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.
