Apples and oranges


It has become fashionable by commentators in the addictions arena to point to research studies confirming three linked findings:  1) the course of alcohol and other drug (AOD) problems are highly variable rather than inevitably progressive, 2) the majority of people experiencing substance use disorders and broader patterns of AOD-related problems resolve these challenges without specialized professional care or mutual aid assistance, and 3) the majority of such resolutions occur through deceleration of the frequency and intensity of use rather than through complete and sustained abstinence.  Those findings, drawn from studies of community populations, have been used to buttress attacks on addiction treatment, Alcoholics Anonymous and other abstinence-based mutual aid organizations, the conceptualization of addiction as a disease, and the characterization of addiction as a “chronic” disorder.

Bill goes on to identify and discuss risk factors that can be used to differentiate between those with the chronic and severe type of AOD problem and those with the naturally resolving type. Toward the end of the post he shares the following observation.

Not everyone sharing such risk factors will develop severe and chronic addiction, and some lacking such factors will still experience prolonged addictions.  Some in the former group will also resolve their AOD-related problems without professional or formal peer assistance.  But addiction is a disorder of odds, and one’s odds of escaping addiction and achieving recovery without help from others decline in tandem with the accumulation of risk factors and the absence of factors that protect and promote resiliency.

I continue to be concerned that the failure to distinguish between these types of AOD problems, by advocates and critics, constitutes a significant threat to the field, the concept of recovery and the welfare of those with the chronic and severe type of AOD problem.