Is It Possible to Stay Clean Without Getting Sober?

Anything is possible, but that doesn’t make it a good idea. Someone can be clean but not emotionally, spiritually, or socially sober.

Physical dependence and substance use disorders are distinct conditions. Physical dependence is not synonymous with addiction. Addiction—or a substance use disorder—is a disease, and physical dependence is characterized by the existence of a withdrawal syndrome due to biological changes caused by the long-term presence of drugs in a person’s system. A physically dependent person might not have a substance use disorder, and someone with a substance use disorder may not currently have a physical dependence.

Addictions are much more than physical dependence or excessive use. Psychologist Mark Griffiths says: “a healthy excessive enthusiasm adds to life whereas an addiction takes away from it.” When a compulsive behavior becomes more of a priority than our responsibilities to others and ourselves, that’s a cause for concern.

For the purposes of this essay, clean is defined as being off “hard drugs” and sober is being off all drugs (alcohol included). Accepting these definitions, is it possible to stay clean without getting sober?

Anything is possible, but that doesn’t make it a good idea. Especially if the addiction is to opioids.

The underlying factors that contribute to a person to developing one addiction can lead them into another addiction. Research has found that the majority of people who are in treatment for drug addiction also meet the DSM-IV criteria for alcohol use disorder. Studies have also found that “comorbid alcohol use disorder [with opioid addiction] increases the risk of fatal overdose and hepatic deaths.”

Most people with a non-alcohol substance use disorder first drank alcohol, the real “gateway drug.” Almost everyone who uses non-prescribed opioids first used other drugs, usually alcohol. The earlier (and younger) intervention can occur, the better the outcomes are with less intensive treatment. A lot of folks are dealing with comorbidity (a substance use disorder and one or more mental health conditions) and proper treatment for mental illnesses is critical. Scientific research is finding more evidence that people with dual diagnoses should have their conditions treated concurrently.

Almost all recovery programs recommend total abstinence from all intoxicating substances for at least the early stages of addiction treatment. Methadone or buprenorphine, when used as directed, do not count as intoxicating substances under this definition. Even moderation management has participants first practice abstinence before attempting moderation. The basic principle is similar to why doctors advise patients with stomach issues to engage in an elimination diet. You have to know your baseline if you want to know how different foods affect your body.

In early recovery, it’s important to not test the waters. Extended abstinence increases the odds of staying in recovery for the long haul. There are “rich patterns of change” that occur in someone’s life over the course of multi-year recovery that influence the odds of long-term sobriety. People can and do relapse after decades of sobriety, but the incidence rate for people who have been sober for five years is drastically lower than the relapse rate for people who have less than a year of abstinence under their belt.

Maintaining continued care after the initial sobering up period helps these individuals manage the underlying factors that contributed to their active substance use in the past. Aftercare can look different for different people. Continued participation in sober communities and peer support groups is common. Like any chronic medical condition, aftercare is important. Those who don’t receive it, or discontinue it, are more likely to slip back into their addictive habits.

Relapse is a normal part of recovery and not uncommon. It’s not a moral failing and neither is it typically a conscious choice. That doesn’t make relapse a good thing, but it does happen. Countering compulsive decision making requires self-awareness. Anything that reduces that self-awareness by lowering inhibitions, like alcohol or marijuana, can put a person at risk for relapsing on other substances. As Jim LaPierre, a licensed clinical social worker, explains, “alcohol reduces inhibitions without concern for whether the inhibition is healthy or unhealthy.”

The first step in 12-step programs says, “We admitted we were powerless over [insert addiction here]—that our lives had become unmanageable.” Unmanageability can take many forms: emotional, familial, domestic, work-related, and more. It is also subjective, to an extent. Many people equate unmanageability with rock bottom. Science has challenged the notion that hitting rock bottom has to come before recovery, but it is still true that most people who get to the point of seeking help have lost the ability to manage important aspects of their lives. Some go through multiple relapses, each worse than the last, before attaining long-term recovery.

Being clean is a term often used to describe when drugs have left a person’s system. In the recovery community, sobriety is considered, to some, being engaged in a program of action and not just a physical descriptor. Someone can be clean but not emotionally, spiritually, or socially sober. This isn’t just a idea borrowed from Alcoholics Anonymous, it’s grounded in evidence-based psychological theories and rigorous scientific research.

Originally published on The Fix.