ABSTRACT
Traditionally, addiction has been understood from the clinical perspective as an inexorably progressive ‘disease’ with addiction-related problems getting more severe and damaging in the absence of therapeutic intervention. The clinical focus on severely dependent populations, representing only the tip of the iceberg when considering epidemiological studies, supported such a deterministic disease concept (Room 1977), while in fact self-change is the major path out of addiction (Dawson et al. 2005, 2006; Smart 2007). The concept of self-change (called also “natural recovery”, “spontaneous remission” or “self-healing”), that is overcoming addiction without professional help or exiting an addiction career without formal intervention (Klingemann 2004; Stall and Biernacki 1986), has challenged this paradigm and received broad empirical support as numerous reviews of the literature have shown (Klingemann and Sobell 2007; Klingemann et al. 2010; Smart 1976; Sobell et al. 2000; Waldorf and Biernacki 1979). This contribution positions the self-change concept within a broader theoretical context and highlights its central assumption in comparison. Moreover, the diffusion of the self-change concept as an innovation in the addiction field is described from a socio-historical perspective. Finally the ideological, normative implications of this concept and research are highlighted.
