BACKGROUND Most people with alcohol use disorder (AUD) do not use treatment services, yet the majority ultimately resolve their AUD. As the phenomenon of untreated recovery remains poorly understood, we investigated the strategies used for recovery without treatment.

METHODS We conducted semi-structured interviews with 65 adults (27 women, 37 White) with resolved AUD and no history of using specialty services (e.g., inpatient or outpatient rehabilitation, medication-assisted treatment). Using both inductive and deductive coding, we identified and elaborated themes and meanings. We verified our findings through nine member-check sessions with interviewers and interview participants.

RESULTS Majorities of interview participants met criteria for severe lifetime AUD (84.6%), were in long-term recovery (>5 years; 81.5%), and indicated abstinence was their recovery goal (56.9%). Close to half (41.5%) had attended mutual-help groups (e.g., Alcoholics Anonymous). We identified five active strategies (Changing Contexts, Social Connections. Activities, Substitution, and Other Strategies) and four additional factors (Mutual-help Groups, Self-Reliance, Spirituality, and Aging/Maturing) that contributed to their recovery. Most participants employed multiple strategies and were intentional in adopting the ones that best suited them. By far, the two most common strategies were Changing Contexts (reported by 69.2% of participants) whereby people reduced their alcohol exposure by modifying social networks or physical settings and relying on Social Connections (reported by 67.7%), especially connections to people with similar lived experiences and struggles. Notably, Social Connections and Mutual-Help groups were the themes most often discussed jointly. Among other contributing factors mentioned, Spirituality appeared to play an important, but not universal, role as it was invoked by approximately half (49.2%) of participants.

CONCLUSIONS Our study confirms that recovery without specialty treatment is possible, and that multiple strategies and contributing factors help to achieve it. These findings may inform novel interventions to support recovery among people unwilling or unable to obtain treatment for AUD.