NIAAA Recovery Research Definitions

What is the definition of recovery from Alcohol Use Disorder (AUD)?

Recovery from AUD

Recovery is a process through which an individual pursues both remission from alcohol use disorder (AUD) and cessation from heavy drinking¹. An individual may be considered “recovered” if both remission from AUD and cessation from heavy drinking are achieved and maintained over time. For those experiencing alcohol-related functional impairment² and other adverse consequences, recovery is often marked by the fulfillment of basic needs, enhancements in social support and spirituality, and improvements in physical and mental health, quality of life, and other dimensions of well-being³. Continued improvement in these domains may, in turn, promote sustained recovery.

Remission from DSM-5 AUD

Remission from DSM-5 AUD Remission from alcohol use disorder (AUD), as defined by DSM-5 criteria⁴, requires that the individual not meet any AUD criteria (excluding craving). Remission from AUD is categorized based on its duration: initial (up to 3 months), early (3 months to 1 year), sustained (1 to 5 years), and stable (greater than 5 years).

Cessation from Heavy Drinking

Cessation from heavy drinking is defined as drinking no more than 14 standard drinks⁵ 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 women⁶. 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).

¹See definitions: “Remission from AUD” and “Cessation from Heavy Drinking”

²Alcohol-related functional impairment varies among individuals and may involve intimate, family, and social relations; financial status; vocational functioning; legal affairs; and residence/living arrangements.

³Self-care, personal growth, subjective experiences (e.g., happiness), engagement in community, concern for others

⁴DSM-5 Criteria for AUD Diagnosis

• Consumed more alcohol or spent more time drinking than intended.
• Want to limit or halt alcohol use but haven’t succeeded.
• Spends an inordinate duration drinking, being ill and undergoing the after-effects of alcohol use.
• Strong cravings for alcohol.
• Consuming alcohol or becoming ill because of it has kept the person from properly attending to household duties and children, or resulted in difficulties performing on the job or at school.
• Continued drinking in spite of it causing problems with family and loved ones.
• Discontinue or are only sporadically involved with things that were once enjoyable or important to be able to drink.
• Have repeatedly been in situations during the consumption of alcohol that have increased the chance of being injured (using machinery, driving).
• Even though a person feels sad or distressed, or it affects an already existing health problem, the person continues to drink. Or, after episodes of forgetting or going blank about the events during drinking, the individual continues to use alcohol.
• Have to increase drinking to get the results he/she wants. (The usual amount of alcohol provides little results.)
• When alcohol wears off, causing symptoms like such as insomnia, difficulty staying asleep, aggravation, nervousness, sadness, stomach upset and nausea and/or perspiring. Or, the person felt items were there, but they are actually not.

⁵In the United States, one "standard" drink (or one alcoholic drink equivalent) contains roughly 14 grams of pure alcohol, which is found in the following: 12 ounces of beer or 5 ounces of wine or 1.5 ounces of distilled spirits/hard liquor

⁶The risks associated with different levels of alcohol consumption for health and functioning vary across individuals. Compared to continued heavy drinking, cessation from heavy drinking (as well as other potential significant reductions in heavy drinking) is associated with decreased risk of physical, mental, and functional impairment. Abstinence, however, is considered the safest course, especially in certain subgroups, including, individuals managing medical conditions such as liver disease, bipolar disorder, abnormal heart rhythm, and chronic pain, women who are pregnant or trying to become pregnant, individuals who are taking medications that interact with alcohol, and individuals who cannot maintain a non-heavy drinking level over time.