Very few people manage to stop drinking at the first attempt, but even those that do had countless failed attempts at control before they made their first determined effort to stop. We try changing what we drink, where we drink, when we drink and how much we drink, and we try pausing for a while but nothing brings the problem under control. We are desperate to avoid the one guaranteed solution, to stop drinking altogether, because it is an unthinkable thought. Our biased memory insists that drinking is good and we can’t imagine being without alcohol, it is the only “good” left in our lives. But after years of trying to contain our drinking we have to eventually give up on the idea that we can drink moderately; repeated and concerted efforts to do so have all failed. The defining difference between those that will succeed in an effort to stop drinking and those that can’t yet is our understanding of this lack of control. Once we realise beyond all doubt that control is beyond us then it becomes possible to stop, but while we still hold even the smallest hope that we might one day re-gain control then this will cause our effort to fail sooner or later. Success requires that we know with complete certainty that we cannot control our drinking and that we never will otherwise we are simply delaying the day that we will drink again. It is a huge step to reach and then sustain this position but drinking again is a certainty without it.
Eventually we take the plunge… drinking has to stop! Then and only then, when we actually try to stop permanently, do we start to recognise the true extent of our entrapment; until then we have only exposed a fraction of it. Many will fail to achieve lasting abstinence at the first attempt, some succeed after faltering once or twice and some fall into a prolonged pattern of stopping for a while then drinking, and stopping again. But if we do again drink then we re-invigorate drinking triggers.
The reward system is the engine that drives our drinking and it evolved to adapt to changing circumstances. A trigger strengthens when we act on it and secure the objective of the trigger, and it weakens when the trigger fails to secure the objective. In the wild a scenario where this would be advantageous is, for example, a fruit that is seasonal. After we have developed a trigger in response to the fruit being available we should change our behaviour when the fruit ceases to be in season otherwise we will waste a lot of time and energy searching for fruit that will never be found. So when we repeatedly fail to find the fruit where we anticipate it to be (because it is out of season) then the craving for it reduces in intensity. This is how denying cravings works. But there is another step of sophistication in the reward system that is described in the answer to this question: “What is the most successful behaviour when the fruit comes back into season?” The answer to this is that when the fruit comes back into season then the trigger should resume its full strength almost immediately, we should not waste time slowly working the trigger back up to strength. The trigger should recover its vigour as soon as the fruit becomes available again in order to gain the best advantage from the opportunity, and this is precisely how the reward system behaves. When the fruit comes back into season then the remnants of the trigger motivate us to approach and take the fruit. This reinforces the trigger, but now it does so very strongly indeed, and after only a few cycles of seeing and partaking of the fruit the trigger is restored to its full prior strength. Triggers may lose their strength through repeated failure but they are never forgotten because they may become helpful again at some time in the future and they regain their former strength very quickly once they start to be successful again. Unfortunately for us this is precisely what happens to all of our alcohol-related triggers. They are never forgotten and once we act on them again then their former strength is restored very quickly. Even after all the effort that goes into stripping triggers of their power we never manage to remove them completely; they sit there dormant, waiting to be reinvigorated.
It is perfectly common that alcoholics drink again after a period of being alcohol-free. There are many reasons we might do this but if often comes from the idea that we may now be able to control our drinking. This is an illusion but it is an appealing one and many are deceived by it. The deception is essentially that because we’ve managed to stop drinking then we have somehow proven that we can beat the problem. There are four changes that encourage this illusion; cravings lose their intensity, the effects of alcohol-tolerance reverse themselves out, the distance from despair means we no longer recall the intensity of how bad our life was, and the biased memory “drinking is good” continues to insist that we are missing out on fun now that we no longer drink. Many return to drinking in the mistaken belief that we will be able to control it this time, but this effort is doomed to fail sooner or later. For example, we might return to drinking in a controlled manner like only on a Friday after work. The first few times we may succeed in limiting our drinking like this, but on the occasions that we do drink we strongly reinvigorate the triggers relating to the circumstances. We strengthen triggers relating to the time, to the particular location and to certain people, but we also strengthen some universal triggers: the sight of alcohol and the smell of alcohol. This strengthens craving for alcohol not just on the Friday evening we gave ourselves permission to drink, but also any time we smell or see (or see in pictures or imagine) alcohol. Each Friday we strengthen these triggers further and soon the strengthened cravings and accompanying mental justifications lead us to drink outside of the boundary we imposed on ourselves. Unless we intervene to halt this process then we reinvigorate more and more triggers and soon find ourselves drinking exactly like we did before.
Trying to return to drinking in a controlled manner may appear to work for a limited period but unless it is interrupted it will always re-escalate beyond our control. If we return to drinking without placing any boundaries or limits on ourselves then we will bring all our main drinking triggers back up to their former strength alarmingly quickly: in just a few days. But reinvigorating our drinking triggers is not the only consequence of relapse, something else happens that is equally serious.
The reward system evolved to respond to changing circumstances and so did the brain; it changes the way it works to optimally maintain its speed and efficiency. While we drank heavily then our brain adapted to regular alcohol impairment by accelerating processing speed, elevating the flight-or-fight response, and by lowering serotonin and dopamine release. All of these adaptations reverse back to normal levels once we are alcohol-free again for a period. But when our brain function is once again impaired by regular and high blood/alcohol levels then our brain recognises that it has met these conditions before and it reinstates all the remedial measures that were effective previously. When we resume drinking heavily and regularly then all of the changes that our brain made when becoming alcohol-tolerant are put back in place; our mood is lowered by reduced serotonin release, our brain speed is increased by increased glutamate release and decreased GABA release, and our flight-or-fight response is heightened by increased cortisol, adrenaline and noradrenaline levels. But this doesn’t take the months or years that it took the first time, this happens within days. Within a very short time-span we are thrown right back to the same state of fear, anxiety, restlessness and hopelessness that had previously taken years to accumulate. When this happens we once again become locked into the feedback loop of drinking to relieve the symptoms of drinking and our spiral down into hopelessness returns. Resuming regular drinking commits this reversal but crucially taking a few drinks does not. Yes, any drinking at all will reinvigorate some triggers, but if we have the presence of mind to intervene and stop quickly then no further damage is done. Most significantly, if we only have a few drinks and then stop then we do not cause the brain to re-implement all the defensive measures engaged to fend off the consequences of being regularly alcohol-impaired: it does not re-instate the measures taken that come with alcohol-tolerance. This also means that we do not re-activate the feedback loop of addiction where we drink to relieve our distress.
It is not inevitable that if we drink again we will end up in exactly the same position as we started, not at all. If we limit that drinking to a single, or very few drinks then the only significant damage is to our self-esteem. If however we drink repeatedly and heavily then we recommit all the brain-altering effects of alcohol-tolerance and the effect on our self-image can be completely crushing.
The emotional consequences of relapse can be extremely severe. The earlier failures, drinking more or more often than we intended, are frustrating and confusing but drinking again after a period of abstinence can be utterly devastating. It feels like complete and total failure; we have failed in front of those close to us, we have failed in front of our peers, and we have failed ourselves. All we had to do was one simple thing, something that everyone else in the world seems able to do quite easily… but somehow we cannot do it and the position seems to be more hopeless than ever. The earlier sense of impending doom and hopelessness returns in full force and this is deepened by the new evidence that for us it really is impossible to stop drinking. Not only have we failed ourselves we have failed everyone else and it seems that we really are the hopeless alcoholic that everyone says. It is a complete collapse of self-worth. Relapse feels terrible, like complete failure, but it really shouldn’t be seen like this. It seems like we are back at the beginning, but even if the relapse led to a significant period of heavy drinking then we are still nothing like back at the beginning: we still know what we learned, and we have learned a lot.
Learning to be alcohol-free is very like learning to ride a bicycle. The first challenge is to manage staying upright while making forward progress. How many times did we fall before achieving that? But once we’d learned how to maintain balance and move in the direction we wanted there were still many occasions when we fell… because the problem had changed. Yes, we knew how to keep balance, but sometimes we grew over-confident, and sometimes something unforeseen would happen and we’d be down on the ground again. Stopping drinking is a learning challenge that is very much like this; it changes. When we first try to curb our drinking the cravings, those wordless demands that we drink, catch us time after time. Eventually we learn to confront and overcome the cravings and manage to string a few wobbly days together. Then we gather speed and confidence and set off careering down the sober road, but that’s not where the learning story ends. Once we learned to balance on a bike the challenge became different. It no longer took all our concentration to stay upright: we’d mastered balance. The challenges now were overconfidence and the unexpected; we’d try to go too fast, or something unforeseen happened like suddenly hitting a slippery patch while cornering. These are just like the challenges we meet when we’ve achieved a sober period; we become over confident (“perhaps I’m cured”, “I can manage just one” etc.) or we fail to negotiate something that was sudden and unexpected (out-of-the-blue cravings). When we first get sober the challenge is relentless… it requires continuous and determined effort, but once past this the challenges become intermittent. As we close the pathways in our mind to alcohol one-by-one our addiction searches for pathways that are still open and tests us from a new direction. The problem changes and we have to learn to meet the new challenges as they come.
We don’t just get one chance at learning to ride a bike and if we did then nobody would ever succeed. When we fell it wasn’t because we chose to, it was because we lacked the expertise not to. We had to fall in order to learn, and stopping drinking sometimes requires similar learning. We often count days since we last drank as the measurement of success but it is important to recognise just what this is, or more importantly, what it is not. The number of sober days we have accumulated only means the number of consecutive days of abstinence and this is not a measure of recovery, it is a measure of sobriety. Recovery is not determined by the length of time since our last drink but by our mental wellness, and the two can be quite independent of each other. If we drink again then our length of continuous sobriety is lost but our recovery isn’t. We don’t only get one go at stopping drinking, we get as many as it takes, and relapse is not the end of a recovery effort; it is only a pause along the path. We don’t have to go right back to the beginning and start the process all over again. When we fell off the bike we weren’t put back at the start of learning how to ride, we are exactly as far advanced along that path as we were when we fell. Nothing was lost other that a bit of pride and skin. Everything that had been learned was still learned, and because of this fall we will do better at our next attempt. Relapse while trying to stop drinking is precisely like this; we are not put back at the start of recovery. We still know everything that we have learned thus far and we just learned something new. A relapse does not put us back at the beginning of our recovery. In fact, as long as we learn from the event, it advances us.
Stopping drinking is difficult and we don’t fully understand how hard it is until we begin in earnest. As we start out we are completely unaware of the full ferocity of cravings or all the ways that our minds will try to trick us into drinking again, we only discover these as we advance. Sometimes they will catch us out and we drink. But relapse isn’t failure it is education. If we relapse then it is a necessary learning step on the path to recovery. A relapse hasn’t made the problem worse, the problem is unchanged. We are still an alcoholic, we still can’t limit or control our drinking, and drinking will drive us into a downward spiral of despair. What has changed though is our ability to overcome it.
If we only got one attempt at learning to ride a bicycle then nobody in the world would be able to do it… yet millions can. Similarly, nobody ever said we only get one chance at getting sober; we don’t, we get as many as it takes. Nobody, absolutely nobody is able to completely stop drinking at the first attempt, it is always preceded by relapse in one form or another; failures to limit the amount we drink, drinking on occasions we intended not to, or failing to not drink for a set period of time. We don’t need to have some rare super-power to stop drinking. What we need is to learn from our mistakes and the will to try again.
Regardless of how long we remain sober we are never completely free from the possibility of relapse and recovery from alcoholism should be regarded as bringing the condition into remission rather than removing it completely. If we ever think that we have beaten addiction and can have “just one” then we will soon discover to our dismay that our drinking is again completely beyond our control. We can stop drinking and alter our condition so that it no longer interferes with our lives but we can’t remove our addiction completely; those drinking triggers are still there and they always will be. In this respect we are never completely cured because the roots of alcoholism remain in the reward system forever.
If we ever drink regularly again then we very quickly re-invigorate the triggers we acted on, and if we continue to drink then alcohol-tolerance will re-establish itself and we will soon find ourselves exactly back where we were. This is not something that sometimes happens it is something that always happens. This is how the reward system works, it is how our brain attempts to protect itself and we cannot prevent it from happening. There are no exceptions to this. Nobody, has ever become a normal drinker after being an alcoholic. If you are an alcoholic, still drinking or in recovery, then this is one of the most important things you can know: alcoholics can never drink moderately again. There are no exceptions to this and you will not be the first.