A Sober Start to 2024

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By Mary Carpenter

UNDERTAKING Dry—or even Damp—January can help merely to reset drinking habits or make for a healthier month—though one study found that six months after Dry January participants were “drinking less than they were before,” according to the New York Times. Otherwise, complete abstinence with the AA 12-step model continues to be the most-often recommended program for anyone wishing to change their drinking habits.

But behavioral approaches that have proved helpful for reducing alcohol consumption in January are also becoming more widely used to treat addiction, called alcohol abuse disorder (AUD), according to American Addiction Centers. And compared to programs that require abstinence, those linked to cognitive behavior therapy (CBT)—“functional analysis” and “rational emotive behavior therapy”—offer help to those with AUD who want to drink in moderation.

“Some people don’t like basing their recovery on the idea that they cannot control their addiction when there is evidence that there are ways of practicing internal control over the recovery process,” according to American Addiction Centers. Programs such as SMART Recovery and Moderation Management follow this “active control model” for those seeking options other than complete abstinence.

“Research shows that when a person has a strong belief in their ability to drink moderately and reach the goals they set for themselves, they will work harder to reach these goals,” according to the site. “For many in moderation programs, they eventually chose goals of abstinence after practicing moderation first.”

Also becoming better accepted for AUD is medication-assisted treatment (MAT), employing drugs as part of addiction recovery. MAT drugs include buprenorphine, which helps block unpleasant effects of withdrawal; and naltrexone, which diminishes pleasurable effects of alcohol.

Even a few well-established 28-day treatment programs—including pricey “resort rehab” in desirable destinations such as Antigua and Malibu—have begun to offer moderation management and MAT. But most continue to employ AA-based 12-step programs despite success rates as low as 5%, according to retired Harvard psychiatrist Lance Dodes in his book, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry. 

(The success rate for everyone who follows the AA 12-steps may be closer to 10%, especially for those who continue attending regular meetings in their communities. But in the absence of such ongoing support, those who attend 28-day residential programs far from home are more likely to relapse.)

Fewer than one third of rehab programs contacted by Yale policy health research Tamara Beetham “offered medication maintenance treatment, which is the gold standard of treatment,” according to a 2021 NPR report on the “Profit-Driven Rehab Industry.” The absence of M.D.’s on staff lists usually indicate that a program does not incorporate MAT.

“It is quite popular to talk about addiction as a health issue now,” Dr. Sarah Wakeman, senior medical director for substance use disorders at Mass General Brigham, told the New York Times. “But our policies and our clinical models still reflect this notion that really, it’s a bad behavior that people need to be punished for.”

“A vast chasm exists between effective addiction medicine and the people who most need it,” New York Times op-ed writer Jeneen Interlandi points out. Interlandi considers “a growing roster of treatments (medications, behavioral therapies, counseling and other supports)…“just as effective at managing addiction as statins are at managing cholesterol or aspirin is at preventing heart attacks.”

Only about 5% of more than 48 million Americans with a substance use disorder are “getting any kind of help for the condition,” Interlandi notes. And according to the National Institute of Alcohol Abuse and Alcoholism, only 2.2% of more than 28 million adults with AUD in 2022 received MAT.

With changing drinking habits the target of most non-AA sobriety methods, CBD-based programs incorporate mental exercises that focus on irrational beliefs as well as insights into reasons for using alcohol. But most Dry January suggestions focus on behavioral efforts: soliciting support from friends and self-care activities, such as spa days; and identifying triggers or cues, including where, what and with whom one’s drinking is usually done, USC psychologist Wendy Wood told the New York Times.  Another is creating “friction points,” such as making drink glasses harder to reach or removing favorite alcoholic choices from the house.

For Damp January, tips include reserving alcohol for special occasions or adding dry days to the month. British psychologist Richard de Visser, who has studied Dry January participants and considers each restriction a way to develop better skills for managing drinking, told the Washington Post: “The more training sessions you do, the stronger you get.”

For 25,000 participants of the 2023 “Dry(ish) January” challenge created by Sunnyside—a drinking reduction program available with an app—even those aiming only for Damp January reported sleeping better, eating healthier and feeling more productive,” according to the Post. And for many people, figuring out how to manage triggers and create friction points can create positive feelings of having better control over hard-to-break habits.

During my 30s when I attempted spending a week without wine, I found the effort surprisingly difficult and gave up after a few days. But over the years, sobriety enforced for medical reasons and during pregnancies has revealed unexpected benefits, such as being able to stay up late at night to read—which quickly became a new habit in which I often over-indulge.

—Mary Carpenter regularly reports on topical subjects in health and medicine.