Advancing Quality of Life in Addiction Research: Historical, Conceptual, and Theoretical Considerations

The landscape of Quality of Life (QoL) and well-being has markedly progressed over the last few decades. Pioneering work on the multidimensional measurement of well-being is located in two research movements in the mid-1970s, namely, the social indicators movement and QoL. The history of the concept of well-being in these movements followed two distinct pathways. The notion of QoL comprised the measurement of ‘material’ and ‘nonmaterial’ (psychosocial) features of life within populations; the latter was subsequently termed ‘personal well-being’ and widely endorsed across disciplines. QoL in the medical sciences and public health was developed in the 1940s, when social scientists underscored the psychological and social drivers of health during World War 2. This established the field of Health-Related QoL (HRQoL), advanced by the World Health Organization’s (1948) definition of health as more than the absence of disease. Convergently, the social indicators movement has its roots in the American Academy of Arts and Sciences for the National Aeronautics and Space Administration, which culminated in Bauer’s (1966) renowned volume Social Indicators. A key function of the system of social indicators was to determine and predict trends in social change and monitor the content and social impact of social programmes. Social indicators advanced individuals’ subjective evaluations of different components of their lives, to complement existing objective measures for policy decision-making. Various types of data were required to make sense of these ‘complex social realities’. Theory and research endeavours in the field of well-being shifted from objective notions of survival to those focusing on QoL. This gave rise to the concept of subjective well-being (SWB), a component of QoL, defined as people’s affective and cognitive evaluations of their lives. While there has been a burgeoning interest in empirical research on QoL in general and SWB in particular, there has been less focus on theories of SWB. There is an absence of a recent comprehensive review synthesising contemporary applications of theories of QoL. There is also a substantial deficit and knowledge gap in empirical and theoretical QoL research in the field of addiction. While medical and public health research has seen shifts from the traditional paradigm of evaluating interventions and disease-specific outcomes to a new paradigm that includes a consideration of QoL outcomes, the field of addiction has noticeably lagged behind. In the context of the current Handbook, the chapter aims to address this deficit, premised on the notion that the addiction field has reconceptualised the notion of recovery to include both abstinence and improvements in overall functioning and QoL. The chapter comprises three parts. In the first part, we provide a history of the concept of QoL in general, distinguishing between the HRQoL and the social indicators traditions. In the second part, we synthesise various theories of QoL, and finally we provide considerations for QoL and addiction research more broadly.