1/The question posed here seems rather casual, but for a health professional, it is a good opportunity to recognize the scholarship on natural remission of substance-related problems, as it may have hints for how we can help- much has been studied!
2/With alcohol related problems, remission without formal treatment is common and often the dominant pathway ajph.aphapublications.org/doi/pdfplus/10…
3/Predictors of progression to drug use often include underlying psychopathology, But remission of problem drug use without treatment is common in data here ncbi.nlm.nih.gov/pmc/articles/P…
4/Stressful life events threaten progression away from drug use and we health care and social caregivers (and families!) can play a role in helping people better manage those events drugabuse.gov/news-events/ni…
5/Conversely the social capital a person holds (relationships, buffers, opportunities etc) can enhance recovery opportunity with or without specific treatment (“Recovery Capital”) tandfonline.com/doi/full/10.10…
6/We should assess the paths by which drug/alcohol problems remit and not just through randomized trials, because the contextual factors that assist recovery are treated as “dummy variables” in RCT’s. Yes to “evidentiary pluralism” says Dr Jalie Tucker onlinelibrary.wiley.com/doi/abs/10.111… 
7/In my clinic, one of the biggest impediments to one patient’s abstinence is the moment he thinks it is on him to take care of the many people around him having tragic life experiences. That is a contextual factor open to clinical conversation
8/There is,as a result, unavoidable tension between framing addiction as “disease” (which may harness some less-cruel responses) vs “a disordered but learned set of choices” influenced by, but not the inexorable product of,“a diseased brain”. drcarlhart.com @drcarlhart
9/Conclusion: we _must_ offer life saving treatment for addiction, resist crude efforts to portray every dependence as addiction (@nytimes Ed page error shown below) & recognize that our informal &formal social responses to people who use any substance matter immensely
