To Count or Not To Count? The Pros and Cons of Counting “Sobriety” Days

To Count or Not To Count?  The Pros and Cons of Counting “Sobriety” Days

“How much time do you have?” is the question you almost always get when you walk into an Alcoholics Anonymous meeting.  Some meetings even start with members introducing themselves by first names and their sobriety dates, meaning the last day they consumed an alcoholic beverage, or for some “a drink or a drug.”

What counts as a drug is not entirely clear, since while AA as a whole discourages members from “playing doctor” in its pamphlet “The AA Member – Medications and Other Drugs,”1 many AA members still discourage the use of prescription psychiatric medications, and most highly respected rehabs consider legal medications such as benzodiazepines “drugs” and those who use them “not sober.”  Narcotics Anonymous famously does not consider anyone on Medication Assisted Treatment (MAT), the medically recognized gold standard for opioid dependence treatment, “clean.”  Meanwhile, caffeine, sugar, and one of the deadliest drugs of all, nicotine, are regularly consumed and encouraged within “the rooms.”

Still, it is long standing practice to count sober days, celebrate anniversaries with coffee, cake and coins, and even call the day you took your last drink or drug a “birthday.”  Every year in September, National Recovery Month, my Facebook feed is full of people posting their sobriety dates.  Newcomers to AA wait eagerly for their 30 day coin, then 60, then 90.  The feeling of achievement from going 90 days without a substance that you once could not imagine even a day without is amazing.

Many jobs, especially in the recovery treatment industry, require counting.  If you go to the websites of most any major treatment center, you will see a phrase like, “If in recovery, two years of continuous sobriety preferred.”

Why Counting Counts

The reasons for counting vary, but the most obvious is that not wanting to lose “time” can provide a reason to stay away from that first drink or other drug that could lead to more.  Seeing those days of sobriety rack up on the Sobriety Calculators that are now on many people’s phones can be gratifying, and keep people motivated to do what it takes to achieve their goals.  Reporting sobriety time in meetings can be a happy occasion.  The congratulations one receives on every day, every month, and every year may be the only positive reinforcement that some people get when their lives have been so destroyed by the wreckage of drug use and the stigma around it that they feel proud of little other than their “time.”

But What Happens When You Slip?

Almost everyone slips.  In AA, there is no difference between a slip, meaning one drink or even a few sips, and a full blown relapse.  SMART Recovery makes this difference very clear: a brief slip need not turn into a full blown relapse.2  A relapse is a return to problematic use behavior that has very negative health, social, and/or employment consequences.  SMART stresses that the guilt over a slip can turn into a full blown relapse if a person views a lapse as a personal failure.  This is what Alan Marlatt called the Abstinence Violation Effect.3 Rather, it should be seen as an opportunity for learning about triggers and planning for how to maintain abstinence in the future.2

The Alcoholics Anonymous Approach to a Slip:

In AA, even a few sips of alcohol is regarded as a relapse.  Even a person with 30 years continuous abstinence from alcohol is considered a “newcomer” if they drink even one drink.  You “lose all your time.”

That requires going back to Step One in the Twelve Step process, a process undertaken at least once by serious AA members and often repeatedly over a lifetime of AA participation.

Why, I asked, does one sip of alcohol or one drink, require going back to the beginning?  Do you really lose all you’ve gained in recovery as a result of one moment, even if no harm (such as drinking and driving or hurting self or others) came from it?

Since there is no central authority in AA that adjudicates such matters, I posed this question to AA members.  Here are some of the answers I received:

“The rationale is that if you have taken 1 drink, you don’t believe you are an alcoholic. You don’t believe you are powerless over alcohol.  If you go back through Step One, hopefully the evidence will suggest that you are and therefore you will not risk yourself again.”

In response to my second question, “How do you respond to those who say that taking a sip or two of a drink should not cause them to lose all their time and endure the public humiliation of going back to step one and identifying as a newcomer?”

The answer I got was: “I would simply say that pride and dishonesty kill alcoholics. Go to the meeting, admit exactly what has happened and get the help you need. You are in trouble spiritually just as much if you take two sips as if you go on a full blown bender.”

I followed up with: “What do you say to the people who say that a few sips has caused no harm, especially if the person poured the rest of the drink down the drain, but that the sense of failure can cause the person to keep drinking because they’ve already ‘lost their time?’”

The long term AA member responded: “They are responsible if they have a sense of failure – no one else is responsible for their feelings. Don’t try and blame it on AA because the suggestion of AA is entire abstinence and they haven’t been able to keep to it. In terms of the one sip: a relapse is about a lot more than just taking a drink. If you take a sip you are in just as much trouble spiritually as if you drink a bottle. In fact, maybe more because there seems to be totally denial of the severity of what has happened. For an alcoholic to risk sipping a drink they have to be very spiritually unwell.”

But I Thought an “Alcoholic” Couldn’t Have Just One?

It’s a common theme throughout the Big Book and AA meetings that once one is an “alcoholic,” it is impossible to maintain control of alcohol consumption after even one drink.  If this were the case, then counting days and living in fear of losing time would be rational behavior.  Anyone who gets to the stage where alcohol or other drugs threaten their health, relationships, livelihood and even safety and freedom does not want to risk losing control again!

There is, however, no scientific evidence to support this belief.  On the contrary, the National Institute on Alcohol Abuse and Alcoholism reports that “Twenty years after onset of alcohol dependence, about three-fourths of individuals are in full recovery; more than half of those who have fully recovered drink at low-risk levels without symptoms of alcohol dependence.”4  On the basis of a multiwave study surveying thousands of people, the governmental authority charged with studying alcohol use disorders has concluded that the vast majority of people who were ever alcohol dependent do recover, and of those, more than half drink safely.4  So it is simply not the case that people who have been alcohol dependent can never control their drinking.

The belief that an “alcoholic” loses control can, however, become a self-fulfilling prophecy.  According to the developers of the Self-Stigma in Alcohol Dependence Scale (SSAD), a survey designed to measure the degree to which one identifies with negative stereotypes about those who drink too much and how much harm these beliefs do to the person’s self-esteem, the worse you feel about yourself because of your drinking, the less likely you are to be able to refuse a drink.5

A Different Approach:

Tom Horvath, PhD, , founder of Practical Recovery and President of SMART Recovery for 20 years, said this of counting days: “In SMART, I have observed that most seem to count, but in their own fashion. So I hear statements like ‘I started my journey about three years ago. I’ve had two relapses and three slips along the way. I can’t guarantee that there will be no more slips in the future, but I think I’m past the relapse stage. And I still use pot sometimes, but I was never concerned about it to begin with. Someday I may attempt moderate drinking, but my plan for now is no drinking.’”

Kenneth Anderson, MA, is the founder and Executive Director of Harm Reduction, Abstinence and Moderation Support, an international organization dedicated to helping people change their drinking.  HAMS supports all goals, from complete abstinence from alcohol to moderation to safer drinking.  On counting, Anderson said, “In HAMS it is up to the individual to decide whether or not s/he wishes to count days. Some people find it a useful tool and we support them in choosing to count and post their counts if they so desire. Other people find it counterproductive and we support that decision, too.”

When Does Counting Help, and When Does It Hurt?

Practically speaking, a person should count days if it helps them achieve their goals.

Counting helps when:

  • It provides motivation for sticking to one’s plan.
  • It gives a sense of achievement for achieving one’s goals.
  • If a person decides to share their count, they enjoy social support and encouragement.
  • The individual is counting out of excitement at beginning a new life, not fear of falling back into old patterns.

Counting hurts when:

  • A slip becomes a full blown relapse because the person figures, “I’ve lost my time anyway, may as well go all out!”
  • Fear of public humiliation deters a person from seeking help and support after a slip or relapse.
  • Counting is imposed by an outside authority, which will eventually lead to rebellion.
  • A person bases their entire self-worth on the number of days on the sobriety calculator or the number of AA/NA chips collected. Just as dietitians recommend against basing feelings of self-worth entirely on the number on the scale, professionally trained therapists (not those whose only training is participation in 12 Step programs) warn against believing that more sobriety equals being a better person.  Or worse, that having a drink or drug reduces a person to worthlessness.  Such feelings can lead to severe relapse and even suicide.

So Should I Count?

Should you count?  What should you count?  Who should you tell about your count?

It’s up to you.  Unless you are in a program where you are drug tested on a regular basis and required to share your count with someone to stay out of jail or maintain your professional license, you are under no obligation to count.  Almost all “sobriety dates” are self-reported, and I’m sure I’m not the first to wonder if everyone who reports many years of “continuous sobriety” in or outside of AA is telling the whole truth.

If you love waking up in the morning to see the number on your sobriety counter go up, if you’re committed to abstinence and have a clear vision of what that means to you, and if you have a plan to survive a slip without losing your self-esteem, then by all means, count.

If you’re counting because your parents, spouse, boss, doctor, or AA sponsor and home group expect you to, you’re probably being set up for failure.  If you wake up in terror that you drank the night before, even though you know you didn’t, and you reach for your sobriety calculator to reassure yourself you’re still worthy, you may be putting too much emphasis on the day count and not enough on finding ways to love and care for yourself, regardless of the number of days.

Counting days should be a tool, not a moral compass.  Remember – no matter what your day count – YOU count!

 

References:

1  Alcoholics Anonymous.  The AA Member – Medications and Other Drugs.  https://www.aa.org/pages/en_US/aa-member-medications-and-other-drugs

2  SMART Recovery: Stopping a Slip from Becoming a Relapse.  https://www.smartrecovery.org/stopping-a-slip-from-becoming-a-relapse/

3 Larimer ME, Palmer RS, Marlatt AG.  (1999)  Relapse Prevention: An Overview of Marlatt’ s Cognitive-Behavioral Model.  Alcohol Research and Health.

4  NIAA Spectrum.  Alcoholism Isn’t What It Used to Be.  https://www.spectrum.niaaa.nih.gov/archives/v1i1Sept2009/features/Alcoholism.html

5 Schomerus G, Corrigan PW, Klauer T, Kuwert P, Freyberger HJ, Lucht M.  (2011)  Self-stigma in alcohol dependence: consequences for drinking-refusal

self-efficacy. Drug and Alcohol Dependence.

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