“What problem does this study address?
There are many factors that research has shown are important to achieving and sustaining recovery. Among the most important factors is motivation to quit alcohol and other drugs (see here for an example of a well-done recent study showing this). Less is known, however, about the desire to maintain abstinence (also alternatively referred to as sobriety). Motivation to make an initial change in drinking or drug use, and motivation to maintain this change are related, but different.
For example, Kelly and Greene showed that, among young adults who attended residential substance use disorder (SUD) treatment, commitment to abstinence – implying a stronger and high priority abstinence motivation – was independently and more strongly related to abstinence over time even than a gold standard measure of how ready someone was to quit alcohol and other drugs, called the Stages of Change Readiness and Treatment Eagerness Scale, or SOCRATES (see here).
In their prior work the authors of this study, Polcin and Korcha, found that among members of sober living homes …the benefits someone believes he/she will get from being abstinent (e.g., ability to rebuild relationships) are related to positive recovery outcomes, but more weakly than the costs they feel abstinence will have for them (e.g., will be difficult to relax or have fun). In this study, the authors conducted focus groups with the staff of sober living homes to explore motivation for abstinence in residents in order to offer directions for future research and to help potentially identify ways to enhance motivation for abstinence among individuals in, or seeking, recovery.
Why is this study important?
In order to help maximize ways to enhance recovery (e.g., increasing abstinence motivation), it is critical to fully understand each of these concepts from the perspectives of individuals in recovery and those who help them day-to-day. Focus groups like those conducted in this study, and the rich qualitative data they provide, may increase knowledge and lead to more effective ways of addressing low motivation for abstinence and recovery.
What did this study do?
Authors conducted two focus groups with staff from sober living homes in California. Although they vary in their rules and policies as well as the services they provide, sober living homes are residences where individuals are usually required to remain abstinent, encouraged to attend mutual-help meetings, and supported in their efforts to obtain employment or engage in school.
The first focus group included the owner of a sober living home organization in Northern California, an administrative staff person, and four of the house managers. The second focus group included an administrative staff person, and five house managers from a sober living home organization in Southern California.
Although detail on focus group participants was somewhat limited, authors noted that a majority of participants were men who were in recovery themselves. In these particular sober living home organizations, the residences generally had a “zero-tolerance” policy around alcohol and other drug use. In other words, residents who drank or used drugs would be asked to leave, and linked with treatment, for example. They also required residents to attend 12-step mutual-help meetings. On average, residents stayed in the sober living homes for about 5 months. Both focus groups were recorded and transcribed to text. See the box below for the content areas covered by the focus groups. Following transcription, two members of the research team identified dominant themes from the text, resolved any discrepancies between their themes, and created a set of finalized themes from both focus groups.
Content areas covered by the focus groups:
- General factors that influence motivation for abstinence
- How peer and peer support influences motivation for abstinence
- How family/friend support influence motivation for abstinence
- How both costs and benefits of abstinence influence motivation for abstinence
- Interesting results from prior quantitative studies (e.g., perceived costs of abstinence was an especially strong predictor of abstinence for those high in psychiatric severity)
What did this study find?
Participants felt that residents’ motivation was positively influenced by drug testing and the sober living homes’ zero-tolerance substance use policies. In addition, they felt that various forms of external pressure (from the legal system or family, for example) served as motivators for abstinence among their residents.
One primary theme of note was the key role of families in residents’ motivation: first in making financial support dependent on entering the sober living home as influencing initial motivation, and then, residents’ desire to repair and rebuild relationships as influencing abstinence motivation over time.
In addition, focus group participants described a general transition from being motivated for abstinence by consequences of using alcohol and other drugs (e.g., “deficit motivation”) to using the benefits of abstinence as a strategy to maintain or enhance motivation (e.g., being able to maintain a job).
Regarding social support, participants identified fellow residents (i.e., peers) as powerful tools in helping keep each other motivated for abstinence, 1) by checking in with resident peers they felt may be struggling emotionally, or 2) being directive if they felt their resident peers were not fully engaging with recovery activities. Although support specifically from family and friends was part of the initial list of questions, responses pertaining to this question were either not reported in the findings or not discussed in focus groups.
Regarding reactions to authors’ previous quantitative studies, participants noted the potential benefits of smaller vs. larger social networks, and felt generally that sober living homes may be poorer fits for individuals high in psychiatric severity such as those with psychotic disorders like schizophrenia. These individuals, they felt, may need a more flexible living situation, particularly with respect to their generally rigid policies around relapse. Participants were unable to provide insights as to the added influence of perceived abstinence benefits for those who are less involved with mutual-help groups as the prompt led primarily to a discussion of the benefits of mutual-help involvement more generally among residents.
What does this study add to our understanding of recovery?
In treatment and recovery, motivation is a complex concept with many sides including perceived costs and benefits of abstinence as well as perceived costs and benefits of substance use. This understanding is consistent with a “decisional balance”, an exercise that allows individuals to consider the pros and cons of change and the pros and cons of not changing (see here). This study adds to that understanding of motivation by exploring factors that help individuals maintain abstinence over time including the influence of other people in recovery and one’s desire to rebuild family relationships.
Link to Summary of Study
Inside The Alcoholic Brain 