Determinants of transitions from harmful to low-risk substance use and gambling.

Understanding the factors that influence the transition from harmful to low-risk substance use and gambling or abstinence is important for reducing the societal burden of harm attributable to these behaviours. Following the same methodology used in Chapters 3 and 4, this chapter presents determinants within domains including social identity and social networks, economic and cultural changes, emotional and cognitive factors, life circumstances, and neurocircuitry. Analyses are limited to transitions without formal help like treatment (often named as ‘self-change’, ‘spontaneous remission’, or ‘natural recovery’), as such transitions are understudied, even though this is the most frequent pathway to full or partial remission. There is a particular lack of evidence on relevant factors for the transition from harmful to low-risk gambling or abstinence. As with psychoactive substances, most people change their problem gambling behaviour without formal interventions, but the underlying processes are not well understood.