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Although treatment samples dominate research on recovery from alcohol use disorder (AUD), natural recovery is the dominant recovery pathway in the population with problems. This chapter summarizes key natural recovery research findings: (1) Most individuals with AUD never receive treatment; associations among AUD severity, help-seeking, and recovery are complex; and influences on help-seeking and behavior change are not wholly redundant. (2) Drinking practices and improved functioning are not highly correlated, indicating domains for defining recovery require expansion. (3) Moderation outcomes are more common in natural than treatment-assisted recovery attempts, in part because most treatments emphasize abstinence. (4) Compared to abstinence and relapse, moderation outcomes of natural recovery attempts are associated with distinct variability in drinking practices and monetary spending patterns that increase access to valued non-drinking rewards. This variability in AUD problem severity, help-seeking, and recovery patterns merits consideration in defining recovery and guiding services across the AUD spectrum.
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