Understanding recovery from alcohol use disorder: Longitudinal observation of two voluntary temporary abstinence periods

PROJECT SUMMARY/ABSTRACT Alcohol use disorder (AUD) in the U.S. is a significant public health concern. NIAAA recently proposed an operational definition of recovery from AUD to advance research in this area, including: 1) remission from DSM-5 AUD, 2) cessation from heavy drinking, and 3) improvements in biopsychosocial functioning and quality of life. Knowledge gained from studying recovery as operationally defined by NIAAA using novel methodological and theoretical approaches has great potential to inform clinical practice and improve patient care for those suffering from AUD. Most people who recover from AUD never receive treatment, and yet very little is known about the process of “natural” recovery in the absence of intervention. Voluntary temporary abstinence campaigns, such as “Dry January” and “Sober October,” are month-long periods of abstinence from alcohol that are increasing in popularity. As self-initiated change attempts for a defined period, these campaigns provide a unique means for studying natural AUD recovery. Longitudinal observational studies of voluntary temporary abstinence campaigns can be used to test theoretically informed predictors of recovery during and after participation in the campaign. The proposed study will test two disparate theories, self- determination theory and behavioral economic theory, both of which are novel theories of mechanisms underlying AUD recovery. Self-determination theory explains behavior change based on internalization of motivation, whereas behavioral economic theory explains behavior change based on benefits and costs of competing behaviors. Testing both theories will provide critically important information about how individuals may initiate (or not) and maintain (or not) self-directed changes in behavior during and following intended participation in a voluntary temporary abstinence campaign. Our objective in this proposal is to leverage two voluntary temporary abstinence campaigns to comprehensively investigate the tenets of self-determination theory and behavioral economic theory to better understand AUD recovery. We will recruit sex-balanced and racially/ethnically diverse online samples who meet criteria for past-year AUD, engaged in past-month hazardous drinking, and intend to participate in either Dry January (n = 125) or Sober October (n =125). Participants will complete a baseline assessment prior to participation in voluntary temporary abstinence and follow-up assessments 3, 6, and 12 months after. This innovative design will allow us to examine natural AUD recovery, as defined by NIAAA, in the context of voluntary temporary abstinence campaigns (Aim 1), and to test the processes of recovery described by self-determination theory (Aim 2) and behavioral economic theory (Aim 3). Exploratory analyses will ascertain differences in theoretical predictions and test sex and racial/ethnic differences for Aims 2 and 3. Each aspect of the research design and associated training goals were chosen deliberately to enhance the candidate’s training and facilitate the transition to independent alcohol researcher.