Natural recovery from alcohol and drug problems: methodological review of the research with suggestions for future directions

Aims. The methodology of studies that reported data on individuals who reco vered from an alcohol or other drug problem (cigarette smokers were exclude d) without formal help or treatment were reviewed Design/ measurements. Pot ential studies were identified (a) through computerized literature searches , (b) by reviewing references from key publications and (c) by corresponden ce with researchers in the field. Studies had to (a) be in English, (b) be published, in press, or presented before the end of 1997, (c) report origin al results or be part of an original survey and (d) separately report respo ndents whose recoveries were and were not attributable to treatment. No cas e studies were included. Eligible studies were evaluated with respect to me eting criteria for (a) natural recovery, (b) methodological rigor and (c) r eporting demographic and substance abuse history variables. Findings. Until 1997 only 38 articles (40 different respondent samples) met the inclusion criteria far this review. This small number of studies is not surprising, a s natural recovery from substance abuse is a relatively new area of study. Moreover, the majority of the 38 articles were published in the past 8 yeat s. For most studies, descriptions of the respondent samples at pre- and pos t-recovery were seriously deficient. Alcohol was the mast studied drug, wit h heroin a distant second. Low-risk drinking (78.6%) and limited drug use ( 46.2%) were commonly reported outcomes in natural recovery studies. Conclus ions. Based on this review, future natural recovery studies should: (a) rep ort respondents' demographic characteristics at the time of their recovery; (b) describe respondents' pre-recovery problem severity; (c) explore in so me depth what factors, events or processes are associated with the self-cha nge process; (d) provide corroboration of respondents' self-reports; (e) ex amine factors related to the maintenance of recoveries; (f) conduct intervi ews with individuals who have naturally recovered from cocaine, marijuana a nd polydrug abuse; (g) include a second interview at a later rime to examin e stability of natural recoveries; and (h) require a minimum 5-year recover y time frame.