Maturing Out

Stanton Peele



I considered several titles for this column, but the one I've used — "Maturing Out" — describes how most people resolve addictions. The term "maturing out" has long been applied to heroin addicts who outgrow their habits. An important social researcher in New York City, Charles Winick, was the first to use this "street" term. In exploring public health records of known heroin addicts, he noted that those who first became addicts in their late teens ceased to appear on these lists between their mid-twenties and mid-thirties. Only a few died; the others, he discovered, eventually assumed the adult roles they had avoided while they were immersed in their drug habits and environments. (See Charles Winick, 1962, "Maturing Out of Narcotic Addiction," Bulletin on Narcotics, 14, 1-7.)

Alternate terms for this process are "natural recovery" or "spontaneous remission." These terms generally refer to people who overcome diseases, even though they either did not receive treatment or did not respond to it. This process is often a mysterious one, similar to when people recover from cancer or other serious illness without explanation. But maturing out of addiction, as observed by Winick, is more typical than not. Unlike pneumonia or diabetes or most other somatic diseases, addiction is often a self-correcting problem.

This doesn't mean it is easy, or that it doesn't take effort. Nor does it mean that people who fail to overcome addiction currently will never do so — more often than not, sooner or later, many do. For instance, most people who smoke will eventually quit. And most will do so without relying on formal treatment or even a support group — no small task considering smoking may be the most difficult addiction to quit. (For those of you who have quit drinking and smoking, which did you find easier to give up?)

To illustrate the vast number of people who are able to overcome addictions on their own (or at least without entering a treatment program or AA), let's look at research produced by epidemiological investigators for the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Keep in mind that the head of the NIAAA, Enoch Gordis, is a physician who is strongly committed to the view that alcoholism is a treatable disease.

The National Longitudinal Alcohol Epidemiologic Survey (NLAES) was conducted in 1992 by the US Census Bureau on behalf of the NIAAA. Census field workers interviewed nearly 43,000 respondents across America, a sample of US adults 18 years of age and older. Each interview examined the use of alcohol and drugs over a person's entire life with a focus on the preceding year.

Deborah A. Dawson, an NIAAA epidemiologist, then analyzed interviews with 4585 NLAES subjects who had at some time in their lives been alcohol-dependent, according to diagnostic criteria from DSM-IV. (This is the manual used by the American Psychiatric Association.) Only a quarter of this group had ever been treated for alcoholism. Those who had received some kind of treatment were slightly more likely than their untreated counterparts to have had a drinking problem in the previous year. (Although a surprising number continued to drink without a diagnosis of either abuse or dependence, fewer did so than those who had not been in treatment.)


NLAES Data on Ever-Alcohol-Dependent Subjects Outcome categories
over past year: Treated (n=1233) Untreated (n=3309) Drinking with abuse/dependence 33% 26% Abstinent 39% 16% Drinking w/o abuse/dependence 28% 58% (Deborah Dawson, 1996, "Correlates of past-year status among treated and untreated person with former alcohol dependence: United States, 1992," Alcoholism: Clinical and Experimental Research, 20, 771-779.)

Since the treated and untreated groups differed in the initial severity of their problems, it would not be fair to claim that therapy leads to worse results than no therapy. But treatment is far from uniformly beneficial for those who undergo it:

• Most people who do not undergo treatment are ultimately able to come to grips with their drinking problems on their own.
• Most do so by reducing their drinking rather than abstaining.
• Even a quarter of treated alcoholics accomplished this feat over the previous year (note they are not necessarily drinking socially, but only without a fully diagnosable problem).

Why describe the nature and frequency of maturing out with drugs, alcohol and cigarettes? This is at the heart of how I view and treat addiction. To say that people "mature out" is not to say that maturing out is a passive process. Maturing into an adult role takes time, motivation, effort and a facilitative environment. Moreover, even for those people who are able to lick alcoholism without treatment, the process of eliminating pathological drinking can sometimes take decades.

Obviously, bad things can happen to people in the time it takes to recover on their own (if they ever do), so it's wise to try to accelerate this process. How do I do this? First, I help people see that according to their own values, leaving the addiction is more valuable than continuing in the addiction. Second, I work with them to channel this realization into efforts at improving their work, social and recreational lives. Third, I focus on their environments — to look for the supports they will need in this process, and to observe the changes that will be required in their lives to escape addiction.

What do I see as the advantages of the "maturing out" approach? Many consider that the "disease" model allows people to feel their addiction is not their fault, and that they should seek help to overcome it. In the maturing out approach, people come to see that "recovery" is a natural process that is more likely than not to occur as long as they make realistic progress in the key areas of their lives. The addiction is not lifelong and all-powerful; rather, it is something with which ordinary people like themselves can come to grips. Armed with this perspective, many people find additional strength and motivation to pursue a path of health and growth that will put the addiction in their rear view mirrors.

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