This chapter reviews lifespan developmental perspectives on cessation of risky alcohol use and recovery from alcohol use disorder (AUD). The chapter discusses AUD assessment with an emphasis on lifespan developmental issues; the epidemiology of risky alcohol use with an emphasis on age differences; and influences on risky use, AUD, and recovery in different periods of the lifespan. Adolescent risky drinking can be understood as developing through three etiologic-risk pathways. Risky drinking is especially normative at 18-23 years old and thus especially likely to reflect a temporary, context-driven “developmental disturbance,” which has implications for subsequent recovery. Drinking-related rates decline in young adulthood, and apparent mechanisms of this “maturing out” are discussed (e.g., personality maturation, marriage, parenthood). Regarding midlife and older adulthood, the limited extant literature is reviewed and indicates the need for more lifespan developmental research attending to these ages and examining differences in how recovery occurs across the lifespan.

Alcohol use disorder (AUD) has been described as a chronic relapsing condition, yet most individuals who develop AUD will reduce or resolve their problem, and many will “recover.” This chapter summarizes historical and contemporary definitions of recovery, including those developed by key stakeholder groups and definitions based on research with individuals who meet AUD criteria and resolve their problems with or without treatment. The literature supports an expanded definition of recovery as an ongoing dynamic behavior change process characterized by relatively stable improvements in biopsychosocial functioning and purpose in life. Definitions focused solely on abstinence and absence of AUD symptoms do not capture the multidimensional and heterogeneous pathways to recovery found in general population and clinical samples, and non-abstinent recovery is possible. The chapter discusses a shift away from a pathology-based model of recovery towards a strength-based, resilience-building model that recognizes many possible pathways to stable positive change.

Although treatment samples dominate research on recovery from alcohol use disorder (AUD), natural recovery is the dominant recovery pathway in the population with problems. This chapter summarizes key natural recovery research findings: (1) Most individuals with AUD never receive treatment; associations among AUD severity, help-seeking, and recovery are complex; and influences on help-seeking and behavior change are not wholly redundant. (2) Drinking practices and improved functioning are not highly correlated, indicating domains for defining recovery require expansion. (3) Moderation outcomes are more common in natural than treatment-assisted recovery attempts, in part because most treatments emphasize abstinence. (4) Compared to abstinence and relapse, moderation outcomes of natural recovery attempts are associated with distinct variability in drinking practices and monetary spending patterns that increase access to valued non-drinking rewards. This variability in AUD problem severity, help-seeking, and recovery patterns merits consideration in defining recovery and guiding services across the AUD spectrum.

Approximately 23.5 million people in America need assistance for an alcohol, tobacco, or other drug use (ATOD) disorder, although many do not obtain the help that they need. This disorder is extremely difficult to resolve, as it can be hard to make the necessary lifestyle changes to accommodate sobriety. Sometimes, individuals may recover without formalized treatment, otherwise known as natural recovery. Other times, inpatient or outpatient treatment, or partial-hospitalization, is warranted. Even for individuals taking the proper steps and going to treatment, attrition rates are high, with consistent drop-out rates of 30 percent to 40 percent within three months of treatment initiation. Racial and gender disparities in both treatment participation and outcomes exist, indicating a need for tailoring of treatments and further research on breaking barriers to treatment entrance. Motivation is central in several recovery models proposed to explain stages of change in treatment. Treatment options include initial detoxification and pharmacological options (such as medication-assisted treatment using buprenorphine for opioid use disorder), cognitive-behavioral therapy, motivational interviewing, cue exposure, attentional retraining, twelve-step programs, and group/family therapy. Relapse rates are high, and oftentimes individuals move from one addiction to another. Harm reduction approaches may be beneficial to those that cannot fully quit an addiction, and relapse prevention is an important treatment component, as addiction is a life-long battle.