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Although there are specialty journals and professions focusing on addictions treatment, the reasons why people change addictive behaviors are still not well understood. The simplistic account that people change because they receive treatment is wanting in many ways. Many people who recover do so without formal treatment. Even relatively brief interventions seem to trigger change, and the dose of treatment delivered is surprisingly unrelated to outcomes. Client compliance with many different approaches, including placebo medication, has been linked to better outcomes. Client outcomes also vary widely depending upon the therapist who delivers treatment. Various models are briefly considered that may help in understanding this intriguing puzzle of change.