Recovery: Varieties and Dimensions

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DESCRIPTION (provided by applicant): Alcohol researchers are increasingly recognizing the importance of understanding the process of recovery. This paradigm shift away from psychopathology focuses attention on how individuals move away from alcohol problems, including what initiates and supports recovery, thereby providing information on how individuals improve versus how they deteriorate. Research and clinical experience indicates that recovery is a process, not an endpoint, and that there are significant individual differences in the rate and timing of improvement in key life domains such as mental, physical, social relationships, spiritual/existential well-being, pro-social behaviors, and productivity, as well as reduction, if not elimination, of drinking and drug use. A clearer understanding of the recovery process including factors that initiate and help sustain it, as well as temporal changes in non-drinking characteristics, has significant implications for a more targeted continuum of care. It can also provide realistic expectations to substance users and their families, as well as service providers and other stakeholders. The proposed study capitalizes on an existing NIH-funded prospective dataset to examine these issues through secondary analyses of both quantitative and qualitative data on the recovery experiences of this sample. Participants were alcoholics surveyed every 6 months for 30-36 months as part of a previous grant (R01AA014442). They will be characterized by their drinking patterns over the years of the study according to two sets of criteria for recovery/remission - the Betty Ford Institute Consensus Panel (2007, 2009) and DSM-IV. For each of these groups, we will investigate: (1) the characteristics of the different groups defined by these criteria, the agreement among them in group assignment, and the degree of change in dimensions of recovery (i.e., mental, physical, social, existential, and prosocial health) from baseline to final interview, (2) the degree and timing of prospective changes (positive or negative) in key dimensions of recovery (e.g., mental, physical, social and occupational health, spiritual/existential well-being) by determining for each group the trajectory across time of these dimensions; and (3) the circumstances and behaviors that initiate and sustain recovery, including identifying specific events (e.g., consequences, quantum change) that trigger abstinence efforts. Findings will be useful in the development and evaluation of recovery-oriented services and supports, as it informs a continuum of care model that is consistent with prevalent conceptualizations of substance use disorders as chronic disorders. Findings will also inform policy, service development and funding by speaking to the needs of active and former substance dependent persons. Finally, the study will contribute to filling knowledge gaps about factors that promote the initiation and maintenance of recovery. PUBLIC HEALTH RELEVANCE: Although the field of substance abuse treatment is shifting toward a recovery paradigm (see recent SAMHSA guidelines, CSAT, 2007), our understanding is incomplete on the nature and timing of changes in the dimensions of recovery that accompany increased episodes of abstinence. Deeper knowledge of changes in mental and physical health, social relationships, spiritual/existential health, pro-social behaviors, and productivity, can inform the development of interventions that support recovery. The proposed research intends to investigate the nature and timing of change in dimensions of recovery through a secondary analysis of an R01 dataset, which provides 2 1/2 to 3 years of prospective quantitative and qualitative data on 285 alcoholics.