Do People Simply Outgrow Their Addictions?

I read an interesting piece this week on the Pacific Standard stating that most people just grow out of their addictions.

Maia Szalavitz argues that once the prefrontal cortex reaches maturity, usually in the mid 20’s, many people simply stop using drugs and alcohol. This part of the brain is responsible for self-restraint and good judgment.

So her theory goes; immature people drink and get high because they don’t know any better. Once they grow up, they can make smarter choices, and stop getting high.

She points to various studies from the National Institute of Health that say substance abuse is not life long, but has a predictable life span:

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.

This really left me scratching my head. I work in a treatment facility and see people who have been struggling for years and years. I see guys in their 60’s and 70’s who come to meetings on our campus every single day who have been sober for 40 or 50 years. I think they might have something to say about alcohol addiction being “resolved” in 15 years. (Also, anyone who has dealt with an alcoholic in their life knows that 15 years may as well be 200 years. Lives, families, marriages can be completely destroyed in 15 years of alcohol abuse, so throwing the word “resolved” around is pretty naive.)

Anyway, Maia Szalavitz refrences a study of 42,000 Americans that took place to help understand recovery rates. In this group, around half of all those who qualified as addicts in their young 20’s were no longer addicts by 35 years old.

This still has me scratching my head, so you may be confused too. Her point is that many people who grow out of their addictions never seek treatment, never see a therapist or counselor, are not in the emergency room or at their doctors office discussing addiction, so we (in the treatment world) never see them. They do not show up on our radars because we only see the worst cases, those who chronically relapse.

Now, there may be some validity to her point. Actually there must be, because she writes for Time and has a book about this very topic coming out soon. But, I think this perspective can be very damaging.

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How are we supposed to begin to help people and families struggling with addiction? Ask them how long they have been struggling with alcohol?

“Oh, your life has been upended, lost your job, car, house, wife, you are broke and can barely feed yourself? And you have only been drinking for 13 years? Your addiction to alcohol should go away on it’s own in 2 years or so. If it hasn’t, come back and see us.”

Forgive my snarkyness, I know that’s not what Maia Szalavitz is suggesting, but when millions of Americans are struggling with substance abuse, waving some numbers around and talking about prefrontal cortex maturity is not going to help.

She closes her piece by saying “There are many paths to recovery—and if we want to help people get there, we need to explore all of them. That means recognizing that natural recovery exists—and not dismissing data we don’t like.” I agree, we need to embrace every method and theory to help as many people get sober as possible, I just don’t see any value in telling people, “This might just be a phase”.

Here are links to the data she used to build her addiction life spans:

• Probability and predictors of remission from lifetime nicotine, alcohol, cannabis, or cocaine dependence
• Probability and predictors of remission from life-time prescription drug use disorders
• Addiction and Choice