Can Alcohol Use Disorder Recovery Include Some Heavy Drinking? A Replication and Extension up to 9 Years Following Treatment

Abstract

Background Recent research indicates some individuals who engage in heavy drinking following treatment for alcohol use disorder fare as well as those who abstain with respect to psychosocial functioning, employment, life satisfaction, and mental health. The current study evaluated whether these findings replicated in an independent sample and examined associations between recovery profiles and functioning up to 6 years later. Methods Data were from the 3‐year and 7‐ to 9‐year follow‐ups of subsamples initially recruited for the COMBINE study (3‐year follow‐up: n = 694; 30.1% female, 21.0% non‐White; 7‐ to 9‐year follow‐up: n = 127; 38.9% female, 27.8% non‐White). Recovery at 3 years was defined by latent profile analyses including measures of health functioning, quality of life, employment, alcohol consumption, and cannabis and other drug use. Functioning at the 7‐ to 9‐year follow‐up was assessed using single items of self‐rated general health, hospitalizations, and alcohol consumption. Results We identified 4 profiles at the 3‐year follow‐up: (i) low‐functioning frequent heavy drinkers (13.9%), (ii) low‐functioning infrequent heavy drinkers (15.8%), (iii) high‐functioning heavy drinkers (19.4%), and (iv) high‐functioning infrequent drinkers (50.9%). At the 7‐ to 9‐year follow‐up, the 2 high‐functioning profiles had the best self‐rated health, and the high‐functioning heavy drinking profile had significantly fewer hospitalizations than the low‐functioning frequent heavy drinking profile. Conclusions Previous findings showing heterogeneity in recovery outcomes were replicated. Most treatment recipients functioned well for years after treatment, and a subset who achieved stable recovery engaged in heavy drinking and reported good health outcomes up to 9 years after treatment. Results question the long‐standing emphasis on drinking practices as a primary outcome, as well as abstinence as a recovery criterion in epidemiologic and treatment outcome research and among stakeholder groups and funding/regulatory agencies. Findings support an expanded recovery research agenda that considers drinking patterns, health, life satisfaction, and functioning.

Shifts in behavioral allocation patterns as a natural recovery mechanism: Postresolution expenditure patterns

“…These results generally concur with long‐term prospective studies of treatment and community samples of heavy drinkers that found positive drinking outcomes were accompanied by improved health, life satisfaction, and functioning (e.g., Moos & Moos, 2007; Witkiewitz, Pearson et al, 2020; Witkiewitz et al, 2019), and they have potential implications for assessment and treatment. First, assessing how persons with substance use disorders spend their money on substances and other commodities has utility for predicting behavior change outcomes and thus may inform treatment goals.…”

Can Individuals with Alcohol Use Disorder Achieve and Sustain Non-Abstinent Recovery? Non-Abstinent Outcomes 10 Years After Alcohol Use Disorder Treatment

“…Overall, study findings support and extend a growing body of literature that suggests that abstinence is not the only path to achieve and/or sustain a high level of psychosocial functioning in the years following alcohol treatment. Rather, there appear to be multiple paths to recovery that can include moderate or heavy alcohol consumption post-treatment for some individuals 16,23,25,48 .…”

“…The present study attempts to replicate and extend our recent work with the COMBINE Study 24 by investigating the relationships between recovery profiles identified at three years following treatment and alcohol consumption and psychological functioning outcomes at ten years following treatment among a site-specific subset of participants involved in Project MATCH 22 . Importantly, this is an extension of our analyses with COMBINE 25 to include a broader set of psychosocial functioning indicators, for a longer time period, and the analyses are conducted in a more diverse sample of participants. We hypothesized the recovery typologies characterized by high functioning heavy drinking and high functioning infrequent non-heavy drinking at three years following treatment 23 would be associated with less drinking and higher psychological functioning at ten years following treatment when compared to recovery typologies characterized by low functioning frequent or infrequent heavy drinkers at three years following treatment.…”

“…A limited number of studies with follow-up intervals longer than three years suggest this is the case. For example, using follow-up data from the COMBINE Study 24 , we found that individuals who were high functioning at three years post-treatment, regardless of level of alcohol consumption, had the best self-reported health and fewer hospitalizations at 7-9 years posttreatment 25 . An observational study of individuals with AUD surveyed participants about their drinking practices, psychosocial functioning, and life contexts at baseline and 1, 3, 8, and 16 years later.…”

Recovery and identity: a five-year follow-up of persons treated in 12-step-related programs

“…Previous research has shown that identity changes can occur independently of changes in patterns of substance use (Martinelli et al, 2020;Witkiewitz et al, 2019Witkiewitz et al, , 2020. Other researchers question the need for a change of social identity during the recovery process (e.g.…”