Prevalence, predictors, correlates, and dynamic changes in the NIAAA-defined "recovery" definition

Area of Science:

• Addiction research
• Clinical psychology
• Public health

Background:

• Existing definitions of alcohol use disorder (AUD) recovery lack operational clarity.
• The National Institute on Alcohol Abuse and Alcoholism (NIAAA) proposed an operational definition: AUD remission with no heavy drinking.
• Limited understanding exists regarding the NIAAA definition's utility and comparison to other recovery metrics.

Purpose of the Study:

• To evaluate the NIAAA operational definition of AUD recovery.
• To compare recovery trajectories and psychosocial outcomes across different remission statuses.
• To identify predictors of AUD recovery and remission stability.

Main Methods:

• A prospective, multisite study followed 442 individuals attempting AUD recovery.
• Hidden Markov models (HMMs) were used to estimate NIAAA-defined recovery status and transitions.
• Participants were assessed at multiple time points for AUD symptoms, alcohol use, and functioning/well-being.

Main Results:

• Four groups emerged: Remission+Abstinence (R+A), Remission+Low-Risk Drinking (R+LRD), Remission+Higher-Risk Drinking (R+HRD), and No Remission (NR).
• NIAAA-defined groups (R+A and R+LRD) showed significant psychosocial improvements compared to NR and R+HRD.
• While R+A demonstrated more stable remission, ongoing drinking (R+LRD, R+HRD) was associated with less stability and poorer outcomes.

Conclusions:

• The NIAAA definition captures significant psychosocial improvements, potentially representing different AUD phenotypes or stages.
• Stable remission is more likely with abstinence; continued drinking, especially heavier use, destabilizes recovery and is linked to poorer functioning.
• Findings underscore the importance of considering alcohol use levels within remission definitions for clinical and public health applications.