“At least I’m not…”: Problem behaviors beyond substance use in recovering people attending Narcotics Anonymous
People with substance use disorders are also at risk for other problem behaviors or “process addictions”, such as gambling and compulsive spending. Even though an individual is in recovery from substance use disorder, they might develop a new pattern of behavior that can lead to unintended negative consequences. This study examined experiences with new or changing problem behaviors beyond substance use among Narcotics Anonymous attendees in recovery.
Substance use disorder commonly co-occurs with other problematic behaviors beyond alcohol and other drug use, such as gambling, sex, compulsive spending, and gaming. While in some cases, substance use and problem behaviors co-occur – when a person initiates substance use disorder recovery, the other problem behaviors may persist. Another concern for people in recovery is increased risk for developing a new problematic behavior, sometimes referred to as a “substitute” addiction. These new problem behaviors may pose ongoing risks to one’s physical and emotional well-being independent of the harms conferred by their substance use. Overall, empirical research on problem behaviors during substance use disorder recovery is needed to inform clinical and public health recommendations. Qualitative research can help capitalize on the perspectives of individuals with lived experience and generate hypotheses for future work. This study summarized perspectives of problem behaviors during substance use disorder recovery in people attending the community-based, mutual-help organization Narcotics Anonymous.
HOW WAS THIS STUDY CONDUCTED?
This qualitative study consisted of 23 individual interviews with Narcotics Anonymous (NA) attendees of groups located in the Western Cape, South Africa from October through December of 2018 and was part of a larger study characterizing other potential problem behaviors – including both “process” addictions such as gambling and exercise as well as cigarette smoking – during substance use disorder recovery. The participants were recruited through “snowball sampling”—after an interview, a participant was asked to identify another potential participant, explain the purpose and anonymity of the research to that potential referral, and then share contact information with the research team if that person was interested in participating. All participants had to be currently attending NA meetings and identify as being in recovery. Interviews were conducted in participants’ homes and workplaces, restaurants, and coffee shops. The interviews lasted between 31 and 157 minutes and were conducted in English and Afrikaans, which are both prominent languages in South Africa.
Each interview was semi-structured, adhering to an interview guide while also permitting probing and follow-up questions for in-depth exploration. One example question was “Since you first pursued recovery, have you noticed yourself doing any behaviors or activities over and over again/ or more of/ that you didn’t do before?” A follow-up question then asked if the participant was happy or unhappy with those behaviors and specifically asked about the use of substances, including alcohol, nicotine/cigarettes, CAT (methcathinone, ephedrine); cocaine/ crack; cannabis; cannabis; ecstasy; heroin; inhalants; methamphetamine; Nyaope (a combination of cannabis, antiretroviral drugs, heroin, cocaine, opioids, and bulking/cutting agents)/Whoonga (low-grade heroin), over-the-counter drugs, and prescription medicines such as methylphenidate. A follow-up question also asked about specific behaviors including exercise, shopping, sex, eating, work, love/relationships, religious activities, use of the internet and video games, social networking sites, and gambling. Participants were explicitly asked if they felt they had substituted their addiction with any of the substances or behaviors previously queried. This study focused specifically on problem behaviors that emerged after entering substance use disorder recovery.
A total of 23 interviews were conducted, of which 14 were male and 9 were female. They ranged in age from 22-55 years old, with an average of 39. They represented a range of time in recovery: 3 in early recovery (<1 year), 10 in sustained recovery (1-5 years), and 10 in stable recovery (>5 years). Only 4 participants had not attended outpatient or residential treatment.
WHAT DID THIS STUDY FIND?
Participants experienced changes in health behaviors during substance use disorder recovery.
Most participants (19) in the study described how they engaged in negative health behaviors (e.g., nicotine/cigarette use) and behaviors corresponding with potential “process addictions” (e.g., shopping, eating, exercise, gambling) for purposes of distraction, isolation, coping, harm reduction, relapse prevention, and avoidance. Nearly half (11) of the participants mentioned nicotine/cigarette use. Several participants (10) mentioned binge eating and overeating, and some (5) reported pornography, sex, and romantic relationships becoming problematic during their recovery from a substance use disorder.
Continued engagement with recovery supports perceived as vital to address other potential problem behavior.
Participants felt that some changes in substance use (e.g., increased caffeine intake) or behaviors (increased exercise) did not have negative consequences or increase the risk of relapse. However, many participants shared the importance of continued engagement with recovery supports and the need for awareness and monitoring of behaviors to maintain their recovery. Some felt that their addiction was more than just the primary substance and that their addiction could manifest in other substances or behaviors, which necessitates continued recovery maintenance. Participants also described how feedback from NA sponsors and peers aided the identification and management of a range of behaviors that could become problematic if not monitored.
WHAT ARE THE IMPLICATIONS OF THE STUDY FINDINGS?
Recovery can be thought about as the process of improved biopsychosocial health and functioning after having suffered from a substance use disorder, although there are many ways to operationally define the recovery construct. Relapse (reinstatement of the disorder), or a return to harmful use, does occur for some, though many people resolve their substance use problem and go on to lead fulling lives. One concern for people in recovery is the emergence or change in other substance use or behaviors that may lead to unintended negative consequences. While the current study focused on the emergence of new problem behaviors after entering substance use disorder recovery, research has also shown that people with substance use disorder in remission are less likely to develop another substance use disorder compared to those not in remission. Nevertheless, participants in this study shared that during their recovery some health behaviors (e.g., nicotine/cigarette use) and potential behavioral addictions (e.g., shopping, eating, gambling) emerged that had a negative impact on their life. Future research can help examine the nature and degree of consequences from these other problem behaviors, and how they change over time for people in recovery. For example, in the National Recovery Study, a representative sample of people who resolved an alcohol or other drug problem, 30% were current cigarette smokers, but individuals who entered recovery more recently are quitting smoking sooner. This highlights the role of social norms and public health policies (e.g., smoking restrictions and excise taxes) in shaping problem behaviors for those in substance use disorder recovery. Also, participants in this study felt engagement with recovery supports and on-going self-reflection and awareness buoyed their recovery and quality of life. The effects of substance use disorder treatment and recovery supports in helping individuals address other problem behaviors such as gambling will be important to study going forward.
The study was small and relied on convenience sampling among Narcotics Anonymous attendees in West Cape, South Africa, which means that the findings may not apply other recovery settings or services.
The interview questions did not probe for the potential positive changes made during recovery or other potential life circumstances that can influence substance use and behavior, for example lessons learned from substance use disorder recovery that can be applied to other problem behaviors.
Participants’ reflection of past substance use and behavior changes are subject to recall bias, which may be influenced by personal identities and experiences, interview questions, and context.
BOTTOM LINE
This qualitative study of new potentially problematic behaviors emerging after initiating substance use disorder recovery suggested ongoing engagement in recovery services and self-monitoring may serve dual roles, helping address a range of addictive behaviors. More research is needed to understand the nature of problem behaviors beyond substance use for those in recovery and to examine what role or function these may play and how treatment and recovery services may help, or whether new targeted interventions for the co-occurring problem behaviors may be needed.
For individuals and families seeking recovery: Qualitative evidence from this study suggests that although some people in recovery engage in, maintain, or increase health risk behaviors (e.g., nicotine/cigarette use) as well as other behaviors with the potential to become problematic that fill a perceived gap left by the abstained substance (e.g., gambling and sex), peer-support and self-monitoring can assist stable recovery and facilitate ongoing self-improvement.
For treatment professionals and treatment systems: Substance use disorders are often accompanied by other problems and behaviors that require attention to maintain recovery. Findings from this study suggest equipping people in recovery with self-reflective and coping tools to assess and address a range of behaviors may benefit recovery directly and indirectly. For example, participants in this study noted how behaviors such as exercising and dating are often healthy, yet they can become problematic if not monitored. Exploring other areas of life beyond substance use that impact an individual’s health and wellbeing is likely to help and unlikely to hinder recovery.
For scientists: This qualitative study explored NA attendees’ perceptions and experiences with substance use and other behaviors that were believed to replace their primary substance use during recovery. Participants shared how nicotine/cigarette use, and other behaviors (sex, shopping, eating) were engaged in for distraction, isolation, coping, harm reduction, relapse prevention, and avoidance. Yet, participants also noted how their participation in NA and awareness of their own patterns of behaviors supported their recovery. The findings from this study, however, are limited by the convenience sampling and focus on “substitute behaviors”. Additional investigation is needed to explore the range of behaviors that persist, desist, and emerge during the recovery journey. Future longitudinal designs that incorporate measures of quality of life and other behaviors (e.g., eating, shopping) from active addiction through stable recovery would provide further evidence on how behaviors change during recovery and how those behaviors are linked to outcomes among various people.
For policy makers: Funding for research that examines and addresses problem behaviors such a problem gambling and gaming may provide critical information to enhance outcomes for individuals in substance use disorder recovery. .
Substance use disorder commonly co-occurs with other problematic behaviors beyond alcohol and other drug use, such as gambling, sex, compulsive spending, and gaming. While in some cases, substance use and problem behaviors co-occur – when a person initiates substance use disorder recovery, the other problem behaviors may persist. Another concern for people in recovery is increased risk for developing a new problematic behavior, sometimes referred to as a “substitute” addiction. These new problem behaviors may pose ongoing risks to one’s physical and emotional well-being independent of the harms conferred by their substance use. Overall, empirical research on problem behaviors during substance use disorder recovery is needed to inform clinical and public health recommendations. Qualitative research can help capitalize on the perspectives of individuals with lived experience and generate hypotheses for future work. This study summarized perspectives of problem behaviors during substance use disorder recovery in people attending the community-based, mutual-help organization Narcotics Anonymous.
HOW WAS THIS STUDY CONDUCTED?
This qualitative study consisted of 23 individual interviews with Narcotics Anonymous (NA) attendees of groups located in the Western Cape, South Africa from October through December of 2018 and was part of a larger study characterizing other potential problem behaviors – including both “process” addictions such as gambling and exercise as well as cigarette smoking – during substance use disorder recovery. The participants were recruited through “snowball sampling”—after an interview, a participant was asked to identify another potential participant, explain the purpose and anonymity of the research to that potential referral, and then share contact information with the research team if that person was interested in participating. All participants had to be currently attending NA meetings and identify as being in recovery. Interviews were conducted in participants’ homes and workplaces, restaurants, and coffee shops. The interviews lasted between 31 and 157 minutes and were conducted in English and Afrikaans, which are both prominent languages in South Africa.
Each interview was semi-structured, adhering to an interview guide while also permitting probing and follow-up questions for in-depth exploration. One example question was “Since you first pursued recovery, have you noticed yourself doing any behaviors or activities over and over again/ or more of/ that you didn’t do before?” A follow-up question then asked if the participant was happy or unhappy with those behaviors and specifically asked about the use of substances, including alcohol, nicotine/cigarettes, CAT (methcathinone, ephedrine); cocaine/ crack; cannabis; cannabis; ecstasy; heroin; inhalants; methamphetamine; Nyaope (a combination of cannabis, antiretroviral drugs, heroin, cocaine, opioids, and bulking/cutting agents)/Whoonga (low-grade heroin), over-the-counter drugs, and prescription medicines such as methylphenidate. A follow-up question also asked about specific behaviors including exercise, shopping, sex, eating, work, love/relationships, religious activities, use of the internet and video games, social networking sites, and gambling. Participants were explicitly asked if they felt they had substituted their addiction with any of the substances or behaviors previously queried. This study focused specifically on problem behaviors that emerged after entering substance use disorder recovery.
A total of 23 interviews were conducted, of which 14 were male and 9 were female. They ranged in age from 22-55 years old, with an average of 39. They represented a range of time in recovery: 3 in early recovery (<1 year), 10 in sustained recovery (1-5 years), and 10 in stable recovery (>5 years). Only 4 participants had not attended outpatient or residential treatment.
WHAT DID THIS STUDY FIND?
Participants experienced changes in health behaviors during substance use disorder recovery.
Most participants (19) in the study described how they engaged in negative health behaviors (e.g., nicotine/cigarette use) and behaviors corresponding with potential “process addictions” (e.g., shopping, eating, exercise, gambling) for purposes of distraction, isolation, coping, harm reduction, relapse prevention, and avoidance. Nearly half (11) of the participants mentioned nicotine/cigarette use. Several participants (10) mentioned binge eating and overeating, and some (5) reported pornography, sex, and romantic relationships becoming problematic during their recovery from a substance use disorder.
Continued engagement with recovery supports perceived as vital to address other potential problem behavior.
Participants felt that some changes in substance use (e.g., increased caffeine intake) or behaviors (increased exercise) did not have negative consequences or increase the risk of relapse. However, many participants shared the importance of continued engagement with recovery supports and the need for awareness and monitoring of behaviors to maintain their recovery. Some felt that their addiction was more than just the primary substance and that their addiction could manifest in other substances or behaviors, which necessitates continued recovery maintenance. Participants also described how feedback from NA sponsors and peers aided the identification and management of a range of behaviors that could become problematic if not monitored.
WHAT ARE THE IMPLICATIONS OF THE STUDY FINDINGS?
Recovery can be thought about as the process of improved biopsychosocial health and functioning after having suffered from a substance use disorder, although there are many ways to operationally define the recovery construct. Relapse (reinstatement of the disorder), or a return to harmful use, does occur for some, though many people resolve their substance use problem and go on to lead fulling lives. One concern for people in recovery is the emergence or change in other substance use or behaviors that may lead to unintended negative consequences. While the current study focused on the emergence of new problem behaviors after entering substance use disorder recovery, research has also shown that people with substance use disorder in remission are less likely to develop another substance use disorder compared to those not in remission. Nevertheless, participants in this study shared that during their recovery some health behaviors (e.g., nicotine/cigarette use) and potential behavioral addictions (e.g., shopping, eating, gambling) emerged that had a negative impact on their life. Future research can help examine the nature and degree of consequences from these other problem behaviors, and how they change over time for people in recovery. For example, in the National Recovery Study, a representative sample of people who resolved an alcohol or other drug problem, 30% were current cigarette smokers, but individuals who entered recovery more recently are quitting smoking sooner. This highlights the role of social norms and public health policies (e.g., smoking restrictions and excise taxes) in shaping problem behaviors for those in substance use disorder recovery. Also, participants in this study felt engagement with recovery supports and on-going self-reflection and awareness buoyed their recovery and quality of life. The effects of substance use disorder treatment and recovery supports in helping individuals address other problem behaviors such as gambling will be important to study going forward.
The study was small and relied on convenience sampling among Narcotics Anonymous attendees in West Cape, South Africa, which means that the findings may not apply other recovery settings or services.
The interview questions did not probe for the potential positive changes made during recovery or other potential life circumstances that can influence substance use and behavior, for example lessons learned from substance use disorder recovery that can be applied to other problem behaviors.
Participants’ reflection of past substance use and behavior changes are subject to recall bias, which may be influenced by personal identities and experiences, interview questions, and context.
BOTTOM LINE
This qualitative study of new potentially problematic behaviors emerging after initiating substance use disorder recovery suggested ongoing engagement in recovery services and self-monitoring may serve dual roles, helping address a range of addictive behaviors. More research is needed to understand the nature of problem behaviors beyond substance use for those in recovery and to examine what role or function these may play and how treatment and recovery services may help, or whether new targeted interventions for the co-occurring problem behaviors may be needed.
For individuals and families seeking recovery: Qualitative evidence from this study suggests that although some people in recovery engage in, maintain, or increase health risk behaviors (e.g., nicotine/cigarette use) as well as other behaviors with the potential to become problematic that fill a perceived gap left by the abstained substance (e.g., gambling and sex), peer-support and self-monitoring can assist stable recovery and facilitate ongoing self-improvement.
For treatment professionals and treatment systems: Substance use disorders are often accompanied by other problems and behaviors that require attention to maintain recovery. Findings from this study suggest equipping people in recovery with self-reflective and coping tools to assess and address a range of behaviors may benefit recovery directly and indirectly. For example, participants in this study noted how behaviors such as exercising and dating are often healthy, yet they can become problematic if not monitored. Exploring other areas of life beyond substance use that impact an individual’s health and wellbeing is likely to help and unlikely to hinder recovery.
For scientists: This qualitative study explored NA attendees’ perceptions and experiences with substance use and other behaviors that were believed to replace their primary substance use during recovery. Participants shared how nicotine/cigarette use, and other behaviors (sex, shopping, eating) were engaged in for distraction, isolation, coping, harm reduction, relapse prevention, and avoidance. Yet, participants also noted how their participation in NA and awareness of their own patterns of behaviors supported their recovery. The findings from this study, however, are limited by the convenience sampling and focus on “substitute behaviors”. Additional investigation is needed to explore the range of behaviors that persist, desist, and emerge during the recovery journey. Future longitudinal designs that incorporate measures of quality of life and other behaviors (e.g., eating, shopping) from active addiction through stable recovery would provide further evidence on how behaviors change during recovery and how those behaviors are linked to outcomes among various people.
For policy makers: Funding for research that examines and addresses problem behaviors such a problem gambling and gaming may provide critical information to enhance outcomes for individuals in substance use disorder recovery. .
Substance use disorder commonly co-occurs with other problematic behaviors beyond alcohol and other drug use, such as gambling, sex, compulsive spending, and gaming. While in some cases, substance use and problem behaviors co-occur – when a person initiates substance use disorder recovery, the other problem behaviors may persist. Another concern for people in recovery is increased risk for developing a new problematic behavior, sometimes referred to as a “substitute” addiction. These new problem behaviors may pose ongoing risks to one’s physical and emotional well-being independent of the harms conferred by their substance use. Overall, empirical research on problem behaviors during substance use disorder recovery is needed to inform clinical and public health recommendations. Qualitative research can help capitalize on the perspectives of individuals with lived experience and generate hypotheses for future work. This study summarized perspectives of problem behaviors during substance use disorder recovery in people attending the community-based, mutual-help organization Narcotics Anonymous.
HOW WAS THIS STUDY CONDUCTED?
This qualitative study consisted of 23 individual interviews with Narcotics Anonymous (NA) attendees of groups located in the Western Cape, South Africa from October through December of 2018 and was part of a larger study characterizing other potential problem behaviors – including both “process” addictions such as gambling and exercise as well as cigarette smoking – during substance use disorder recovery. The participants were recruited through “snowball sampling”—after an interview, a participant was asked to identify another potential participant, explain the purpose and anonymity of the research to that potential referral, and then share contact information with the research team if that person was interested in participating. All participants had to be currently attending NA meetings and identify as being in recovery. Interviews were conducted in participants’ homes and workplaces, restaurants, and coffee shops. The interviews lasted between 31 and 157 minutes and were conducted in English and Afrikaans, which are both prominent languages in South Africa.
Each interview was semi-structured, adhering to an interview guide while also permitting probing and follow-up questions for in-depth exploration. One example question was “Since you first pursued recovery, have you noticed yourself doing any behaviors or activities over and over again/ or more of/ that you didn’t do before?” A follow-up question then asked if the participant was happy or unhappy with those behaviors and specifically asked about the use of substances, including alcohol, nicotine/cigarettes, CAT (methcathinone, ephedrine); cocaine/ crack; cannabis; cannabis; ecstasy; heroin; inhalants; methamphetamine; Nyaope (a combination of cannabis, antiretroviral drugs, heroin, cocaine, opioids, and bulking/cutting agents)/Whoonga (low-grade heroin), over-the-counter drugs, and prescription medicines such as methylphenidate. A follow-up question also asked about specific behaviors including exercise, shopping, sex, eating, work, love/relationships, religious activities, use of the internet and video games, social networking sites, and gambling. Participants were explicitly asked if they felt they had substituted their addiction with any of the substances or behaviors previously queried. This study focused specifically on problem behaviors that emerged after entering substance use disorder recovery.
A total of 23 interviews were conducted, of which 14 were male and 9 were female. They ranged in age from 22-55 years old, with an average of 39. They represented a range of time in recovery: 3 in early recovery (<1 year), 10 in sustained recovery (1-5 years), and 10 in stable recovery (>5 years). Only 4 participants had not attended outpatient or residential treatment.
WHAT DID THIS STUDY FIND?
Participants experienced changes in health behaviors during substance use disorder recovery.
Most participants (19) in the study described how they engaged in negative health behaviors (e.g., nicotine/cigarette use) and behaviors corresponding with potential “process addictions” (e.g., shopping, eating, exercise, gambling) for purposes of distraction, isolation, coping, harm reduction, relapse prevention, and avoidance. Nearly half (11) of the participants mentioned nicotine/cigarette use. Several participants (10) mentioned binge eating and overeating, and some (5) reported pornography, sex, and romantic relationships becoming problematic during their recovery from a substance use disorder.
Continued engagement with recovery supports perceived as vital to address other potential problem behavior.
Participants felt that some changes in substance use (e.g., increased caffeine intake) or behaviors (increased exercise) did not have negative consequences or increase the risk of relapse. However, many participants shared the importance of continued engagement with recovery supports and the need for awareness and monitoring of behaviors to maintain their recovery. Some felt that their addiction was more than just the primary substance and that their addiction could manifest in other substances or behaviors, which necessitates continued recovery maintenance. Participants also described how feedback from NA sponsors and peers aided the identification and management of a range of behaviors that could become problematic if not monitored.
WHAT ARE THE IMPLICATIONS OF THE STUDY FINDINGS?
Recovery can be thought about as the process of improved biopsychosocial health and functioning after having suffered from a substance use disorder, although there are many ways to operationally define the recovery construct. Relapse (reinstatement of the disorder), or a return to harmful use, does occur for some, though many people resolve their substance use problem and go on to lead fulling lives. One concern for people in recovery is the emergence or change in other substance use or behaviors that may lead to unintended negative consequences. While the current study focused on the emergence of new problem behaviors after entering substance use disorder recovery, research has also shown that people with substance use disorder in remission are less likely to develop another substance use disorder compared to those not in remission. Nevertheless, participants in this study shared that during their recovery some health behaviors (e.g., nicotine/cigarette use) and potential behavioral addictions (e.g., shopping, eating, gambling) emerged that had a negative impact on their life. Future research can help examine the nature and degree of consequences from these other problem behaviors, and how they change over time for people in recovery. For example, in the National Recovery Study, a representative sample of people who resolved an alcohol or other drug problem, 30% were current cigarette smokers, but individuals who entered recovery more recently are quitting smoking sooner. This highlights the role of social norms and public health policies (e.g., smoking restrictions and excise taxes) in shaping problem behaviors for those in substance use disorder recovery. Also, participants in this study felt engagement with recovery supports and on-going self-reflection and awareness buoyed their recovery and quality of life. The effects of substance use disorder treatment and recovery supports in helping individuals address other problem behaviors such as gambling will be important to study going forward.
The study was small and relied on convenience sampling among Narcotics Anonymous attendees in West Cape, South Africa, which means that the findings may not apply other recovery settings or services.
The interview questions did not probe for the potential positive changes made during recovery or other potential life circumstances that can influence substance use and behavior, for example lessons learned from substance use disorder recovery that can be applied to other problem behaviors.
Participants’ reflection of past substance use and behavior changes are subject to recall bias, which may be influenced by personal identities and experiences, interview questions, and context.
BOTTOM LINE
This qualitative study of new potentially problematic behaviors emerging after initiating substance use disorder recovery suggested ongoing engagement in recovery services and self-monitoring may serve dual roles, helping address a range of addictive behaviors. More research is needed to understand the nature of problem behaviors beyond substance use for those in recovery and to examine what role or function these may play and how treatment and recovery services may help, or whether new targeted interventions for the co-occurring problem behaviors may be needed.
For individuals and families seeking recovery: Qualitative evidence from this study suggests that although some people in recovery engage in, maintain, or increase health risk behaviors (e.g., nicotine/cigarette use) as well as other behaviors with the potential to become problematic that fill a perceived gap left by the abstained substance (e.g., gambling and sex), peer-support and self-monitoring can assist stable recovery and facilitate ongoing self-improvement.
For treatment professionals and treatment systems: Substance use disorders are often accompanied by other problems and behaviors that require attention to maintain recovery. Findings from this study suggest equipping people in recovery with self-reflective and coping tools to assess and address a range of behaviors may benefit recovery directly and indirectly. For example, participants in this study noted how behaviors such as exercising and dating are often healthy, yet they can become problematic if not monitored. Exploring other areas of life beyond substance use that impact an individual’s health and wellbeing is likely to help and unlikely to hinder recovery.
For scientists: This qualitative study explored NA attendees’ perceptions and experiences with substance use and other behaviors that were believed to replace their primary substance use during recovery. Participants shared how nicotine/cigarette use, and other behaviors (sex, shopping, eating) were engaged in for distraction, isolation, coping, harm reduction, relapse prevention, and avoidance. Yet, participants also noted how their participation in NA and awareness of their own patterns of behaviors supported their recovery. The findings from this study, however, are limited by the convenience sampling and focus on “substitute behaviors”. Additional investigation is needed to explore the range of behaviors that persist, desist, and emerge during the recovery journey. Future longitudinal designs that incorporate measures of quality of life and other behaviors (e.g., eating, shopping) from active addiction through stable recovery would provide further evidence on how behaviors change during recovery and how those behaviors are linked to outcomes among various people.
For policy makers: Funding for research that examines and addresses problem behaviors such a problem gambling and gaming may provide critical information to enhance outcomes for individuals in substance use disorder recovery. .
