When Brian realized that his depression, work problems and relationship difficulties were due to his crystal meth use, his new clarity initially felt exciting and empowering. Having put two and two together, figuring out why his life had gotten so hard, he checked into a 28-day inpatient addiction treatment program with enthusiasm and optimism.
But when I saw him a few days after he finished treatment, he was depressed and deflated, despite the fact that he had not used in a month and was feeling much better physically. He said that he was discouraged because he now “knows” what it really means to be an addict. It supposedly means he has an incurable, progressive and fatal disease. It progresses even when he’s not using, meaning that, if he relapses ten years from now, his years of abstinence won’t make any difference. He’ll be as bad off as if he had been using the whole time.
He was informed that, once he’s addicted to one drug he’s addicted to them all, so that his only option is lifelong abstinence from all mind-altering substances. He has never consumed alcohol much, but he was advised that if he ever lets himself drink, “cross-addiction” would guarantee that he’d become an alcoholic. His life options, going forward, are supposedly total abstinence or “jails, institutions, and death.” He began treatment with plenty of motivation to overcome his drug problem, but the dire picture he learned in his program sapped his morale and convinced him that his situation is hopeless.
Fortunately for Brian, the evidence doesn’t support the idea that there is a one-size-fits-all “disease of addiction” that is the same for everyone who has a substance abuse problem. Maia Szalavitz, a columnist for Substance.com who is one of the nation’s leading neuroscience and addiction journalists, recently reviewed the available data on addiction recovery. She found much evidence to support therapeutic optimism.
Szalavitz shares, “The average cocaine addiction lasts four years, the average marijuana addiction lasts six years, and the average alcohol addiction is resolved within 15 years. Heroin addictions tend to last as long as alcoholism, but prescription opioid problems, on average, last five years. In these large samples, which are drawn from the general population, only a quarter of people who recover have ever sought assistance in doing so (including via 12-step programs). This actually makes addictions the psychiatric disorder with the highest odds of recovery.”
If addictions are progressive diseases, the data should show that the odds of quitting get worse over time. In fact, Szalavitz reports, they remain the same on an annual basis. This means that as people get older, a higher and higher percentage wind up in recovery. In other words, your odds of recovery actually get better with age.
Is life-long abstinence from all drugs and alcohol Brian’s only option? In 1992, the National Institute on Alcohol Abuse and Alcoholism conducted one of the largest surveys of substance use ever, sending Census Bureau workers to interview more than 
42,000 Americans about their lifetime drug and alcohol use. The results showed that many people in their late teens or early twenties drink or use drugs heavily, often despite serious adverse consequences. Most people who know them wouldn’t hesitate to describe them as addicts or alcoholics.
But if we look at the teens and young adults ten or twenty years later, most are drinking in a moderate, non-problematic way. As people take on more adult responsibilities, they often seem to “mature out” of self-destructive substance use. Most of them do it without going into rehab, therapy, or attending 12-step meetings. In other words, most substance abusers have all the inner resources they need to overcome their addictions. Most of them do it by learning moderation rather than by becoming completely abstinent. Moderation, it seems, is the rule rather than the exception.
Brian is well aware that his addiction to crystal meth is dangerous and potentially deadly. He doesn’t need to be scared into recovery, but he could use a little more hope. Accurate information could go a long way toward lifting his spirits, and evidence-based therapy would surely be more likely to help him get free of meth than “treatment” that is based on the folklore and myths that, after decades of addiction research, are still all too prevalent in the recovery community.
Tom Moon is a psychotherapist in San Francisco. For more information, please visit tommoon.net
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