# Recovery Definitions and Behavior Change Processes in Recovery outside of Treatment

> **NIH NIH R01** · UNIVERSITY OF IOWA · 2020 · $490,289

## Abstract

PROJECT SUMMARY/ABSTRACT
General population surveys have regularly found that less than one-quarter of adults with a lifetime alcohol use
disorder (AUD) ever obtain treatment; nevertheless, the majority of those with AUD will achieve remission at
some point. This phenomenon of untreated recovery (also known as natural recovery, spontaneous remission,
and quantum change) has been long recognized but remains poorly understood. For example, several decades
of research have confirmed its existence and even identified correlates; however, interventions to promote
recovery outside of treatment have yielded equivocal or modest results, which are likely the result of unaddressed
gaps, such as little knowledge of the meaning of recovery and the mechanisms of behavior change outside of
traditional treatment services. Guided by Stall and Biernacki's conceptual model of spontaneous remission from
compulsive behaviors and integrating processes of change from the Transtheoretical Model, the proposed study
will use mixed quantitative-qualitative approaches to identify the processes associated with recovery outside of
treatment and test how recovery definitions relate to those processes and recovery outcomes. Specific aims are:
(1) to characterize recovery definitions by treatment exposure; (2) to identify the processes of recovery without
treatment; (3) to estimate the likelihood of sustained recovery and identify modifiable correlates to support
recovery; and in an exploratory aim (4) to investigate variation by subgroups. First, a detailed online
questionnaire will be administered to 1,500 adults with resolved problematic drinking drawn from Knowledge
Panel (Ipsos Public Affairs; Norwalk CT), a pre-existing national probability sample. Respondents will be
classified as in treated recovery (used specialty services, with or without 12-step groups), assisted recovery
(used 12-step groups but not specialty services), or independent recovery (never used specialty services or 12-
step groups), which will permit contrasts by level of intervention exposure (i.e., independent vs. assisted and
treated recovery groups). Under Aim 1, we will use Kaskutas and colleagues' multi-dimensional What Is
Recovery scale to quantify conceptualizations of recovery using cross-sectional baseline survey data (n=1,500).
Under Aim 2, we will conduct qualitative interviews with a purposive sub-set (n=80) of respondents in assisted
and independent recovery to investigate the meaning of recovery, what guides the decision not to seek treatment,
and how respondents initiate and maintain behavior change. Under Aim 3, a subset of respondents in early
recovery (<5 years; n=270) will be followed for 3 additional years, completing annual quantitative surveys to
establish stability of recovery and identify factors associated with successful maintenance of recovery by group.
Our long-term goal is to expand the repertoire of responses to problem drinking. Findings may be used to develop
and test nov...

## Key facts

- **NIH application ID:** 10020882
- **Project number:** 5R01AA027266-02
- **Recipient organization:** UNIVERSITY OF IOWA
- **Principal Investigator:** Paul A. Gilbert
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $490,289
- **Award type:** 5
- **Project period:** 2019-09-20 → 2024-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10020882

## Citation

> US National Institutes of Health, RePORTER application 10020882, Recovery Definitions and Behavior Change Processes in Recovery outside of Treatment (5R01AA027266-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10020882. Licensed CC0.

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