Alcohol use disorder (AUD) is a significant public health concern, and treatments for this disorder need to go beyond reducing or eliminating alcohol use. People trying to maintain their recovery from AUD also probably benefit from having plenty of alcohol-free activities to engage in. This week, The DRAM reviews a study by Alena Kuhlemeier and colleagues that assessed whether engagement in and enjoyment of alcohol-free activities six months after treatment influenced drinking and psychosocial well-being outcomes twelve months after treatment.
What were the research questions?
Does engagement in and enjoyment of alcohol-free activities improve AUD outcomes after completing treatment?
What did the researchers do?
The researchers performed a secondary analysis of longitudinal data from Project MATCH, a randomized clinical trial of behavioral AUD treatments. The current sample included 1,279 participants who completed six- and twelve-month treatment follow-ups. The researchers measured drinking and psychosocial well-being variables at baseline, six months, and twelve months post-treatment. Participants were also asked to identify and rate their enjoyment of alcohol-free and alcohol-involved activities at baseline and six months post-treatment. The researchers calculated relative-reinforcement value (RRV), a measure of how frequently participants engaged in alcohol-free activities and how much they enjoyed those activities, relative to all of their activities. Higher RRV scores indicate that the person has shifted toward more alcohol-free activities that they find enjoyable. The researchers used ordinary least squares regression to assess whether (1) the number of alcohol-free activities and (2) the RRV of those activities six months post-treatment had an impact on drinking and psychological well-being twelve months post-treatment.
What did they find?
The number of alcohol-free activities and the RRV of those activities six months after treatment predicted decreased drinking and improved psychosocial functioning one year after treatment. For example, every alcohol-free activity that participants engaged in at six months post-treatment resulted in one less drinking day and a 1.8- point increase in purpose of life score at twelve months post-treatment (see Figure). Participants with higher RRV had 46% less drinking days and a 6-point reduction in depression symptoms at twelve months post-treatment compared to those with lower RRV. RRV had a stronger impact on recovery outcomes compared to the number of alcohol-free activities, suggesting that the value a person places on alcohol-free activities has more influence on their behavior choices.
Figure. Impact of total number and RRV of alcohol-free activities at six months post-treatment on drinking and functioning outcomes one year after treatment. All effects were statistically significant. Click image to enlarge.
Why do these findings matter?
Recovery is an ongoing process characterized by improved functioning and purpose in life. The findings of this study suggest that longstanding recovery from AUD can be achieved, in part, by substituting alcohol use with rewarding and enjoyable alcohol-free alternatives. To promote this positive behavior change, providers can implement contingency management strategies that reward patients for choosing substance-free activities. Encouraging change in this way may make recovery seem more manageable and realistic, compared to interventions aimed at constraining individuals’ access to alcohol or punishing them for using alcohol.
Every study has limitations. What are the limitations in this study?
The results of this study may not be generalizable, as the data was gathered over 30 years ago and the sample was primarily made up of White men. The researchers were also unable to analyze data about potential environmental factors that could have prevented participants from accessing alcohol-free activities, and the data that they could analyze about activity engagement was limited to only one follow-up time point. Future studies should assess the effect of these environmental factors and measure engagement in and enjoyment of alcohol-free activities at multiple timepoints to show the impact of these activities over a longer period of time.
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The National Institute on Alcohol Abuse and Alcoholism also has tips and resources for people struggling with problem drinking. For additional drinking self-help tools, please visit our Addiction Resources page.
— Nakita Sconsoni, MSW