Millions Change Risky Health Behaviors and Maintain Those Changes


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:

8 Key Findings on Self-Guided Behavior Change

  1. Studies indicate that 90% to 99% of people, as they age, overcome their problems with heroin, cocaine, nicotine, alcohol and gambling.
  2. Most people change their behavior without formal treatment or consistent self-help meeting attendance.
  3. Most of the change that occurs appears to be self-guided. People have a goal in mind and gradually, using a variety of strategies, change. Then, sometimes using different strategies, they maintain that change.
  4. Millions of people take weight off and keep it off, despite the myth that this is not the case. While it is true that only 20% of people take weight off and keep it off, if you look at that percentage in terms of absolute numbers, the percentage still represents millions of people. Everyone has to eat. But almost everyone who is reading this blog has changed the way she or he eats in the past twenty years. If not, they would have gained even more weight than they did.
  5. People often take a long time to moderate or stop risky behaviors. While half of cocaine users may have quit within five years of becoming dependent, the other 50% may go on for years before they finally stop. Along the way, they may do a lot of damage to their relationships and their pocket books.
  6. Data from a recent federal study on alcohol use showed that over 60,000,000 people in the United States binge drink at least once per month. Many binge drink more than one per month.
  7. While these drinkers may correctly see themselves as “moderate drinkers,” once per month or more, they purposely binge drink or drink much more than they intend to drink.
  8. There are few resources available for people who would like to moderate or stop risky health behaviors like heavy drinking, besides CheckUp & Choices, some self-help books, and mutual-help groups like Moderation Management and SMART Recovery.

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