What Does Being Sober Mean? The Details on Alcohol-Free Living

A stressful time for drinking

The Covid-19 pandemic has upended normal life for countless people across the United States. Many have lost friends and family to the virus, and many others have lost jobs, homes, or food security. Still more are struggling with long-term isolation, often while also raising kids in perpetual lockdown. Amid this upheaval, it may come as little surprise that many Americans have been drinking more alcohol than usual.

Frequency of alcohol consumption rose by 14 percent for adults 30 and older during the early months of the pandemic, according to a study published in September 2020 in JAMA Network Open. The study also found a 41 percent increase in heavy drinking episodes among women. Among heavy drinkers, the likelihood of binge drinking increased with every week of lockdown, according to a study published in December 2020 in the American Journal of Drug and Alcohol Abuse. The researchers noted that “specific Covid-19-related stressors are related to alcohol consumption.”

These stressors may not disappear anytime soon. But the end of 2020 and the dawn of a new year could inspire some Americans to rethink their pandemic drinking habits. That might just mean slowing down and drinking less. Or it might mean quitting alcohol altogether, either temporarily or for good.

In any case, the decision to rein in excessive drinking can offer big rewards—if you know what your goal is, why it matters, and how you plan to get there.

Health benefits of sobriety

Drinking too much alcohol over time can lead to a variety of chronic health issues, including certain cancers, heart disease, high blood pressure, liver disease, and stroke.

Even in a non-pandemic year, excessive drinking contributes to about 90,000 deaths annually in the U.S., according to the Centers for Disease Control and Prevention (CDC), shortening the lives of those who died by 29 years, on average.

For heavy drinkers, curbing or quitting alcohol can reduce the risk of death and ailments like these, along with many other destructive effects of excessive alcohol use. (Abruptly stopping alcohol can be potentially dangerous if you are a chronic heavy drinker, so it’s best to do so under a doctor’s supervision.)

The risks may be lower for less intensive drinkers. But cutting back on alcohol can offer health and quality-of-life benefits for a wide range of people—from improved sleep and better memory to more free time and money.

If you’re interested in sobriety, it might help to start by looking at your current behavior and what you want to change about it. It isn’t always easy to know if your drinking qualifies as excessive. But it’s often wise to seek professional help if you or a loved one think you have a problem. The CDC also offers guidance on how to identify excessive drinking.

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What does sober mean?

Someone who is sober is free from intoxication, as in, not drunk. But does being sober or having a sober lifestyle require an ongoing abstinence from alcohol? Yes, at least according to the standard medical definition of sobriety, a common view shared by popular recovery programs like Alcoholics Anonymous.

“In medicine, we define sobriety by objective criteria, namely not consuming alcohol,” says Keith Humphreys, PhD, a professor of psychiatry at Stanford University. His research explores the prevention and treatment of addictive disorders. “But many people who are in recovery from alcohol addiction define it more broadly to include a new outlook on life, improvements in relationships, and sense of spiritual serenity.”

There are also “moderation management” approaches, which aim to help people control their patterns of destructive drinking rather than forbidding alcohol entirely. This works for some people, but it could be inappropriate for someone with a true substance use disorder, says James R. Langabeer, PhD, a professor of emergency medicine and vice chair of population health at the University of Texas Health Science Center.

These are chronic brain diseases caused partly by neuroanatomy, he says, and people are predisposed to substance misuse. Because the condition is chronic, it may require lifelong treatment.

“I believe that sobriety is binary (yes or no), and does not necessarily vary by individual,” Langabeer says. “We always hear about the exception—that people cut back use and ultimately recovered from something without going through abstinence, counseling, and medical treatments. But these are the exception and not the norm. Of course, each person’s path to recovery is unique, and what leads to recovery can vary quite a bit.”

What is recovery?

The term “sober” tends to be associated with quitting alcohol, while people who stop using other drugs are often referred to as “clean,” explains Andrew Finch, PhD, an addiction expert and professor of human and organizational development at Vanderbilt University. In either case, the concept typically implies abstinence.

But the addictions field has also begun to move toward a different terminology, Finch adds, more focused on the notion of “recovery.”

“As the terms ‘sober’ and ‘clean’ are associated specifically with the act of drinking or using, ‘recovery’ has a more holistic connotation that encompasses physical/emotional/behavioral states,” he says. “Recovery also does not necessarily require full abstinence, though it usually does involve a reduction of use or use of substances perceived to be less ‘harmful.’ There are myriad definitions of recovery.”

Finding the right road to recovery

There are also many routes to recovery, Humphreys points out.

“This isn’t a religion,” he says. “There are lots of ways to get to heaven.” Those include Alcoholics Anonymous, Women for Sobriety,  medications, and psychotherapy, says  Humphreys. “Whatever helps you get to a place where alcohol isn’t destroying your life is the way for you.”

For most people who have been clinically diagnosed with a substance use disorder, abstinence is probably the only way to achieve full recovery, due to the brain’s inherent difficulty with self-regulation and moderating behavior, says Langabeer.

“So, for true substance use disorders, I think abstinence is the path—in combination with many other things such as redirecting that energy into something more productive, healthy, and positive,” he adds. “However, for many people who just feel they drink too much or too often, but never experience any negative consequences—then moderation could work well in those patients. But they would not fall under the clinical diagnosis for a substance use disorder.”

What is the best path?

The best path to recovery depends largely on your reasons for seeking sobriety, Finch agrees, since managing a substance use disorder isn’t the same as quitting alcohol to lose weight or save money.

It also depends on other factors, he adds, including “access to services and recovery capital, cultural differences, level of severity, co-occurrence of mental health disorders, and age/life phase,” along with personality and life circumstances.

You could start by seeing a therapist or recovery specialist, Langabeer suggests, or by trying a free mutual-help group, which can provide key relationships to support recovery. (He recommends the SAMHSA treatment locator to find resources near you.)

It might be best to find a professional counselor who’s trained in various approaches, Finch suggests, and who can help you decide which might be most effective for you. In one evidence-based approach called Screening-Brief Intervention-Referral to Treatment (SBIRT), a screening identifies the severity of someone’s condition, followed by brief interventions to find a suitable recovery plan.

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Temporary vs. permanent sobriety

Some people give up alcohol or other drugs temporarily, often for monthlong periods like Dry January, as a cleanse or a test for longer sobriety. That may help in some situations. But experts say it shouldn’t be confused with treatment for actual substance use disorders.

“A month of abstinence will not remove alcohol addiction,” Humphreys says. “Dry January is mainly there to serve a different population of people who have a drinking problem, but not at the severe end.”

It won’t be enough on its own, Langabeer agrees, but a month of sobriety might be a valuable first step for some people.

“I have mixed feelings about the pursuits of temporary sobriety,” Langabeer says. “Clinically speaking, sobriety is binary. However, sort of like fasting could lead to liking less calorie intake, or eating vegetables for a week might lead to a less meat-intensive diet, temporarily not drinking could make you see that these new behaviors are better than what you are doing.

“Everybody needs ‘clear eyes’ to see what they are doing, where they are going, and how they should get there,” he adds. “Everybody who takes recovery seriously redefines themselves—they find themselves—they look at life differently and never want to trade their new life for their former one. So if a temporary abstinence helps to bring clarity, then that can’t be bad.”

Discipline, focus, and meaning

There may be multiple paths to recovery, but the most successful routes tend to share certain hallmarks, such as long-term commitment. “Because it’s a chronic problem that usually takes a long time to develop, it also takes a long time to get into stable recovery,” says Humphreys. “The best supports are there for the long haul.”

Attitude about recovery is also key, Langabeer adds. “When we look at what makes people recover successfully, the first thing I notice is that they have a sense of overall purpose and meaning,” he says. “They feel that they have to get better for their children or loved ones.”

They also see recovery as a set of daily small decisions, he adds, and know even one misstep could lead to relapse. At the same time, however, they also know relapsing isn’t the end of the world, allowing them to pick up where they left off.

“Discipline, focus, and a search for meaning are what make people better,” Langabeer says.

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