The concept of "recovery" from alcohol use disorders (AUD) has garnered increasing scientific interest in recent years including attempts to explicate and measure its presumed component parts. In general, there is consensus that "recovery" should not be solely about abstinence or quantity-frequency measures of alcohol consumption and should include measures of functioning. Some researchers have taken an even more radical step, however, to suggest that psychosocial functioning should be the sine qua non defining feature of "recovery," seemingly irrespective of how much one drinks; as such, people can be classified as achieving and maintaining successful "recovery" despite engaging in regular very heavy drinking. This commentary argues against this notion, as it goes beyond existing data and largely ignores the more insidious toxicity-related, as well as acute intoxication-related, health risks, known to occur with heavy alcohol exposure that contradict the salubrious intent of the "recovery" construct. Furthermore, classifying someone as being in successful "recovery" due to high functioning but while engaging in very heavy drinking, ignores the potential collateral damage to close significant others (eg, children, partners), whose well-being can be severely impacted by the enduring unpredictability of heavy use. Finally, it is argued that exclusive championing of "functioning," while paying little if any attention to AUD remission or alcohol exposure status, creates a conceptual conundrum whereby someone with low functioning but who is in long-term AUD remission or completely abstinent could be classified as not achieving "recovery," holding such individuals to a higher standard and may be stigmatizing.
While clinical interventions used to support the recovery process of U.S. adults are well understood, community-based solutions such as peer-based recovery support services delivered by a recovery community organization are not.
Previously collected administrative data of 3459 participants at 20 recovery community organizations in the U.S. were analyzed using a paired samples t-test to examine intake and current recovery capital differences, and multiple linear regression models to examine the association between peer-based recovery support engagement on changes in recovery capital.
Participants were mostly male (52.1%), non-Hispanic (80.2%), White (75.5%), with an average age of 39.38 years (SD = 12.57). Participants’ average engagement was 130.68 days (SD = 166.6) with a total of 4290 engagement sessions (M = 4.75, SD = 4.74) and 8913 brief check-ins (M = 5.0, SD = 5.03) facilitated. Reported health events were 0.09 recurrences of substance use (SD = 0.61) and 0.02 emergency room visits (SD = 0.26) on average. Paired sample t-test results showed a statistically significant increase in recovery capital of 1.33 points (95% CI: 0.97–1.69). Multiple linear regression models for predicting improvements in recovery capital (adjusted r2 = 0.61) found number of follow-up engagements and completed recovery plan goals were statistically significant predictors.
Peer-based recovery support services delivered by recovery community organizations assist in significantly improving individual recovery capital, as well as helping to facilitate involvement with an array of recovery support services that may contribute to other functional social determinant domain improvements and lower negative health events.