuden a tratamiento y los que se recuperan por sí mismos. Las estrategias conductuales y cognitivo-motivacionales, además de los procesos de cambio cognitivos, son los factores que mejor explican el cambio y el mantenimiento de la abstinencia en el juego patológico. De todos modos se necesitan más investigaciones sobre los factores implicados en la recuperación del juego patológico, de cara a mejorar los recursos terapéuticos disponibles para tratar este tipo de problemas. AbstractResearch shows that only a very small percentage of pathological gamblers seek professional treatment at any time, and that the commonest form of escape from pathological gambling is natural recovery. In general, gamblers who follow treatment programmes present greater severity of the problem than those who do not follow such programmes. There do not appear to be excessive differences in the factors related to change between those who seek treatment and those who recover by themselves. Behavioural and cognitive-motivational strategies, as well as cognitive processes of change, are the factors that best explain change and maintained abstinence in pathological gambling. In any case, further research is necessary on the factors involved in recovery from pathological gambling, with a view to improving the therapeutic resources available for treating this type of problem.
... That is, in the absence of an explicit intervention, changes in drug use must be a function of everyday circumstances. Two quite different literatures support this inference: studies of non-clinic drug users (Biernacki, 1986;Toneatto, Sobell, Sobell, & Rubel, 1999;Waldorf, Reinarman, & Murphy, 1991) and studies of the effects of nation-wide changes in government policies regarding drug use. ...
Article
Full-text available
Introduction: This paper addresses two overlapping questions: Do addicts have the capacity to voluntarily quit drugs? And do individuals knowingly pursue courses of action that they realize are bad for them, such as excessive drug use? Methods: I propose two testable versions of free will. First, the observation that activities differ in the degree to which they are susceptible to the influence of their consequences (e.g., costs and benefits) has proven a useful criterion for classifying behavior as voluntary or involuntary. Thus,we can ask if drug use in addicts is influenced by its consequences. For instance, do laws that promise legal sanctions for drug use reduce drug use in addicts? Second, the philosopher Harry Frankfurt proposed a definition of free will that takes into account desires and self-reflection. I propose that addicts who do not want to desire drugs and successfully stop craving drugs pass his test. Results: Dependence on illicit drugs typically ends after about four to six years. Dependence on cigarettes and alcohol persists for much longer, but most smokers and alcoholics eventually voluntarily quit using. Smokers and heroin addicts can voluntarily regulate their drug cravings as a function of the availability of their drug of choice. They have the capacity to pass Frankfurt's test of free will. Conclusions: Addicts have free will as defined by the capacity to voluntary quit using drugs and to voluntarily regulate their cravings.
Article
Objective The objective of this study is to review the scientific literature on natural recovery from alcohol. The study examined and compared the methodology, alcohol use recovery variables, reasons for recovery, and maintenance factors among studies of natural recovery from alcohol. Methods Articles published in English between 2006–2019 were systematically searched through the PUBMED, EMBASE and SCOPUS electronic databases. Three reviewers independently extracted data using a standard form. Results After screening 412 records, eleven studies were selected and data extracted. All eleven studies were self-reports. Five of the studies used advertisements for recruitment and sampling, three studies had control groups, and seven of eleven studies were conducted in the United States. Participants tended to be older (mean age 55.2 years), educated (mean education 14.3 years), White (76.1%), and unmarried (64.9%). Roughly half were male (62.3%) and employed (54.1%). There were 13 reasons of natural recovery, most were health-related, finance-related, and due to negative personal effects (45.5%). The most important maintenance factor was social support/change in social group (36.4%) Conclusions Most studies were conducted in the United States, among older, White men. Qualitative studies where contexts and situations are assessed and critically analyzed may be important to move the field forward.
Article
Full-text available
This study explores how older age shapes processes of substance abuse cessation among male substance users recently released from prison. Semistructured in-depth interviews and brief surveys were conducted with 15 men age 49+, released from prison in a large, eastern U.S. city. A follow-up interview was conducted with each participant (n = 15). Conventional content analysis was used to analyze these data. Aging was central to the stories men told about attaining and maintaining sobriety. Men gained clarity after forced detoxification in prison, which was often followed by a period of reflection and evaluation of their lives. Older age seemed integral for this period of sobriety and reflection to catalyze cognitive change, a phenomenon the author terms “sober aged reflection.” Further, men described a heightened awareness of mortality that had come with older age and were deeply afraid of dying in prison. This fear helped inspire a new commitment to sobriety and concordant rejection of the crime that had been linked with their drug use in the past. Finally, men revealed identities and goals that had changed with time, changes incompatible with ongoing drug use. Policy implications are discussed.
Article
Full-text available
The treatment of cocaine abusers is a newly emerging discipline. Many of the strategies that are being developed for this purpose have been adapted from the drug and alcoholism treatment systems. These include use of established programs that are only minimally modified for cocaine abusers, such as the 28-day inpatient hospital, therapeutic community, and 12-step programs. Other approaches have created specific techniques to meet particular clinical needs of cocaine abusers, such as behavioral, pharmacologic, and nontraditional interventions. Finally, several attempts have been made to create integrated outpatient approaches that address the multiple needs of the cocaine abusers. Many of the clinical researchers conducting research on these modalities feel optimistic about the value of treatment for cocaine abusers. Many of the methods appear to have considerable promise. However, only recently have well-controlled research efforts begun to provide the information necessary for empirically based decision-making. During the next several years, outcome studies should provide an excellent set of data to guide treatment efforts. This paper reviews the treatment efforts that have been conducted, overviews the research data available, and describes some of the outcome research in progress.
Article
The smoking of freebase cocaine produces faster and higher peak blood and brain levels. Cocaine intoxication can produce virtually any psychiatric symptom. Significant medical complications include seizures, cardiac arrhythmias and respiratory arrest. An understanding of the neuropharmacology of cocaine enhances the identification of cocaine use and addiction.
Article
This study compares a sample of cocaine users in drug treatment programs to a sample of cocaine users not in treatment. These samples were compared on: (1) level of cocaine use, (2) consequences of user, (3) employment, (4) social support system, and (5) criminal behavior. These attributes were related to being in treatment. Among intermediate-level cocaine users, friendship patterns, employment, and criminal history were associated with treatment status. The implications for the treatment of cocaine use are addressed.