It has been argued that people often overcome substance abuse problems without benefit of professional treatment or formal intervention (1). There is even evidence that this may be significantly more common than treatment-facilitated desistance from drugs (2). Variously referred to as spontaneous remission (3), natural recovery (4), maturing out (5), and unassisted change (6), this process is as difficult to understand as it is to define. This may be attributable, in part, to the fact that studies investigating spontaneous remission have often relied on impressionistic and qualitative measures that defy unambiguous interpretation. This review serves as a preliminary attempt to provide a quantitative analysis of the literature on spontaneous remission, cognizant of the fact that even a quantitative analysis is subject to alternate interpretation. Despite the fact that unassisted change is often neither spontaneous nor remission to a previously “healthy” state (see Ref. 6), spontaneous remission is the term used here to identify desistance from substance abuse in the absence of formal intervention because it is the term most commonly encountered in the literature.

The purpose of this review is to provide a preliminary quantitative analysis of research on spontaneous remission organized to answer three primary questions. The first question posed by this review is, Does spontaneous remission from alcohol, tobacco, and other drug abuse occur, and if so, at what rate? To test this hypothesis, the general prevalence of spontaneous remission is calculated for studies on alcohol, tobacco, and illicit drugs. The present review also questions whether self-remitting individuals are fundamentally different from people who continue misusing substances or remit through formal treatment; the preremission substance abuse histories of these groups are used for this examination. The four pre-remission measures used to compare self-remitters with nonremitters and treatment remitters were the frequency of prior use, past signs of dependency, prior drug-related problems, and previous attempts at cessation. The third and final question addressed in this review is whether the initiating and maintaining factors responsible for spontaneous remission from alcohol, tobacco, and other drug abuse can be identified and quantified.

DEFINITION ISSUES

Before addressing the three questions that form the body of this paper, the terms substance abuse, formal intervention, and spontaneous remission need to be clarified and defined. Congruent with DSM-IV (7), substance abuse is defined as usage that (a) exceeds a certain frequency and (b) creates physical, social, legal, or psychological problems for the individual. Frequency of alcohol and other drug abuse was minimally defined as weekly ingestion of an illegal substance and/or consumption of 4 ounces or more of alcohol in a single sitting for a minimum of 12 consecutive months or at least 2 alcohol binges, each of which lasted 3 or more days, over a period of 1 year (8). Averaging 10 or more cigarettes a day for a period of 1 or more years, on the other hand, served as the sole criterion for tobacco abuse. Problems were distinguished by the presence of one or more of the following negative consequences of alcohol or illicit drug abuse: withdrawal symptomatology, tolerance, medical problems, family conflict, work/ school problems, and legal difficulties.

There is no simple way to define formal intervention, although criteria introduced by Stall (9) may provide some clarification. Stall defines formal intervention as assistance “received through a generally recognized organization which has as a primary goal the resolution of alcohol (or other drug) related problems” (p. 194). As such, formal intervention can be accessed through medical, psychiatric, private, and public rehabilitative and self-help (e.g., Alcoholics Anonymous, AA) channels. Assistance received through friends, family, and religious organizations or in verbal warnings from medical or legal authorities do not constitute formal intervention under this definition. Some readers may take issue with the decision to place self-help groups like AA and Narcotics Anonymous (NA) in the same category as medical and rehabilitative services. However, the primary goal of an organization like AA is to help people resolve substance use difficulties. Consequently, self-help groups; were eliminated as possible explanations for spontaneous remission initiation, although they were retained as potential explanations for spontaneous remission maintenance.

Here, spontaneous remission is defined as cessation of alcohol, tobacco, or other drug abuse without formal intervention or a statement by the subject that formal intervention had no effect on his or her decision to desist from the abuse of one or more of these substances. Many of the studies in this area do not stipulate abstinence as a necessary condition for remission from substance abuse. Accordingly, the present review employed two different definitions of spontaneous remission. The narrow definition of spontaneous remission required total abstinence from the identified substance of abuse for a period of 6 consecutive months. The broad definition of spontaneous remission utilized in this study held that subjects had to be abstinent or have significantly reduced the amount or frequency of alcohol or illegal drug use and be free of any substance-related negative consequences for at least 6 consecutive months. In the case of tobacco, an average daily inhalation of no more than 1 cigarette was required for spontaneous remission using the broad definition of remission. It should be noted that, in studies utilizing a broad definition of remission, the proportion of subjects who were totally abstinent was 65.6%.