Alcohol use disorder (AUD) is among the most prevalent psychiatric disorders and is associated with enormous public health costs. Although AUD and other addictive behaviors have been described as chronic relapsing conditions, most individuals who develop AUD will eventually recover. This narrative review provides an overview of definitions of recovery, with a focus on recovery from AUD. The definitions reviewed include those developed by key stakeholder groups, as well as definitions derived from recent quantitative and qualitative studies of individuals who meet criteria for AUD and attempt to resolve their problems with or without treatment or who self-identify as pursuing or achieving recovery. The literature reviewed supports a definition of recovery as an ongoing dynamic process of behavior change characterized by relatively stable improvements in biopsychosocial functioning and purpose in life. The review concludes that definitions of recovery that rely solely on abstinence from alcohol and the absence of AUD symptoms fail to capture the multidimensional and heterogeneous pathways to recovery that are evident among individuals in general population and clinical samples.
This very early harm reduction perspective contrasts with the subsequent focus of the Temperance Movement on ridding society of alcohol. The movement was active through the remainder of the 1800s and into the early 1900s and had many distinct groups and societies. Initially, the Temperance Movement focused on promoting abstinence from liquor, then transitioned to a singular goal of abstinence from alcohol, and later advocated for the legal prohibition of alcohol.14 Inebriate asylums, which required abstinence from alcohol, emerged as a residential treatment option in the 1840s.13
Abstinence; essential recovery (e.g., handling negative feelings without using drugs or alcohol); enriched recovery (e.g., taking responsibility for the things I can change); and spirituality in recovery (p. 9)
Abstinence; essential recovery (e.g., handling negative feelings without using drugs or alcohol); enriched recovery (e.g., taking responsibility for the things I can change); and spirituality in recovery (p. 1008)
Using a similar data-driven approach, Witbrodt and colleagues identified five latent classes based on recovery elements reported in in-depth interviews and surveys completed by 9,341 individuals who self-identified as being in recovery. The five classes were characterized as (1) 12-step traditionalist, (2) 12-step enthusiast, (3) secular, (4) self-reliant, and (5) atypical.6,32 Individuals in the 12-step traditionalist and enthusiast classes were most likely to have been or to be currently engaged in AA or other 12-step programs and were mostly abstinent. Those in the secular, self-reliant, and atypical recovery classes were less likely to be abstinent or engaged in 12-step programs. Across all five classes, four items were commonly endorsed from among the top 10 ranking items as important to recovery: (1) being honest with oneself, (2) handling negative feelings without using drugs or alcohol, (3) being able to enjoy life, and (4) engaging in a process of growth and development.
In prospective research that followed a community sample of individuals who drank alcohol over 20 years, Moos and colleagues found that cognitions, attitudes, and beliefs, as well as contextual, social, and environmental factors, were critically important in predicting long-term reductions in drinking.33,34 In terms of the role of drinking, any drinking was not predictive of long-term negative outcomes, but persistent average heavy drinking and heavy episodic drinking were each associated with greater problems related to alcohol use.35
Natural recovery studies also have highlighted the role of contextual variables in different pathways to AUD resolution. Tucker and colleagues conducted a series of studies guided by behavioral economics among individuals with AUD who resolved a drinking problem in the absence of treatment.36,37 In addition to showing that many participants maintained stable abstinence or low-risk drinking without problems over 1- to 2-year follow-ups, this research distinguished those who maintained low-risk drinking from other outcome groups by how they handled their monetary spending before and after they initially stopped problem drinking (i.e., pre-resolution). Pre-resolution, participants who achieved stable low-risk drinking outcomes had more balanced allocations between spending on alcohol versus saving money for the future compared to those who remained abstinent or relapsed and who spent proportionately more on alcohol than savings. After initial resolution, the spending patterns of stable low-risk drinkers changed in ways that led to receipt of heretofore delayed large rewards (housing in particular) that yielded ongoing lifestyle benefits. By comparison, after resolution, participants who remained abstinent or relapsed spent less overall and tended to spend on smaller rewards (e.g., consumable goods, entertainment, gifts) throughout the post-resolution year, appearing to substitute alcohol with small frequent substance-free rewards. Thus, different recovery-relevant outcomes were associated with patterns and contexts of non-drinking behaviors before and after a quit attempt.
Collectively, these studies support adoption of a more flexible definition of recovery (or other inclusive term) that focuses on improvements in areas of functioning adversely affected by drinking and enhanced access to non-drinking rewards. Furthermore, beneficial changes in limited areas of alcohol-related dysfunction and reductions in drinking can occur that contribute to improved health and well-being, even if they fall short of traditional definitions of recovery that emphasize abstinence as a required element. Although recent research is consistent in supporting these conclusions, they are advanced preliminarily, given that each of the aforementioned findings are from single studies and require additional investigation to establish their robustness and generalizability across diverse AUD populations.
Drawing from prior definitions and informed by recent empirical work, the authors conclude that recovery is a process of behavior change characterized by improvements in biopsychosocial functioning and purpose in life. As shown in Table 1, this conceptualization of recovery is similar to definitions of recovery developed by SAMHSA and the Recovery Science Research Collaborative, and it aligns with the empirical findings from Kaskutas, Neale, Kelly, and Witkiewitz, among others. These conceptualizations of recovery, including that of the authors, differ from the Betty Ford Institute Consensus Panel, which requires abstinence. Similarities across definitions of recovery shown in Table 1 indicate that alcohol recovery is a process that is dynamic and focuses on improvement of health and wellness. Definitions differ with respect to the inclusion of language pertaining to abstinence or changes and improvement in biopsychosocial functioning and purpose in life.
Based on the available literature, the authors question the validity of any definitions of recovery that rely solely on abstinence from alcohol or the absence of AUD symptoms and fail to consider changes in other outcomes related to improved functioning and purpose in life. Abstinence will be important for some individuals to start the recovery process and will likely contribute to the abatement of many AUD symptoms, both of which may be important for some individuals in the recovery process. But this is not universal, and limiting definitions of recovery to the elimination of alcohol consumption and AUD symptoms fails to capture the multidimensional and heterogeneous pathways to recovery that are evident in general population samples, as well as among patients who receive alcohol treatment.23
Although caffeine use may be safe for adults, it's not a good idea for children. Adolescents and young adults need to be cautioned about excessive caffeine intake and mixing caffeine with alcohol and other drugs.
It is necessary to disconnect the Focus Blue from your computer and make sure it is powered off before beginning this test. The display test is used to ensure that each pin on the braille display can be activated. The display test also allows you to clean the braille display. Press the Power button while pressing the rightmost Cursor Router buttons (above the last two cells) simultaneously. This action causes all cells to be activated for cleaning. Use a soft cloth moistened with isopropyl alcohol. Do not use any other substance to clean the cells.
Heavy alcohol consumption has been associated with brain atrophy, neuronal loss, and poorer white matter fiber integrity. However, there is conflicting evidence on whether light-to-moderate alcohol consumption shows similar negative associations with brain structure. To address this, we examine the associations between alcohol intake and brain structure using multimodal imaging data from 36,678 generally healthy middle-aged and older adults from the UK Biobank, controlling for numerous potential confounds. Consistent with prior literature, we find negative associations between alcohol intake and brain macrostructure and microstructure. Specifically, alcohol intake is negatively associated with global brain volume measures, regional gray matter volumes, and white matter microstructure. Here, we show that the negative associations between alcohol intake and brain macrostructure and microstructure are already apparent in individuals consuming an average of only one to two daily alcohol units, and become stronger as alcohol intake increases.
Alcohol consumption is one of the leading contributors to the global burden of disease and to high healthcare and economic costs. Alcohol use disorder (AUD)1 is one of the most prevalent mental health conditions worldwide2, with harmful effects on physical, cognitive, and social functioning3. Chronic excessive alcohol consumption is associated with direct and indirect adverse effects, including (but not limited to) cardiovascular disease4, nutritional deficiency5, cancer6, and accelerated aging7,8,9. 153554b96e