Comprehensive review identifies three key concepts for recovery from substance use disorders

Certain concepts have been shown to help people recover from hazardous alcohol or drug use, according to an analysis of the scientific literature since 1990. The most evidence-supported treatment elements include self-efficacy (belief in one’s ability to achieve a goal), social support, and craving control.

Effective treatment of alcohol use disorder (AUD) and other substance use disorders (SUDs) depends on understanding how human behavior changes and integrating this knowledge into clinical practice. Ongoing research continues to examine different treatment approaches and their association with recovery outcomes, but this evidence has not yet been well synthesized into a useful format.

For the new review published in Alcohol: Clinical and experimental researchResearchers from across the United States reviewed published studies, identified the treatment elements that were best supported by data, and assessed their potential as key drivers of behavior change. Researchers drew on existing study design criteria to validate conclusions about treatment elements.

Researchers examined reviews of studies published between 2008 and 2023 that looked at AUD and SUD treatments and the effects on substance use and related outcomes in adults. Three constructs associated with treatment were best supported by data from 11 studies: self-efficacy, social support, and craving (coping skills, which were also well supported, did not fit the current review process).

They then reviewed 48 studies published between 1990 and 2023 that focused on one or more of these three concepts in adult recovery and met rigorous methodological standards. The 48 studies used different research designs, participant samples, and contexts.

The studies analyzed provided evidence that self-efficacy, social support, and craving likely influence people’s behavior during treatment or recovery. The researchers called for these three constructs to be included in treatment and clinical training for AUD and SUD.

Such an approach could improve recovery interventions, enable new treatment modalities and clinical training, help clinicians direct patients toward modalities likely to be effective for them, and refine community-based recovery programs.

The researchers called for further research into how these three concepts produce behavior change and an evaluation of existing scientific evidence to identify other evidence-based approaches. They recommended several directions for future research, including extending the outcomes studied to other manifestations of mental and physical health and experimenting with key elements of treatment to provide direct evidence of associations between these constructs and outcomes.

Investigating the role of context (such as policies, incentives, social norms, and attitudes) and combinations of influences could improve outcomes in various real-world situations. Determining how behavioral changes occur—such as the relevant neurological and biological pathways—is a critical gap that needs to be filled.