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Key points
- Short-term sobriety is defined as a minimum of two years without use.
- The more time someone spends in active treatment, the more likely they are to remain sober.
- Research shows that genetics play a significant role in addictive behavior.
This past weekend, we woke up to the devastating news that beloved "Friends" actor Matthew Perry, who had long struggled with addiction, was found dead in the bathroom of his California home. Police quickly assured the public that there were no signs of foul play while simultaneously assuring the public that no official cause of death would be announced for quite some time.
The absence of a clearly worded explanation for the loss of yet another public figure has placed a rather large, loud spotlight on the lonely question of addiction:
"Who gets sober, who stays sober, and why?"
Short-Term Sobriety
Short-term sobriety, defined as two years and under, is correlated with being in formal treatment for addiction,1 length of time in treatment,2 and participating in a 12-step program, such as Alcoholics Anonymous (AA), both during and after treatment. What does this mean exactly?
What is formal treatment for addiction? This is a treatment that first prevents someone from using their substance of choice and then provides information about the harm of using.
A tremendous amount of research demonstrates that the more time you spend in formal treatment—especially inpatient rehabilitation and intensive outpatient programming (3 or more days a week of intensive psychoeducation), the more you improve your odds of staying sober.
Time and time again, studies across the globe consistently report that people the more time people spend in treatment, the more likely they are to get sober and to stay sober, in both the "short-term" goal of two years, as well as in the long-term goal of beyond those two years. And in case it wasn't already obvious, the only way to get to long-term sobriety is to first achieve short-term sobriety.
Are Your Parents to Blame for Your Addiction?
Matthew Perry was just one of many celebrities whose weekly whereabouts would alternately display their shiny, happy mugs and/or much less happy mugshots splashed across tabloids. If it seems like some people can't catch a break when it comes to breaking free of their addiction, according to science, many people have their genetics to blame.
It has long been established that the genetic code you inherit from your parents can contribute almost 50 percent of the genetic code3 that determines your likelihood of being predisposed to alcoholism, a number that is influenced by whether one or both of your parents is an alcoholic.
These studies compared the effect of biological parents versus adoptive parents as a way to parse apart the influence of the environment of being raised by an alcoholic parent versus the influence of sharing the same genetic code as an alcoholic parent.
In addition, over the past 20 years, several studies have identified specific genes that metabolize alcohol and are associated with potential risk of alcoholism in the individuals who have these particular genes,4 as well as a gene that identifies individuals who are more likely to consume a greater number of drinks in one sitting.5
A 2011 study sought to examine a specific genotype known as ALDH2 and found that in cisgender women, the age of onset of alcoholism was significantly younger in those whose ALDH2 was inactive, and higher in those individuals with active ALDH2.
What does this mean?
Investigators hypothesize that something about the ALDH2 genotype prevents the early onset of female alcoholism. The same difference was not found in male counterparts.
Another interesting finding that came from this research was that females with the inactive ALDH2 genotype were more likely to suffer from major depression, eating disorder, panic disorder, and borderline personality disorder. Once again, males demonstrated no significant differences.
How Do We Achieve Long-Term Sobriety?
Most of the research on sobriety has targeted 12-step self-help groups, the mothership of which is the well-known Alcoholics Anonymous. But, does it work? Does AA lead to long-term sobriety?
The answer is more complicated than you might think.
A large body of research exists examining—and proving—the efficacy of AA for sobriety. However, it is important to keep in mind that there are very few other groups that boast of the same sample size, who are quite comfortable labeling themselves an alcoholic and willing to talk to strangers about a disease that has torn apart their lives. A 2011 study by Krentzman, Robinson, et al. sought to answer the question of why some people chose to continue going to meetings even after they achieved short-term sobriety.
The answer was more negative consequences of drinking and more positive associations with God and/or spirituality. Interestingly, as of 2019, 73 percent of addiction treatment programs in the United States used a spiritual component,6 the majority referencing God or a Higher Power.
But, for some people—especially those who are younger, less religious, and less observant of Judeo-Christian religions—the idea of handing over your free will to someone else, no matter how all-powerful and all-knowing this Higher Power might be, is an incredibly tough pill to swallow. Especially if you are the kind of teenage or 20-something or even 30-something mostly grown-up child whose parents have spent an eternity giving you pep talks about how you can be anything you want to be if only you try hard enough or put your mind to it.
But...what if your parents were wrong?
What if the answer to long-term sobriety is simply accepting that you are powerless against your addiction?
The Addicted-Self Model
The Addicted-Self Model operates under the belief that the only way to get rid of an addiction is to accept the fact that you have no control over your addiction, that there can be no middle ground of light or moderate use, and that there will never be a time in your life when you will be able to safely use again.
Sure, for many people in the beginning stages of accepting that they have an addiction or just beginning to accept that this problem is not a temporary phase they are going through, accepting the permanence of this trait, rather than a temporary state of being, is going to be an enormous mouthful to swallow. However, the idea behind the Addicted-Self Model is that alcoholism, like many other diseases, is a physical ailment—one that there is no cure for, only treatments that can help alleviate the symptoms. And one of those treatments is to simply (or not so simply) avoid consuming alcohol or whatever substance is the object of the addiction.
This model is very much one of tough love: The fact is, you have this disease, you must avoid this triggering object/drug for the rest of your life. Although it sounds easy on paper, it's not at all easy when you're watching a loved one go through it.
References
1. Prendergast M, Anglin MD, Maugh T, Hser Y. The Effectiveness of Treatment for Drug Abuse. National Institute of Drug Abuse; Rockville, MD: 1994.
2. Fiorentine R, Hillhouse M. Self-efficacy, expectancies and abstinence acceptance: Further evidence for the Addicted-Self model of cessation of alcohol and drug-dependent behavior. American Journal of Drug and Alcohol Abuse. 2000b;26(4):497–521.
3. Verhulst, B., Neale, M. C. & Kendler, K. S. The heritability of alcohol use disorders: a meta-analysis of twin and adoption studies. Psychol Med. 45, 1061–1072 (2015).
4. Quillen, E. E. et al. ALDH2 is associated to alcohol dependence and is the major genetic determinant of “daily maximum drinks” in a GWAS study of an isolated rural Chinese sample. Am J Med Genet B Neuropsychiatr Genet. 165B, 103–110 (2014).
5. Kapoor, M. et al. A meta-analysis of two genome-wide association studies to identify novel loci for maximum number of alcoholic drinks. Hum. Genet. 132, 1141–1151 (2013).
6. Grim BJ, Grim ME. Belief, Behavior, and Belonging: How Faith is Indispensable in Preventing and Recovering from Substance Abuse. J Relig Health. 2019 Oct;58(5):1713–1750. doi: 10.1007/s10943-019-00876-w. Erratum in: J Relig Health. 2019 Aug 21;: PMID: 31359242; PMCID: PMC6759672.
7. Kelly JF, Bergman BG, Fallah-Sohy N. MECHANISMS OF BEHAVIOR CHANGE IN 12-STEP APPROACHES TO RECOVERY IN YOUNG ADULTS. Current Addiction Reports. 2018 Jun;5(2):134–145. DOI: 10.1007/s40429-018-0203-1. PMID: 30416931; PMCID: PMC6224158.
