Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-23T06:15:12.914Z Has data issue: false hasContentIssue false

2 - Biopsychosocial Process of Change in Alcohol Use Disorder Recovery

from Part I - Micro Level

Published online by Cambridge University Press:  23 December 2021

By
Katie Witkiewitz  and
Stephen A. Maisto
Edited by
Jalie A. Tucker  and
Katie Witkiewitz
Jalie A. Tucker
Affiliation:
University of Florida
Katie Witkiewitz
Affiliation:
University of New Mexico
Get access

Summary

Recovery from alcohol use disorder (AUD) is a dynamic process of behavior change. This chapter explores the biological, psychological, social, and contextual factors that are associated with AUD recovery. Models of AUD remission and AUD relapse are reviewed, and some possible extensions of these models to our understanding of AUD recovery are offered. The chapter focuses on a broad range of research that has examined biopsychosocial predictors and correlates of AUD remission, AUD relapse, and AUD recovery processes in treatment seeking samples and in the context of natural recovery. Also highlighted are current findings and gaps in the literature, as well as discussion of directions for future research. The literature reviewed encourages a broadening of the research agenda to focus on dynamic interactions between biological, psychological, social, contextual, cultural, and life course developmental factors in predicting the onset and maintenance of recovery processes.

Keywords

recoverydynamic modelbehavior changealcohol use disorderbiopsychosocial
Type
Chapter
Information
Dynamic Pathways to Recovery from Alcohol Use Disorder
Meaning and Methods
 , pp. 25 - 40
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596CrossRefGoogle Scholar
Anton, R. F., O’Malley, S. S., Ciraulo, D. A., Cisler, R. A., Couper, D., Donovan, D. M., Gastfriend, D. R., Hosking, J. D., Johnson, B. A., LoCastro, J. S., Longabaugh, R., Mason, B. J., Mattson, M. E., Miller, W. R., Pettinati, H. M., Randall, C. L., Swift, R., Weiss, R. D., Williams, L. D., & Zweben, A. (2006). Combined pharmacotherapies and behavioral interventions for alcohol dependence: the COMBINE study: A randomized controlled trial. JAMA, 295(17), 2003–2017. https://doi.org/10.1001/jama.295.17.2003CrossRefGoogle ScholarPubMed
Ashford, R. D., Brown, A., Brown, T., Callis, J., Cleveland, H. H., Eisenhart, E., Groover, H., Hayes, N., Johnston, T., Kimball, T., Manteuffel, B., McDaniel, J., Montgomery, L., Phillips, S., Polacek, M., Statman, M., & Whitney, J. (2019). Defining and operationalizing the phenomena of recovery: A working definition from the recovery science research collaborative. Addiction Research and Theory, 27(3), 179–188. https://doi.org/10.1080/16066359.2018.1515352Google Scholar
Best, D., Vanderplasschen, W., & Nisic, M. (2020). Measuring capital in active addiction and recovery: The development of the strengths and barriers recovery scale (SABRS). Substance Abuse: Treatment, Prevention, and Policy, 15(1), 1–8. https://doi.org/10.1186/s13011–020-00281-7Google Scholar
Betty Ford Institute Consensus Panel. (2007). What is recovery? A working definition from the Betty Ford Institute. Journal of Substance Abuse Treatment, 33(3), 221–228. https://doi.org/10.1016/j.jsat.2007.06.001Google Scholar
Chow, S.-M., Witkiewitz, K., Grasman, R. P., & Maisto, S. A. (2015). The cusp catastrophe model as cross-sectional and longitudinal mixture structural equation models. Psychological Methods, 20(1), 142–164. https://doi.org/10.1037/a0038962Google Scholar
Cloud, W., & Granfield, R. (2008). Conceptualizing recovery capital: Expansion of a theoretical construct. Substance Use & Misuse, 43(12–13), 1971–1986. https://doi.org/10.1080/10826080802289762Google Scholar
Delucchi, K. L., & Kaskutas, L. A. (2010). Following problem drinkers over eleven years: Understanding changes in alcohol consumption. Journal of Studies on Alcohol and Drugs, 71(6), 831–836. www.ncbi.nlm.nih.gov/pubmed/20946739CrossRefGoogle ScholarPubMed
Dodge, K., Krantz, B., & Kenny, P. J. (2010). How can we begin to measure recovery? Substance Abuse Treatment, Prevention, and Policy, 5(1), 31. https://doi.org/10.1186/1747-597X-5-31CrossRefGoogle ScholarPubMed
Elder, G. H., Johnson, M. K., & Crosnoe, R. (2003). The emergence and development of life course theory. In Mortimer, J. T. & Shanahan, M. J. (Eds.), Handbook of the life course (pp. 3–19). Springer. https://doi.org/10.1007/978-0-306-48247-2_1Google Scholar
Garner, B. R., Scott, C. K., Dennis, M. L., & Funk, R. R. (2014). The relationship between recovery and health-related quality of life. Journal of Substance Abuse Treatment, 47(4), 293–298. https://doi.org/10.1016/j.jsat.2014.05.006Google Scholar
George, A. A., & Tucker, J. A. (1996). Help-seeking for alcohol-related problems: Social contexts surrounding entry into alcoholism treatment or alcoholics anonymous. Journal of Studies on Alcohol, 57(4), 449–457. https://doi.org/10.15288/jsa.1996.57.449Google Scholar
Project MATCH Research Group (1993). Project MATCH: Rationale and methods for a multisite clinical trial matching patients to alcoholism treatment. Alcoholism: Clinical and Experimental Research, 17(6), 1130–1145. https://doi.org/10.1111/j.1530-0277.1993.tb05219.xGoogle Scholar
Hendershot, C. S., Witkiewitz, K., George, W. H., & Marlatt, G. A. (2011). Relapse prevention for addictive behaviors. Substance Abuse Treatment, Prevention, and Policy, 6(1747–597X, 1747–597X), 17. https://doi.org/10.1186/1747-597X-6-17Google Scholar
Hunt, W. A., Barnett, L. W., & Branch, L. G. (1971). Relapse rates in addiction programs. Journal of Clinical Psychology, 27(4), 455–456. www.ncbi.nlm.nih.gov/pubmed/5115648Google Scholar
Jakubczyk, A., Ilgen, M. A., Kopera, M., Krasowska, A., Klimkiewicz, A., Bohnert, A., Blow, F. C., Brower, K. J., & Wojnar, M. (2016). Reductions in physical pain predict lower risk of relapse following alcohol treatment. Drug and Alcohol Dependence, 158, 167–171. https://doi.org/10.1016/j.drugalcdep.2015.11.020CrossRefGoogle ScholarPubMed
Kaskutas, L. A., Borkman, T. J., Laudet, A., Ritter, L. A., Witbrodt, J., Subbaraman, M. S., Stunz, A., & Bond, J. (2014). Elements that define recovery: The experiential perspective. Journal of Studies on Alcohol and Drugs, 75(6), 999–1010. https://doi.org/10.15288/jsad.2014.75.999Google Scholar
Kelly, J. F., Abry, A. W., Milligan, C. M., Bergman, B. G., & Hoeppner, B. B. (2018). On being “in recovery”: A national study of prevalence and correlates of adopting or not adopting a recovery identity among individuals resolving drug and alcohol problems. Psychology of Addictive Behaviors, 32(6), 595–604. https://doi.org/10.1037/adb0000386Google Scholar
Klingemann, H. K., & Sobell, L. C. (2007). Promoting self-change from addictive behaviors: Practical implications for policy, prevention, and treatment. Springer.Google Scholar
Koob, G. F., & Volkow, N. D. (2016). Neurobiology of addiction: A neurocircuitry analysis. Lancet Psychiatry, 3 (8), 760–773. https://doi.org/10.1016/S2215–0366(16)00104-8CrossRefGoogle ScholarPubMed
Laudet, A. B. (2007). What does recovery mean to you? Lessons from the recovery experience for research and practice. Journal of Substance Abuse Treatment, 33(3), 243–256. https://doi.org/10.1016/j.jsat.2007.04.014Google Scholar
Laudet, A. B. (2009). Environmental scan of measures of recovery. Substance Abuse and Mental Health Services Administration.Google Scholar
Lee, M. R., Boness, C. L., McDowell, Y. E., Vergés, A., Steinley, D. L., & Sher, K. J. (2018). Desistance and severity of alcohol use disorder: A lifespan-developmental investigation. Clinical Psychological Science, 6(1), 90–105. https://doi.org/10.1177/2167702617736852Google Scholar
Lowman, C., Allen, J., Stout, R. L., Connors, G., Longabaugh, R., Maisto, S. A., Miller, W. R., Rubin, A., Stour, R. L., Waldron, D., Westerberg, V. S., & Zywiak, W. H. (1996). Replication and extension of Marlatt’s taxonomy of relapse precipitants: Overview of procedures and results. Addiction, 91, S51–S71. https://doi.org/10.1111/j.1360-0443.1996.tb02327.xCrossRefGoogle ScholarPubMed
Maisto, S. A., Connors, G. J., & Zywiak, W. H. (1996). Construct validation analyses on the Marlatt typology of relapse precipitants. Addiction, 91(12s1), 89–98. https://doi.org/10.1046/j.1360-0443.91.12s1.19.xCrossRefGoogle ScholarPubMed
Maisto, S. A., Hallgren, K. A., Roos, C. R., & Swan, J. E. (2020). Patterns of transitions between relapse to and remission from heavy drinking over the first year after outpatient alcohol treatment and their relation to long-term outcomes. Journal of Consulting and Clinical Psychology 88 (12), 1119–1132. https://doi.org/10.1037/ccp0000615Google Scholar
Maisto, S. A., Hallgren, K. A., Roos, C. R., & Witkiewitz, K. (2018). Course of remission from and relapse to heavy drinking following outpatient treatment of alcohol use disorder. Drug and Alcohol Dependence, 187, 319–326. https://doi.org/10.1016/j.drugalcdep.2018.03.011CrossRefGoogle ScholarPubMed
Maisto, S. A., Kirouac, M., & Witkiewitz, K. (2014). Alcohol use disorder clinical course research: Informing clinicians’ treatment planning now and in the future. Journal of Studies on Alcohol and Drugs, 75(5), 799–807. https://doi.org/10.15288/jsad.2014.75.799Google Scholar
Maisto, S. A., Roos, C. R., O’Sickey, A. J., Kirouac, M., Connors, G. J., Tonigan, J. S., & Witkiewitz, K. (2015). The indirect effect of the therapeutic alliance and alcohol abstinence self-efficacy on alcohol use and alcohol-related problems in Project MATCH. Alcoholism: Clinical and Experimental Research, 39(3), 504–513. https://doi.org/10.1111/acer.12649Google Scholar
Maisto, S. A., Xie, F. C., Witkiewitz, K., Ewart, C. K., Connors, G. J., Zhu, H., Elder, G., Ditmar, M., & Chow, S.-M. (2017). How chronic self-regulatory stress, poor anger regulation, and momentary affect undermine treatment for alcohol use disorder: Integrating social action theory with the dynamic model of relapse. Journal of Social and Clinical Psychology, 36(3), 238–263. https://doi.org/10.1521/jscp.2017.36.3.238CrossRefGoogle Scholar
Marlatt, G. A. (1996). Lest taxonomy become taxidermy: A comment on the relapse replication and extension project. Addiction, 91(12s1), 147–154. https://doi.org/10.1046/j.1360-0443.91.12s1.5.xCrossRefGoogle ScholarPubMed
Marlatt, G. A., & Gordon, J. R. (Eds.) (1985). Relapse prevention: Maintenance strategies in addictive behavior change. Guilford Press.Google Scholar
McKay, J. R., Lynch, K. G., Shepard, D. S., Morgenstern, J., Forman, R. F., & Pettinati, H. M. (2005). Do patient characteristics and initial progress in treatment moderate the effectiveness of telephone-based continuing care for substance use disorders? Addiction, 100(2), 216–226. https://doi.org/10.1111/j.1360-0443.2005.00972.xGoogle Scholar
Miller, W. R. (1996). What is a relapse? Fifty ways to leave the wagon. Addiction, 91(Suppl.), S15–27. https://doi.org/10.1111/j.1360-0443.1996.tb02324.xCrossRefGoogle ScholarPubMed
Moos, R. H., & Moos, B. S. (2005). Sixteen-year changes and stable remission among treated and untreated individuals with alcohol use disorders. Drug and Alcohol Dependence, 80(3), 337–347. https://doi.org/10.1016/j.drugalcdep.2005.05.001Google Scholar
Neale, J., Vitoratou, S., Finch, E., Lennon, P., Mitcheson, L., Panebianco, D., Rose, D., Strang, J., Wykes, T., & Marsden, J. (2016). Development and validation of SURE: A patient reported outcome measure for recovery from drug and alcohol dependence. Drug and Alcohol Dependence, 165, 159–167. https://doi.org/10.1016/j.drugalcdep.2016.06.006Google Scholar
Roos, C. R., & Witkiewitz, K. (2017). A contextual model of self-regulation change mechanisms among individuals with addictive disorders. Clinical Psychology Review, 57. https://doi.org/10.1016/j.cpr.2017.08.008CrossRefGoogle ScholarPubMed
Sinha, R. (2011). Effects of adrenal sensitivity, stress- and cue-induced craving, and anxiety on subsequent alcohol relapse and treatment outcomes. Archives of General Psychiatry, 68(9), 942. https://doi.org/10.1001/archgenpsychiatry.2011.49Google Scholar
Sliedrecht, W., de Waart, R., Witkiewitz, K., & Roozen, H. G. (2019). Alcohol use disorder relapse factors: A systematic review. Psychiatry Research, 278, 97–115. https://doi.org/10.1016/j.psychres.2019.05.038Google Scholar
Substance Abuse and Mental Health Services Administration. (2011). SAMHSA working definition of recovery: 10 guiding principles of recovery. Department of Health and Human Services.Google Scholar
Swan, J. E., Votaw, V. R., Stein, E., & Witkiewitz, K. (2020). The role of affect in psychosocial treatments for substance use disorders. Current Addiction Reports, 7, 108–116. https://doi.org/10.1007/s40429-020-00304-0Google Scholar
Tucker, J. A., Cheong, J., Chandler, S. D., Lambert, B. H., Pietrzak, B., Kwok, H., & Davies, S. L. (2016). Prospective analysis of behavioral economic predictors of stable moderation drinking among problem drinkers attempting natural recovery. Alcoholism: Clinical and Experimental Research, 40(12), 2676–2684. https://doi.org/10.1111/acer.13245Google Scholar
Tucker, J. A., Roth, D. L., Vignolo, M. J., & Westfall, A. O. (2009). A behavioral economic reward index predicts drinking resolutions: Moderation revisited and compared with other outcomes. Journal of Consulting and Clinical Psychology, 77(2), 219–228. https://doi.org/10.1037/a0014968CrossRefGoogle ScholarPubMed
US Department of Health & Human Services. (2016). Facing addiction in America: The surgeon general’s report on alcohol, drugs, and health. Department of Health & Human ServicesGoogle Scholar
Vilsaint, C. L., Kelly, J. F., Bergman, B. G., Groshkova, T., Best, D., & White, W. (2017). Development and validation of a Brief Assessment of Recovery Capital (BARC-10) for alcohol and drug use disorder. Drug and Alcohol Dependence, 177, 71–76. https://doi.org/10.1016/j.drugalcdep.2017.03.022CrossRefGoogle ScholarPubMed
White, W. L. (2007). Addiction recovery: Its definition and conceptual boundaries. Journal of Substance Abuse Treatment, 33(3), 229–241. https://doi.org/10.1016/j.jsat.2007.04.015Google Scholar
Witkiewitz, K. (2011). Predictors of heavy drinking during and following treatment. Psychology of Addictive Behaviors, 25(3), 426–438. https://doi.org/10.1037/a0022889CrossRefGoogle ScholarPubMed
Witkiewitz, K. (2013). Temptation to drink as a predictor of drinking outcomes following psychosocial treatment for alcohol dependence. Alcoholism: Clinical and Experimental Research, 37(3), 529–537. https://doi.org/10.1111/j.1530-0277.2012.01950.xGoogle Scholar
Witkiewitz, K., Falk, D. E., Litten, R. Z., Hasin, D. S., Kranzler, H. R., Mann, K. F., O’Malley, S. S., & Anton, R. F. (2019). Maintenance of World Health Organization risk drinking level reductions and posttreatment functioning following a large alcohol use disorder clinical trial. Alcoholism: Clinical and Experimental Research, 43(5), 979–987. https://doi.org/10.1111/acer.14018Google Scholar
Witkiewitz, K., Kranzler, H. R., Hallgren, K. A., O’Malley, S. S., Falk, D. E., Litten, R. Z., Hasin, D. S., Mann, K. F., & Anton, R. F. (2018). Drinking risk level reductions associated with improvements in physical health and quality of life among individuals with alcohol use disorder. Alcoholism: Clinical and Experimental Research, 42(12), 2453–2465. https://doi.org/10.1111/acer.13897Google Scholar
Witkiewitz, K., & Marlatt, G. A. (2004). Relapse prevention for alcohol and drug problems: That was Zen, this is Tao. American Psychologist, 59(4), 224–235. https://doi.org/10.1037/0003-066X.59.4.224Google Scholar
Witkiewitz, K., & Masyn, K. E. (2008). Drinking trajectories following an initial lapse. Psychology of Addictive Behaviors, 22(2), 157–167. https://doi.org/10.1037/0893-164X.22.2.157CrossRefGoogle ScholarPubMed
Witkiewitz, K., McCallion, E. A., Vowles, K. E., Kirouac, M., Frohe, T., Maisto, S. A., Hodgson, R., & Heather, N. (2015). Association between physical pain and alcohol treatment outcomes: The mediating role of negative affect. Journal of Consulting and Clinical Psychology, 83(6), 1044–1057. https://doi.org/10.1037/ccp0000033Google Scholar
Witkiewitz, K., Montes, K. S., Schwebel, F. J., & Tucker, J. A. (2020). What is recovery? A narrative review of definitions of recovery from alcohol use disorder. Alcohol Research: Current Reviews, 40(3), 1–12. https://doi.org/10.35946/arcr.v40.3.01Google Scholar
Witkiewitz, K., Pearson, M. R., Wilson, A. D., Stein, E. R., Votaw, V. R., Hallgren, K. A., Maisto, S. A., Swan, J. E., Schwebel, F. J., Aldridge, A., Zarkin, G. A., & Tucker, J. A. (2020). Can alcohol use disorder recovery include some heavy drinking? A replication and extension up to nine years following treatment. Alcoholism: Clinical and Experimental Research, 44 , 1862–1873. https://doi.org/10.1111/acer.14413CrossRefGoogle Scholar
Witkiewitz, K., Van Der Maas, H. L. J., Hufford, M. R., & Marlatt, G. A. (2007). Nonnormality and divergence in posttreatment alcohol use: Re-examining the Project MATCH data “another way.” Journal of Abnormal Psychology, 116(2), 378–394. https://doi.org/10.1037/0021-843X.116.2.378Google Scholar
Witkiewitz, K., Wilson, A. D., Pearson, M. R., Montes, K. S., Kirouac, M., Roos, C. R., Hallgren, K. A., & Maisto, S. A. (2019). Profiles of recovery from alcohol use disorder at three years following treatment: Can the definition of recovery be extended to include high-functioning heavy drinkers? Addiction, 114(1), 69–80. https://doi.org/10.1111/add.14403Google Scholar
World Health Organization. (2018). International classification of diseases for mortality and morbidity statistics (11th Revision). World Health Organization. https://icd.who.int/browse11/l-m/enGoogle Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×