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

The research team, led by Anna Preece, a PhD student at Bournemouth University, conducted a scoping review of 44 previous studies to understand how common this overlap is and what psychological mechanisms drive it. Scoping reviews of this kind are a valuable tool in health research because they map the breadth of existing evidence across many separate studies, allowing researchers to identify patterns that no single investigation could reveal on its own. By synthesising findings from dozens of clinical and community samples, the team was able to build a picture of how frequently eating difficulties appear among people with alcohol problems, and to explore the shared roots of the two conditions.

What emerged from the analysis was a consistent set of underlying difficulties that appear to fuel both conditions. The researchers found that disordered eating and problematic alcohol use are often rooted in the same psychological vulnerabilities, particularly difficulties regulating emotions, low self-esteem, and impulsive behaviour. This shared foundation helps explain why the two problems so frequently travel together. Someone who struggles to tolerate distress may reach for alcohol in one moment and restrict food, binge, or purge in another, with each behaviour serving a similar function of managing overwhelming feelings. Impulsivity, meanwhile, is a well-documented risk factor for both substance misuse and certain eating disorder presentations, creating a further point of convergence.

Among the eating disorders identified across the studies reviewed, bulimia nervosa was the most frequently reported. This is a significant detail, because bulimia nervosa is characterised by cycles of binge eating followed by compensatory behaviours such as vomiting, laxative use, or fasting, and it is strongly associated with emotional dysregulation and impulsivity. Its prominence in this literature reinforces the idea that the same psychological processes underpin both conditions. It also carries clinical implications, since bulimia can cause serious physical harm, including electrolyte imbalances and cardiac complications, which may be compounded by the physiological effects of heavy alcohol use on the liver, digestive system, and nutritional status.

The review’s central criticism is directed at the architecture of healthcare itself. Support for eating disorders and support for alcohol recovery are separated in healthcare systems, typically housed in different specialist services with different referral routes, assessment tools, and treatment philosophies. A patient who presents to an alcohol service will usually be assessed and treated for their drinking, while their relationship with food goes unexamined. Conversely, someone who reaches an eating disorder service may not be asked in detail about their alcohol use. Preece argued that treating the two as distinct problems does not reflect the reality of many people’s lives, noting that healthcare systems have well established recovery programmes for alcohol problems and disordered eating, but that many people with alcohol problems also struggle with overeating, restricting what they eat, or using food to cope with their emotions.

The consequences of missing this link can be serious. The researchers warn that failure to identify the connection earlier can make it harder for a patient to recover and can increase the risk of leaving treatment early. Disengagement from treatment is a persistent challenge in addiction care, and unaddressed comorbid conditions are a known contributor. If a person completes an alcohol programme while their disordered eating remains untouched, the coping mechanisms that drove both behaviours may simply resurface in the surviving condition, undermining the durability of recovery. Conversely, an untreated alcohol problem can sabotage progress in eating disorder treatment, since intoxication impairs judgement, disrupts eating patterns, and damages the therapeutic work of rebuilding a healthy relationship with food.

The findings also raise pointed questions about treatment models that focus solely on alcohol abstinence without considering a person’s relationship with food. Preece cautioned that abstinence-focused approaches could inadvertently reinforce someone’s restrictive eating habits, and she called for more research into integrated treatment for both conditions. This concern highlights a subtle but important clinical risk. Some people in early recovery report substituting sugar or other foods for alcohol, and while improved nutrition is generally welcome, an unexamined shift toward rigid restriction, bingeing, or compensatory behaviour can entrench a new disorder in the space left by the old one. Without routine screening for eating behaviours, clinicians cannot distinguish a healthy dietary improvement from the emergence of a harmful pattern.

The review complements a parallel project led by Preece’s PhD supervisor, Dr Chloe Casey, a Lecturer in Nutrition and Behaviour at Bournemouth University, which explores how support with healthy eating can help people recovering from alcohol addiction. Working with the recovery charity WithYou and the Friendly Food Club, Dr Casey has run cooking courses for people with alcohol problems in the Bournemouth area. Early findings from that project have been encouraging, with participants reporting that the physical and mental health benefits of a healthy diet are supporting their recovery. Dr Casey explained that people’s relationships with food and alcohol are closely connected and that both can become ways of coping with life’s stresses, so when people seek recovery support they may need help with their relationship with food as well. She described how seeing this pattern within her own family inspired her to explore how healthy eating can be better supported alongside alcohol recovery.

While the authors acknowledge that more research is needed into joint treatment plans, they recommend a practical first step: alcohol support services should ask people about their eating behaviours early in the recovery process. Screening does not require new specialist infrastructure, only a change in the questions that are asked at assessment and follow-up. As Preece concluded, healthcare services are organised around diagnoses and specialties, but patients are not, and if alcohol services ask about alcohol but not eating, they may be missing a significant part of the problem. The study, published as a scoping review in the Journal of Eating Disorders, adds to a growing body of evidence that comorbidity is the norm rather than the exception in mental health and addiction care, and that services designed around single diagnoses will inevitably leave part of each patient’s struggle unaddressed until assessment practices catch up with the reality of lived experience.

Subject of Research: Comorbidity of disordered eating behaviour and alcohol use disorder

Article Title: Health services may be missing the link between alcohol problems and eating disorders, study suggests

Article References: Health services may be missing the link between alcohol problems and eating disorders, study suggests. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: eating disorders, alcohol use disorder, comorbidity, bulimia nervosa, scoping review, Bournemouth University, Journal of Eating Disorders, alcohol recovery, mental health services, emotional regulation, nutrition, screening