Historical and Contemporary Perspectives on Pathways to Recovery from Alcohol Use Disorder

Substance use disorders (SUD) are among the most prevalent mental health disorders worldwide. Alcohol is the most commonly used substance and contributes to 5 percent of the global burden of disease (World Health Organization [WHO], 2018). Globally, it has been estimated that over 100.4 million people meet current criteria for an alcohol use disorder (AUD; GBD 2016 Alcohol and Drug Use Collaborators, 2018), and many more persons engage in risky drinking or experience negative consequences related to drinking that fall short of clinical diagnostic criteria. Thus, alcohol use is a major public health problem associated with enormous social and economic costs (US National Institute on Alcohol Abuse & Alcoholism [NIAAA], 2020). Despite the ubiquity and burden of risky alcohol use and AUD, most individuals who develop an AUD or have subclinical problems will eventually reduce or resolve their problem (Dawson et al., 2005, 2007; Fan et al., 2019; Kelly et al., 2017; Sobell et al., 1996). This contrasts with long-held views of alcohol problems as chronic and intractable and is based on evidence from many sources including epidemiological surveys, prospective observational studies, and randomized clinical trials of patients with AUD (Tucker et al., 2020; Witkiewitz et al., 2020). Many will reduce risky drinking practices and experience AUD symptom reduction, and some will further achieve and maintain “recovery.” Although different stakeholders (e.g., researchers, government agencies, service providers, mutual help groups, and persons with AUD) have defined recovery somewhat differently, most definitions emphasize improvements in health, functioning, and well-being. The extent to which definitions focus on reductions in risky drinking practices or require abstinence is more variable. Scientific work on AUD recovery is maturing and has propelled a shift from a monolithic abstinence-oriented view of alcohol problems, treatment approaches, and recovery pathways to a pluralistic view that recognizes the heterogeneous, multidimensional nature of these central features of AUD. This chapter describes historical and contemporary perspectives and empirical findings concerning the