Recovery from alcohol problems in the absence of treatment: a qualitative narrative analysis

Abstract

Background and aims Recovery from alcohol problems in the absence of treatment or mutual‐aid is very common, but under‐researched. This study explores the lives of people who had resolved their alcohol problems without treatment, seeking to situate experiences of recovery in social contexts and broader life narratives. Design The in‐depth qualitative interviews were aided by a life‐history methodology that invited participants to account retrospectively for their lives. A narrative analysis was undertaken. Setting Two major cities (Sydney and Melbourne) in Australia. Participants People who had resolved an alcohol problem in the absence of treatment (n = 12) were recruited from the general community using convenience sampling. Measurements Eligible participants had received ‘minimal treatment’ for an alcohol use disorder: fewer than three sessions in an outpatient treatment programme or nine sessions with mutual‐aid groups (e.g. Alcoholics Anonymous), or having accessed mental health treatment for problems other than drinking at least 2 years prior or 1 year after having resolved an alcohol problem. Participants were considered to have had an alcohol use disorder if they reported two or more symptoms (DSM‐V) within a 1‐year period prior to the past year, using questions endorsed by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). People were considered to have resolved their alcohol use disorder by responding to the recruitment message calling for people who "used to have an alcohol problem but no longer do". The Alcohol Use Disorders Identification Test (AUDIT‐C) was used to understand participant’s drinking behaviours in the past 12 months. Findings Four different narratives were identified in the analysis. In the emancipation narrative, identity development and major changes across the life‐curve were associated with separating oneself from an oppressive circumstance. In discovery narratives, art culture and other consciousness‐expanding experiences were sources of identity development, but sometimes a barrier to alcohol recovery. In mastery narratives, life events were understood as failures or successes, and recovery was positioned as an individual journey accomplished through increased problem awareness. Finally, in coping narratives, changes were understood as a series of continuous struggles, and recovery was made sense of through diagnostic discourses. Conclusions People who resolve an alcohol use disorder in the absence of treatment or mutual‐aid appear to explain their recovery in terms of at least four different life narratives: emancipation, discovery, mastery or coping. Social contexts and cultures outside the treatment setting, and the various identities and narratives they provide, shape change processes.

Commentary on Henssler et al.: The public health case for promoting and valuing drinking reductions in the treatment of alcohol use disorder

“…These results provide further support for considering non-abstinent recovery from AUD as a potential treatment target that could expand the scope and reach of AUD treatment in the population with problems [7,8]. They are also consistent with drinking reductions and positive functional outcomes achieved by the majority of the population with alcohol-related problems who recover on their own outside of the context of formal treatment ('natural recovery') [9][10][11].…”

Characteristics of alcohol recovery narratives: Systematic review and narrative synthesis

“… a Natural recovery (recovery outside treatment setting,): The authors specified recovery outside treatment setting where; i) participant did not have formal alcohol treatment in an institution, organisation or by a person with an objective to relive alcohol problem. Or ii) No participation in substance abuse treatment or self-help groups 2 year prior to achieving abstinence or iii) Fewer than 9 sessions with AA or temperance society [ 16 , 26 , 38 ]. b No specific treatment settings: author did not specify settings.…”

“…Recovery narratives can be defined as personal stories of health problems and of recovery [ 13 ], which can be shared with others [ 14 ], and which can provide recipients with insights into the phenomenology of recovery [ 15 ]. In this regards, the Social Identity Model of Recovery (SIMOR) identifies alcohol recovery as “a process of social identity transitioning, wherein an individual becomes a member of a recovery-orientated group, and in so doing internalizes the values and beliefs of the in-group which, in turn, leads to a new sense of self (or recovery identity) that strongly guides their attitudes and behaviours” (page 113) [ 7 , 16 ]. The act of sharing alcohol narratives has been an important component of the Alcohol Anonymous (AA) 12-step programme [ 17 ].…”

“…Indeed, the recovery narrative is an evolving concept in the field of drug and alcohol misuse, and has been a focus of discussion in contemporary literature [ 29 ]. Alcohol misuse recovery narratives have been studied by researchers to understand different processes of change [ 11 ], how people can recover in both the presence or absence of treatment [ 16 ], and how people differ on individual factors e.g., age, gender, ethnicity in recovery process [ 30 ]. Although alcohol misuse recovery narratives have been widely studied by the research community, no overarching conceptual framework for alcohol recovery narratives exists.…”

Examining untreated and treated alcohol problem resolution in an Australian online survey sample

“…To further develop the stepped‐care framework [23], there might be a need for future research to identify other cost‐effective practices, which have the potential to function as standalone measures to support the process of alcohol problem resolution in the absence of specialist services. Many people will choose to manage their alcohol problems without specialist services, and in doing so might draw upon narratives that diverge from the usual treatment discourses [47,48]. Therefore, novel approaches might be required to reach this population, including promoting untreated alcohol problem resolution through social media campaigns, which introduce healthy alternatives to drinking and/or promote the idea that change in the absence of treatment is not only possible, but also common [49,50].…”