Withdrawal is why things might get worse before they get better.
You commonly hear debates about whether alcohol (especially wine) is “good” or “bad” for your health, but the answer isn’t always simple. In small or moderate amounts, alcohol is typically safe for the average person, and can even come with some minor health benefits.
However, when drinking becomes excessive, your brain can start to depend on it at levels that are damaging to your mental and physical health. “They can’t function without it. They’re damaging their liver and their brain, and they can’t sort of survive without alcohol being a part of their body,” says Jonathan Avery, MD, director of Addiction Psychiatry at Weill Cornell Medicine and NewYork-Presbyterian Hospital.
Withdrawal: Why It’s So Hard to Quit
Many people who struggle with alcohol often have “narratives” about why they must continue to drink, according to Dr. Avery. The person may know they are drinking more than what’s recommended, but the narratives help validate the habit. These reasons are often things like drinking to help with sleep or to deal with anxiety.
“It can feel at first that it helps for those things, but all our data shows that when you’re drinking regularly … you’re actually just medicating withdrawal,” says Dr. Avery. “It increases your odds of insomnia, of anxiety, and so the very thing that you think it’s helping for, it’s actually making worse.”
Because alcohol is a depressant, your brain learns to adapt to the constant exposure of a depressant by producing its own stimulants, like serotonin and norepinephrine. These stimulants have an adrenaline-like effect on the body. As a result, many alcohol withdrawal symptoms are a sign of overstimulation, like tremors and irritability.
Furthermore, because alcohol has become a way to cope, when you take it away, your insomnia or anxiety might actually get worse temporarily. Not only are you experiencing withdrawal symptoms, but you’ve lost your way of coping with discomfort or difficult emotions. Anything that you’ve been medicating with alcohol will suddenly be felt at full force.
“Once you’re in recovery, these things get better, and so it’s been shown, for example, four months out from an alcohol problem, a lot of the anxiety that exists right at the period of stopping has gone away,” says Dr. Avery.
Alcohol Withdrawal: What to Expect
“Alcohol withdrawal symptoms range from mild to more severe,” says Dr. Avery. The symptoms of alcohol withdrawal include:
Confusion or delirium
“When you’ve been drinking heavily, it’s advisable to not stop on your own, in fact, and to have medications that can help wean you off of the alcohol,” says Dr. Avery. “Otherwise, you’re gonna get that really severe state of delirium.”
Recovery Is Worth It
The early days of recovery are some of the hardest, and getting over that initial hurdle can be daunting. You might even wonder if recovery is worth it, since the “end result” may be a life with no alcohol.
“The narrative that people often have for struggling with alcohol or even misusing alcohol, is that they can’t have a rewarding, fun life without it,” says Dr. Avery. “What I tell patients is, ‘I promise you, if you trust me, if you stop, those relationships will actually be better, and actually, they’re not as good as they could be … because of the drinking.’”
In other words, while not drinking may change the way you hang out with your friends or how you “let loose,” a life with an alcohol use disorder isn’t as good of a life as it could be. In the end, you may find that sobriety is less of a “loss” and more of a “freedom” from alcohol.
Dr. Avery is the director of Addiction Psychiatry at Weill Cornell Medicine and NewYork-Presbyterian Hospital.
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When we think of problematic alcohol use,
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we think of the person that's drinking every day
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and starts drinking in the morning,
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and those are some obvious consequences.
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They can't function without it.
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They're damaging their liver and their brain
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and they can't sort of survive without alcohol being a part of their body.
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Everyone who's using substances in an ongoing way
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has a narrative about why they use,
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and that narrative is very hard sometimes to combat,
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and so we very commonly hear, "I need alcohol to sleep."
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What's happening, really, when one's using alcohol
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or any substances chronically is that you need it to sleep
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or not feel anxious just because it's become a part of your brain.
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It's become a molecule, and so your brain's saying,
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"I need this to sleep and exist, just because you've been
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exposing it to me every day."
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And it can feel at first that it helps for those things,
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but all our data shows that when you're drinking regularly,
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using regularly, you're actually just medicating withdrawal likely,
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and it increases your odds of insomnia, of anxiety,
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and so the very thing that you think it's helping for,
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it's actually making worse.
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And the hard part of this is that as you take away alcohol,
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it makes those things worse temporarily,
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and then once you're in recovery, these things get better,
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and so it's been shown, for example,
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like four months out from an alcohol problem,
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a lot of the anxiety that exists right at the period
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of stopping has gone away.
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But you need some time,
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and so that's what makes it really hard is that you think
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you're using it for something, be it sleep or anxiety,
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and you're not, it's not actually helping.
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It's making it worse, but it's also gonna make it worse
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to stop it temporarily, and you're really not gonna get
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improvement in those symptoms until some time later.
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Alcohol withdrawal symptoms range from mild to more severe.
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Mild symptoms of alcohol withdrawal can be
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sort of a hangover, or tremors, or anxiety.
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On the more severe end,
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especially when you've been drinking heavily,
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alcohol withdrawal can result in seizures,
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or even states where you're confused or delirious,
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where you don't know where you are or who you are.
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When you've been drinking heavily, it's advisable to not stop
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on your own, in fact, and to have medications
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that can help wean you off of the alcohol.
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Otherwise, you're gonna get that really severe state of delirium.
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The narrative that people often have for struggling with alcohol
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or even misusing alcohol, is that they can't have
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a rewarding, fun life without it,
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that they can't hang out with their old drinking buddies,
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they can't go to a college reunion, they can't see the people
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that they love most in this life because all of them drink.
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My experience, though, with people in recovery,
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and what I often tell patients is, "I promise you, if you trust me,
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if you stop, that those relationships will actually be better,
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that actually, they're not as good as they could be,
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all these fun experiences, because of the drinking."
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And sometimes I connect people to people in recovery or in AA
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because they can often say, "Hey, this fun time that you're thinking
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can actually get better, and your relationships get better,
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and your life can be more fulfilling in all sorts of ways."
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Alcohol withdrawal. Cambridge, MA: Harvard Health Publishing, Harvard Medical School, 2019. (Accessed on April 30, 2020 at https://www.health.harvard.edu/a_to_z/alcohol-withdrawal-a-to-z.)
Alcohol withdrawal. Washington, DC: MedlinePlus, U.S. National Library of Medicine. (Accessed on April 30, 2020 at https://medlineplus.gov/ency/article/000764.htm.)