Most people resolve their difficulties with alcohol, cocaine, heroin, and nicotine on their own, without professional help. However, research shows that behavior change happens slowly, and more support is needed to speed the self-guided change process.
When I entered the substance use field in 1987, the focus was on “alcoholics” and “drug addicts,” people who had become severely addicted to a substance. At the time, “best practice” in medicine was what older, more seasoned professionals said worked best. I wanted my therapy practice, however, to be based on research; so I began unraveling what worked from a research perspective. Almost immediately, I stumbled upon a report that noted 75% of people who had problems with alcohol resolved those problems on their own. I remember sitting at my desk, stunned. That was certainly not what I believed or what I was being told. If clients had a problem with alcohol, I was told, “They have to stop and they have to go to AA.”
As I continued studying, I read that most heroin addicts quit before the age of 40. I was taken aback. I did not know anyone actually got off of heroin. Then I came across a study of returning Vietnam vets. About 20% of a group of 900 returning vets were reportedly addicted to heroin, but one year later, almost all of them had quit. Not only that, they had quit without treatment. What?
More recently, someone asked me, “Do people really change?” Yes, of course people change. I know hundreds of people who have changed and have maintained that change. Then I read in a journal – only two years ago – that while people may change they almost never maintain that change. That assertion really annoyed me. So I set out to look (again) at the research. So many interesting questions: How often do people change? How do they maintain that change? What did I learn? People can absolutely overcome substance use problems, and many do so on their own every day. In fact, millions of people in the United States change problematic behaviors and maintain those changes.
Here are my research findings:
In 2018, more than three decades after I first entered the field, there are now proven, multiple paths to overcoming substance use problems. A recent study found that four different self-help groups, including SMART Recovery and AA, are equally effective. Counselors and therapists were advised to stop referring clients solely to AA, a step in the right direction. Now, prevention needs to be the new frontier. Online programs like CheckUp & Choices can help people to 1) speed up behavior change; and 2) support the self-guided change process. How can we prevent people from becoming seriously addicted to a substance or a behavior? CheckUp & Choices provides such a program, but we need even more resources for people who are functioning well and want to change a risky behavior.
F. Michler Bishop, Ph.D, is an Associate Professor of Psychology at SUNY, College at Old Westbury and Director of Alcohol and Substance Abuse Services at the Albert Ellis Institute (AEI). Bishop is past president of the Division of Addictions of the New York State Psychological Association and the Addictive Behaviors Special Interest Group of the Association for Behavior and Cognitive Therapies. As national vice president of SMART Recovery® for over twenty years, he was instrumental in the development of SMART Recovery’s Four-Point Program and SMART Recovery Therapy. He can be reached at fmbishop1@gmail.com.