Natural history of substance-related problems

The natural history of substance-related problems is technically challenging to study, and data comes from a combination of point prevalence and long-term outcome studies of treatment populations. Use of both alcohol and drugs is highest in people in their early 20s, although the majority cut down their use as adult responsibilities take hold. Addicts with a progressive course either continue to abuse substances despite a worsening of their problems, or they become stably abstinent, usually in response to the very severity of their addiction. The mortality rate of people dependent on alcohol or drugs is much higher than the non-addict population. The study of 'natural recovery' or self-change has provided new insights into the process of recovery from addiction, and it is likely that treatment plays only a minor part in this process. Factors relating to both the characteristics of the substance and the context of its use influence both the proportion of people who will become dependent on it and the longevity of their addiction careers.