Archive for January, 2012

“Can a person spontaneously recover from Heroin Addiction?”
An interesting question!
Spontaneous recovery from substances misuse appears more common than many people initially think, but acceptance of whether this concept exists is dependent on whether you believe that addiction is based in a purely medical/disease model, or whether your are more inclined to believe that addiction is a sum of many parts as it were, i.e. it is a manifestation of greater psycho-social issues that affect the individual collectively.
Medical/Disease Model:
If you subscribe to this model, then spontaneous recovery will not exist. The medical model relies on Addiction being seen and accepted as a disease, and at the very core of this model is the almost zealot like belief that addiction is a disease and as such has symptoms and a prognosis. Also embedded in this conceptual framework, is the belief that once the person has succumbed to the ravishes of addiction, they are always an addict, and at the mercy of this disease.
Advocates of this conceptual construct would also suggest that the only treatment for this “disease” is a medicalised one, and the only real “treatment” is abstinence.
It is therefore not surprising that followers of this particular construct would be more than happy to argue that the concept of “Spontaneous Recovery” as it is almost heresy to suggest that an addict can “cure” themselves.
A believer would argue that this concept of “self-management” hence “self-treatment” & “self-cure” is near impossible due to the all encompassing “cravings” that the addict suffers from which makes them unable to refuse, or stop taking their substance of choice even when their health both mental and physical depends on stopping.
They would also suggest that the very real nature of this “craving” & its resultant threat to successful medical management of the symptoms resulted in the development of replacement therapies such as Methadone Replacement Therapy, and pharmacological interventions such as Disulafram, Campral and Suboxone. These interventions, which have incidentally all been scientifically tested via years of clinical trials, and have been proved by researchers to do as they say on the box as it were, that is to help addicts/service users negate “cravings” provide scientific proof that addiction is a disease. Therefore “spontaneous Recovery” does not, cannot exist.
Some proponents of this model would also go as far to suggest that those who claim to have suffered from an addiction, and to have “spontaneously recovered” are not “really suffering from an addiction” and are not real “addicts” so their opinions and stories are not “valid”.
All convincing arguments, but we must also consider the wider picture around this argument.
It is well known, and written about by academics like Berridge that the Disease Model has its roots in the earlier Moral model. Like this model, the disease/medical model relies on utilising and informing public opinion. These opinions allow the model to be sustained and legitimised which combines to form an almost evangelical layer to its use by the public and politicians.
From this legitimacy has sprung treatment centres, pharmacology research and development, and specific professions in an ever expanding industry. All good reasons not to examine or think about an anomaly called “spontaneous recovery.”
Psychosocial Model
Earlier I mentioned the Psychosocial Model, and indicated that followers of this school of thought may view this model differently, and it is my suggestion that they would argue almost as religiously for “spontaneous recovery” as the “medicalists” would against it.
Psychosocialists would argue that as their construct for addiction looks upon the issue as a life choice, all be it a bad one, which is influenced by society, environment and the psychological makeup of the substance user, then the inclusion of this concept into their construct is fundamental.
Psychosocialists believe that addiction is a choice which is made by the individual. This choice is then influenced by the subjects psychology, environment, social discourse both personally and societal, and other factors such as physical / mental health, developmental abnormalities and learned behaviour.
All of these issue are relevant to the development of addiction; therefore psychosocialists accept the concept of a natural limit to an addictive episode exists and that “spontaneous recovery” is the proof of this concept.
They also argue that learned behaviour, especially within close knit sub cultures can explain why you have families who seem to be “blighted” by addiction, the argument being that within a family were drug use is normalised, and accepted, that family will inevitably be part of a larger sub group that is isolated by a concept of deviance(behaviour outside the host societies accepted norm)then there is a lack of positive reinforcement , that is found in normal society which may negate the negative behaviour(drug use). The argument is that this learned behaviour would mimic genetic disposition, “alcoholism is genetic, sons of heavy drinkers are heavy drinkers themselves”, especially in the family group as described.
So back to the question, can a person recover spontaneously from a heroin addiction?
Yes is the answer.
People change for various reason but what seems to be most effective is if they change for themselves. As a young staff nurse ,fresh out of the wards, I was advised by my first addictions charge nurse, that folk who change because they are told to, or “for others” will inevitably relapse, however those who change for themselves or for a reason that is personal to themselves will inevitably always succeed. This is apparent when you look at Prochaska & Di Clemente’s model of change or Rollnick’s thoughts on Motivational Interviewing, the central concept in both is based on the person developing their own personal discourse on change and accepting it.
So I would suggest that a person with an opiate addiction, as with any other, can recover naturally if their internal discourse is personal and relevant to them.
This personal discourse also has to offer the client a powerful personal “buy in” which in the case of a client with a heroin addiction could be the result of criminal justice proceedings or violent injury.
This “buy in” however has to offer the person some validation of the change they want to make, and is valued and desired by the person, and this discourse is maybe the thing that is missing in the person who is being coerced into change by the belief that they are doing it for an external person thing or reason.