Black Americans demonstrably suffer from a range of health disparities rising from a long history of structural inequities and racism. Although Black Americans are slightly less likely to drink alcohol than the general population, the rate of Black drinkers with alcohol use disorders (AUD) is comparable, representing 1.5 million Black Americans with AUD. Blacks suffer more negative consequences due to alcohol use such as illnesses, injuries, criminal-legal involvement, and social problems. Recovery is a dynamic process of behavior change leading to stable improvements in functioning, purpose and well-being. NIAAA further highlights recovery as remission from AUD symptoms as well as cessation of heavy drinking. Recovery support services and recovery community organizations aim to build recovery capital. Yet, to date little effort has been made to consider recovery within population groups rather than across groups. A “centering in the margins” approach emphasizes the need to examine experiences of racialized and minoritized populations. This proposed study to advance recovery pathways and support services for Black men and women heeds that call. It is directly responsive to RFA-AA-21-001 in its emphasis on health disparities in AUD populations, intersecting with the RFA goals to advance culturally-informed measures and interventions, increase access to AUD services, make services more appealing, and evaluate evidence-based practices. We do this with a focus on Black men and women in AUD recovery. We thus aim to iteratively use quantitative and qualitative methods to capture and assess questions related to AUD recovery in a heterogenous Black population, in partnership with a Black- majority recovery community organization in Detroit. Specifically: (1) Use qualitative methods with a Black population to (a) define AUD recovery pathways; (b) assess and refine a measure of recovery domains (e.g., relationships, living environment); and (c) identify and map community indicators that may facilitate or interfere with AUD recovery. (2) Use quantitative methods to describe and assess the provision of AUD recovery support services provided by the recovery community organization in terms of matching to needs, stage of recovery and other client and community characteristics, by race/ethnicity. (3) Conduct a pragmatic randomized controlled trial that builds on Aims 1 and 2 with a Black AUD recovery population, compared to a treatment as usual group with in-person recovery support services, to determine the effectiveness of an added phone+digital recovery support service intervention (i.e., provision of smartphones and guidance/support for online recovery activities). The proposed study will enable a deep understanding of what recovery means to Black men and women, how it can be measured, and how we can advance recovery journeys of Black Americans with AUD. The results will be meaningful to Black individuals themselves, providers who treat Blacks who have AUD, and to researchers and policymakers who need to better understand the meaning and needs of a heterogenous US population.

Recovery is a dynamic process of behavior change leading to stable improvements in functioning, purpose and well-being in addition to remission from AUD symptoms and cessation of heavy drinking. The proposed study highlights Black men and women and their recovery pathways, provides means for individual recovery support services outside of the formal organization setting, and seeks to understand the recovery organization and community in which these individuals are seeking to sustain their own AUD recovery. By centering our work on the Black population in Detroit, with a Black-led and Black-serving community recovery organization, we will provide both depth and breadth of knowledge that will enable better supports in the future for AUD recovery among Black men and women.