Nonabstinence among US Adults in Recovery from an Alcohol or Other Drug Problem.

Objectives: Most US treatment and recovery services are abstinence-based. However, many people in recovery from an alcohol or other drug (AOD) use problem do not abstain completely. This study estimated the prevalence of and characteristics associated with nonabstinence among US adults in recovery.

Methods: Nonabstinence-operationalized as past-month use of alcohol, illicit drugs, or nonmedical use of prescription drugs-was estimated among a sample of 3763 US adults in self-identified recovery from the 2022 National Survey on Drug Use and Health, weighted to be nationally representative. Multivariable logistic regression identified factors associated with nonabstinence.

Results: An estimated 65.2% (95% confidence interval [CI] = 62.6-67.8) of adults in self-identified recovery reported past-month AOD use. Half (50.8%) reported alcohol use, and one-third (33.2%) reported cannabis use. Females had lower odds of use than males (adjusted odds ratio [AOR] = 0.73, 95% CI = 0.54-0.99), and lesbian/gay-identified individuals had greater odds of use than heterosexual/straight-identified individuals (AOR = 2.39, 95% CI = 1.13-5.07). Greater religiosity (AOR = 0.90, 0.84-0.96) and mutual aid attendance (AOR = 0.16, 95% CI = 0.06-0.27) were associated with lower odds of use. Significant differences were not detected for self-reported health, psychological distress, and other measures of functioning. However, relative to those without a past-year substance use disorder (SUD), odds of nonabstinence were greater among those with one mild (AOR = 14.60, 9.05-23.55), one moderate or severe (AOR = 13.05, 7.06-24.14), and multiple (AOR = 23.33, 10.59-51.37) past-year SUDs.

Conclusions: Most US adults who self-identified as in recovery from an AOD use problem were nonabstinent. Treatment and recovery services may improve engagement and outcomes by supporting nonabstinent goals.