How Recovery Definitions Vary by Service Use Pathway: Findings From a National Survey of Adults

Objective: How people define recovery may affect their recovery goals, service use, and ultimately their outcomes. We examined recovery definitions among adults in recovery from an alcohol use disorder (AUD) who had different service use histories. Method: We analyzed online survey data from 1,492 adults with resolved lifetime AUD in "treated recovery" (any use of specialty services, such as inpatient or outpatient rehabilitation; n = 375), "assisted recovery" (any use of lay services, such as mutual-help groups, and no use of specialty services; n = 174), or "independent recovery" (no use of specialty or lay services; n = 943). Surveys assessed recovery definitions using the 39-item What Is Recovery? (WIR) scale. We compared endorsement of WIR domains and individual recovery elements across groups using survey-weighted chi-square tests and logistic regression. Results: Endorsement of WIR scale domains was significantly lower among the independent than treated and assisted groups, but few differences emerged between the treated and assisted groups. Two recovery elements were endorsed by approximately equivalent majorities of all groups: "being honest with myself" (92.7%-94.8%) and "taking care of my physical health" (87.4%-90.9%). Five additional elements were similarly endorsed by large majorities (>= 85%) in each group, albeit at lower levels in the independent group. Conclusions: People who have experienced AUD and have not obtained alcohol services may have a narrower definition of recovery compared to those accessing treatment or attending mutual-help groups. This suggests a need to broaden alcohol services to better match varied recovery definitions; however, some highly endorsed elements suggest commonalities across recovery pathways. Public Health Significance Statement<br /> How people with alcohol problems define recovery may affect their decisions and behaviors (e.g., substance use goals and help-seeking patterns) and related outcomes (e.g., substance use and well-being). The present study concluded that those in independent recovery from an alcohol problem may have a narrower definition of recovery than those who have accessed treatment or attended mutual-help groups. The different conceptions of recovery among those in independent recovery may contribute to their avoidance of alcohol services, suggesting that broadening such services to better serve those with varied recovery definitions could result in greater services uptake and ultimately better outcomes.