Measuring Success in Sobriety.

One of the most vexing problems in treating alcoholism is that it is extremely difficult to find reasonable measures of success. Once again, when writing this post I need to point out that I am not an alcoholism researcher. My interest in the subject is as a concerned laymen, and an alcoholic. I am an engineer who does health care research, not a physician, psychologist, or biologist. I’m reasonably educated and informed on the subject matter, but not an expert. Please consider this entirely opinion, not expert testimony.

I am regularly disparaging towards the state of alcoholism research and treatment in the scientific and medical community. This is not because I think that the scientists and physicians who do this work are ill-intentioned, or incompetent. It is because I think that for the most part, people continue to misunderstand the disease of alcoholism, and that non-sufferers may be largely incapable of understanding it. That is not to say that all alcoholics understand it (we don’t), or that we have perfected alcoholism treatment in AA (we haven’t). This disease continues to vex all of us.

The problem with measuring sobriety is that it’s open-ended. For alcoholics, the only way for us to live as successful members of society is in total abstinence. So, the common measures of “duration of sobriety”, “time to relapse”, etc., are utterly useless to us. If I drink again, I will descend immediately to my previous state of desolation and uselessness. We all do. Certainly, there are people who are problem drinkers when young and later learn to moderate. However, once the disease has progressed to dependence, to alcoholic misery, there is no going back, at all.

So, a drug that increases mean time to relapse from 10 days to 20 days is not helpful. And in general, I think methods which attempt to address alcoholism through medical treatment (beyond the acute phase of detoxification), are generally doomed to fail. Because nothing can make us want sobriety. Nothing except reduction to the last, worst place where our souls, our psyches, can no longer tolerate active addiction. And the fact is, many, many, many of us will choose to die rather than recover. All that engaging with the medical apparatus does for those alcoholics is chew up resources that could be spent aiding people with hope.

Recovery begins when we reach out for it ourselves. Legal consequences, health consequences, those things help bring some of us there. But not all of us. Some of us reach out after we lose our families, or our jobs. Most of us require more dire consequences that those. But we all reach the same emotional/spiritual space: intolerable demoralization. And the only emergence from that is total abstinence combined with a wholesale investigation of our selves, abandonment to something greater than ourselves, and commitment to a lifelong program of daily maintenance of our spiritual/emotional/psychiatric condition. Any relapse is death.

Part of the reason that medical/psychiatric treatment of addiction is so ineffective is that the very act of engaging with medical care can thwart progress in sobriety. We alcoholics will seek out any excuse to keep drinking. Any excuse to blame our problems on anything other than our own drinking. Any toehold we can find that allows us to blame someone else for our failures, our feelings, our shortcomings. Frequently, this means the physicians and other mental health professionals who are trying to treat us.

There is no cure for alcoholism. And so, when alcoholics engage with medical care seeking a cure, seeking a way out of alcoholic misery that allows us to either drink normally, or to give up alcohol without effort, without pain, we then use the “failure” of medicine to cure us as an excuse to continue to drink. “It’s not my fault,” we say, “the doctors failed me.” When what has happened is that we tried to find the easier, softer way, of letting someone else relieve us of our own internal burden. We expected a magic cure from a doctor. There isn’t one.

So, even if we achieve some small measure of abstinence by engaging with treatment, or medicine, we end up resentful and embittered, and still wanting alcohol. Because we entered into the treatment not wanting sobriety, but wanting an easy way out. Medicine is capable of allowing us to detox from addiction without dying. But it cannot make us want to be sober people. And it cannot make us take responsibility for our own recovery, and for the damage we did while drunk. But it can enable us, by assuming the responsibility for our failures (in our minds, not in reality, of course.).

Here’s the irony: If we do not want sobriety, medicine will only help us fail. If we truly want sobriety, if we are willing to go to any length to get it, then medical interventions are certainly helpful in detox, and possibly in reducing acute craving in the early stage, in helping to reduce the burden of alcohol dependence. But if we are in that state, then medical interventions are unnecessary, for what we need is willingness to understand that alcohol is not our problem. We are.