Greater engagement in pleasant and rewarding alcohol-free activities may protect against alcohol use during early recovery. This study examined whether alcohol-free activities were associated with both alcohol use and psychosocial functioning outcomes over time.
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People use alcohol for many reasons including social belonging, relieving negative emotions, and making an experience more enjoyable. Although heavy and persistent alcohol use is often accompanied by significant harms, these can be outweighed (at least early on) by the immediate, potent, and predictable rewarding properties of alcohol. Similarly, the immediate and potent pharmacological properties of alcohol can make alcohol-free sources of reward much less appealing.
For many, recovery from alcohol use disorder is marked by a sustained shift away from alcohol towards a pattern of selecting rewarding alcohol-free activities. Increasing alcohol-free activities has been identified as a potential mechanism of behavior change for recovery in alcohol use disorder. Studies show people with higher rates of substance-free activities report lower levels of alcohol use. Other studies show that recovery is marked by shifts in how one spends their money with decreases in alcohol purchases and increases in financial savings.
Theoretically, alcohol use disorder treatment is marked by similar shifts; however, the research establishing this effect within treatment for alcohol harms is limited. One study found that availability and engagement in substance-free activities is associated with reduced risk of return to use in the first month following a different type of treatment including partial hospitalization, intensive outpatient, or supervised detoxification treatment. Research in this area can help us understand whether these effects are sustained over time.
Further, studies have primarily focused on alcohol and other drug use outcomes. Most individuals in recovery from alcohol use disorder have additional goals beyond substance use that include improving their quality of life and functioning. This study evaluated whether engagement in alcohol-free activities during the first 6 months post-treatment was associated with treatment outcomes, including alcohol use and whole person recovery outcomes such as quality of life and psychosocial functioning, 1 year after starting treatment.
This study was a secondary data analysis of longitudinal data from Project “Matching Alcoholism Treatments to Client Heterogeneity” (MATCH). Project MATCH was a multisite randomized clinical trial that recruited people with alcohol use disorder from 9 sites across the United States and randomly assigned them to one of three behavioral treatments: (a) cognitive behavioral therapy, (b) motivation enhancement therapy, and (c) 12-step facilitation. Project MATCH found similar alcohol outcomes among the three conditions with advantages for 12-step facilitation on measures of continuous abstinence and remission. This secondary analysis included 1,279 participants from the study who completed the baseline survey, and a 6-month and 12-month follow up survey. The primary outcomes were drinks per drinking day, percent drinking days, percent heavy drinking days, depression, purpose in life, and psychosocial functioning at the 12-month follow up.
Alcohol-free activity was based on the frequency which they engaged in up to 12 activities, how much they enjoyed the activities, and whether they typically used alcohol while participating in these events. There were 3 indices of alcohol-free activity: the number of alcohol-free activities, the number of alcohol-involved activities, and the proportion of reinforcement derived from alcohol-free relative to alcohol-involved activities (relative reinforcing value). Reinforcement was calculated by multiplying the frequency of engagement and enjoyment of each alcohol-free and alcohol-involved activity separately, averaging these scores across alcohol-free and alcohol-involved categories, and dividing the alcohol-free average cross-product by a total score (alcohol-free + alcohol-involved cross products).
The researchers first examined changes in alcohol-free activity engagement from baseline to 6-months. Next, the researchers examined whether alcohol-free indices measured at the 6-month follow up predicted drinking and other recovery outcomes at 12-months post treatment. Analyses controlled statistically for treatment arm (aftercare sample that had received inpatient treatment prior to starting the MATCH study vs. outpatient sample who did not have any inpatient treatment prior to beginning the study) and treatment condition (MET vs. CBT vs. TSF) as covariates.
Participants included in the analyses were on average 40.3 years of age at baseline and had completed on average 13.3 years of education. The participants were 75.8% male, 25.5% unemployed, and 41.9% married, and 81.0% non-Hispanic White, 9.5% Black, 7.7% Hispanic/Latino, 1.5% American Indian/Alaska Native, and less than 1% Asian American and other races.
Alcohol-free activities and other recovery outcomes increased, and drinking outcomes decreased, over the course of the study
From baseline to the 6-month follow up, the average number of alcohol-free activities increased by 74%, the average number of alcohol-involved activities decreased by 61%, and the relative reinforcing value of alcohol-free activities increased by 73%. Further, there was a 69% decrease in drinks per drinking day, a 66% decrease in percent drinking days, a 74% decrease in percent heavy drinking days, a 24% decrease in depression scores, a 9% increase in meaning in life scores, and an 8% increase in psychosocial functioning scores. Scores for all outcomes remained relatively stable between the 6-month and 12-month follow-ups.
Alcohol-free activities at 6-months predicted drinking and other recovery outcomes 6-months later
Each additional alcohol-free activity was associated with 1 less drink per drinking day, 7 fewer percent days drinking, and 6 fewer percent heavy drinking days. Also, alcohol free activities at 6 months were associated with small to medium improvements in depression scores, purpose in life, and psychosocial functioning scores, at the 12-month follow up. Greater relative reinforcement value at 6-months (proportion of activities that were alcohol-free) was also associated with lower numbers of drinks per drinking day, percent drinking days, percent heavy drinking days, depression scores, and higher purpose in life and psychosocial functioning, 6 months later at the 12-month follow up. While understanding the real-world effects of relative reinforcement are more complex, the general magnitudes were similar. For example, a 10% increase in proportion of one’s activities that were alcohol-free was associated with a .68 decrease in drinks per drinking day and 5 fewer percent days drinking.
People in alcohol treatment demonstrated increases in alcohol-free activity engagement, and reductions in alcohol-involved activities. It is unclear whether these treatments actually increased alternative reward engagement, or if people have more time to participate in fun rewarding activities as they reduce their drinking, or both. The researchers also found that higher levels of alcohol-free activity engagement 6-months after treatment was associated with improved drinking and other recovery outcomes 6-months later. Importantly, the authors did not control for baseline alcohol-free activity engagement, and therefore the results only demonstrate how levels of substance-free activity engagement at 6 months is associated with changes in drinking at 12 months. It is unclear whether changes in substance-free activity engagement during treatment might be associated with changes in drinking over time. Further, the researchers did not statistically control for other mechanisms which may have also accounted for changes in drinking and other recovery outcomes across the recovery period. Regardless, these findings are broadly consistent with previous research in samples of people with harmful patterns of substance use and among people who are attempting recovery without formal services.
Though this study did not establish whether one specific treatment approach may be better than others at increasing substance-free reinforcement, the results do suggest that higher levels of alcohol-free activity engagement post-treatment is associated with improved recovery outcomes 6 months later. Treatments that specifically target increasing engagement in substance-free activities may provide incremental improvement in recovery outcomes. Some recent advances in psychosocial treatment approaches, such as Life Enhancement Treatment for Substance Use or the Substance-free Activity Session have targeted non-drug reinforcement to improve treatment outcomes with success. The substance free activity session, for example, is a 1 session adjunct to a brief intervention that focuses on increasing engagement in substance-free activities by assessing life goals, attempting to bring long-term benefits of goals into the present moment, and by discussing the congruence between patterns of drinking with those long-term goals. Studies demonstrate that these interventions may increase the efficacy of brief interventions. The substance-free activity session has also been combined with outpatient treatment for alcohol use disorder, with results suggesting that this approach increases engagement in alcohol-free activities. Other adjacent approaches, such as Network Support, attempt to help people in treatment for alcohol use disorder adjust their close social support networks through involvement in substance free activities including but not limited to fun, social experiences. These approaches suggest that targeting alcohol-free activities may be a useful mechanism for increasing the chance of sustained remission for alcohol use disorder in early recovery.
More alcohol-free activities during the 6 months after entering treatment was associated with better drinking and other recovery outcomes 6 months later. Those who reduced their drinking may have had more time to engage in other activities, which could have accounted for this effect over treatment. The degree to which alcohol-free activities is driving change in recovery cannot be determined by this study. That said, this strong theoretically-grounded relationship between fun, alcohol-free activities and better outcomes suggests such activities may bolster treatment and recovery for people attempting to reduce or abstain from alcohol. Notably, it is likely that the negative consequences from an alcohol use disorder pushes people to want to stop or dramatically reduce their alcohol use and seek other kinds of activities to occupy the time typically devoted to alcohol use. When these are also enjoyable, it is an added bonus that can reinforce ongoing alcohol elimination or sustained reductions.
Kuhlemeier, A., Tucker, J. A., & Witkiewitz, K. (2024). Role of relative-reinforcement value of alcohol-free activities during recovery from alcohol use disorder in an adult clinical sample. Experimental and Clinical Psychopharmacology. Advance online publication. doi.: 10.1037/pha0000713
l
People use alcohol for many reasons including social belonging, relieving negative emotions, and making an experience more enjoyable. Although heavy and persistent alcohol use is often accompanied by significant harms, these can be outweighed (at least early on) by the immediate, potent, and predictable rewarding properties of alcohol. Similarly, the immediate and potent pharmacological properties of alcohol can make alcohol-free sources of reward much less appealing.
For many, recovery from alcohol use disorder is marked by a sustained shift away from alcohol towards a pattern of selecting rewarding alcohol-free activities. Increasing alcohol-free activities has been identified as a potential mechanism of behavior change for recovery in alcohol use disorder. Studies show people with higher rates of substance-free activities report lower levels of alcohol use. Other studies show that recovery is marked by shifts in how one spends their money with decreases in alcohol purchases and increases in financial savings.
Theoretically, alcohol use disorder treatment is marked by similar shifts; however, the research establishing this effect within treatment for alcohol harms is limited. One study found that availability and engagement in substance-free activities is associated with reduced risk of return to use in the first month following a different type of treatment including partial hospitalization, intensive outpatient, or supervised detoxification treatment. Research in this area can help us understand whether these effects are sustained over time.
Further, studies have primarily focused on alcohol and other drug use outcomes. Most individuals in recovery from alcohol use disorder have additional goals beyond substance use that include improving their quality of life and functioning. This study evaluated whether engagement in alcohol-free activities during the first 6 months post-treatment was associated with treatment outcomes, including alcohol use and whole person recovery outcomes such as quality of life and psychosocial functioning, 1 year after starting treatment.
This study was a secondary data analysis of longitudinal data from Project “Matching Alcoholism Treatments to Client Heterogeneity” (MATCH). Project MATCH was a multisite randomized clinical trial that recruited people with alcohol use disorder from 9 sites across the United States and randomly assigned them to one of three behavioral treatments: (a) cognitive behavioral therapy, (b) motivation enhancement therapy, and (c) 12-step facilitation. Project MATCH found similar alcohol outcomes among the three conditions with advantages for 12-step facilitation on measures of continuous abstinence and remission. This secondary analysis included 1,279 participants from the study who completed the baseline survey, and a 6-month and 12-month follow up survey. The primary outcomes were drinks per drinking day, percent drinking days, percent heavy drinking days, depression, purpose in life, and psychosocial functioning at the 12-month follow up.
Alcohol-free activity was based on the frequency which they engaged in up to 12 activities, how much they enjoyed the activities, and whether they typically used alcohol while participating in these events. There were 3 indices of alcohol-free activity: the number of alcohol-free activities, the number of alcohol-involved activities, and the proportion of reinforcement derived from alcohol-free relative to alcohol-involved activities (relative reinforcing value). Reinforcement was calculated by multiplying the frequency of engagement and enjoyment of each alcohol-free and alcohol-involved activity separately, averaging these scores across alcohol-free and alcohol-involved categories, and dividing the alcohol-free average cross-product by a total score (alcohol-free + alcohol-involved cross products).
The researchers first examined changes in alcohol-free activity engagement from baseline to 6-months. Next, the researchers examined whether alcohol-free indices measured at the 6-month follow up predicted drinking and other recovery outcomes at 12-months post treatment. Analyses controlled statistically for treatment arm (aftercare sample that had received inpatient treatment prior to starting the MATCH study vs. outpatient sample who did not have any inpatient treatment prior to beginning the study) and treatment condition (MET vs. CBT vs. TSF) as covariates.
Participants included in the analyses were on average 40.3 years of age at baseline and had completed on average 13.3 years of education. The participants were 75.8% male, 25.5% unemployed, and 41.9% married, and 81.0% non-Hispanic White, 9.5% Black, 7.7% Hispanic/Latino, 1.5% American Indian/Alaska Native, and less than 1% Asian American and other races.
Alcohol-free activities and other recovery outcomes increased, and drinking outcomes decreased, over the course of the study
From baseline to the 6-month follow up, the average number of alcohol-free activities increased by 74%, the average number of alcohol-involved activities decreased by 61%, and the relative reinforcing value of alcohol-free activities increased by 73%. Further, there was a 69% decrease in drinks per drinking day, a 66% decrease in percent drinking days, a 74% decrease in percent heavy drinking days, a 24% decrease in depression scores, a 9% increase in meaning in life scores, and an 8% increase in psychosocial functioning scores. Scores for all outcomes remained relatively stable between the 6-month and 12-month follow-ups.
Alcohol-free activities at 6-months predicted drinking and other recovery outcomes 6-months later
Each additional alcohol-free activity was associated with 1 less drink per drinking day, 7 fewer percent days drinking, and 6 fewer percent heavy drinking days. Also, alcohol free activities at 6 months were associated with small to medium improvements in depression scores, purpose in life, and psychosocial functioning scores, at the 12-month follow up. Greater relative reinforcement value at 6-months (proportion of activities that were alcohol-free) was also associated with lower numbers of drinks per drinking day, percent drinking days, percent heavy drinking days, depression scores, and higher purpose in life and psychosocial functioning, 6 months later at the 12-month follow up. While understanding the real-world effects of relative reinforcement are more complex, the general magnitudes were similar. For example, a 10% increase in proportion of one’s activities that were alcohol-free was associated with a .68 decrease in drinks per drinking day and 5 fewer percent days drinking.
People in alcohol treatment demonstrated increases in alcohol-free activity engagement, and reductions in alcohol-involved activities. It is unclear whether these treatments actually increased alternative reward engagement, or if people have more time to participate in fun rewarding activities as they reduce their drinking, or both. The researchers also found that higher levels of alcohol-free activity engagement 6-months after treatment was associated with improved drinking and other recovery outcomes 6-months later. Importantly, the authors did not control for baseline alcohol-free activity engagement, and therefore the results only demonstrate how levels of substance-free activity engagement at 6 months is associated with changes in drinking at 12 months. It is unclear whether changes in substance-free activity engagement during treatment might be associated with changes in drinking over time. Further, the researchers did not statistically control for other mechanisms which may have also accounted for changes in drinking and other recovery outcomes across the recovery period. Regardless, these findings are broadly consistent with previous research in samples of people with harmful patterns of substance use and among people who are attempting recovery without formal services.
Though this study did not establish whether one specific treatment approach may be better than others at increasing substance-free reinforcement, the results do suggest that higher levels of alcohol-free activity engagement post-treatment is associated with improved recovery outcomes 6 months later. Treatments that specifically target increasing engagement in substance-free activities may provide incremental improvement in recovery outcomes. Some recent advances in psychosocial treatment approaches, such as Life Enhancement Treatment for Substance Use or the Substance-free Activity Session have targeted non-drug reinforcement to improve treatment outcomes with success. The substance free activity session, for example, is a 1 session adjunct to a brief intervention that focuses on increasing engagement in substance-free activities by assessing life goals, attempting to bring long-term benefits of goals into the present moment, and by discussing the congruence between patterns of drinking with those long-term goals. Studies demonstrate that these interventions may increase the efficacy of brief interventions. The substance-free activity session has also been combined with outpatient treatment for alcohol use disorder, with results suggesting that this approach increases engagement in alcohol-free activities. Other adjacent approaches, such as Network Support, attempt to help people in treatment for alcohol use disorder adjust their close social support networks through involvement in substance free activities including but not limited to fun, social experiences. These approaches suggest that targeting alcohol-free activities may be a useful mechanism for increasing the chance of sustained remission for alcohol use disorder in early recovery.
More alcohol-free activities during the 6 months after entering treatment was associated with better drinking and other recovery outcomes 6 months later. Those who reduced their drinking may have had more time to engage in other activities, which could have accounted for this effect over treatment. The degree to which alcohol-free activities is driving change in recovery cannot be determined by this study. That said, this strong theoretically-grounded relationship between fun, alcohol-free activities and better outcomes suggests such activities may bolster treatment and recovery for people attempting to reduce or abstain from alcohol. Notably, it is likely that the negative consequences from an alcohol use disorder pushes people to want to stop or dramatically reduce their alcohol use and seek other kinds of activities to occupy the time typically devoted to alcohol use. When these are also enjoyable, it is an added bonus that can reinforce ongoing alcohol elimination or sustained reductions.
Kuhlemeier, A., Tucker, J. A., & Witkiewitz, K. (2024). Role of relative-reinforcement value of alcohol-free activities during recovery from alcohol use disorder in an adult clinical sample. Experimental and Clinical Psychopharmacology. Advance online publication. doi.: 10.1037/pha0000713
l
People use alcohol for many reasons including social belonging, relieving negative emotions, and making an experience more enjoyable. Although heavy and persistent alcohol use is often accompanied by significant harms, these can be outweighed (at least early on) by the immediate, potent, and predictable rewarding properties of alcohol. Similarly, the immediate and potent pharmacological properties of alcohol can make alcohol-free sources of reward much less appealing.
For many, recovery from alcohol use disorder is marked by a sustained shift away from alcohol towards a pattern of selecting rewarding alcohol-free activities. Increasing alcohol-free activities has been identified as a potential mechanism of behavior change for recovery in alcohol use disorder. Studies show people with higher rates of substance-free activities report lower levels of alcohol use. Other studies show that recovery is marked by shifts in how one spends their money with decreases in alcohol purchases and increases in financial savings.
Theoretically, alcohol use disorder treatment is marked by similar shifts; however, the research establishing this effect within treatment for alcohol harms is limited. One study found that availability and engagement in substance-free activities is associated with reduced risk of return to use in the first month following a different type of treatment including partial hospitalization, intensive outpatient, or supervised detoxification treatment. Research in this area can help us understand whether these effects are sustained over time.
Further, studies have primarily focused on alcohol and other drug use outcomes. Most individuals in recovery from alcohol use disorder have additional goals beyond substance use that include improving their quality of life and functioning. This study evaluated whether engagement in alcohol-free activities during the first 6 months post-treatment was associated with treatment outcomes, including alcohol use and whole person recovery outcomes such as quality of life and psychosocial functioning, 1 year after starting treatment.
This study was a secondary data analysis of longitudinal data from Project “Matching Alcoholism Treatments to Client Heterogeneity” (MATCH). Project MATCH was a multisite randomized clinical trial that recruited people with alcohol use disorder from 9 sites across the United States and randomly assigned them to one of three behavioral treatments: (a) cognitive behavioral therapy, (b) motivation enhancement therapy, and (c) 12-step facilitation. Project MATCH found similar alcohol outcomes among the three conditions with advantages for 12-step facilitation on measures of continuous abstinence and remission. This secondary analysis included 1,279 participants from the study who completed the baseline survey, and a 6-month and 12-month follow up survey. The primary outcomes were drinks per drinking day, percent drinking days, percent heavy drinking days, depression, purpose in life, and psychosocial functioning at the 12-month follow up.
Alcohol-free activity was based on the frequency which they engaged in up to 12 activities, how much they enjoyed the activities, and whether they typically used alcohol while participating in these events. There were 3 indices of alcohol-free activity: the number of alcohol-free activities, the number of alcohol-involved activities, and the proportion of reinforcement derived from alcohol-free relative to alcohol-involved activities (relative reinforcing value). Reinforcement was calculated by multiplying the frequency of engagement and enjoyment of each alcohol-free and alcohol-involved activity separately, averaging these scores across alcohol-free and alcohol-involved categories, and dividing the alcohol-free average cross-product by a total score (alcohol-free + alcohol-involved cross products).
The researchers first examined changes in alcohol-free activity engagement from baseline to 6-months. Next, the researchers examined whether alcohol-free indices measured at the 6-month follow up predicted drinking and other recovery outcomes at 12-months post treatment. Analyses controlled statistically for treatment arm (aftercare sample that had received inpatient treatment prior to starting the MATCH study vs. outpatient sample who did not have any inpatient treatment prior to beginning the study) and treatment condition (MET vs. CBT vs. TSF) as covariates.
Participants included in the analyses were on average 40.3 years of age at baseline and had completed on average 13.3 years of education. The participants were 75.8% male, 25.5% unemployed, and 41.9% married, and 81.0% non-Hispanic White, 9.5% Black, 7.7% Hispanic/Latino, 1.5% American Indian/Alaska Native, and less than 1% Asian American and other races.
Alcohol-free activities and other recovery outcomes increased, and drinking outcomes decreased, over the course of the study
From baseline to the 6-month follow up, the average number of alcohol-free activities increased by 74%, the average number of alcohol-involved activities decreased by 61%, and the relative reinforcing value of alcohol-free activities increased by 73%. Further, there was a 69% decrease in drinks per drinking day, a 66% decrease in percent drinking days, a 74% decrease in percent heavy drinking days, a 24% decrease in depression scores, a 9% increase in meaning in life scores, and an 8% increase in psychosocial functioning scores. Scores for all outcomes remained relatively stable between the 6-month and 12-month follow-ups.
Alcohol-free activities at 6-months predicted drinking and other recovery outcomes 6-months later
Each additional alcohol-free activity was associated with 1 less drink per drinking day, 7 fewer percent days drinking, and 6 fewer percent heavy drinking days. Also, alcohol free activities at 6 months were associated with small to medium improvements in depression scores, purpose in life, and psychosocial functioning scores, at the 12-month follow up. Greater relative reinforcement value at 6-months (proportion of activities that were alcohol-free) was also associated with lower numbers of drinks per drinking day, percent drinking days, percent heavy drinking days, depression scores, and higher purpose in life and psychosocial functioning, 6 months later at the 12-month follow up. While understanding the real-world effects of relative reinforcement are more complex, the general magnitudes were similar. For example, a 10% increase in proportion of one’s activities that were alcohol-free was associated with a .68 decrease in drinks per drinking day and 5 fewer percent days drinking.
People in alcohol treatment demonstrated increases in alcohol-free activity engagement, and reductions in alcohol-involved activities. It is unclear whether these treatments actually increased alternative reward engagement, or if people have more time to participate in fun rewarding activities as they reduce their drinking, or both. The researchers also found that higher levels of alcohol-free activity engagement 6-months after treatment was associated with improved drinking and other recovery outcomes 6-months later. Importantly, the authors did not control for baseline alcohol-free activity engagement, and therefore the results only demonstrate how levels of substance-free activity engagement at 6 months is associated with changes in drinking at 12 months. It is unclear whether changes in substance-free activity engagement during treatment might be associated with changes in drinking over time. Further, the researchers did not statistically control for other mechanisms which may have also accounted for changes in drinking and other recovery outcomes across the recovery period. Regardless, these findings are broadly consistent with previous research in samples of people with harmful patterns of substance use and among people who are attempting recovery without formal services.
Though this study did not establish whether one specific treatment approach may be better than others at increasing substance-free reinforcement, the results do suggest that higher levels of alcohol-free activity engagement post-treatment is associated with improved recovery outcomes 6 months later. Treatments that specifically target increasing engagement in substance-free activities may provide incremental improvement in recovery outcomes. Some recent advances in psychosocial treatment approaches, such as Life Enhancement Treatment for Substance Use or the Substance-free Activity Session have targeted non-drug reinforcement to improve treatment outcomes with success. The substance free activity session, for example, is a 1 session adjunct to a brief intervention that focuses on increasing engagement in substance-free activities by assessing life goals, attempting to bring long-term benefits of goals into the present moment, and by discussing the congruence between patterns of drinking with those long-term goals. Studies demonstrate that these interventions may increase the efficacy of brief interventions. The substance-free activity session has also been combined with outpatient treatment for alcohol use disorder, with results suggesting that this approach increases engagement in alcohol-free activities. Other adjacent approaches, such as Network Support, attempt to help people in treatment for alcohol use disorder adjust their close social support networks through involvement in substance free activities including but not limited to fun, social experiences. These approaches suggest that targeting alcohol-free activities may be a useful mechanism for increasing the chance of sustained remission for alcohol use disorder in early recovery.
More alcohol-free activities during the 6 months after entering treatment was associated with better drinking and other recovery outcomes 6 months later. Those who reduced their drinking may have had more time to engage in other activities, which could have accounted for this effect over treatment. The degree to which alcohol-free activities is driving change in recovery cannot be determined by this study. That said, this strong theoretically-grounded relationship between fun, alcohol-free activities and better outcomes suggests such activities may bolster treatment and recovery for people attempting to reduce or abstain from alcohol. Notably, it is likely that the negative consequences from an alcohol use disorder pushes people to want to stop or dramatically reduce their alcohol use and seek other kinds of activities to occupy the time typically devoted to alcohol use. When these are also enjoyable, it is an added bonus that can reinforce ongoing alcohol elimination or sustained reductions.
Kuhlemeier, A., Tucker, J. A., & Witkiewitz, K. (2024). Role of relative-reinforcement value of alcohol-free activities during recovery from alcohol use disorder in an adult clinical sample. Experimental and Clinical Psychopharmacology. Advance online publication. doi.: 10.1037/pha0000713
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