Update from a top addiction researcher: People who quit drug abuse, smoking and other habits do best if they do it themselves

Morristown, NJ

A man who had been drunk every night for many years arrived home late, bombed once again. The next morning his mother, with whom he was living, found him staring at himself in the mirror. He turned to her and announced: "I'm giving up drinking and, while I'm at it, smoking." Then he placed a pack of cigarettes and a bottle of beer on the mantelpiece. "What's that for?" his mother asked. He said: "That's so I'll know where to find a smoke or drink if I want one. Then I can just kill myself instead." He has touched neither cigarettes nor booze for nearly 10 years.

A union official, noting that the price of cigarettes had risen yet again, put the extra nickel in the vending machine. A coworker laughed at him: "You'll pay whatever they ask." The smoker thought: "God, he's right; the tobacco company has me where it wants me." Then and there, he quit his three-pack-a-day habit forever.

Talk-show host Merv Griffin watched a comedian imitating him—as a fat man. The comic had stuffed himself with padding and Griffin could not bear the caricature. He put himself on a diet and exercise program, and soon showed off his new, thin self to his audience.

Stories like these seldom make the newspapers; for that matter, people who quit their long-standing habits by themselves often go unrecognized by scientific studies. Instead, we hear dire stories about people who can't seem to quit, and gloomy statistics on relapse rates. Among people in therapy to lose weight, stop smoking, kick a drug or drink addiction, as few as 5% actually make it.

But here's the irony and the hope: Self-cure can work, and depending on someone else to cure you usually does not.

This is the case for addictions like cigarette smoking and alcoholism, as well as for some more complex habits. Obesity, for example, may involve compulsive overeating—an addiction to food that some thin people also struggle with for years. But genetics and a lifetime of inactivity and bad eating habits also play a role. Whatever the cause, though, losing weight takes a major change in lifestyle—and the people who do it best are those who do it on their own.

Therapists tend to fail their clients by undermining self-reliance: they encourage people to rely upon others for cure, and to give up responsibility for their own behavior. But because therapy works so rarely, many researchers have come to view addictions as almost impossible to beat. And that mistake makes habits harder to break.

Many have begun to think of addiction as an exclusively biological process—one that cannot be overcome by psychological effort or will power. In this view, alcoholics have a "disease," a "genetic susceptibility" to liquor. Obese people have a preordained weight level. Smokers are hooked on nicotine, and their bodies cannot tolerate a depletion of the drug.

All of these theories stem from the grandfather addiction of them all, heroin. Everyone knows the image: the suffering heroin addict, inexorably bound to a physiological dependence. The penalty for withdrawal is intolerable agony, so the addict increases the doses until death. Remember The Man with the Golden Arm?

For more than 10 years, I have been conducting interviews with all sorts of addicts and reviewing the research on all kinds of addiction. Addiction, I've found, may be affected by biological factors, but they are not enough to explain it. True, addiction is caused partly by the pharmacological action of the drug (if it's a drug addiction), but also by the person's social situation, attitudes and expectations. Even people who are constitutionally sensitive to a substance can control their use of it, if they believe that they can.

There is now good evidence for these heretical assertions. The most compelling statistics come from the success of people who cure themselves without therapy:

• University of Kentucky sociologist John O'Donnell, analyzing a national survey of drug use among men in their twenties, found that only 31% of the men who had ever used heroin had touched the drug in the previous year.
• Similarly, when American soldiers who had used heroin in Vietnam returned home after the war, over 90% of them gave up the drug without difficulty. Addiction experts predicted an epidemic of heroin abuse by the vets, but it never materialized. Washington University sociologist Lee Robins found that even among men who had truly been addicted in Vietnam, only 14% became dependent on narcotics in the U.S.
• Harvard psychiatrist George Vaillant found that more than half of the one-time alcohol abusers in a group of several hundred men had ceased problem drinking (the men had been interviewed over a period of 40 years).
• Social psychologist Stanley Schachter at Columbia University, interviewing members of two different communities, discovered that about half of those who had once been obese or hooked on cigarettes had lost weight or quit smoking. The formerly overweight people said they had lost an average of 35 pounds and kept it off for an average of 11 years.

Some of these statistics, admittedly, are open to question. When you're asking people to talk about how they've changed over the past several years, they may paint an excessively rosy picture of their ability to improve themselves. But even if the percentages are inflated, the evidence is still good that people can change for the better, far more than they have been given credit for.

Often people simply outgrow their bad habits. Sociologist Charles Winick of City College of New York has examined the lives of drug addicts. Many, in Winick's words, "mature out" as they get older. Long-term studies of alcoholics and smokers show the same pattern. Some people even outgrow their teenage cravings for Twinkies and sugar "fixes."