BACKGROUND: Historically, the addiction field used total abstinence as the primary marker of recovery. Although harm reduction is increasingly accepted, abstinence remains a primary treatment outcome and central goal of mutual aid groups. Recovery research often measures success primarily in terms of abstinence. This focus limits knowledge about recovery progress and outcomes for non-abstinent individuals and the field’s ability to support this population. This dissertation advances research in the field because it studies a community, rather than a treatment sample; it focuses on early recovery, which is a crucial period in the recovery trajectory; and studies a rarely researched population – individuals who identify as having resolved an addiction and are non-abstinent.
AIMS: This three-paper dissertation explores insights into the perceptions of individuals in a community sample about their experiences in early recovery. The first two papers used data from a survey to achieve the following aims: (1) Recruit a sample of abstinent and non-abstinent individuals with diverse substance use and treatment histories; (2) Compare abstinent and non-abstinent participants’ responses to the pre-screen questionnaire; (3) Compare participants’ addiction and treatment history and mental health and wellness (e.g., depression and difficulty regulating emotions) by abstinence-status. The third paper used interview data to achieve the following aims: (1) Explore motives for cannabis substitution; (2) Describe the experience of using cannabis; and (3) Examine whether cannabis use supported or harmed recovery.
METHODS: The Socioecological Framework and Harm Reduction principles provided the theoretical and philosophical underpinnings for this dissertation. Participants completed online surveys about substance use, mental health, and life experiences known to impact recovery (e.g., addiction-stigma, racial and ethnic discrimination). Individuals were eligible for the study if they self-identified as having “resolved an addiction” evidenced by (1) reduced use, OR (2) reduced negative consequences, OR (3) improved social or occupational experiences. I recruited interview participants by posting advertisements on Facebook and Reddit in groups specifically related to addiction and recovery. Participants were eligible who reported that they had resolved an addiction to opioids or stimulants and subsequently increased their cannabis use (i.e., cannabis substitution).
I analyzed the pre-screen questionnaire data via content analysis. Descriptive statistics and regression models were computed in SAS. I took a grounded theory approach to analyzing the interview data. First, I coded the data deductively for motivations in the Motivational Model and characterization of substitution effects. Then I coded inductively for emergent themes including additional motives (e.g., to manage withdrawal).
RESULTS & DISCUSSION: Criteria for self-identification of resolving an addiction successfully enrolled abstinent and non-abstinent adults (N=267). Forty-five percent reported abstinence; the most common primary substances were alcohol (46%), opioids (23%), and stimulants (17%). Surprisingly, pre-screen responses about resolving an addiction did not differ according to abstinence-status. In bivariate analysis, abstinent participants had more often been to treatment and mutual aid groups, however there was no difference in past use severity. In regression modeling, abstinence-status was not associated with depression, though it was associated with difficulty regulating emotions. These results suggest that abstinence-status affects distinct mental health outcomes differently, and that positive recovery experiences may be achievable in some domains for non-abstinent adults. In paper three, interview participants (N=14) revealed a series of motives for cannabis use, including those identified in the Motivational Model and those that emerged from the data. Participants viewed cannabis use as compatible with their recovery. Though many participants reported negative side effects, for example increased social anxiety, they did not believe these outweighed the benefits of cannabis use.
CONCLUSIONS: Counter to common assumptions in the addiction field about the necessity of abstinence in recovery, survey responses from both abstinent and non-abstinent participants proved to be more similar than different. Insight into how these groups perceive the process of resolving an addiction (1) enhance our understanding of recovery, including non-abstinent recovery, and (2) can facilitate engagement with individuals resolving addictions, even when abstinence is not one of their identified goals. The interview data offered additional insights into the role of cannabis in non-abstinent recovery, demonstrating its potential to support individuals during cravings. Clinicians in addiction treatment settings and other medical and mental health settings who see clients who are working on recovery can benefit from the findings reported here by supporting their clients regardless of the client’s abstinence goals. / 2025-10-24T00:00:00Z
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/47192 |
| Date | 24 October 2023 |
| Creators | Beaugard, Corinne Ann |
| Contributors | Amodeo, Maryann |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
| Rights | Attribution-NonCommercial-NoDerivatives 4.0 International, http://creativecommons.org/licenses/by-nc-nd/4.0/ |
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