Oddly, the easiest thing to write about right now is a topic that brings me perennial frustration. And no, I’m not talking about COVID-19, politics, or where half my socks go when I do the laundry. I’m talking about the way society treats alcohol misuse and pigeonholes sobriety, and how that prevents people from cutting back or seeking treatment.
I want to explore the stigma surrounding alcohol abuse and alcohol dependence, which are grouped together into Alcohol Use Disorder (AUD) in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM–5). Dictionary.com defines stigma as “a mark of disgrace or infamy; a stain or reproach, as on one’s reputation.” Well, that’s intense!
Widespread stigma creates a feedback loop of shame and discomfort for those suffering from AUD. Because people often assume that one would only choose to quit drinking due to a severe problem, this generates stigma towards those living a sober life. Sobriety, or even seeking help, becomes something a person feels guilty about, complicating what can otherwise be a very positive experience.
I would argue that the stigma around alcohol misuse is associated with stigma in the U.S. and many other countries around other mental illnesses. Anything we diagnose or label suddenly becomes bad and serious, a thing to fear. But applying a label to the thing that most challenges us can help us find the appropriate methods to overcome it.
Why we drink and why we quit
Consuming alcohol – for pleasure, relief, celebration, condolence, social bonding, and pretty much any other reason under the sun – is the norm in this society. So, where does the stigma come from? And why must so many people hover uncomfortably at the tipping point between socially sanctioned heavy consumption and AUD before realizing they might be better off quitting?
I believe each of us has developmentally unique reasons for the way we drink. That’s why not everyone has a problem with alcohol, and why recovery can look a lot different among individuals who do. But we’re in a society powered by the alcohol industry that pressures many young people to drink long before their minds and bodies are fully developed. Many of us go through high school (and maybe college) with a heavy mix of drinking, blacking out, and making mistakes that can lead to a compounding of regrets and personal shame.
Some people grow out of heavy drinking, whether it’s right after high school or college, as they age into their thirties, or further, or after something they consider their “rock bottom.” Maybe it’s when they start a family or reach a new decade or milestone. It may be for health, mental health, interpersonal relationships, or perhaps a unique combination of personal reasons. A lot of people need assistance with maintaining sobriety through tools like recovery groups. Behavioral patterns can develop quickly, are often rooted in other ingrained problems, and can be hard to break.
Despite all its turbulence, drinking alcohol (heavily) is still the norm and quitting is frowned upon. Alcohol is embedded into everything we do and celebrate. We laugh off the development of serious drinking problems, skirting the issue with swagger and finding solidarity in alcohol memes and merchandise. Stigma is a dangerous thing – it prevents people from admitting to and addressing inner traumas or turmoil.
The history of social norms surrounding alcohol
Alcohol is part of a social contract that evolved from nomadic cultures. It was extended to strangers to demonstrate hospitality, establishing the beginning of the social relationship. And not much has changed since. Because alcohol represents and fosters human connection, to say I’m not drinking is to say “I’m not in communion with you.”
What’s more, we have a beloved antihero archetype in our culture of the heavy drinker. America loves a scoundrel. The cycle of sin and redemption excites us. It feeds the narrative arc, which is embedded in our evolved affinity for storytelling. Stories often deal in binaries, in good guy vs. bad guy. So we translate those labels to anyone who has admitted to having a problem, deeming any deviation from the recovery path sinful and bad while we continue to sip our own drinks.
The earning of “chips” or tokens in AA based on accumulated time sober plays into this, as well. When we count the days someone has stayed sober and treat returning to alcohol as a “relapse”, saying things like “why did you fall off the wagon?” or “what made you give that all away?”, we aren’t helping. First, we’re assuming the person had a major issue with alcohol, when they may have quit for less serious reasons, or reasons they want to keep private. Second, we’re making the person feel terribly ashamed and acting like anything they’ve gained from their time sober has now been lost.
It’s more accurate and productive to think of reverting to alcohol consumption after a period of sobriety as a “lapse” – not a “relapse.” Contrary to popular belief, a person doesn’t suddenly lose the wisdom they’ve gained and can often pick up where they left off. Many people lapse several times before maintaining sobriety. In doing so, they may even learn something about themselves and their relationship with alcohol, their emotional regulation and triggers.
In addition to affecting how we treat sober people, the archetype of the alcoholic antihero allows us to allay any discomfort we have towards our own alcohol consumption by projecting it onto a character who’s presented as unconventional, rugged, and dark. We’re not that dark, we tell ourselves. Perhaps we revel a little in the character’s debauchery. We know how good it feels to lean into the hedonic life, but we know when to stop and come up for air.
Our limited rhetoric for alcohol use and sobriety forces us into an “all or nothing” mentality when it comes to consumption. Quitting becomes fatalistic, a huge shame-beast that most people who are struggling aren’t ready to tackle. Approaching sobriety with a more mellow attitude – not treating it as so much of “a thing” – can be tremendously easier, more subtle and joyous. Also, many people can cut back and moderate their alcohol consumption. Abstinence is not the only option.
How to combat stigma
Stigma can make weddings, work travel, dating, parties, and holidays highly unnerving for those who’ve quit drinking. From interacting with people who are walking on eggshells to thanking those who offer backhanded compliments, it becomes the sober person’s job to seem so normal that everyone forgets they aren’t drinking and is comfortable with the elephant of their sobriety.
Even the well-intended “I’m proud of you” is sometimes housed in stigma. Depending on how (and from whom) it’s delivered, it can have underlying implications that the sober person overcame what was a truly disgusting habit that must have brought them deep shame. That may or may not be true. Either way, it isn’t something they need to be continually reminded of.
A better way to interact with a sober person is to treat them as not all that different from oneself. For instance, it isn’t “too bad” they can only drink a soda. Maybe they like soda and it’s helping them feel at ease! You can tell them their mocktail looks tasty. It’s okay to be enthusiastic and still sip on one’s own drink of choice.
Don’t talk to them about how hard it must feel to be surrounded by people who are drinking or make a show of protecting them from pressures or the urge to drink. That forces us into an unnecessary, awkward position of defending our comfort level, which isn’t everyone’s business and may fluctuate. Asking if they’re okay is a thoughtful gesture, but if your friend tells you they’re fine, don’t push it. Thinking that everyone is worried about you can be distressing and annoying.
A sober person can still dance, laugh, joke, and hold conversations. They may seem to introvert themselves a little at times, especially as other people become more drunk and talkative. Let them do their thing – it’s easy to get overstimulated and overwhelmed in crowded drinking environments, and sometimes sober people just need some time (or caffeine) to adjust before diving back in.
If you have friends who are sober, try not to exclude them. You can still invite them to events (during this time, virtually) with alcohol, and they can decide whether they’re comfortable attending. You could also occasionally propose a hangout that doesn’t involve alcohol. Something creative or educational, maybe. There are a lot of ways to support sober friends without making them feel different or like you’re tiptoeing around a monster who’s about to flip. Your friend may be much more in control of their life than you think.
Stigma subverts public health and prevents people from seeking treatment options. It leads to prejudice and discrimination, threatens jobs and relationships, and pushes people into secrecy. It compounds feelings of shame and self-loathing through which people who drink heavily or have quit are already suffering.
It’s a dark entity that has no place in recovery, but it’s ubiquitous. The only thing those of us who care can do is to slowly change attitudes through the way we act, the example we set, and the words we use to empower the people around us. So, if you care, do what you can to break down stigma in your social circles.