Newswise — Recovering from alcohol use disorder (AUD) can sometimes involve drinking reductions that do not come close to abstinence, according to recent research — challenging the dogma that recovery from AUD requires abstinence or infrequent drinking. In a new study, one in five participants achieved stable recovery while occasionally drinking heavily. These participants reported success in various measures of life satisfaction, functioning, and health several years after treatment for AUD, according to the study in Alcoholism: Clinical and Experimental Research. Their experience highlights the value of any drinking reduction. This study expands a body of work that is calling into question the longstanding emphasis — in research and recovery programs, including Alcoholics Anonymous — on drinking practices as a primary measure of success. A similar shift is taking place around other psychiatric disorders, with recovery increasingly measured by improved health and functioning over the absence of symptoms.

Researchers analyzed data from 694 people three years after they were treated for AUD. The participants answered questions assessing their substance use, employment status, physical and mental health, and perceived quality of life. In a further investigation seven to nine years after treatment, 133 people answered questions on their health, hospitalizations, and drinking. Investigators also considered demographic data and additional factors. They used statistical analysis to organize participants into four profile types and explore associations between alcohol use and various outcomes relating to health and functioning.

Seven out of ten people in recovery functioned well for at least three years after treatment. Most of them abstained from alcohol or infrequently drank (profile 4). Many people recover through abstinence; abstinence is recommended given its health benefits and reduced risks of continued drinking. That said, one in five participants (profile 3), achieved stable recovery while drinking frequently and occasionally heavily (more than three drinks for women and more than four drinks for men). This group reported above-average health and low unemployment, even though their alcohol consumption in recovery exceeded moderate use guidelines. At the later follow-up, these “high functioning heavy drinkers” reported good health and relatively few hospitalizations. In contrast, 14 percent of the initial participants (profile 1) reported frequent heavy drinking and below-average health and quality of life. Sixteen percent (profile 2) either abstained or drank infrequently yet reported poor outcomes, which may be related to environmental disadvantages.

Drinking alcohol is associated with considerable health risks, and any reductions in alcohol use can improve how people feel and function. These study findings provide further evidence that long-term recovery from AUD, including well-being and positive psychosocial functioning, can be achievable in some who continue drinking heavily. The investigators encourage researchers and other stakeholders to broaden their recovery criteria. This study has several limitations. The researchers call for further explorations that incorporate objective measures of well-being and physical health.

Can alcohol use disorder recovery include some heavy drinking? A replication and extension up to nine years following treatment. K. Witkiewitz, A. Wilson, E. Stein, V. Votaw, K. Hallgren, S. Maisto, J. Swan, F. Schwebel, A. Aldridge, G. Zarkin, J. Tucker (pages xxx).

ACER–20–4413.R1

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