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

Background

Many people report resolving an alcohol or other drug (AOD) problem but continue some form 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 well-being and reduce risks.

Methods

Nationally representative sample of individuals who endorsed having resolved an AOD problem (N= 2,002). 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: 20.3% endorsed continuous abstinence; 33.7% endorsed current abstinence; 21.0% endorsed current use of a secondary substance; 16.2% endorsed currently using primary substance; and 8.8% endorsed currently using both a secondary and primary substance. 2) Correlates: Lower risk substance use status was associated with 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.

Conclusions

About half of Americans who self-identify as having resolved an AOD problem continue to use AOD in some form. Abstinence is associated with greater well-being, and people appear to gravitate toward abstinence/lower risk substance use with greater time since problem resolution.

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