Prevalence and pathways of recovery from drug and alcohol problems in the United States population: Implications for practice, research, and policy

Abstract

Background: Alcohol and other drug (AOD) problems confer a global, prodigious burden of disease, disability, and premature mortality. Even so, little is known regarding how, and by what means, individuals successfully resolve AOD problems. Greater knowledge would inform policy and guide service provision. Method: Probability-based survey of US adult population estimating: 1) AOD problem resolution prevalence; 2) lifetime use of “assisted” (i.e., treatment/medication, recovery services/mutual help) vs. “unassisted” resolution pathways; 3) correlates of assisted pathway use. Participants (response = 63.4% of 39,809) responding “yes” to, “Did you use to have a problem with alcohol or drugs but no longer do?” assessed on substance use, clinical histories, problem resolution. Results: Weighted prevalence of problem resolution was 9.1%, with 46% self-identifying as “in recovery”; 53.9% reported “assisted” pathway use. Most utilized support was mutual-help (45.1%,SE = 1.6), followed by treatment (27.6%,SE = 1.4), and emerging recovery support services (21.8%,SE = 1.4), including recovery community centers (6.2%,SE = 0.9). Strongest correlates of “assisted” pathway use were lifetime AOD diagnosis (AOR = 10.8[7.42–15.74], model R2 = 0.13), drug court involvement (AOR = 8.1[5.2–12.6], model R2 = 0.10), and, inversely, absence of lifetime psychiatric diagnosis (AOR = 0.3[0.2–0.3], model R2 = 0.10). Compared to those with primary alcohol problems, those with primary cannabis problems were less likely (AOR = 0.7[0.5–0.9]) and those with opioid problems were more likely (AOR = 2.2[1.4–3.4]) to use assisted pathways. Indices related to severity were related to assisted pathways (R2 < 0.03). Conclusions: Tens of millions of Americans have successfully resolved an AOD problem using a variety of traditional and non-traditional means. Findings suggest a need for a broadening of the menu of self-change and community-based options that can facilitate and support long-term AOD problem resolution.

Expanding the reach of alcohol and other drug services: Prevalence and correlates of US adult engagement with online technology to address substance problems

“…Results of the primary NRS analyses showed that 9.1% of the US adult population (22.35 million individuals) have resolved a substance use problem (Kelly, Bergman, et al, 2017). Consistent with GfK’s rigorous approach, the sample ( N = 2002; M = 46.7 years; SD = 15.3) was diverse demographically in virtually all respects.…”

“…We do not report on their participation in MHOs more generally (e.g., AA, NA, SMART Recovery; Kelly et al, 2011) as a function of ROOT, since greater MHO attendance among those with ROOT is an artifact of a participant needing to have reported lifetime MHO attendance in order to respond to an item regarding online MHO attendance, an indicator of ROOT. See Kelly, Bergman, et al (2017) for data on MHO attendance in the NRS more generally. We do, however, report other community-based recovery support where trained staff typically aid in service provision (e.g., faith-based recovery services or recovery community centers; Institute of Behavioral Research, 2002)…”

“…This current study leveraged a geo-demographically representative sample of US adults who resolved a substance use problem (from the National Recovery Study, or NRS; Kelly, Bergman, Hoeppner, Vilsaint, & White, 2017; Kelly, Greene, & Bergman, 2017; Kelly, Greene, & Bergman, 2018) to conduct the first nationwide investigation of ROOT. This analysis of ROOT in the NRS had the following specific aims:…”

How Many Recovery Attempts Does it Take to Successfully Resolve an Alcohol or Drug Problem? Estimates and Correlates From a National Study of Recovering U.S. Adults

“…This is suggestive that there are subgroups of individuals within the sample who may be quite different. This is what we would expect given the nature of this sample of individuals who have resolved a significant AOD problem who exhibit a wide range of impairment and distress (Kelly et al., , ).…”

“…There are several treatment implications of the current findings. First, if AOD problems do not represent a singular clinical entity with a narrow developmental pathway and course treatable through a fixed “program” for all patients, but rather a spectrum disorder characterized by heterogeneous etiological pathways, diverse clinical profiles, highly variable courses, and diverse pathways and styles of problem resolution (e.g., Kelly et al., ; White, ), then one would expect to see the wide range of recovery attempts found in the present study. Such diversity requires highly individualized approaches to addressing AOD problems.…”