Paths to recovery from substance misuse: change of lifestyle and the role of treatment.

Controlled outcome studies have, on the whole, failed to demonstrate more than rather weak and short-lived effects of substance misuser treatment. There is, at the same time, growing evidence that people often recover from substance misuse problems without the help of formal treatment. This state of affairs has, not least in times of economic recession, been taken as an argument for cutting fundings of treatment facilities and other forms of formal help. This article questions that present knowledge necessarily justifies such conclusions. We do know that even severe misusers are sometimes capable of changing their way of life. We do not, however, know very much about the circumstances and situations-planned or not and designated as "treatment" or something else-that contribute to such change processes. A closer integration of two research areas-outcome research and research on "spontaneous recovery"-is proposed as a way of learning more about the possible interplay between "real life" events, various formal interventions, and change of life style.