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CORK Bibliography: Spontaneous Remission



41 citations. January 2010 to present

Prepared: March 2012



Beenstock M. Epidemiology of desistence among adddicted and non-addicted drug users. IN: Rosenqvist P; Blomqvist J; Koski-Jannes A; Ojesjo L, eds. Addiction and Life Course. Monograph No. 44. Helsinki Finland: Nordic Council for Alcohol and Drug Research, 2004. pp. 117-136. (24 refs.)

The study of "desistance" (i.e. cessation or termination) of problematic substance use of two types. One is based on in-depth interviews and emphasizes psychological and sociological factors. The other is derived from epidemiological studies, the tradition represented in the studies reported here. It summarizes the results from two longitudinal projects conducted in Israel. Both examine the phenomenon of "maturing out" of drug use, maturing out as an age-dependent phenomenon, as well as examining maturing out as a duration-related phenomenon. The data suggest that there are a number of factors that are important. These include the type of drug used, i.e. cannabis versus "hard drugs." Seemingly for an addict sample, "aging out" becomes less common with increasing age. Nonetheless with the passage of time, addicts are more likely to desist. Patterns also differ between addicts and non-addicted users, with use becoming less common, independent of the duration of use. For cannabis, desistance rates vary across ethnic groups, socialization, and cohort effects. This is essentially untrue for hard drug users.

Copyright 2006, Project Cork


Bezdek M; Croy C; Spicer P; AI-SUPERPFP Team. Documenting natural recovery in American-Indian drinking behavior: A coding scheme. Journal of Studies on Alcohol 65(4): 428-433, 2004. (21 refs.)

Objective: This report describes a coding scheme developed to analyze how some American Indians changed their drinking behavior and explores the contributions of this approach to our understanding of natural recovery in American-Indian communities. Method: We analyzed the responses to two open-ended questions about drinking in an epidemiological survey. The first question asked what helped respondents to quit or cut down on their drinking; the second asked respondents what they did instead of drinking when they wanted to drink. Codes were developed using anthropological analyses of content and then refined through analyses of frequencies and attempts to establish reliability. The frequencies of these codes were then examined by gender, age and current drinking status. Results: Reliability was attained for the coding of responses to both questions. Their content reflects salient themes in the literature on natural recovery. The distribution of these codes across gender, age and current drinking status reveals interesting insights into what prompts and supports quitting and change for different members of these American-Indian communities, especially for women, older respondents and those who abstain from alcohol. Conclusions: This approach points the way to a consideration of a broad set of factors related to changes in drinking behavior in American-Indian populations that can be applied in future studies, both in American-Indian communities and, potentially, in other populations as well.

Copyright 2004, Alcohol Research Documentation Center


Bischof G; Rumpf HJ; Hapke U; Meyer C; John J. Types of natural recovery from alcohol dependence: A cluster analytic approach. Addiction 98(12): 1737-1746, 2003. (53 refs.)

Social capital and a low severity of alcohol-related problems have been focused upon to explain the processes of natural recovery from alcohol dependence. However, studies using control groups have not found significant differences in these variables. Subtypes of natural remission which might account for this inconsistency have only been described on grounds of qualitative data. To identify subtypes of natural remitters using cluster analysis. One hundred and seventy-eight media-recruited natural remitters were interviewed personally. Several triggering mechanisms and maintenance factors of remission were assessed using standardized questionnaires. Based on age of onset and severity of dependence, adverse consequences from drinking, social pressure and social support, cluster analyses were performed. Cluster analyses yielded three groups of natural remitters: one cluster with a high severity of dependence, low alcohol-related problems and low social support ('low problems -- low support'; n = 65), one group characterized by high severity of dependence, high alcohol-related problems and medium social support ('high problems -- medium support'; n = 37), and a third group which consisted of subjects with high social support, late age of onset, low severity of dependence, and low alcohol-related problems ('low problems -- high support'; n = 76). Cluster solutions were confirmed using discriminant analyses. Analyses of variance (ANOVAs) revealed further group differences on other triggering and maintaining factors of remission. Failure to identify specific pointers to natural recovery in previous research might be due to heterogeneous subgroups of natural remitters. In order to build a conceptual framework for understanding the processes of natural recovery, interactions of different independent variables should be considered.

Copyright 2003, Society for the Study of Addiction to Alcohol and Other Drugs


Bischof G; Rumpf HJ; Meyer C; Hapke U; John U. Influence of psychiatric comorbidity in alcohol-dependent subjects in a representative population survey on treatment utilization and natural recovery. Addiction 100(3): 405-413, 2005. (60 refs.)

Background: It is well known that only a minority of alcohol-dependent subjects seek help and that the majority of alcohol-dependent individuals recover without utilization of formal help. Psychiatric comorbidity is highly prevalent among alcohol-dependent individuals. However, no data are available on the impact of psychiatric comorbidity on natural recovery. Aims: To analyse the impact of non-psychotic psychiatric comorbid Axis I disorders on remission rate and utilization of formal help in alcohol-dependent individuals drawn from a representative general population sample in northern Germany (response rate: 70.2%, n = 4075). Psychiatric diagnoses and utilization of help were assessed in a personal interview using standardized instruments. One hundred and fifty-three life-time alcohol-dependent individuals were assessed, among whom 98 fulfilled the criteria for sustained long-term remission according to the Diagnostic and Statistical Manual version II (DSM-IV) criteria. Any coincidence of DSM-IV non-psychotic Axis I disorders with alcohol dependence was counted as comorbidity. Comorbidity rate in the whole sample was 36.1%. Results: The rate of individuals who remitted from alcohol dependence without formal help was 36.9% in the non-comorbid and 42.6% in the comorbid group. Utilization of formal help was unrelated to comorbidity. Dually diagnosed subjects without a history of help-seeking showed minor differences concerning reasons for not seeking help. Seeking help was not related to schooling, severity of dependence and gender. Conclusion: Data reveal that remission without formal help is equally prevalent among non-comorbid as among comorbid alcohol-dependent individuals. Axis I comorbidity is not related directly to utilization of alcohol-related help. Negative prognoses for untreated comorbid alcohol-dependent individuals are not justified from an epidemiological point of view.

Copyright 2005, Society for the Study of Addiction to Alcohol and Other Drugs


Bischof G; Rumpf HJ; Meyer C; Hapke U; John U. What triggers remission without formal help from alcohol dependence: Findings from the TACOS-Study. IN: Rosenqvist P; Blomqvist J; Koski-Jannes A; Ojesjo L, eds. Addiction and Life Course. NAD Monograph No. 44. Helsinki Finland: Nordic Council for Alcohol and Drug Research, 2004. pp. 85-101. (43 refs.)

Studies of remission from dependence without formal treatment can help increase the understanding on the natural history of alcohol use disorders, as well as development new treatment approaches. The history on remission without formal help can e described as a process divided into two stages. The first was to demonstrate that the phenomenon exists. The second wave involved the use of control groups. One of the main topics in this research has been the identification of triggering factors of natural recovery. Most analysis include severity of alcohol-related problems, psychosocial stressors and psychosocial resources. One of the aims described here was to replicate earlier studies using standardized instruments and larger samples. another concern was to examine methodological issues to better inform future research. The aim of this chapter is to provide an overview of current knowledge of natural recovery drawing the results of TACOS-study.

Copyright 2004, Nordic Council for Alcohol and Drug Research


Bloom NL. Family factors that influence self-resolution of alcohol problems: The drinker's perspective. Dissertation Abstracts International 68(3): 3904B, 2003

The study of self-change or natural recovery is in its infancy. Studies to date have yielded inconsistent results with regard to what triggers the recovery of individuals who stop drinking without treatment. This study interviewed participants recruited from the community to investigate factors that may influence self-recovery. After asking open-ended questions about influences on self-change, the inquiry increasingly narrowed to ask in more detail about the influence of family factors. A semi-structured interview and numerous paper and pencil questionnaires were administered to two groups of participants. Men and women who previously had a drinking problem of at least five years, who had been abstinent for at least two years, and who had resolved this problem with minimal, if any, treatment served as the experimental group (n = 18). The control group included men and women who currently had a drinking problem of at least five years and who also had minimal, if any, treatment (n = 15). Results suggest that unhappiness within an important romantic relationship and experiencing life events which negatively impact one's life may serve as an impetus to change, and that feeling supported by and cohesive with one's family may give an individual the strength and/or encouragement to do so.

Copyright 2003, University Microfilms International


Bourgois P; Hart LK. Commentary on Genberg et al. (2011): The structural vulnerability imposed by hypersegregated US inner-city neighborhoods: A theoretical and practical challenge for substance abuse research. (editorial). Addiction 106(11): 1975-1977, 2011. (7 refs.)


Burman S. Cognitive processes: Their influence on varying pathways to recovery. Journal of Social Work Practice in the Addictions 3(3): 21-39, 2003. (61 refs.)

Cognitive processes have been known to have a significant impact on recovery from alcohol and other drugs. From a study of self-changers (natural recoverers) without treatment or self-help groups, analysis of the data has identified beliefs that influenced the change experience- from the evaluation of reasons for drinking and the consequences that instigated the motivation and determination to take action, to the individually-conceived strategies to implement and maintain abstinence, and the perceived consequences of abstaining. Belief systems and strategies of recovery are compared across three pathways to recovery- self-change, cognitively-oriented treatment, and Alcoholics Anonymous.

Copyright 2003, The Haworth Press, Inc.


Calabria B; Degenhardt L; Briegleb C; Vos T; Hall W; Lynskey M et al. Systematic review of prospective studies investigating "remission" from amphetamine, cannabis, cocaine or opioid dependence. (review). Addictive Behaviors 35(8): 741-749, 2010. (47 refs.)

Aims: To review and summarize existing prospective studies reporting on remission from dependence upon amphetamines, cannabis, cocaine or opioids. Methods: Systematic searches of the peer-reviewed literature were conducted to identify prospective studies reporting on remission from amphetamines, cannabis, cocaine or opioid dependence. Searches were limited to publication between 1990 and 2009. Reference lists of review articles and important studies were searched to identify additional studies. Remission was defined as no longer meeting diagnostic criteria for drug dependence or abstinence from drug use; follow-up periods of at least three years were investigated. The remission rate was estimated for each drug type, allowing pooling across studies with varying follow-up times. Results: There were few studies examining the course of psychostimulant dependence that met inclusion criteria (one for amphetamines and four for cocaine). There were ten studies of opioid and three for cannabis dependence. Definitions of remission varied and most did not clearly assess remission from dependence. Amphetamine dependence had the highest remission rate (0.4477; 95%CI 0.3991, 0.4945), followed by opioid (0.2235; 95%CI 0.2091, 0.2408) and cocaine dependence (0.1366; 95%CI 0.1244, 0.1498). Conservative estimates of remission rates followed the same pattern with cannabis dependence (0.1734; 95%CI 0.1430, 0.2078) followed by amphetamine (0.1637; 95%CI 0.1475, 0.1797), opioid (0.0917; 95%CI 0.0842, 0.0979) and cocaine dependence (0.0532; 95%CI 0.0502, 0.0597). Conclusions: The limited prospective evidence suggests that "remission" from dependence may occur relatively frequently but rates may differ across drugs. There is very little research on remission from drug dependence; definitions used are often imprecise and inconsistent across studies and there remains considerable uncertainty about the longitudinal course of dependence upon these most commonly used illicit drugs.

Copyright 2010, Elsevier Science


Cameron D. Reshaping drinkers' identities. IN: Rosenqvist P; Blomqvist J; Koski-Jannes A; Ojesjo L, eds. Addiction and Life Course. NAD Monograph No. 44. Helsinki Finland: Nordic Council for Alcohol and Drug Research, 2004. pp. 173-184. (4 refs.)

Within the general population, people's drinking patterns change over time. Most commonly, drinking decreases with age, especially among men, in terms of both amount per occasion and number of occasions. There are gender differences with women starting to drink later and consumption remains more stable. However, within the population data are a number of sub-groups, distinguished by differing patterns for their drinking careers. For drinkers too there are different trajectories for the process which culminates as getting designated as having a drinking problem, a process which occurs at several levels -- the intimate interpersonal, the person's larger social matrix, and at the level of societies as a whole. The author provides two case illustrations, both for the process of problem "definition" and problem resolution.

Copyright 2006, Project Cork


Cloud W; Granfield R. A life course perspective on exiting addiction: The relevance of recovery capital in treatment. IN: Rosenqvist P; Blomqvist J; Koski-Jannes A; Ojesjo L, eds. Addiction and Life Course. NAD Monograph No. 44. Helsinki Finland: Nordic Council for Alcohol and Drug Research, 2004. pp. 185-202. (24 refs.)

The life course perspective suggests that trajectories and transitions are bounded by broader social environments and social relationships. As has been shown adults are inhibited from committing crime to the extent that over time, they accumulate social capital in their work and family, regardless of delinquent background. These researchers recognize that the accumulation of social capital can lead to normative systems as well as assorted resources that serve as pathways to change. This paper adopts a life course perspective, and particularly the focus on social capital, to examine the process of natural recovery and explores the implications that natural recovery has for treatment providers. the study reported is derived form interviews with 46 individuals who overcame addiction without formal treatment. Most respondents experience a turning point that sharply and dramatically disrupted their lives so that that they recognized that they were no longer "themselves." These turning points frequently involved other people, particularly intimates, e.g. for women, responsibilities to children. In terms of the strategies used to initiate cessation clustered into three general areas: alternative activities, relying upon relationships with family and friends, and avoiding drug use and social settings associated with use. Examples of these are provided. The final stage in the transformative process was in the realization of rewards associated with new, non-addicted status. There is a discussion of the notion of "recovery capital", i.e. access to resources to achieve desired changes. The construct of recovery capital and its importance to treatment providers is considered. It is noted that an important part of treatment planning and aftercare is assessing and mobilizing recovery capital of clients.

Copyright 2004, Nordic Council for Alcohol and Drug Research


Copersino ML; Boyd SJ; Tashkin DP; Huestis MA; Heishman SJ; Dermand JC. Quitting among non-treatment-seeking marijuana users: Reasons and changes in other substance use. American Journal on Addictions 15(4): 297-302, 2006. (21 refs.)

This study examines the self-reported reasons for quitting marijuana use, changes in other substance use during the quit attempt, and reasons for the resumption of use in 104 non-treatment-seeking adult marijuana smokers. Reasons for quitting were shown to be primarily motivated by concerns about the negative impact of marijuana on health and on self-and social image. The spontaneous quitting of marijuana use is often associated with an increase in the use of legal substances such as alcohol, tobacco, and sleeping aids, but not with the initiation of new substance use. These findings suggest areas for further research on spontaneous recovery from marijuana use.

Copyright 2006, American Academy of Psychiatrists in Alcoholism and Addictions


Cunningham JA; Blomqvist J; Cordingley J. Beliefs about drinking problems: Results from a general population telephone survey. Addictive Behaviors 32(1): 166-169, 2007. (6 refs.)

As part of a general population telephone survey (N = 3006), respondents were asked their beliefs about alcohol problems. The majority of respondents were skeptical about the possibility of untreated and of moderate drinking recoveries. The predominant conceptions of the nature of alcohol problems were those of a disease or of drug addiction. Beliefs about the need for treatment and abstinence were positively associated with being female, older, and married. Current heavy drinkers were less likely to believe that treatment was needed. Former heavy drinkers were more likely to believe that abstinence was required, as compared to all other respondents.

Copyright 2007, Elsevier Science


Cunningham JA; Blomqvist J; Koski-Jannes A; Cordingley J. Maturing out of drinking problems: Perceptions of natural history as a function of severity. Addiction Research & Theory 13(1): 79-84, 2005. (10 refs.)

This study tested the hypothesis that maturing out descriptions of change were more common among respondents whose drinking problems were less severe prior to reduction and that consequence driven changes were more common among those who had a lifetime diagnosis of alcohol dependence, prior to resolution. As part of a general population telephone survey, former heavy drinkers were asked their reasons for change. These responses were tape-recorded, transcribed and then coded into three categories - consequence driven reasons, drifting out reasons and reflective maturational reasons. As predicted, drifting out reasons were more often provided by those with less severe alcohol use and consequence related reasons appeared associated with respondents who had had more severe alcohol problems. The differing descriptions of pathways to change observed in natural history studies may be the result of research that captures only partial samples of the larger population of former heavy drinkers.

Copyright 2005, Taylor & Francis Ltd.


Dawson DA; Grant BF; Stinson FS; Chou PS. Maturing out of alcohol dependence: The impact of transitional life events. Journal of Studies on Alcohol 67(2): 195-203, 2006. (45 refs.)

Objective: The purpose of this study was to investigate the effects of transitional life events related to education, employment, and family formation on the likelihood of recovery from alcohol dependence as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), distinguishing the short- and long-term effects of these events and potential effect modification by treatment history, gender, and severity of dependence. Method: This analysis is based on data from the Wave 1 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a cross-sectional, retrospective survey of a nationally representative sample of U.S. adults 18 years of age and older. The analytic sample consisted of 4,422 individuals with prior-to-past-year (PPY) onset of DSM-IV alcohol dependence. Time-dependent proportional hazards models were used to estimate the effects of completing school, starting full-time work, getting married, becoming separated/divorced/widowed, and becoming a parent on the outcomes of nonabstinent recovery (NR; e.g., low-risk asymptomatic drinking) and abstinent recovery (AR). Results: Entry into and exit from a first marriage each increased the likelihood of NR during the first 3 years after those events occur-red (hazard rate ratio [HRR] = 1.37 and 1.76, respectively). However, individuals who were still dependent 3 or more years after those events occurred had a decreased likelihood of subsequent NR (HRR = 0.70 for both events), as did those who were still dependent 3 or more years after completing schooling (HRR = 0.54). The likelihood of AR was more than doubled in the 3 years after first becoming a parent (HRR = 2.22) but was decreased among individuals still dependent 3 or more years after starting full-time work. For the outcome of NR, all of the negative effects associated with still being dependent 3 or more years after the occurrence of key life events were more strongly negative among individuals with less severe cases of dependence. Conclusions: Transitional life events demonstrate many effects on recovery, including both direct effects consistent with role socialization and associations more reflective of selectivity than causation. Taken as a whole, these events appear to contribute to (but by no means fully explain) the high rates of recovery from alcohol dependence that have been observed even in the absence of treatment.

Copyright 2006, Alcohol Research Documentation, Inc. Used with permission


Dawson DA; Grant BF; Stinson FS; Chou PS; Huang B; Ruan WJ. Recovery from DSM-IV alcohol dependence - United States, 2001-2002 (reprinted from Addiction vol 100, pg 281, 2005). Alcohol Research & Health 29(2): 131-142, 2006. (48 refs.)

Aims: To investigate the prevalence and correlates of recovery from Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) alcohol dependence by examining the past-year status of individuals who met the criteria for prior-to-past-year (PPY) dependence. Design: Cross-sectional, retrospective survey of a nationally representative sample of U.S. adults age 18 and older (first wave of a planned longitudinal survey). Methods: This analysis is based on data from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), in which data were collected in personal interviews conducted with one randomly selected adult in each sample household. A subset of the NESARC sample (total n = 43,093), consisting of 4,422 U.S. adults age 18 and older classified with PPY DSM-IV alcohol dependence, were evaluated with respect to their past-year recovery status: past-year dependence, partial remission, full remission, asymptomatic risk drinking, abstinent recovery (AR), and nonabstinent recovery (NR). Correlates of past-year status were examined in bivariate analyses and using multivariate logistic regression models. Findings: Of people classified with PPY alcohol dependence, 25.0 percent were still classified as dependent in the past year; 27.3 percent were classified as being in partial remission; 11.8 percent were asymptomatic risk drinkers who demonstrated a pattern of drinking that put them at risk of relapse; 17.7 percent were low-risk drinkers; and 18.2 percent were abstainers. Only 25.5 percent of people with PPY dependence ever received treatment. Being married was associated positively with the odds of both AR and NR, and ethanol intake was negatively associated with both. Severity of dependence increased the odds of AR but decreased the odds of NR. The odds of AR (but not NR) increased with age and female gender but were decreased by the presence of a personality disorder. Treatment history modified the effects of college attendance/graduation, age at onset, and interval since onset on the odds of recovery. Conclusions: There is a substantial level of recovery from alcohol dependence. Information on factors associated with recovery may be useful in targeting appropriate treatment modalities.

Public Health


Dawson DA; Grant BF; Stinson FS; Chou PS; Huang B; Ruan WJ. Recovery from DSM-IV alcohol dependence: United States, 2001-2002. (editorial). Addiction 100(3): 281-292, 2005. (45 refs.)

Aims: To investigate the prevalence and correlates of recovery from Diagnostic and Statistical Manual version IV (DSM-IV) alcohol dependence by examining the past-year status of individuals who met the criteria for prior-to-past-year (PPY) dependence. Design: Cross-sectional, retrospective survey of a nationally representative sample of US adults 18 years of age and over (first wave of a planned longitudinal survey). Methods: This analysis is based on data from the 2001-02 National pidemiological Survey on Alcohol and Related Conditions (NESARC), in which data were collected in personal interviews conducted with one randomly selected adult in each sample household. A subset of the NESARC sample (total n = 43 093), consisting of 4422 US adults 18 years of age and over classified with PPY DSM-IV alcohol dependence, were evaluated with respect to their past-year recovery status: past-year dependence, partial remission, full remission, asymptomatic risk drinking, abstinent recovery (AR) and non-abstinent recovery (NR). Correlates of past-year status were examined in bivariate analyses and using multivariate logistic regression models. Findings: Of people classified with PPY alcohol dependence, 25.0% were still classified as dependent in the past year; 27.3% were classified as being in partial remission; 11.8% were asymptomatic risk drinkers who demonstrated a pattern of drinking that put them at risk of relapse; 17.7% were low-risk drinkers; and 18.2% were abstainers. Only 25.5% of people with PPY dependence ever received treatment. Being married was associated positively with the odds of both AR and NR, and ethanol intake was negatively associated with both. Severity of dependence increased the odds of AR but decreased the odds of NR. The odds of AR (but not NR) increased with age and female gender but were decreased by the presence of a personality disorder. Treatment history modified the effects of college attendance/graduation, age at onset and interval since onset on the odds of recovery. Conclusions There is a substantial level of recovery from alcohol dependence. Information on factors associated with recovery may be useful in targeting appropriate treatment modalities.

Copyright 2005, Society for the Study of Addiction to Alcohol and Other Drugs


DiClemente CC. Natural change and the troublesome use of substances: A life-course perspective. (Chapter 6). IN: Miller WR; Carroll KM, eds. Rethinking Substance Abuse: What the Science Shows, and What We Should Do about It. New York: Guilford Press, 2010

This chapter is one of four in Section III which addresses psychological factors in the the eteiology of substance use disorders. This chapter examines the resolution of substance use problems in the absence of formal treatment. At times this is referred to as spontaneous remission. This phenomenon is examined from the perspective of life course. This is one of four chapters in a section dealing with the psychological factors related to addiction and substance use.

Copyright 2011, Project Cork


Ellingstad TP; Sobell LC; Sobell MB; Eickleberry L; Golden CJ. Self-change: A pathway to cannabis abuse resolution. Addictive Behaviors 31(3): 519-530, 2006. (48 refs.)

Long-term daily cannabis abusers (N = 25) who without treatment stopped using cannabis for at least one year were interviewed about their past substance use, antecedents to change, and factors supportive of change. Respondents' cannabis problems decreased in the year prior to their recovery compared to their lifetime use. Respondents described their successful quit attempts through structured interviews and autobiographical narratives. The narratives were content analyzed for factors related to recovery. The reports indicated that marijuana cessation was motivated more by internal than external factors, and the most common precipitants of quit attempts were cognitive anti-cannabis factors. The major reason reported by respondents for stopping cannabis was a change in how they viewed their cannabis use, followed by negative personal effects. The most common reported maintenance factors were avoidance of situations in which cannabis was used, changes in lifestyle, and the development of non-cannabis-related interests. Cognitive and respiratory functioning were also assessed. Lastly, more than 75% of respondents reported not seeking treatment because they believed it was not needed or because they wanted to quit on their own. Directions for future research are offered.

Copyright 2006, Elsevier Science


Genberg BL; Gange SJ; Go VF; Celentano DD; Kirk GD; Latkin CA et al. The effect of neighborhood deprivation and residential relocation on long-term injection cessation among injection drug users (IDUs) in Baltimore, Maryland. Addiction 106(11): 1966-1974, 2011. (45 refs.)

Aims To determine the incidence of long-term injection cessation and its association with residential relocation and neighborhood deprivation. Design ALIVE (AIDS Linked to the Intravenous Experience) is a prospective cohort with semi-annual follow-up since 1988. Multi-level discrete time-to-event models were constructed to investigate individual and neighborhood-level predictors of long-term injection cessation. Setting Baltimore, USA. Participants: A total of 1697 active injectors from ALIVE with at least eight semi-annual study visits. Measurements Long-term injection cessation was defined as 3 consecutive years without self-reported injection drug use. Findings: A total of 706 (42%) injectors achieved long-term cessation (incidence = 7.6 per 100 person-years). After adjusting for individual-level factors, long-term injection cessation was 29% less likely in neighborhoods in the third quartile of deprivation [hazard ratio (HR) = 0.71, 95% CI: 0.53, 0.95) and 43% less likely in the highest quartile of deprivation (HR = 0.57, 95% CI: 0.43, 0.76) compared to the first quartile. Residential relocation was associated with increased likelihood of long-term injection cessation (HR = 1.55, 95% CI: 1.31, 1.82); however, the impact of relocation varied depending on the deprivation in the destination neighborhood. Compared to those who stayed in less deprived neighborhoods, relocation from highly deprived to less deprived neighborhoods had the strongest positive impact on long-term injection cessation (HR = 1.96, 95% CI: 1.50, 2.57), while staying in the most deprived neighborhoods was detrimental (HR = 0.76, 95% CI: 0.63, 0.93). Conclusions Long-term cessation of injection of opiates and cocaine occurred frequently following a median of 9 years of injection and contextual factors appear to be important. Our findings suggest that improvements in the socio-economic environment may improve the effectiveness of cessation programs.

Copyright 2011, Society for the Study of Addiction


Hao W; Tan LX; Tang QS. Towards a self-change-friendly treatment and policy for addictive behaviours. (editorial). Addiction 105(9): 1519-1520, 2010 , 2010. (6 refs.)


Klingemann H; Sobell MB; Sobell LC. Continuities and changes in self-change research. Addiction 105(9): 1510-1518, 2010 , 2010. (77 refs.)

Aims: A substantial literature demonstrates that natural recoveries from substance use disorders not only occur but are a common pathway to recovery. This article reviews selectively and comments on the current state-of-the-art in natural recovery research. Methods: Basic concepts in natural recovery research are presented, and topical and methodological trends and changes in self-change research over time are discussed. Conclusions: Although considerable progress has occurred in natural recovery research, several topics deserving of further research are identified, and implications for policy practice are discussed.

Copyright 2010, Society for the Study of Addiction to Alcohol and Other Drugs


Klingemann H; Sobell MB; Sobell LC. Response to commentaries 'Continuities and changes in self-change research.' (editorial). Addiction 105(9): 1524-1524, 2010 , 2010. (7 refs.)


Littlefield AK; Sher KJ; Wood PK. A personality-based description of maturing out of alcohol problems: Extension with a five-factor model and robustness to modeling challenges. Addictive Behaviors 35(11): 948-954, 2010 , 2010. (43 refs.)

Aim: To examine the relation of changes in Five-Factor personality traits (i.e., extraversion, agreeableness, conscientiousness, neuroticism, and openness to experience; Costa & McCrae, 1985), drinking motives, and problematic alcohol involvement in a cohort of college students (N = 467) at varying risk for alcohol use disorders from ages 21 to 35. Method: Parallel process latent growth models were estimated to determine the extent that prospective changes in personality and alcohol problems covaried as well as the extent to which drinking motives appeared to mediate these relations. Results: Changes in neuroticism and conscientiousness covaried with changes in problematic alcohol involvement. Specifically, increases in conscientiousness and decreases in neuroticism were related to decreases in alcohol from ages 21 to 35, even after accounting for marriage and/or parenthood. Change in coping (but not enhancement) motives specifically mediated the relation between changes in conscientiousness and alcohol problems in addition to the relation between changes in neuroticism and alcohol problems. Discussion: Personality changes, as assessed by a Five-Factor model of personality, are associated with "maturing out" of alcohol problems. Of equal importance, change in coping motives may be an important mediator of the relation between personality change and the "maturing out" of alcohol problems.

Copyright 2010, Elsevier Science


Metrik J; McCarthy DM; Frissell KC; MacPherson L; Brown SA. Adolescent alcohol reduction and cessation expectancies. Journal of Studies on Alcohol 65(2): 217-226, 2004. (51 refs.)

Objective: Although many youths reduce or stop drinking without formal treatment, little is known of cognitive mechanisms influencing such alcohol change efforts during adolescence. The present research examines alcohol cessation expectancies of adolescents in the context of a cognitive-behavioral de-escalation model of alcohol use. Grounded in Developmental Social Information Processing theory (Coie and Dodge, 1998) and empirical findings on adolescent self-change process. alcohol cessation expectancies are defined as anticipated consequences of ceasing or decreasing drinking. The present study is the first to develop a measure of adolescent alcohol cessation expectancies. Method: A 23-item measure was administered to 5,446 high school students (51% female) as part of a survey on alcohol and drug use. Results: Using data for adolescents who reported any history of alcohol use (N = 3.098). exploratory and confirmatory factor analyses identified expectations of global changes and social effects. Expectancy factor structure was examined within drinking groups (light, moderate, heavy drinkers) and as a function of age and change goal (reduction and cessation). Predictive validity of the expectancy measure was examined for youth who reported efforts to decrease or stop drinking during the prior year. Our results suggest greater differentiation in cessation expectancies with increased alcohol experience. The findings also provide evidence that youth cessation expectancies uniquely predict alcohol change efforts over and above alcohol use and problems. Conclusions: Youths maintain several types of alcohol reduction/cessation expectancies predictive of behavioral change efforts. Articulation of this construct for youth contributes to an understanding of mechanisms involved in adolescent efforts to reduce or stop drinking.

Copyright 2004, Alcohol Resarch Documentation, Inc.


Miller PM; Smith JP. What do marshmallows and golf tell us about natural recovery research? (editorial). Addiction 105(9): 1521-1522, 2010 , 2010. (7 refs.)

In this issue, Klingemann, Sobell & Sobell present an analysis of the evolution of self-change research in the addictions field. A concern discussed is that possibly there is an over-reliance on controlled, quantitative investigations to the exclusion of qualitative and case studies. It is suggested because we do not really know why people self-change, we need to partner with those who have experienced it to help develop a grounded and testable theoretical framework.. Related to this approach is the importance of paying as much attention to the ingredients of successful self-control and self-change as we do to what triggers substance use and abuse. This same strategy can be applied not only to natural recovery but also recovery resulting from minimal professional intervention, such as those individuals who improve dramatically after being exposed to substance use assessment alone, brief, 10-minute advice from their primary care physician, or placebo medications in clinical trials. There exists a treasure trove of self-change experiences within our current system of research that could expand our understanding exponentially of what makes people change.

Copyright 2010, Society for the Study of Addiction to Alcohol and Other Drugs


Miller WR; Carroll KM, eds. Rethinking Substance Abuse: What the Science Shows, and What We Should Do about It. New York: Guilford Press, 2006. (Chapter refs.)

Several years ago one author lamented that the research being conducted on "change" within the substance abuse field was 'mis-directed.' The core problem he stated was not a lack of understanding about how clients change, but the absence of knowledge about how clinicians change, i.e. and what will enable them to adopt best practices. This volume is intended to deal with the conundrum. This book has the goal of describing what treatment and prevention would look like were they based on the best science available. It presents key information from the current substance abuse research in a practical fashion to promote better clinical care. This volume, organized into 18 chapter with 28 contributors, is organized into five section. The first section deals with the field's failure to utilize best practices, the increasing understanding of essentially complex phenomenon related to drug use/abuse, and outlines the goals for the book. Section II considers the neurobiology of addiction, the insights provided by brain imaging in respect to risk factors and relapse, as well as the genetic factors related to substance use and abuse. Section III considers psychological factors. It includes examination of the phenomenon of natural change, change in the absence of treatment. It reviews the relationship of substance use and co-occurring psychological problems. Another chapter also summarizes the insights into developmental factors that play a role in the development of substance abuse problems. Section IV turns to examination of social factors. The domains considered are the presence of race and gender differences, the impact of family and close relationships, the impact of social context, as well as the insights provided by ethnographic and anthropological studies. Section V is devoted to intervention. Beyond consideration of specific modalities, such as behavior therapies and drug therapies, a domain less discussed, religion and spirituality is also examined. In this section the limitations of the current treatment system are also considered. The concluding chapter sets forth ten principles and ten recommendations.

Copyright 2006, Project Cork


Mitchell CM; Beals J; Novins DK; Spicer P. Drug use among two American Indian populations: Prevalence of lifetime use and DSM-IV substance use disorders. Drug and Alcohol Dependence 69(1): 29-41, 2003. (46 refs.)

American Indians (AIs) have often reported higher rates of drug use than have other racial/ethnic groups. However, the majority of these studies have focused on drug use among high school adolescents, with little attention to pathological use such as drug abuse or dependence. This study is among the first to report lifetime drug use and disorder (abuse/dependence) information from community samples of two culture groups of AI people-one in the Southwest (SW), one in the Northern Plains (NP)-ranging in age from 15 to 57 years old. Analyses were conducted within four groups: SW men, SW women, NP men, and NP women. Across the four groups, lifetime use rates for marijuana (36.9-57.5%), cocaine (4.3-21.5%), and inhalants (3.6-17.0%) were the highest drug use rates; heroin (0.5-2.1%), the lowest. Lifetime drug disorder rates were highest for marijuana (4.5- 14.1%), cocaine (1.1-2.3%), and stimulants (0.7-1.7%). Lifetime polydrug use disorder rates from 1.2 to 4.5%. Women generally had lower prevalence rates than did men in their culture group. The SW women generally had the lowest rates of use and disorder. Lifetime use and disorder rates among the youngest group were often not different from rates of the older groups. Overall, 40-60% had never used any drugs; 85-95% had not developed any drug disorder. Despite widespread concern and rhetoric about drug problems among AIs, many who had used various drugs either were using them without serious consequences or had quit use altogether.

Copyright 2003, Elsevier Scientific Publishers Ireland, Ltd.


Moos RH; Moos BS. Rates and predictors of relapse after natural and treated remission from alcohol use disorders. Addiction 101(2): 212-222, 2006. (58 refs.)

Aims: This study examined the rates and predictors of 3-year remission, and subsequent 16-year relapse, among initially untreated individuals with alcohol use disorders who did not obtain help or who participated in treatment and/or Alcoholics Anonymous in the first year after recognizing their need for help. Design and measures: A sample of individuals (n = 461) who initiated help-seeking was surveyed at baseline and 1 year, 3 years, 8 years and 16 years later. Participants provided information on their life history of drinking, alcohol-related functioning and life context and coping. Findings: Compared to individuals who obtained help, those who did not were less likely to achieve 3-year remission and subsequently were more likely to relapse. Less alcohol consumption and fewer drinking problems, more self-efficacy and less reliance on avoidance coping at baseline predicted 3-year remission; this was especially true of individuals who remitted without help. Among individuals who were remitted at 3 years, those who consumed more alcohol but were less likely to see their drinking as a significant problem, had less self-efficacy, and relied more on avoidance coping, were more likely to relapse by 16 years. These findings held for individuals who initially obtained help and for those who did not. Conclusions: Natural remission may be followed by a high likelihood of relapse; thus, preventive interventions may be indicated to forestall future alcohol problems among individuals who cut down temporarily on drinking on their own.

Copyright 2006, Society for the Study of Addiction to Alcohol and Other Drugs


Moos RH; Moos BS. Treated and untreated individuals with alcohol use disorders: Rates and predictors of remission and relapse. International Journal of Clinical and Health Psychology 6(3): 513-526, 2006. (35 refs.)

This observational descriptive study focused on whether individuals with alcohol use disorders who participate in professional treatment and/or Alcoholics Anonymous (AA) experience better long-term outcomes than individuals who do not obtain help. Participants were surveyed at baseline when they initiated help-seeking and 1 year, 3 years, 8 years, and 16 years later. Compared with individuals who obtained no help, individuals who participated in treatment and/or AA for 9 weeks or more in the first year after help-seeking had better 16-year outcomes. Participation in treatment and/or AA accelerated an overall pattern of change, so that individuals who obtained help improved somewhat more and more quickly than those who did not. Overall, individuals who did not obtain help were less likely to achieve remission and, even if they achieved remission, were more likely to relapse. The findings support the value of strengthening the referral process for individuals who seek help and indicate that providers should structure treatment programs to ensure continuing care and affiliation with AA.

Copyright 2006, Asociacion Espanola Psicologia Conductual


Schutte KK; Moos RH; Brennan PL. Predictors of untreated remission from late-life drinking problems. Journal of Studies on Alcohol 67(3): 354-362, 2006. (51 refs.)

Objective: Studies of mixed-aged samples have suggested that a majority of problem drinkers achieve remission "naturally," without formal treatment. We sought to describe the life history predictors of untreated remission among older adults. Method: We compared 330 older untreated remitters to 120 older treated remitters and to 130 untreated nonremitters. Results: A majority (73%) of remitted, older problem drinkers attained remission without any formal treatment for drinking problems. Compared with treated remitters, late-life untreated remitters were more likely to be women and had completed more schooling, reached their peak alcohol consumption and ceased development of new drinking problems earlier, had much less severe drinking and depression histories, and were less likely to have received any advice to reduce consumption. Compared with untreated nonremitters, untreated remitters were more likely to be women, reached their peak alcohol consumption and stopped developing new drinking problems almost a decade earlier, had somewhat less severe drinking histories, were less likely to have been advised to reduce consumption, and were more likely to have reacted to late-life health problems by reducing their alcohol consumption. Conclusions: Many late-life problem drinkers with milder drinking problems achieve remission without treatment or advice to reduce consumption. However, a notable percentage of untreated older individuals who have more severe drinking problems could benefit from public health efforts to aid detection of late-life drinking problems and interventions aimed at reducing alcohol consumption. Results suggest that such interventions should highlight the negative health consequences of excessive late-life drinking.

Copyright 2006, Alcohol Research Documentation, Inc


Slutske WS. Why is natural recovery so common for addictive disorders? (editorial). Addiction 105(9): 1520-1521, 2010 , 2010. (15 refs.)


Sobell LC; Sobell MB. Linda and Mark Sobell: Problem drinking or addiction? Self-recovery or therapy? (editorial) [German]. Verhaltenstherapie 14(2): 150-152, 2004. (0 refs.)


Sobell MB; Sobell LC. Time to tear down the wall: Comment on Dawson et al. (2005) (commentary). Addiction 100(3): 294-295, 2005. (7 refs.)


Sobell MB; Sobell LCVaillant G. Secrets and lies: Comments on Dawson et al. (editorial). Addiction 100(3): 294-294, 2005. (3 refs.)


Solomon LJ; Quinn VP. Spontaneous quitting: Self-initiated smoking cessation in early pregnancy. (review). Nicotine & Tobacco Research 6(Supplement 2): S203-S216, 2004. (52 refs.)

This article reviews the empirical literature on spontaneous quitting of cigarette smoking among pregnant women. We define spontaneous quitting and discuss its prevalence and the characteristics that differentiate spontaneous quitters from women who continue to smoke during pregnancy. We examine the success of these women in abstaining throughout their pregnancy, and their pattern of relapse back to smoking during the postpartum period. We review studies that have tested strategies to maintain abstinence among spontaneous quitters, and we conclude the article with gaps identified in the literature that warrant further study.

Copyright 2004, Taylor & Francis Ltd.


Steensma C; Boivin JF; Blais L; Roy E. Cessation of injecting drug use among street-based youth. Journal of Urban Health 82(4): 622-637, 2005. (46 refs.)

Young injecting drug users (IDUs) are at high risk for a number of negative health outcomes such as hepatitis B, hepatitis C, and human immunodeficiency virus (HIV) infection. However, very little is known about injecting drug-use patterns among this population, particularly with respect to cessation of injection. We sought to identify the factors associated with cessation of injection in a population of young street-based IDUs. A prospective cohort study design was used to assess long-term (>= 1 year) cessation of drug injection. Data was collected between January 1995 and September 2000 in Montreal, Quebec, Canada. Subjects were originally recruited from various street-based outreach programs in Montreal and, for this study, had to have reported injecting drugs within the prior 6 months at baseline or during follow-up and had to have completed at least two semiannual follow-up questionnaires. Cessation incidence rates stratified by duration of injection and adjusted hazard ratios (AdjHRs) were calculated. A Cox proportional hazards regression model was used to identify risk factors independently associated with cessation of drug injection. Of 502 young IDUs, 305 subjects met the inclusion criteria. Cessation of injection for approximately 1 year or more occurred in 119 (39%) of the young IDUs. The incidence of cessation was 32.6/100 person-years but consistently declined as duration of time spent injecting increased. Independent predictors of cessation of injection were currently injecting on a less than monthly or less than weekly basis (HR = 6.4; 95% confidence interval (CI): 3.0-13.6 and HR = 2.4; 95% CI = 1.1-5.3, respectively); currently injecting two or fewer different types of drug (HR = 2.1; 95% CI = 1.1-4.0); currently employed (HR = 1.7; 95% CI = 1.1-2.7); and having at least one parent born outside of Canada (HR = 1.4; 95% CI = 1.1-1.7). Independent predictors of not ceasing injection were currently attending a needle-exchange program (HR = 0.5; 95% CI = 0.3-0.8); and current homelessness (HR = 0.6; 95% CI = 0.4-1.0). The early sharp decline in cessation of drug injection followed by a consistent decrease in this rate suggest difficulties in breaking the habit later on in the drug injecting career. Intensity of drug use and factors which may help to stabilize the social environment of the young IDU may also influence the ability to stop injecting.

Copyright 2005, Oxford University Press


Sussman S; Dent CW. Five-year prospective prediction of marijuana use cessation of youth at continuation high schools. Addictive Behaviors 29(6): 1237-1243, 2004. (11 refs.)

This paper reports the prediction of marijuana use cessation among young adults who were regular users 5 years earlier. Social, attitude, intrapersonal, violence-related, drug use, and demographic baseline measures served as predictors of whether or not 339 teenage marijuana users reported having quit use 5 years later. Young adult social role variables were included as additional predictors. Quitting was defined as having not used marijuana in the last 30 days (42% of the sample at follow-up). After controlling for covariation among predictors, in a three-step analysis, only baseline level of marijuana use, male gender, young adult marital status, and friends' marijuana use (marginal) remained statistically direct predictors. Implications of these results include the need to reduce psychological dependence on marijuana and increase social unacceptability of marijuana use across genders to help increase prevalence of quit attempts.

Copyright 2004, Elsevier Science Ltd.


Teesson M. What does self-change mean for how we deliver treatment? (editorial). Addiction 105(9): 1522-1523, 2010 , 2010. (9 refs.)


Termorshuizen F; Krol A; Prins M; van Ameijden EJC. Long-term outcome of chronic drug use: The Amsterdam Cohort Study among Drug Users. American Journal of Epidemiology 161(3): 271-279, 2005. (27 refs.)

In the present study, mortality rates and prevalence of abstinence from illicit drugs among persons with a history of addiction to heroin, cocaine, and/or amphetamines were estimated along the drug-using career time scale. Follow-up data on drug use and vital status were analyzed for participants in the Amsterdam Cohort Study among Drug Users (n = 899; 1985-2002). Participants in the study were primarily recruited at low-threshold methadone outposts. It was estimated that at least 27% of drug users had died within 20 years after starting regular drug use; for half, death had been due to causes unrelated to human immunodeficiency virus. A favorable trend towards abstinence with increasing time since initiation of regular use was observed. However, among those alive, the estimated prevalence of abstinence for at least 4 months from the above drugs and methadone was only 27% at 20 years since initiation. A higher age at initiation, a calendar year of initiation before 1980, and a Western European ethnic origin were associated with higher prevalence of abstinence. These results indicate that the concept of "maturing out" to a drug-free state does not apply to the majority of drug users. Further studies on determinants of individual transitions in drug use are important in order to establish evidence-based intervention strategies.

Copyright 2005, Johns Hopkins University School of Hygiene and Public Health. Used with permission


Tucker JA. Finding common ground in the 'two worlds of alcohol problems': When behaviour change succeeds. (editorial). Addiction 100(11): 1573-1574, 2005. (4 refs.)

Years ago, Robin Room wrote incisively about the 'two worlds of alcohol problems' that had emerged from the then segregated literatures from population surveys and clinical studies. The study by Matzer in this issue echoes and reinforces themes in the natural resolution, help-seeking and treatment outcome literature. They sampled problem drinkers from the general population and alcohol treatment programs, and focused on those who maintained sizeable, stable reductions in problem drinking over a 5-year follow-up period compared to baseline. At the 1-year follow-up participants were asked about their perceived reasons for drinking less, and the pattern and relationship of reasons to sustained remission at 5 years were the focus of study. Consistent with their more serious drinking problems, the clinical sample endorsed almost twice as many reasons for decreased drinking. But when sample differences in problem severity and demographic characteristics were statistically controlled, the reasons that predicted sustained remission at 5 years were strikingly similar across the clinical and population samples: hitting rock bottom with drinking, having a traumatic experience and having a religious or spiritual experience more than doubled the odds of remission, which replicated earlier findings that a crisis or series of negative events often precede recovery attempts. Whether these purported reasons are in fact causal is open to question.

Copyright 2005, Society for the Study of Addiction to Alcohol and Other Drugs


Tucker JA. Natural resolution of alcohol-related problems. IN: Galanter M, ed. Recent Developments in Alcoholism. Volume 16: Research on Alcoholism Treatment. Methodology/Psychosocial Treatment/Selected Treatment Topics/Research Priorities. New York: Kluwer Academic, 2003. pp. 77-90. (65 refs.)

The natural resolution of alcohol-related problems in the absence of intervention is discussed. The author notes that natural resolution, which was previously termed spontaneous remission, has been viewed mostly as a nuisance variable requiring statistical control in treatment outcome evaluations rather than as an object of study in its own right. Additionally, the disease model and the presumed progressive and irreversible nature of alcohol problems is incompatible with the possibility that affected individuals could change their behavior without benefit of intensive and extended treatment. However, there is increasing evidence that some problem drinkers resolve their problem without interventions. It is concluded that treatment is neither a necessary nor a sufficient condition for resolution, which can occur a number of ways and is influenced by extratherapeutic contextual variables. Section headings in this book chapter include: (1) state of knowledge; (2) epidemiology of treatment-assisted and natural resolutions; (3) environmental contexts surrounding natural resolutions; (4) gaps in knowledge and research opportunities; (5) investigating natural resolution across the distribution of problem drinkers; (6) explicating environment-behavior relations; (7) determining pathways to moderation and harm reduction; and (8) understanding relations between help-seeking and drinking behavior change.

Copyright 2003, Kluwer Academic


Tyler KA; Johnson KA. Pathways in and out of substance use among homeless-emerging adults. Journal of Adolescent Research 21(2): 133-157, 2006. (30 refs.)

Although high rates of alcohol and drug use have been found among homeless young people, less is known about who is responsible for their initiation, the reasons for their continued use, and why some individuals eventually transition out of using whereas others do not. Based on qualitative interviews with 40 homeless individuals 19 to 21 years of age in the Midwest, results revealed that the majority of respondents were initiated into substance use by friends and acquaintances, although family also played a significant role. Almost one half of respondents reported using substances to cope with early family abuse, stress, and life on the streets. Additionally, the majority indicated that they had no intentions of quitting. Substance misuse that is left untreated may lead to chemical dependency among homeless emerging adults and may contribute to long-term homelessness.

2006, Sage Publications


Vartian BA; Hawken ER; Delva NJ. Spontaneous long-term smoking cessation in a patient with schizophrenia after treatment with ziprasidone. Addictive Disorders and Their Treatment 3(3): 138-143, 2004. (51 refs.)

A patient suffering from schizophrenia stopped smoking 9 days after the initiation of treatment with ziprasidone and had not resumed smoking 2 years later. While a reduction in cigarette consumption has been previously observed after the switch from typical to atypical antipsychotics, spontaneous cessation of smoking has not been previously reported during treatment with ziprasidone. Cigarette smoking is very common in patients with schizophrenia, and it is a major cause of morbidity and mortality in this group. Any treatment that assists these patients to stop smoking is thus of great value. The relationships between schizophrenia, smoking, and antipsychotic medication are complex. In the context of a brief but comprehensive literature review, we discuss potential explanations for the successful outcome seen in our patient.

Copyright 2004, Lippincott, Williams & Wilkins


Wells JE; Horwood LJ; Fergusson DM. Stability and instability in alcohol diagnosis from ages 18 to 21 and ages 21 to 25 years. Drug and Alcohol Dependence 81(2): 157-165, 2006. (47 refs.)

Background: Only in recent years have longitudinal studies of adolescents diagnosed alcohol use disorders and these have not distinguished between abuse and dependence. This study describes the course of disorder from age 18 to age 25 for abuse and dependence and investigates the extent to which continuities in disorder call be explained by background factors. Methods: A birth cohort of 1265 individuals front Christchurch, New Zealand, followed annually to age 16 years then at 18, 21 and 25 years (1003 at age 25). DSM-IV diagnoses were made from reports of alcohol symptoms at 18, 21 and 25 years. Results: The most stable diagnosis was that of no diagnosis, with 83-91% staying the same from one interview to the next. There were high rates of remission to no disorder; 57-75% for those with initial abuse and 50-54% of those with initial dependence. Nonetheless prior diagnosis was a strong predictor of subsequent diagnosis (ORs of 3.7-27.6). Adjustment for background risk factors reduced these odds ratios but all remained significant and substantial (minimum 2.6). Conclusions: The dual finding of substantial discontinuity and substantial continuity indicates that both public health and treatment interventions are warranted.

Copyright 2006, Elsevier Science