Abstinence versus moderation recovery pathways following resolution of a substance use problem: Prevalence, predictors, and relationship to psychosocial well‐being in a U.S. national sample

Abstract

Background: Many people who report resolving an alcohol or other drug (AOD) problem continue some level of substance use. Little information exists, however, regarding the prevalence of this resolution pathway, or how continued substance use after resolving an AOD problem, relative to abstinence, relates to functioning, quality of life, and happiness (i.e., well-being). Greater knowledge of the prevalence and correlates of non-abstinent AOD problem resolution could inform public health messaging and clinical guidelines, while encouraging substance use goals likely to maximize wellbeing and reduce risks. Methods: We analyzed data from a nationally representative sample of individuals who endorsed having resolved an AOD problem (N = 2002). Analyses examined: (1) The prevalence of various substance use statuses coded from lowest to highest risk: (a) continuous abstinence from all AOD since problem resolution; (b) current abstinence from all AOD with some use since problem resolution; (c) current use of a substance reported as a secondary substance; (d) current use of the individual's primary substance only; or, (e) current use of a secondary and primary substance; (2) relationships between substance use status and demographic, clinical, and service use history measures; and (3) the relationship between substance use status and well-being.Weighted, controlled, regression analyses examined the influence of independent variables on substance use status. Results:(1) Prevalence: In this sample, 20.3% of participants endorsed continuous abstinence; 33.7% endorsed current abstinence; 21.0% endorsed current use of a secondary substance; 16.2% endorsed current use of a primary substance; and 8.8% endorsed current use of both a secondary and a primary substance. (2) Correlates:Lower-risk substance use status was associated with the initiation of regular substance use at an older age, more years since problem resolution, and fewer lifetime psychiatric diagnoses. (3) Well-Being: Controlling for pertinent confounds, lower-risk substance use status was independently associated with greater self-esteem, happiness, quality of life and functioning, and recovery capital, as well as less psychological distress.

The Holistic Recovery Capital in Gambling Disorder index: A pilot study

“…These results support previous studies on individuals with substance use and GDs, which have reported a negative association between PRC, depression and anxiety, but a positive association between state of recovery and higher levels of PRC (Best et al, 2015;Gavriel-Fried, 2018). The results related to the positive association between PRC and happiness corresponded with previous findings in substance use problems (Eddie, Bergman, Hoffman, & Kelly, 2022). Hence, the HRC-GD index can thus be used as a measurement tool which we believe has significant implications for GD treatment, particularly as it relates to assessing both obstacles and facilitators of RC for clients.…”

Recovery Capital Correlates With Less Methamphetamine Use and Crime in the Community

“…Higher RC has previously been significantly associated with employment, 23 stable housing, 23 and lower risk substance use (as compared with high risk). 22 Investments in human capital through stable housing, such as Housing First Interventions, have shown significant decreases in emergency department visits and frequency of hospitalization; however, there were no differences in substance use. 34 Existing research has also noted sex-based differences in RC growth, with predictors of growth in males being increased meaningful activities (like employment and education), whereas predictors in females were increased community involvement and improvements in overall health.…”

“…20 Baseline RC has been positively correlated with higher quality of life and sustained recovery at 1-year follow-up 21 along with a lower risk of substance use. 22 Conversely, reductions in RC have been inversely correlated with an increased number of substances used, 23 which may reflect the severity of one's substance use. Recovery capital is also compatible with other treatments such as structured therapy or medication management.…”

“…Within an OUD cohort engaged with treatment, RC has been shown to improve over time along with a reduction in total illicit substance use 20 . Baseline RC has been positively correlated with higher quality of life and sustained recovery at 1-year follow-up 21 along with a lower risk of substance use 22 . Conversely, reductions in RC have been inversely correlated with an increased number of substances used, 23 which may reflect the severity of one's substance use.…”

A commentary on “Abstinence versus moderation recovery pathways following resolution of a substance use problem”

“…“Moderation” is a great example of describing non‐abstinent outcomes using positive language that emphasizes abilities instead of limitations. This is particularly important when “communicating that some… may be able to resolve an AOD problem without necessarily needing to abstain completely” (Eddie et al, 2022). Of course, not all drug use results from a similar pathological process or serves the same function, and primary vs. secondary substance use may have distinct functional implications (e.g., one may be associated with positive outcomes and the other largely negative).…”