From: drarwingnuttephd@gmail.com   
      
   Most People With Addiction Simply Grow Out of It: Why Is This Widely Denied?   
   There are many paths to recovery--and if we want to help people get there, we   
   need to explore all of them.   
       
      
       
       
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   September 29, 2014  |        
   When I stopped shooting coke and heroin, I was 23. I had no life outside of my   
   addiction. I was facing serious drug charges and I weighed 85 pounds, after   
   months of injecting, often dozens of times a day.   
      
   But although I got treatment, I quit at around the age when, according to   
   large epidemiological studies, most people who have diagnosable addiction   
   problems do so--without treatment. The early to mid-20s is also the period   
   when the prefrontal cortex, the    
   part of the brain responsible for good judgment and self-restraint, finally   
   reaches maturity.   
      
   According to the American Society of Addiction Medicine, addiction is "a   
   primary, chronic disease of brain reward, motivation, memory and related   
   circuitry." However, that's not what the epidemiology of the disorder   
   suggests. By age 35, half of all    
   people who qualified for active alcoholism or addiction diagnoses during their   
   teens and 20s no longer do, according to a study of over 42,000 Americans in a   
   sample designed to represent the adult population.   
      
   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.   
      
   While some addictions clearly do take a chronic course, these data, which   
   replicate earlier research, suggest that many do not. And this remains true   
   even for people like me, who have used drugs in such high, frequent doses and   
   in such a compulsive    
   fashion that it is hard to argue that we "weren't really addicted." I don't   
   know many non-addicts who shoot up 40 times a day, get suspended from college   
   for dealing and spend several months in a methadone program.   
      
   If addiction were truly a progressive disease, the data should show that the   
   odds of quitting get worse over time. In fact, they remain the same on an   
   annual basis, which means that as people get older, a higher and higher   
   percentage wind up in recovery.    
   If your addiction really is "doing push-ups" while you sit in AA meetings, it   
   should get harder, not easier, to quit over time. (This is not an argument in   
   favor of relapsing; it simply means that your odds of recovery actually get   
   better with age!)   
      
   So why do so many people still see addiction as hopeless? One reason is a   
   phenomenon known as the "clinician's error," which could also be known as the   
   "journalist's error" because it is so frequently replicated in reporting on   
   drugs. That is,    
   journalists and rehabs tend to see the extremes: Given the expensive and often   
   harsh nature of treatment, if you can quit on your own you probably will. And   
   it will be hard for journalists or treatment providers to find you.   
      
   Similarly, if your only knowledge of alcohol came from working in an ER on   
   Saturday nights, you might start thinking that prohibition is a good idea. All   
   you would see are overdoses, DTs, or car crash, rape or assault victims. You   
   wouldn't be aware of    
   the patients whose alcohol use wasn't causing problems. And so, although the   
   overwhelming majority of alcohol users drink responsibly, your "clinical"   
   picture of what the drug does would be distorted by the source of your sample   
   of drinkers.   
      
   Treatment providers get a similarly skewed view of addicts: The people who   
   keep coming back aren't typical--they're simply the ones who need the most   
   help. Basing your concept of addiction only on people who chronically relapse   
   creates an overly    
   pessimistic picture.   
      
   This is one of many reasons why I prefer to see addiction as a learning or   
   developmental disorder, rather than taking the classical disease view. If   
   addiction really were a primary, chronic, progressive disease, natural   
   recovery rates would not be so    
   high and addiction wouldn't have such a pronounced peak prevalence in young   
   people.   
      
   But if addiction is seen as a disorder of development, its association with   
   age makes a great deal more sense. The most common years for full onset of   
   addiction are 19 and 20, which coincides with late adolescence, before   
   cortical development is complete.   
    In early adolescence, when the drug taking that leads to addiction by the 20s   
   typically begins, the emotional systems involved in love and sex are coming   
   online, before the cognitive systems that rein in risk-taking are fully active.   
      
   Taking drugs excessively at this time probably interferes with both biological   
   and psychological development. The biological part is due to the impact of the   
   drugs on the developing circuitry itself--but the psychological part is   
   probably at least as    
   important. If as a teen you don't learn non-drug ways of soothing yourself   
   through the inevitable ups and downs of relationships, you miss out on a   
   critical period for doing so. Alternatively, if you do hone these skills in   
   adolescence, even heavy use    
   later may not be as hard to kick because you already know how to use other   
   options for coping.   
      
   The data supports this idea: If you start drinking or taking drugs with peers   
   before age 18, you have a 25% chance of becoming addicted, but if your use   
   starts later, the odds drop to 4%. Very few people without a prior history of   
   addiction get hooked    
   later in life, even if they are exposed to drugs like opioid painkillers.   
      
   If we see addiction as a developmental disorder, all of this makes much more   
   sense. Many kids "age out" of classical developmental disorders like attention   
   deficit/hyperactivity disorder (ADHD) as their brains catch up to those of   
   their peers or they    
   develop workarounds for coping with their different wiring. One study, for   
   example, which followed 367 children with ADHD into adulthood found that 70%   
   no longer had significant symptoms.   
      
      
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