Table 4. Summary of key qualitative findings by time point and theme.

Pre-discharge qualitative themes	Prevalent findings	Sample quotes
Fear / uncertainty related to transition to becoming an inpatient or returning home	• Initial adjustment period upon arriving to inpatient facility (new environment, new “rules”—for some, this was while undergoing medically-assisted detoxification and treatment for withdrawal) • This was often followed by an “adjustment” period and developing a level of comfort with the inpatient rehabilitation program routine • Anxiety, excitement, or a mixture of both feelings regarding the transition back home • Particularly among those who had not attempted sobriety before, some degree of uncertainty surrounding not knowing “triggers” to relapse, whereas those who had been sober before often focused on what they would do differently • Regardless of prior experiences with rehabilitation, participants placed a lot of emphasis on maintaining sobriety / managing stress as primary determinants of their success post-discharge	• “It took me a couple of days…to get adjusted…I observe things when I’m around new things or people… just to see how comfortable I can get.” -34 year old African American female, pre-discharge • “I would be disillusioned to tell you I got this thing figured out, or–anything like that…but…I can’t live here forever…” -45 year old White male, pre-discharge
Healthy lifestyle (structure, health behaviors, health information)	• Appreciation of the structure associated with the inpatient facility (regular meal times, normalizing sleep schedules, making time for physical activity) • Those with concerns about their physical health appreciated the clinical / diagnostic tests and receiving information on their health	• “I have more energy… I focus my energy on more positive things…now, because drinking is eliminated, I’m using that…extra energy for good things. I go to the gym, I play basketball out back, I got my bike here on campus, I go bike riding…” -37 year old White male, pre-discharge • “Definitely now at this point, I…feel that I am on the right path. And I just have a new outlook on life. So, that’s where I am now…I’m a different person that I walked in here…30 –uh, 28 days ago.” -53 year old African American female, pre-discharge
Sleep-related behavior (relaxation strategies and sleep hygiene techniques)	• Initiation of bed-time routines or other sleep-related behaviors during the inpatient stay (use of relaxation techniques, herbal / pharmacological remedies, attempting to implement a regular sleep schedule, etc) • Anticipating the continuation of these behaviors post-discharge	• “I go to sleep with…a little bit more contentment…I’ll put it that way…when I get up in the morning, I used to dance every morning in my bedroom. And I haven’t done that in the last three to four years. So, this morning I found myself dancing before I got dressed…that was cool.” -53 year old African American female, pre-discharge • “I’m back into meditation now…and I’ve also got chamomile tea. But I’m looking forward to sleep now. And I’ve got tools to cope with now.” -53 year old African American female, pre-discharge
Mind or thoughts racing	• Racing thoughts / inability to stop thinking, either when trying to go to sleep or as a precursor to drinking	• “I couldn’t really go to sleep ‘cause my thinking was just…here come the thoughts again…a racket going on in my mind.” -55 year old African American male, pre-discharge • “Sleep’s terrible, you know, ‘cause your mind’s racing–with all the things that are really going on…” -47 year old African American male, pre-discharge
Post-discharge themes	Prevalent findings
Transition back home	• Feeling overwhelmed with the stress of “normal” life—including job interviews, family stressors, and other aspects of their lives they had been away from for at least 3 weeks • In some cases, these stressors led to relapse • Finding a job or finding purpose / meaning in other activities (e.g. re-connecting with family or volunteering in the community) were motivators to stay sober • Those who had not relapsed at the time of the second interview were more likely to perceive other aspects of the transition back home more positively • Participants indicated there were both “ups” and “downs” (positives and negatives) related to this transition	• “A lot of times, I think about drinking and things like that, and just–I knew it was wrong, but I still would just follow my impulses. Now, like–I still get cravings every now and then, but every time they go in my head I think about all the bad stuff that happened, and they’ll go away.” -27 year old African American male • “[The] transition was a little rough. I got out…I went to stay with my cousin for a little bit…and then started drinking again, um…so that fell through…I have had one slip-up since I’ve been there…besides that…[I’m] just really trying to focus on sobriety.” -27 year old White male, post-discharge
Lifestyle changes (health behaviors)	• Healthy lifestyle changes mentioned during the second interview included being sober, having non-alcohol methods of coping with stressful situations, losing weight, increased physical activity, drinking less coffee, re-organizing living spaces or finances	• “I’m not waking up looking for the vodka bottle. That’s…the blunt way to put it…I’ve filled my life with other things, and yes, you can still have fun without drinking.” -53 year old African-American female, post-discharge • “I’m eating much better…much healthier. And I’m still exercising almost every day, whether it’s–I mean, just taking a walk–and I think those two things are kind of important, um…at least, an overall balance, and I think–it definitely helps me.” -50 year old White male, post-discharge
Sleep-related behavior (relaxation strategies and sleep hygiene techniques)	• Some participants continued pre-bedtime rituals they initiated as inpatients, including drinking chamomile tea, meditation, calming music, guided imagery, reading, watching TV, and other methods of relaxation	• “I still do try to meditate before I go to bed… and sometimes that… just calms me down, sometimes it doesn’t. It really depends on, I think, what I went through [during] the day.” -49 year old White female, post-discharge • “And I actually went and bought one of the little tapes that they recommended…it’s just got a bunch of, like, sea sounds in it. Bird chirps…” -47 year old African American male, post-discharge
Overarching changes in sleep (since leaving inpatient facility)	• Drunk dreams, dreaming more frequently (sometimes attributed to a change in medication) • Improved sleep (less interruptions, comfortable environment) • Many who had maintained sobriety felt that sleep was more regular / routine • Stress of the transition back home and everyday life potentially led to increased sleep interruptions	• “I will drink and then pass out–it’s not sleeping, it’s being passed out from alcohol being infused into my whole system. And it’s not a deep sleep, it’s more of a knocked out sleep. And then, after a few hours–I mean, this is not eight, nine hours–after a few hours I wake up…I can also tell in my face…when I’m drinking and I don’t sleep well, which is–always happens…I notice bags under my eyes.” -57 year old White female, post-discharge