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.
Alcohol 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.
What to Expect During Recovery
“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.
00:00.400 --> 00:01.666
00:01.667 --> 00:03.432
When we think of problematic alcohol use,
00:03.433 --> 00:05.199
we think of the person that's drinking every day
00:05.200 --> 00:06.632
and starts drinking in the morning,
00:06.633 --> 00:08.366
and those are some obvious consequences.
00:08.367 --> 00:10.032
They can't function without it.
00:10.033 --> 00:11.499
They're damaging their liver and their brain
00:11.500 --> 00:15.432
and they can't sort of survive without alcohol being a part of their body.
00:15.433 --> 00:21.766
00:21.767 --> 00:24.732
Everyone who's using substances in an ongoing way
00:24.733 --> 00:26.666
has a narrative about why they use,
00:26.667 --> 00:29.966
and that narrative is very hard sometimes to combat,
00:29.967 --> 00:34.366
and so we very commonly hear, "I need alcohol to sleep."
00:34.367 --> 00:36.566
What's happening, really, when one's using alcohol
00:36.567 --> 00:39.599
or any substances chronically is that you need it to sleep
00:39.600 --> 00:42.999
or not feel anxious just because it's become a part of your brain.
00:43.000 --> 00:44.699
It's become a molecule, and so your brain's saying,
00:44.700 --> 00:46.866
"I need this to sleep and exist, just because you've been
00:46.867 --> 00:48.832
exposing it to me every day."
00:48.833 --> 00:51.032
And it can feel at first that it helps for those things,
00:51.033 --> 00:53.599
but all our data shows that when you're drinking regularly,
00:53.600 --> 00:57.399
using regularly, you're actually just medicating withdrawal likely,
00:57.400 --> 01:01.399
and it increases your odds of insomnia, of anxiety,
01:01.400 --> 01:03.799
and so the very thing that you think it's helping for,
01:03.800 --> 01:05.832
it's actually making worse.
01:05.833 --> 01:09.432
And the hard part of this is that as you take away alcohol,
01:09.433 --> 01:11.466
it makes those things worse temporarily,
01:11.467 --> 01:14.066
and then once you're in recovery, these things get better,
01:14.067 --> 01:15.599
and so it's been shown, for example,
01:15.600 --> 01:17.766
like four months out from an alcohol problem,
01:17.767 --> 01:20.799
a lot of the anxiety that exists right at the period
01:20.800 --> 01:22.999
of stopping has gone away.
01:23.000 --> 01:24.232
But you need some time,
01:24.233 --> 01:25.899
and so that's what makes it really hard is that you think
01:25.900 --> 01:28.666
you're using it for something, be it sleep or anxiety,
01:28.667 --> 01:29.866
and you're not, it's not actually helping.
01:29.867 --> 01:32.066
It's making it worse, but it's also gonna make it worse
01:32.067 --> 01:35.399
to stop it temporarily, and you're really not gonna get
01:35.400 --> 01:39.099
improvement in those symptoms until some time later.
01:39.100 --> 01:42.599
Alcohol withdrawal symptoms range from mild to more severe.
01:42.600 --> 01:44.866
Mild symptoms of alcohol withdrawal can be
01:44.867 --> 01:47.632
sort of a hangover, or tremors, or anxiety.
01:47.633 --> 01:48.532
On the more severe end,
01:48.533 --> 01:50.632
especially when you've been drinking heavily,
01:50.633 --> 01:52.966
alcohol withdrawal can result in seizures,
01:52.967 --> 01:55.166
or even states where you're confused or delirious,
01:55.167 --> 01:57.466
where you don't know where you are or who you are.
01:57.467 --> 02:00.766
When you've been drinking heavily, it's advisable to not stop
02:00.767 --> 02:03.432
on your own, in fact, and to have medications
02:03.433 --> 02:07.066
that can help wean you off of the alcohol.
02:07.067 --> 02:10.499
Otherwise, you're gonna get that really severe state of delirium.
02:10.500 --> 02:13.066
The narrative that people often have for struggling with alcohol
02:13.067 --> 02:14.966
or even misusing alcohol, is that they can't have
02:14.967 --> 02:17.632
a rewarding, fun life without it,
02:17.633 --> 02:19.266
02:19.267 --> 02:20.999
that they can't hang out with their old drinking buddies,
02:21.000 --> 02:23.166
they can't go to a college reunion, they can't see the people
02:23.167 --> 02:26.799
that they love most in this life because all of them drink.
02:26.800 --> 02:28.366
My experience, though, with people in recovery,
02:28.367 --> 02:31.132
and what I often tell patients is, "I promise you, if you trust me,
02:31.133 --> 02:34.166
if you stop, that those relationships will actually be better,
02:34.167 --> 02:36.266
that actually, they're not as good as they could be,
02:36.267 --> 02:38.899
all these fun experiences, because of the drinking."
02:38.900 --> 02:41.232
And sometimes I connect people to people in recovery or in AA
02:41.233 --> 02:44.132
because they can often say, "Hey, this fun time that you're thinking
02:44.133 --> 02:48.032
can actually get better, and your relationships get better,
02:48.033 --> 02:52.466
and your life can be more fulfilling in all sorts of ways."
02:52.467 --> 03:03.300
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.)