NIAAA’s Definition of Recovery

By Tom Horvath, PhD

In 2022, the National Institute of Alcohol Abuse and Alcoholism (NIAAA) proposed a definition of recovery that begins:

Recovery is a process through which an individual pursues both remission from alcohol use disorder (AUD) and cessation from heavy drinking. An individual may be considered “recovered” if both remission from AUD and cessation from heavy drinking are achieved and maintained over time.

In case you missed it, note that unlike other definitions of recovery, this definition does not require abstinence. For decades the diagnostic manual, the DSM, has not required abstinence for a diagnosis of sustained remission, but this fact is often overlooked. NIAAA includes the following language later in the definition:

Cessation from heavy drinking is defined as drinking no more than 14 standard drinks per week or 4 drinks on a single day for men and no more than 7 drinks per week or 3 drinks on a single day for women. Cessation from heavy drinking can be categorized based on the duration: initial (up to 3 months), early (3 months to 1 year), sustained (1 to 5 years), and stable (greater than 5 years).

This level of drinking is consistent with other definitions of moderate drinking (such as that by Moderation Management).

NIAAA’s goal was to create an objective, testable, operational definition, one that went beyond diagnosis alone. A recently published study is the first to examine how helpful this definition might be. The investigators followed 442 individuals for a year as they began addressing their alcohol use disorder (a “recovery attempt”). The Recovery Research Institute recently summarized the paper, but here are some highlights:

• Consistent with the idea that the process of change is challenging, the results were modest, even for individuals who volunteered to enter a study and have their progress tracked. They were presumably significantly motivated to change, but only 35% achieved the NIAAA definition of recovery at some period in the year.
• Of this “fully successful” group (the 35%), 2/3 abstained, and 1/3 achieved “cessation from heavy drinking,” i.e. moderation, at some point in the year. This finding is consistent with the idea that “moderation is possible.” The abstainers started out with more alcohol problems than the moderators, suggesting that abstinence may be the better approach for those with severe problems.
• There were significant improvements in overall quality of life in the “fully successful” group.
• Half of the sample (n = 442) did not make any significant progress. The remainder (about 1/6 of the sample) achieved remission from AUD symptoms (at some period in the year) but continued to engage in high risk (not moderate) drinking.

Scientific knowledge advances in part by clarifying definitions. The field of alcohol problems has been dominated by an abstinence-only definition of recovery. That definition does not respect the reality that low risk drinking regularly occurs as a temporary or ongoing part of the process of change. Fortunately, NIAAA has recognized that reality and proposed a definition of recovery that now has evidence to support it.

Liked this article on NIAAA’s Definition of Recovery? You might also like: NIAAA’s Core Resource on Alcohol