Qualitative study of 15 adults in AUD recovery finds social norms shaped problem recognition

A qualitative study of 15 adults in recovery from alcohol use disorder found that social and environmental contexts shaped participants’ descriptions of drinking as normal or acceptable and the standards they used to judge whether their own alcohol use was problematic. In their retrospective accounts, participants often did not regard their drinking as problematic when they continued to work, maintain relationships or fulfill daily responsibilities, despite experiencing other negative effects. Researchers recruited participants through recovery networks, substance use recovery centers, treatment clinics and community organizations in the Northeastern United States between June 18 and September 9, 2025.

Eligible participants were at least 18 years old, could complete study procedures in English or Spanish, and self-identified as being in recovery from alcohol use disorder. Sustained remission for at least 12 months was an additional criterion, but abstinence was not required. The sample ranged from 26 to 82 years old, with a mean age of 51.5 years.

Each participant completed a demographic questionnaire and a semi-structured interview lasting approximately 50 to 90 minutes. Ten interviews were conducted in person and five by videoconference; all were conducted in English. The researchers used Braun and Clarke’s reflexive thematic analysis.

Two team members independently coded each transcript, and the broader team reviewed differences in interpretation, refined codes and developed themes. The analysis was inductive, while Social Cognitive Theory and a social-ecological framework provided conceptual background without guiding interview questions, coding or theme development. Five interrelated themes emerged: social normalization and sustained problematic alcohol use; social comparison and minimization of drinking behavior; alcohol-related consequences in relationships and daily life; recognizing problematic drinking amid recognizable consequences; and reflections on reasons for drinking.

The first theme included subthemes describing early exposure to drinking norms and the continued normalization of drinking in adult social life. Across these accounts, repeated exposure to familiar, accepted or visible drinking provided reference points for understanding both what participants considered normal and what they regarded as evidence of a problem. Several participants described alcohol as embedded in family life, peer settings, recreation and everyday adult activities.

One participant said his uncle maintained that a man could drink to the point of being severely impaired as long as he could make it to work the next day, adding, “So, I kind of lived my life like that.” Participants also compared their own behavior with people they perceived as having more severe alcohol problems, including physical dependence, visible impairment, disorganization, housing instability, legal or interpersonal difficulties, and an inability to maintain responsibilities. That comparison commonly included the ability to continue functioning. A 66-year-old man distinguished his drinking from someone who needed a drink to begin the day, explaining: “I would work all day, and then I would drink after work.

The accounts therefore connected continued daily functioning with participants’ tendency to minimize their drinking or distinguish it from an alcohol problem, even when other harms were present. Participants described consequences involving relationships, family responsibilities, legal involvement and housing. These included escalating conflict, unpaid tickets that became warrants, loss of parental rights after a third driving-under-the-influence charge, and repeated movement through homeless shelters.

Problem recognition often occurred when participants’ circumstances resembled the severe and visible characteristics they associated with an alcohol problem. One woman said she realized she had a problem only after becoming homeless and entering a shelter. Another man described passing out in public, waking in bushes and being unable to get home.

A third woman said hospitalization and withdrawal led her to conclude, “I have a problem, I have to figure this out.” Participants also reflected on why they drank, often describing alcohol as a way to manage difficult interpersonal experiences, loneliness, shyness or emotional distress. Support settings such as Al-Anon and periods that provided time and mental space for reflection also created opportunities to consider alcohol’s role.

These accounts do not establish that social circumstances caused problematic drinking or delayed recognition. Instead, they show how participants interpreted their behavior in relation to family messages, peer experiences, social comparison, and the environments in which drinking occurred. The authors propose that prevention and early-intervention efforts may benefit from moving beyond crisis-driven models and examining how people define problematic drinking and the social reference points they use.

They also suggest that clinical assessment and public health messaging may need to challenge the association of alcohol problems solely with severe or visible dysfunction. These are implications proposed by the authors; the study did not test an intervention or its effectiveness. Several limitations constrain the findings.

The interviews captured retrospective accounts at one point in time, which may differ from participants’ views while they were actively drinking. The sample of 15 was suitable for in-depth qualitative analysis but was not intended to be generalizable, and the wide age range may have exposed participants to different social and historical contexts that the study did not analyze. The Alcohol Use Disorders Identification Test was completed retrospectively for the period of heaviest drinking, although its seven-point cutoff had not been validated for retrospective use.

The interviews also did not specifically assess alcohol outlet density, retail access, affordability, neighborhood conditions, employment security or financial resources during problematic drinking, limiting conclusions about structural and commercial influences.

Subject of Research: Qualitative research on how social drinking norms and functional functioning relate to problem recognition among adults in recovery from alcohol use disorder.

Article Title: “As long as you can make it to work the next day”: normalized drinking and problem recognition among individuals in recovery from alcohol use disorder

Article References: Cano, M. T., Rojas Perez, O. F., McCurdy, L. Y., Mistler, C., Paris, J., Ramirez-Hardy, A., & Fucito, L. M. (2026). “As long as you can make it to work the next day”: normalized drinking and problem recognition among individuals in recovery from alcohol use disorder. Frontiers in Psychiatry, 17, Article 1981903. https://doi.org/10.3389/fpsyt.2026.1981903

Image Credits: AI Generated

DOI: 10.3389/fpsyt.2026.1981903

Keywords: alcohol use disorder, problem recognition, drinking norms, alcohol recovery, social comparison, qualitative research, socioenvironmental factors, alcohol minimization, long, make, work, next