Costs To Abstinence & How To Deal With Them

Further Reading

Are there costs to abstinence and how do you deal with them?

Stanton:

I had a husband (now an ex) who was a long time user of alcohol and pot. He was a genial soul when inebriated but became quite angry when he quit. Or rather I forced him to quit because I was afraid it would kill him. So angry we are no longer a couple.

My brother described to me a Chief of Police in the little town where he lives who became angry terror when he was forced to sober up.

I recently had a young couple I bailed out of jail stay with us until his court appearance. The young man became angrier and angrier. He said that he badly wanted to get high. That he remembered how happy he had been as a kid. Nothing got to him and he was always high.

And my own son who started secretly drinking when he was very young recently told me that he drinks because he loves everybody when he is slightly drunk. But he hates everyone when he is sober.

What is going on here?

Something common to all four?

Elizabeth

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Dear Elizabeth:

You certainly give the other side of the picture. If, as I maintain throughout my site, people use substances to fulfil internal and environmental needs, then in some sense their use is functional. They are getting something from it. In some cases, what they get is crucial. In some cases, possibly, what they get is useful.

Of course, the reason you wanted your husband to stop drinking was because it was damaging his health. The mark of an addiction is that, as a price for getting a sense of well-being and other experienced benefits, some people give up quite a lot. Moreover, they may lose whatever ability they initially have to bring about the feelings they seek without assistance of a substance. (Notice that this same description applies to use of psychoactive pharmaceuticals, such as antidepressants.) The substance use becomes self-perpetuating and essential to their functioning.

The answer I seek is to help people gain the benefits they experience from drinking or drugs without them. For example, John Lennon was cowed by Yoko Ono. But, when he drank with her at dinner, he would start to berate her. The key here is to see the function the drinking served, and to work to be able to accomplish what drinking freed John to do — express his feelings. Obviously, he could learn to do that in a more constructive way. (This is the purpose of marital-negotiations types of counseling with alcoholics and their spouses.)

Your insights and the cases you recount are fresh and important, however. They help to illustrate the ways in which substances serve a function for people. The experiences you recount show the need for a balanced approach, for a recognition that people are pursuing positive experiences, although they may sometimes lose their way. They show that it does little good to demonize drugs and alcohol; such an approach makes no sense to the person, who is after all experiencing certain benefits from substance use. And your stories show just how complicated life is and how difficult it is to roll up all substance use in a simple medical solution.

Stanton

The classic statement of the negative consequences of abstinence for the problem drinker/alcoholic is D.L. Gerard, G. Saenger, & R. Wile, 1962, “The abstinent alcoholic,” Archives of General Psychiatry 6:83-95. While somewhat dated, it remains a fascinating piece of research.