Alcohol Abstinence: Can I Be in AA and Still Drink?

When people with substance use disorders enter into addiction recovery programs, it’s common for them to ask if they will have to completely abstain from drinking. If you or someone you know is trying to quit drinking or cut back on alcohol use, you may be wondering if programs such as Alcoholics Anonymous require total alcohol abstinence.

The answer is a bit more complicated than just yes or no. Like many aspects of alcohol addiction treatment, the best approach for you is dependent on factors unique to your circumstances.

About Alcoholics Anonymous

First, let’s look at what Alcoholics Anonymous is and whether it’s right for you. While AA is typically the first thing people think of when considering alcohol recovery programs, there are other sober communities and support groups that may be better suited to some people.

Alcoholics Anonymous, as defined on the organization’s website, is “an international fellowship of men and women who have had a drinking problem.”1

Though the 12 steps of AA are spiritual in nature, AA is not affiliated with any one sect, denomination, or organization.

As noted in the Twelve Traditions of Alcoholics Anonymous, the only requirement to attend AA meetings is “a desire to stop drinking.”2 Strictly speaking, you can attend AA meetings if you are still using alcohol. AA understands that individuals may not be fully sober when they join or may experience relapses. There are no absolute rules in AA, and no one will check on you to make sure you aren’t drinking.

 

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A Program Based on Alcohol Abstinence

Although AA does not require complete alcohol abstinence, it does encourage it. A general belief exists throughout the AA community that drinking and AA don’t mix. This is due to several reasons.

The first is the belief that those who suffer from alcohol use disorder will never be able to control their drinking for any length of time. According to AA, no true alcoholic ever regains control of their drinking.3 While individuals may experience periods of sobriety, any return to drinking, however small, will ultimately result in a downward spiral. Touching alcohol in any form is too risky. The only safe approach, then, is complete abstinence, even if you think you can control certain concentrations or quantities of alcohol.

The 12 steps of AA also discourage the use of alcohol in any amount. According to the AA website, the 12 steps “are a group of principles, spiritual in their nature, which, if practiced as a way of life, can expel the obsession to drink and enable the sufferer to become happily and usefully whole.”1 Only one step—the first—actually mentions alcohol. It states, “We admitted we were powerless over alcohol—that our lives had become unmanageable.4

After the first step, the program is focused on spiritual principles designed to help members live better lives and reach their full potential. Doing so requires being free from the influence of drugs and alcohol. For many people, fully living the promises of the program first requires long-term sobriety and recovery.

Sobriety vs. Recovery

When considering whether continuing to drink in moderation is right for you, it may be helpful to review the difference between sobriety and recovery. Though often used interchangeably, the terms actually have very different meanings.

What is Sobriety?

Simply put, sobriety is being free from the influences of drugs or alcohol. Sobriety is part of the recovery process, but it is a temporary state and can change from one day to the next. At any point, the use of drugs or alcohol—even a small amount—can change the state of your sobriety.

Because addiction is a chronic disease, the state of being “sober” can be compared to being symptom-free. Periods of sobriety can vary in duration, but that doesn’t mean the disease is cured or that symptoms may not return.

Sobriety may also be used to refer to individuals who are abstaining from drug or alcohol use, but who have not taken the necessary steps to treat “the underlying issues that had either led to their drinking in the first place or developed as their alcoholism progressed,” as noted by ​​Sarah A. Benton, MS, LMHC, LPC, AADC, writing for Psychology Today.5

According to Steven M. Melemis, MD, Ph.D., writing for the Yale Journal of Biology and Medicine, “a person does not achieve recovery by just not using.”6 Without significant lifestyle changes and behavior modification—including the use of cognitive therapy to change negative thinking patterns and develop healthy coping skills—the factors that initially contributed to your addiction will continue to be a factor.

 

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What is Recovery?

If maintaining sobriety is being symptom-free, recovery can be seen as remission. The substance use disorder may not be cured but is controlled “in a way that allows [you] to be free of the cravings and mental obsession.”5 Any underlying mental, spiritual, or physical issues that have contributed to your alcohol use have also been addressed or treated.5

By making the necessary lifestyle changes and addressing the root causes of addiction, you achieve sobriety and gain the skills that will help you avoid relapse.

Another way to look at it is that sobriety is a temporary state, while recovery is an ongoing process. Maintaining sobriety is a part of recovery, but recovery is ultimately the key to overcoming addiction and reaching your true potential.

AA Alternatives

While AA is based on the idea of strict sobriety, other addiction recovery programs may be better suited to you, depending on your circumstances and goals. If you feel that 12-step recovery isn’t right for you, or you can’t relate to the spiritual nature of AA, a different supportive sobriety group may be a better fit.

A growing body of scientific research is lending support to treatment approaches such as harm reduction models or moderation management, which do not demand complete abstinence.

What is a harm reduction model?

Harm reduction is “a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use.”7 Harm reduction includes strategies such as safer drug and alcohol use, managed use, abstinence, and addressing conditions of drug and alcohol use along with the use itself.7

Harm reduction acknowledges that drug and alcohol use are multifaceted issues and that some forms of substance use are safer than others. It also considers quality of life and overall well-being as characteristics of successful intervention rather than complete abstinence.

Harm reduction models may be well-suited to people who want to cut back on alcohol consumption but aren’t willing or ready to quit altogether. They may also be appropriate for those who don’t have an official substance use disorder but may fall into the category of “heavy drinkers” or “binge drinkers.”

Research conducted at the University of Washington School of Medicine, Washington State University, and the VA Puget Sound Health Care System over the past decade has successfully helped individuals at Seattle homeless shelters reduce their drinking.8 Susan Collins, co-director of the Harm Reduction Research and Treatment Center at the University of Washington School of Medicine, offers the following advice to anyone who wants to cut back on their drinking:8

  1. Keep track of how much you drink. To gain an accurate assessment of what your alcohol use looks like, write it down. Don’t rely on memory. Keep track of any problems related to your alcohol consumption that you want to improve, such as negative behavior patterns or poor decision-making. Keep track of what and how much you drank before engaging in negative behavior. Over time, you will see patterns emerge, which can help you identify the changes needed to make the necessary changes.
  2. Identify the rewards you derive from drinking. What is it about drinking that appeals to you? Are there other, less harmful activities from which you could derive the same rewards? For example, if you enjoy drinking because of the social aspects, try inviting your friends to participate in social activities that don’t lend themselves to using alcohol, such as going for a hike or a bike ride.
  3. Examine your goals and intentions. Collins and her colleagues found that when study participants were engaged in meaningful activities, such as participating in community work or making art, they were less likely to experience alcohol-related harm.8 Write down some goals that are important to you and consider how you can work towards making them happen. For larger goals, break them down into more manageable tasks. For example, if you’ve thought about going back to school, set a smaller goal of researching programs in your area of interest. Set goals for your drinking as well. If cutting from six drinks a day to five seems unmanageable, start by cutting down to five and eventually reduce your consumption even further.
  4. Drink safely. Make sure to drink water when drinking alcohol, and don’t drink on an empty stomach. Don’t combine alcohol with other substances that could lead to severe side effects, such as opioids.
  5. Be mindful of physical dependence on alcohol. If your body depends on alcohol to regulate its functions, it can lead to serious health consequences, such as high blood pressure and cardiovascular problems. If you drink every day, start setting aside one day a week as a sober day. Also, try setting designated hours for drinking, such as nothing before 5 p.m. or after 11 p.m.
  6. Talk to your doctor about anti-craving medication. When used appropriately and combined with counseling, anti-craving medication can help individuals remain in alcohol treatment longer and experience more successful outcomes.9 The University of Washington study found that medication can also be effective when used in a harm reduction model. The anti-craving medication helped participants reduce their alcohol consumption as well as drinking-related problems.8

Identifying the Best Approach for You

Identifying your ideal approach to alcohol treatment will require being very honest about your drinking and its effects on your life.

Suppose you have been diagnosed with a substance use disorder. In that case, you have a physical or emotional dependence on alcohol, or you cannot control your drinking even when it causes problems, an abstinence-based approach such as AA is likely in your best interest. Holding on to your desire to drink some alcohol while in AA will impede your recovery and increase your risk of relapse.

If, however, you have experienced problems with heavy drinking or binge drinking, but don’t suffer from a substance use disorder, you could benefit from a program based on a harm reduction model.

For information about treatment options for you or a loved one, call 800-839-1686Who Answers? today.”

Resources

  1. Alcoholics Anonymous. (2021). What is AA?
  2. Alcoholics Anonymous. (2014). The Twelve Traditions of Alcoholics Anonymous.
  3. Alcoholics Anonymous. (2018). A. as a resource for the health care professional.
  4. Alcoholics Anonymous. (2016). The Twelve Steps of Alcoholics Anonymous.
  5. Benton, S. A. (2010, May 17). Being “sober” versus being in “recovery.” Psychology Today.
  6. Melemis, S. M. (2015, September 3). Relapse prevention and the five rules of recovery. The Yale journal of biology and medicine, 88:325-32.
  7. National Harm Reduction Coalition. (2020). Principles of harm reduction.
  8. Collins, S. E., Duncan, M. H., Saxon, A. J., Taylor, E. M., Mayberry, N., Merrill, J. O., Hoffmann, G. E., Clifasefi, S. L., & Ries, R. K. (2021). Combining behavioral harm-reduction treatment and extended-release naltrexone for people experiencing homelessness and alcohol use disorder in the USA: a randomised clinical trial. The lancet. Psychiatry, 8(4), 287–300.
  9. National Institute on Drug Abuse. (2018). Principles of effective treatment.

 

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