The National Recovery Study: How Americans Recover from Alcohol and Drug Problems

The stories about alcohol and drugs we read in the press are almost always negative.

For years, news about alcohol and drugs either revolved around celebrities checking in and out of rehab or the next new drug parents needed to know their thrill-seeking teens might try.

More recently, the press is all about the opioid crisis. And for good reason: the opioid crisis is real. People are dying from opioid overdose at an astounding rate, and we’re just now – after close to a decade of red-flag category data – getting a handle on how the crisis happened, why it happened, and what we need to do moving forward to heal the individuals, families, and communities affected by opioid addiction.

The opioid crisis galvanized the nation into action and raised awareness about several important things related to addiction and recovery:

1. Addiction can touch anyone. Neither age, socioeconomic status, nor location (urban or rural) protects people from addiction: it can happen to anyone, anywhere, at any time, for a variety of reasons.
2. There is a strong stigma against both admitting to an alcohol or drug problem and seeking help for that problem.
3. As a nation, we need to focus more resources on awareness, prevention, and treatment.
4. We need to focus on offering as many people as we can the best and latest evidence-based treatments and therapies.
5. We need to expand our definition of what recovery is and help people recover the way that’s best for them.

When we look over this list, we realize we focus on areas where we’re falling short. And when we read stories about addiction, we read about addiction rates, relapse rates, and overdose deaths – but that’s not the whole story.

Drug and Alcohol Problems: Pathways to Recovery

The rest of the story is that millions of Americans do, in fact, recover successfully from alcohol and drug problems.

That’s what this article is about.

A study published in the Journal of Drug and Alcohol Dependence in 2017 called “Prevalence and Pathways of Recovery from Drug and Alcohol Problems in the United States Population: Implications for Practice, Research, and Policy” examines the ways people in the U.S. recover from alcohol and drug problems.

Researchers used an international polling service and recruited candidates by asking a simple screening question:

“Did you used to have a problem with drugs or alcohol, but no longer do?”

As you can gather from the way the question is phrased, the survey included people with drug or alcohol problems, whether those problems meet the criteria for a clinical diagnosis of addiction (called alcohol use disorder or substance use disorder) or not.

In order to obtain a nationally representative sample, the pollsters used a technique called address-based sampling based on information provided by the U.S. Postal Service. This technique is preferred by researchers because it includes people who may not have telephones, people with unlisted phone numbers, people with cell phones only, and people who do not access to the internet or devices capable of accessing the internet. This approach is valid, vetted, and over the past decade has been used in studies published in the most well-respected scholarly journals in behavioral health, such as the Journal of the American Medical Association (JAMA), the Journal of Child and Adolescent Psychology, the Journal of Abnormal Psychology, and more.

In the end, researchers posed the question above to 39,809 adults over the age of 18. Of those, 25,229 people responded, and of those, around 2000 were included in the final statistical analysis.

Now let’s get to the data.

The National Recovery Study: Results

We hope you’re ready for some numbers.

First, we have to set the stage. And remember, even though they surveyed just 2,000 people, extrapolation to population-level percentages from a sample set that size is a completely valid and accepted practice. FYI: almost every study you’ve ever read that includes population-level percentages uses these same statistical techniques.

We accept them because very smart people use math to get there – and math works.

Here’s what they found.

Prevalence

• Survey results show 9.1% of adults in the U.S. self-identify as having a resolved alcohol or drug problem (AOD).
  • That’s around 20 million people.
• Of the 9.1% of adults who self-identified as having a resolved AOD, 46% self-identified as being currently in recovery.
  • That’s just over 9 million people.

How They Did It

Researchers found that survey respondents moved past their AOD problems in one of two ways: they followed either an assisted resolution pathway or an unassisted resolution pathway. Researchers categorized participants as having followed an assisted resolution pathway if they reported using any of the following recovery management services:

• Outpatient or inpatient/residential treatment at a specialty facility
• Anti-relapse/craving medication such as naltrexone or buprenorphine/naloxone
• Social support groups (also called mutual help groups) such as Alcoholics Anonymous, Narcotics Anonymous, or SMART Recovery
• Community-based recovery support programs with specially trained staff, such as sober living environments, faith-based recovery services, or recovery community centers

Researchers categorized participants as following an unassisted resolution pathway if they reported never using any of the services mentioned above.

Now, let’s look at those numbers.

How America Recovers

Researchers found that among individuals who reported having a resolved AOD problem:

• 53.9% followed an assisted resolution pathway.
• Among that 53.9%, here’s the type of assistance they used:
  • Professional inpatient/outpatient program:
    • Total: 27%.
    • Inpatient: 15.0%
    • Outpatient: 16.8%
    • Detox (subtype of inpatient): 9.1%
  • Social Support (12-Step, SMART Recovery, etc.)
    • Total: 45.1%
    • AA: 34.6%
    • NA: 17.5%
    • CA (Cocaine Anonymous): 2.3%
    • Celebrate Recovery: 2.2%
    • SMART Recovery: 1.3%
    • Women for Sobriety: 1.2%
    • Less than 1.0%: Crystal Meth Anonymous (CMA), Marijuana Anonymous (MA), LifeRing Secular Recovery, Moderation Management (MM), Secular Organizations for Sobriety (SOS).
  • Non-AA-type community support:
    • Total: 21.8%
    • Faith-based: 9.2%
    • Sober living facility: 8.5%
    • Recovery Community Center: 6.2%
    • State or Local Recovery Center: 3.0%
    • Collegiate Recovery Program: 1.7%
    • Recovery High School: 0.8%
  • Medication-Assisted Recovery:
    • Total: 8.6%
      • Alcohol: 4.8%
      • Opiates: 4.4%

That’s a lot of information – and we still need to talk about individuals who followed an unassisted resolution pathway, because – if our math is correct (it is) and we can trust statistical extrapolation (we can) – there are roughly nine million people out there who resolved their AOD problem in ways we know nothing about.

There are, however, a couple of things we can say about the people who followed an unassisted resolution pathway:

• Compared to those who followed an assisted resolution pathway, those who followed an unassisted resolution pathway had less severe and less complex substance use and mental health histories.
• Compared to those who had problems with alcohol, the study found higher use of the assisted resolution pathway for people who had problems with opiates, and lower use of the assisted resolution pathway for people who had problems with cannabis.

What We Can Learn From the Data

This study tells us something encouraging: every day, millions of people in the U.S. live with a resolved alcohol or drug problem. This means that at one point in their lives, their use of alcohol or drugs was heavy enough or problematic enough for them to respond “Yes” to the initial survey question.

Do you remember what it was?

“Did you used to have a problem with drugs or alcohol, but no longer do?”

The statistics say around 20 million people in the U.S. can answer “Yes” to that question.

The statistics also tell us that over half those people (53.9%) resolved their alcohol or drug problem with some type of assistance, while under half of those people (46.1%) resolved their alcohol or drug problem without assistance. The strongest correlates for the assisted resolution pathway were found among individuals with a diagnosed alcohol use disorder (AUD), substance use disorder (SUD), and those individuals involved with the judicial system (i.e. drug courts) in some way. The strongest correlates for the unassisted resolution pathway were found among individuals who had a less complex substance use or mental health history than their assisted counterparts, and those individuals who reported engaging in problem cannabis use.

But we digress.

The point is that people can and do recover from alcohol and drug problems. Tens of millions of Americans have done so already, and millions more will. Our job, as a society, is to remind people living with addiction that there is no shame in addiction: it can happen to anyone. Perhaps more important, though, is this fact: anyone living with addiction can heal, recover, and moved forward toward a life without alcohol or drugs.

It happens every day.