Quality of Life in Former Problem Drinkers: Abstinence Versus Non-abstinence
Many definitions of addiction recovery include abstinence from alcohol and other drugs as its central characteristics. Increasingly, however, research on individuals that identify as being in recovery has shown that not all include abstinence in their definitions.
Regardless of how one defines recovery, non-abstinent routes to problem resolution are more common than abstinent pathways. It is critical to understand the similarities and differences between these two pathways to problem resolution.
This study investigated what factors are related to choosing a non-abstinent path, and whether these individuals have better or worse overall quality of life.
WHAT PROBLEM DOES THIS STUDY ADDRESS?
The substantial majority of residential treatments for substance use disorder (SUD) in the United States advocate for an abstinence approach to SUD recovery, meaning no use of alcohol or other drugs for non-medical purposes.
Non-abstinent recovery, marked by drinking or drug use that is no longer problematic, became a “hot topic” in the 1970s and has continued to receive much attention in the scientific literature, particularly for alcohol-related interventions during the past 15 years. In fact, for individuals in remission from a severe alcohol use disorder, 65% are drinking alcohol in some form.
While abstinence appears to be the safer choice in terms of lower risk of relapse and better health outcomes, non-abstinent recovery is certainly a viable pathway to problem resolution for some, and is almost certainly preferable to ongoing problematic use.
While research examining non-abstinent recovery is ongoing, one area in recovery research receiving less focus is quality of life, often considered a key piece of the recovery process. This study by Subbaraman and Witbrodt analyzed a large sample of individuals identifying as individuals “in recovery”, and compared quality of life outcomes for those who are abstinent versus those who are not.
HOW WAS THIS STUDY CONDUCTED?
This study was a secondary analysis of data from the “What is Recovery” study, highlighted in a prior Bulletin. In short, this study recruited adults (18 years or older) from the community who identified as being “in recovery” from an alcohol and/or other drug problem.
This study by Subarraman picked out just the 5380 who identified alcohol as their primary substance (of 9341 total sample). Abstainers were defined as individuals who reported no use of any substance including alcohol and other drugs in their recovery (n = 4784), while non-abstainers were individuals who reported any use of alcohol or other drugs (n = 596). Of these 596 still using alcohol/drugs, most (61%) reported use of alcohol only in their recovery, while 27% reported use of drugs only, and 11% both alcohol and other drugs.
Virtually the entire sample met diagnostic criteria for alcohol dependence, about half were female, most were above age 35, and half had a college education or greater.
For current quality of life, participants were asked simply to rate their overall quality of life on a four point scale:
- neither poor nor good
- very good
WHAT DID THIS STUDY FIND?
First, with respect to choosing an abstinent vs. non-abstinent pathway, and controlling for demographic characteristics and all other measured variables, younger individuals were more likely to be in the non-abstinent group.
Also, those without a history of treatment were 37% more likely, those without Alcoholics Anonymous exposure 67% more likely, and those without lifetime alcohol dependence 83% more likely, to be in the non-abstinent group.
The relationship between abstinent recovery and quality of life was among the three strongest effects, along with the amount of time someone was in recovery, and being married.
By comparison, whether someone attended treatment, and the severity of their alcohol problem were not significantly related to quality of life.
WHY IS THIS STUDY IMPORTANT
This study was innovative in its focus on quality of life as one aspect of the recovery process & important in its recognition of both abstinent & non-abstinent pathways to recovery.
We recognize that many in the treatment field believe abstinence is one of the defining characteristics of recovery.
Given that this study simply recruited individuals who identified as being in recovery, and other studies of the recovery construct that target the help seekers themselves do not necessarily include total abstinence as a core component, delineating abstinent and non-abstinent forms of recovery will be an important issue in recovery research going forward.
Interestingly, non-abstinent individuals had less time in recovery. Given that non-abstinence has been shown to be a less stable form of alcohol use disorder remission, it is possible a subset of these individuals will ultimately try the abstinent pathway.
Based on these findings, individuals considering a non-abstinent pathway should be aware that abstinence could be better for their overall quality of life in the long run.
- The What is Recovery Study was a large and important undertaking in the field of recovery research. Given that the study used an open recruitment method (sometimes referred to as convenience sampling) where any individuals that meet inclusion criteria can participate, it is not clear whether these individuals are truly representative of the population of individuals who identify as being “in recovery” from an alcohol or other drug problem. For example, while only 11% of these individuals were in the non-abstinent recovery group, as mentioned above nationally representative data suggest more than half of those in remission are not currently abstinent. Of course, however, defining oneself as “in recovery” and meeting the medical definition of remission are not the same.
- The study also used a single question to measure of quality of life. This is a complex construct that may not be completely captured by a single question.
- Finally, other domains related to quality of life, such as recovery capital, happiness, and self-esteem were not assessed in this study could be important to examine.
Further research can help build on this important study examining differences between abstinent and non-abstinent individuals across a range of definitions of problem resolution, including the self-identification of being “in recovery” and the more formal medical definition of being “in remission” (i.e., the absence of substance use disorder symptomatology).
- For individuals & families seeking recovery: Some individuals who have resolved their alcohol and other drug problem will not be completely abstinent. This study of those who had a primary alcohol problem suggests that abstinent individuals may have more stable recoveries and better quality of life in the long-run than non-abstinent individuals, though more research is needed in the area.
- For Scientists: This secondary analysis of a sample of individuals identifying as being “in recovery” from an alcohol or other drug problem focused on those identifying alcohol as primary. While authors controlled for other factors that might predict better quality of life, it is possible that other non-measured factors could be accounting for the observed advantage for abstinent versus non-abstinent individuals. Further research comparing these two pathways to substance problem resolution could build on these important preliminary findings.
- For Policy makers: Some individuals who have resolved their alcohol and other drug problem will not be completely abstinent. This study suggests that abstinent individuals may have more stable recoveries and better quality of life in the long-run than non-abstinent individuals. Funding for studies on this set of pathways to problem resolution, and how they impact recovery beyond abstinence would be an important contribution to the field of recovery research.
- For Treatment professionals and treatment systems: This study examined individuals identifying as being “in recovery” who were recruited from the community. Although these individuals were not necessarily in treatment, the findings showed that abstinent individuals had slightly greater reported quality of life compared to non-abstinent individuals. While more research in the area is needed to say whether this is true definitively, studies like these might have implications for psychoeducation provided to patients when they are choosing treatment goals.
Subbaraman, M. S., & Witbrodt, J. (2014). Differences between abstinent and non-abstinent individuals in recovery from alcohol use disorders. Addictive behaviors, 39(12), 1730-1735.