Unconventional Wisdom: The Cost of Sobriety

A friend of 30 years recently celebrated one year of not drinking. She was a “functional alcoholic.” Every night, she drank at home by herself to the point of intoxication, but managed to hold a job and pay her bills. She got into a rehab program after her family staged an intervention. Even though she says she doesn’t want to drink anymore, she frequently voices anger at her family and, more indirectly, at me for confronting her about her past drinking. I was not part of the intervention, but I did tell her I was worried about her drinking. It seems to me that a person who’s sincere about staying sober would be grateful to the people who cared enough to encourage her to get help. She is not involved in any aftercare or AA, and I really don’t understand her continued anger toward her family and me.

Confrontational gang-ups are not the way most people like their encouragement served. Real encouragement reinforces what is best in a person, not shoves her nose in what is worst. Your friend perceived the intervention—but not its goal—as negative and dehumanizing, and considerable evidence supports her view. A look at the psychological realities of interventions clearly suggests why any self-respecting person might experience lingering anger over being force-fed unasked-for advice, and told that she is unacceptable as she is, defective in some profound ways, and blind about herself, and that everybody else in the room is more enlightened than she is. Most interventions proceed by labeling someone an addict or alcoholic; to sum up a person’s entire being in one pejorative label not only diminishes the whole of a life but makes the problem behavior feel eternal and inescapable. Confrontational methods are practiced nowhere else in the world—for good reason. Interventions are deeply humiliating. They imply a moral and psychological superiority among those staging the intervention. They remove a person’s autonomy and induce shame and guilt—feelings that actually reduce the likelihood of change.

In 2007, psychologist William Miller and consultant William White reported that “decades of research have failed to yield a single clinical trial showing efficacy of confrontational counseling, whereas a number have documented harmful effects.” Interventions actually increase dropout rates from treatment programs and precipitate more and faster relapses. Interventions generally rest on a series of mistaken beliefs. One is that a person would never stop drinking on her own—when, in fact, government data show that three-quarters of alcoholics recover without professional help. Another mistaken assumption is that drinkers are always defensive about their problem, so that gentler methods of approach would not work. Interventions also rest on the mistaken assumption that everyone knows better than the drinker what she is doing—in fact, there is the presumption that the drinker is out of touch with reality and deluded about the nature of her “problem.” The implication that others are authorities on the drinker and drinking compounds the humiliation.

Research points to a better way to stir a person’s own motivation for change. Motivational interviewing is one such approach. It’s gentler, more empathic—more in keeping with current knowledge about how people change.

Your expectations about gratitude are misplaced. Your friend has demonstrated sincerity about being sober by stopping drinking—the only measure that matters. Further, despite the humiliation to which she was subjected, she may feel grateful in her own, silent way. AA is hardly the benchmark of sobriety. Failure rates are high. Nor do many people feel comfortable subscribing to powerlessness..

One element that makes friendship so rewarding is the equality of the relationship. Anything that unbalances the equality is bound to have lingering effects on the friendship. Offering unsolicited advice is dicey under the best of circumstances. Caring might have been better demonstrated through researching and finding methods of approach to problem drinking that maintain a person’s dignity and sense of choice. Humiliation never communicates caring.