Why "Get Sober First" Is Backwards and Wrong

Most addiction/compulsive behavior treatment programs believe focusing on stopping the behavior first is key.

They want to stabilize first, is the rationale.

Well, they're wrong... and they've been wrong for nearly 100 years.

I've written two books on why, and have spent 20 years watching it fail people. And now the research is catching up to what many of us have seen in the room: The order is wrong.

Where the Rule Came From

For the better part of a century, addiction care has run on a simple sequence. First, you remove the substance. Then, once you're stable, you've earned the right to work on whatever pain sits underneath.

The logic seemed sound. Trauma work is intense. Asking someone fragile and newly sober to open their oldest wounds felt risky, like performing surgery on a patient who's still bleeding. So the field built a waiting room and put the pain in it.

Unfortunately, it's also meant that we've ignored the most important factor in a person's well-being (their actual pain) in favor of the part we're most concerned with (their behavior). That's backwards, irresponsible, and borders on unethical.

Think about what that asks of a person. The drinking, the using, the gambling, the compulsive anything—these behaviors usually exist because of the wound. They're the coping mechanism. We take away the coping mechanism, point at the wound, and say, "We'll deal with that later." Then we act surprised when people leave treatment or relapse.

It's the ultimate cart before the horse, and we've been hitching it that way for almost a hundred years.

Then we wonder why more than 90 percent of people fall flat on their face.

What the New Research Shows

A research team in Amsterdam just put the sequence itself to the test. In a randomized controlled trial published in Behaviour Research and Therapy, Faber and colleagues (2026) followed 209 patients with co-occurring posttraumatic stress disorder (PTSD) and substance use disorder. Patients received trauma-focused treatment (eye movement desensitization and reprocessing [EMDR], imagery rescripting, or prolonged exposure) either at the same time as their addiction treatment or after it, in the classic "Get stable first" sequence. Everyone was followed for nine months.

Adding trauma treatment improved exactly the things the old model says to postpone: trauma-related guilt, shame, emotion dysregulation, and overall distress. And simultaneous delivery beat sequential delivery. Every. Single. Time.

Here's the detail that should make you stop ever asking for sobriety first ever again—much of the sequential group's disadvantage came from the waiting period itself. While they sat in the queue being "stabilized," their guilt, shame, and dysregulation stayed right where they were. The waiting room is actually where the damage happens.

In plain terms: The people we make wait don't get better exactly where it matters. They get stuck in an emotional limbo.

And the fear that started all of this, that trauma work would destabilize fragile sobriety? The same trial's primary outcomes, published in Addiction (Lortye et al., 2025), found that adding trauma-focused treatment did not worsen substance use. The danger the rule was built to prevent didn't show up. What did show up was better engagement, with one trauma treatment (imagery rescripting) actually keeping more people in care than the others.

People stay when you treat what hurts.

The Hardest Test Case We Have

Maybe you're thinking this only applies to motivated outpatients in Amsterdam. A second 2026 paper says otherwise.

In the International Journal of Offender Therapy and Comparative Criminology, Ayot (2026) reviewed 24 studies of experiential, emotion-focused therapies (mindfulness, acceptance and commitment therapy [ACT], meditation, creative arts) delivered to incarcerated men, a population carrying some of the heaviest trauma loads we know of. More than 80 percent of incarcerated men report at least one adverse childhood experience. The review found these approaches improved emotional well-being and self-regulation, supported shifts toward a more prosocial identity, and, in several studies, were linked to reduced reoffending.

The review is honest about its limits; study quality varied, and more rigorous trials are needed. But notice the direction. Even in prison, the deepest end of the behavioral pool, what moved people wasn't abstinence enforcement. It was working with emotion, shame, and identity. Who a man believed he was changed before what he did changed.

This Is Bigger Than Addiction

You don't have to struggle with an addiction for this to apply to you.

Every persistent behavior serves a purpose. I call that purpose a hook: the hidden emotional driver that makes a pattern stick.

Take an executive I'll call Rob, who micromanages his team in every important project they take on. His 360-reviews have been calling this out for years. He white-knuckles trust and delegation for three weeks. Then a project slips, and he's back asking for 50 more analyses, documents, and weekend work again. Willpower didn't fail Rob; his need for control and belief that others can't be trusted are controlling him. Take away the incessant task requests and over-reaching, and the pressure underneath simply waits for its next escape.

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Swap the midnight laundry-list emails for gambling, porn, overwork, emotional eating, alcohol, or the way you go cold in intimate relationships. Same mechanism. The behavior is the smoke. Treating smoke has never put out a fire.

That's what both studies are really measuring. Change the underlying emotional reality, the shame, the old wounds, the beliefs about who you are, and the behavior finally has room to change with you.

What to Do With This

If you or someone you love is looking at treatment, ask one question before anything else: "How do you work with trauma and shame, and when?" If the answer is "after stabilization, once they're ready," ask what happens to the pain in the meantime. You now know what the research says happens. Nothing good.

If you're the one struggling, hear this clearly. You do not have to earn healing through suffering first. Working on your pain isn't a privilege you unlock with 90 days of white knuckles. It's the path itself. Start where the wound is, with a professional who will go there with you, and let the behavior change follow.

And drop the shame about past attempts that didn't stick. If you tried to quit a behavior without addressing what drives it, you weren't weak. You were running the wrong race.

Remember This

We've spent a century making people prove they could live without their coping mechanism before we'd treat the pain that made them need it.

It's like taking away someone's crutches after they've broken both their legs and saying, "We'll heal your legs once you prove you're ready to walk."

You don't get better so you can finally heal. You heal, and that's how you get better.

What's the pain you've been told, or told yourself, to deal with later?