Sobriety vs. Abstinence.

Alcoholism is a pernicious disease. I’m sure I haven’t broken any important medical ground in asserting that. Untreated it’s fatal, remission is rare, relapse is common. While remission is not unattainable, it is enigmatic. I know of no predisposing factors which indicate who will eventually seek treatment and who will not. I know of no intrinsic variables associated with sustained remission. There are a few studies (Cross et al 1990) which show that involvement in Alcoholics Anonymous and, in particular, sponsoring other people in the program are associated with sustained remission. However, association is not causation, and it remains unclear why some people recover and some don’t, and how to aid people suffering from active addiction to seek treatment. After all, resistance to treatment is a signature symptom of the disease. A good source for the current state of alcoholism treatment is Jacobson’s Masters Thesis (2010).

But now, I have to abandon the language of science and start speaking the language of recovery. Because I am strongly unconvinced (I think some people refer to this state as “doubtful”) that science will ever succeed in finding any cure for alcoholism. Alcoholics will never be turned into normal drinkers. Because we don’t want to be. I’m fond of saying in meetings: “If I could drink normally, I’d get drunk all the time.” I hold out a bit more hope that science will find effective ways to help people who do not want to drink to not drink, and in fact we already have, and they’re useful. But frankly, we don’t need much more of that. Because the problem, after the first little while, isn’t the craving. It’s the mental illness that tries to convince us that we do not have a mental illness.

Nevertheless, many millions of people have given up drinking. And as I’ve said before and will again, Alcoholics Anonymous is by no means the only way to do so. It is, however, in my experience (and with some scientific evidence to back it up), an effective means of doing so, with the big flashing red qualifier: for those with a desire to stop drinking. People who do not have an honest desire to stop drinking are unlikely to achieve sustained remission.

I keep using the word remission here for a couple of reasons. One, it’s the medical term for a person who, after a period of alcohol dependence, is no longer alcohol-dependant. Technically, it refers to freedom from symptoms of the disease, which in the case of alcoholism is the intake of alcohol. And two, it lumps together the two types of recovery that I’m aware of, which are in the title of this post. Sobriety, and abstinence. These are two very different types of recovery.

In the program, we refer to sobriety to mean sustained remission from both the physical act of drinking, from the intake of alcohol, and also from the mental obsession of the drink, from the restlessness, irritability, and discontentedness that are attendant to the general affect of a person afflicted with alcoholism. We cultivate sobriety by taking the twelve steps, by being accountable others in the program, and by passing on what we have learned to new people, who are struggling to find relief from alcoholism and relief from the deplorable conditions that require alcoholic obliteration.

Abstinence is the state of refusing to drink. If you go to meetings, you’ll hear this condition referred to also as “dry-drunk” (And of course, different people use words differently. I can’t speak for everyone in AA. See the About page for disclaimers.). Many people who come through the doors of AA are recalcitrant to taking the steps. I’ve heard essentially every excuse under the sun. They’re too hard, they’re bullshit, they’re only for stupid people, they’re only for smart people, they’re not relevant to me, I just drink too much, I don’t need a sponsor, I don’t believe in god, etc., etc., etc.. It is rare to see those people in the meetings for long. They can usually talk themselves into a drink very rapidly. But not always. there are a few people who steadfastly refuse to embrace the program, but consistently participate in meetings.

But I wouldn’t want to be one of those. They tend to continue to exhibit all of the old behaviors of a drunk, except the drinking. They are angry, miserable, ashamed, vicious. We don’t call this condition sobriety, because these people aren’t really sober. They’re just not drunk. And they’re not the only ones. People like me, who have done the steps, and who are current with their sponsors, will sometimes get complacent. Stop going to meetings. Stop doing regular inventory. Stop admitting it when they’re wrong. Stop making amends when they hurt people.

There was one such man who spoke at my Sunday morning meeting yesterday. He hasn’t had a drink since 1994. But from about 1998 to 2009, he didn’t go to meetings, and he was miserable as hell for a decade. Even though he didn’t drink. He came back in 2009, and I was actually at his first or second meeting back. I had thought he was new to the program. He looked just like the disheveled and miserable alcoholics who come through the doors a day after a vicious bender. He was angry, and depressed, and sullen. I only found out yesterday that he had been sober for 15 years at that time. It astonished me.

And it frightened the hell out of me. Because I’ve been miserable. In addition to alcoholic misery, I have suffered from major depression. I’ll write about that another time, and its behaviors and difficulties. I know that I could fall into a soul-dredging blackness in short order if I don’t do the work I need to do to keep up my daily condition. Because while I am in sustained remission from alcoholism, I am not immune to relapse. And I am not immune to slipping from sobriety into mere abstinence. To falling from my general disposition of basic contentedness confronting life on life’s terms to a howling misery as I fling myself against barriers I have no hope of surmounting.

I maintain my sobriety through careful and regular examination of my condition, motives, efforts, and engagement with the program. I find myself wanting at times. But failure doesn’t bother me. Failure is how I learn. And I have placed a vast field of obstacles between myself and the failure that truly matters: inebriation. I’ve been spending a lot of time speaking with someone very new to the program lately. I hope it’s done the person some good. They seem to be doing very well. But what I can tell you for certain is that it has done me a great deal of good. Because I am reacquainted with all of the difficulty, confusion, insanity and compulsion that goes along with separating ourselves from active addiction.

And I am reminded that my problem is not alcohol. Alcohol was how I tried to solve my problem. And while I cannot safely consume any alcohol, because I am addicted to it, the real source of my sobriety is in the daily maintenance of my condition, so that I can confront the world in a state of peace, even in the maelstrom. So that I can stand in the roaring hail of stillness, and calm the storm of my mind.

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Cross, G., Morgan, C., Moony, A., Martin, C., & Rafter, J. (1990). Alcoholism treatment: A ten-year follow-up study. Alcoholism: Clinical and Experimental Research, 14, 169-173.

Jacobson DK, “Factors contributing to long term sobriety following treatment for drug and alcohol abuse”, Masters Thesis, California State University, Long Beach, School of Social Work, August 2010