Chapter Nine: After Withdrawal

The extreme measures our brain and body took to offset the impact of regular drinking are fully exposed when we first stop drinking and the result is shocking. We shake uncontrollably and may experience; stomach cramps, nausea, cold-sweats, headaches, a pounding heart, fear, anxiety, and a sense of aloneness. These are all changes that our body and mind made in order to try to keep us functioning effectively while we drank heavily. But these changes are not permanent and once we stop drinking these adaptations start to reverse themselves out. The flight-or-fight response steps down during withdrawal, first by reducing noradrenaline release and then by reducing adrenaline and cortisol. By the end of two or three weeks our flight-or-fight response has mostly returned to normal. Our liver and kidneys have had continuous days without struggling against an overload of alcohol, the body’s accumulated toxins have been largely cleaned away, we are properly hydrated once again, and the physical change in our appearance is noticeable; our skin colour returns, our eyes are clearing, puffiness around the eyes is receding, we feel better and we stand taller. But this last change has nothing to do with hormones or neurotransmitters, it is caused by a change in our state of mind… hope has returned!

The changes that happened to our mind and body over years of drinking are layered on top of each other; an over-strengthened and polarised reward system, a biased memory, lowered mood, accelerated heart rate and elevated blood pressure, raised fear and anxiety, accelerated brain speed, a huge burden of guilt and shame, and psychological defences that counter any thoughts about stopping drinking. The flight-or-fight response is the first to change because its adaptations positively impair our performance once we stop drinking and these adaptations start to fade after about four or five days. The levels of noradrenaline, adrenaline and cortisol continue to normalise and a distinct marker is reached that shows that these have returned to their near normal positions; that marker is that sleep returns. As our days without alcohol accumulate then our cortisol level falls until it is no longer so high that it prevents sleep. Depending on the individual this happens somewhere between one and three weeks, but it is unmistakeable. Once our cortisol level drops to near normal then we are once again able to achieve a deep-sleep state that we haven’t experienced in years. Not only do we suddenly get a full night’s sleep, the sleep itself is different: it is refreshing and restoring. But while the flight-or-fight response steps down the cravings do not, they climb to a peak and it seems like they stay there. They are subsiding but they change so slowly that at first we don’t notice the difference from one day to the next. It happens over weeks and months rather than days, but it does happen and this becomes clear with hindsight.

Cravings don’t occur randomly; they are triggered. Certain circumstances, places, people, occasions and emotions are remembered by the reward system in relation to gaining alcohol. The brain recognises when these circumstances are present and launches the urge to approach alcohol and drink. These processes operate entirely automatically, we can’t choose for this to happen or not, and once these triggers are established they are never forgotten: what has become known cannot become unknown. For the rest of our lives our reward system will scan what comes in through our senses searching for circumstances that match those that have previously yielded alcohol. When those circumstances are found our attention is drawn to the near-availability of alcohol and a craving is launched. We will forever have our attention drawn to alcohol when the circumstances match those of a trigger, but this does not mean that when we stop drinking we have to resist enormous cravings for the rest of our lives; we do not. Once the brain’s reward system has identified a circumstance that yields alcohol then that trigger can never be removed, but what can change is the intensity of the craving that the trigger invokes.

The reward system aids survival but in the wild the availability of something beneficial like an important food can be unpredictable and the reward system accommodates this variability. For example, if we’d learned to sit under a tree because good fruit fell from it then the reward system would urge us to return to the tree and look for more food and this urge would strengthen each time we found food there. But if the tree stopped producing fruit then we would visit there forever if the motivating urges did not change and this would be an inefficient use of our energy. So the reward system evolved to be adaptable as well as compelling. Firstly, the cravings that are invoked have a limited time-span. If there isn’t any fruit available at the tree when we visit then the urge to continue to search there fades after several minutes and so we lose interest and move on. Secondly, if things stop happening the way that a trigger anticipates then the importance assigned to that trigger is lowered. In exactly the same way that a trigger strengthens through repeated success it is weakened by repeated failure. When a trigger consistently fails to return the object sought then the importance of acting on it (the intensity of the craving launched) is reduced. The brain can’t unlearn that something has been identified as something to be sought out, but the importance of securing it can be changed, and it is by successively denying cravings that we reduce their intensity.

By successively denying a craving the reward system recognises that the likelihood of a particular trigger being successful is less than anticipated and the urgency given to seeking out its subject is reduced. This is an incredibly important piece of information for anyone attempting to stop drinking:

Every time we resist a craving then the intensity of the next craving induced by that trigger is diminished.

The urge to drink lessens as we continue to deny the cravings and this is how we manage to stop drinking in the longer term. If this did not happen then the cravings would remain at their peak intensity forever and we would eventually fail because of the enormous effort required to continue fighting them off. We do not manage to stop drinking because we get better at resisting the cravings; we are able to stop drinking because over time the cravings fall to an intensity that we can overcome without undue effort.

The first cravings to lose their vigour are the ones that fire regardless of where we are or what we are doing; these are the ones that fire in response to being sober. When we stop drinking then we immediately feel the effects of our alcohol-tolerance and the triggers related to this fire automatically. Fear, agitation, anxiety, restlessness and alone-ness are all triggers that activate in response to us being sober and these triggers fire relentlessly when we first stop drinking. These are the source of the first cravings we encounter regularly and these are the first to lose their ferocity, but cravings do not change quickly. They diminish in strength as we continue to deny them but it still takes weeks and months to achieve a significant reduction. However, they do diminish and one day we look back and see that the cravings that once took everything we had to resist have faded and all but disappeared. By successively denying cravings from many triggers over an extended period our cravings for alcohol diminish to a level that doesn’t disturb our daily passage through life. We still get them but we can step past them without being unduly distracted from what we are doing. When we successively deny the cravings then we end up yearning for a drink no more than, for example, a donut that we might see in a baker’s shop window, or a strawberry, or some chocolate; the intensity of the cravings is back to within a natural range. But for this to happen we have to successfully deny the cravings from every trigger we encounter day after day, and when we first stop drinking the cravings are so intense that this effort is exhausting.

When we stop drinking we are not only confronted by the most intense cravings we’ve ever encountered, they are also never-ending. No sooner has one craving subsided than another begins; we can’t escape from them and indeed we must not. In order to make the power of a trigger diminish it has to fail, and to make it fail we must first experience the craving and then not drink in response to it. But avoiding triggers altogether does not help us as it leaves them still at their full power. So if we are to move around freely in a world filled with triggering circumstances then we need to bring the intensity of the cravings down to a point that they are manageable, and to do this they have to be experienced and denied. Initially the non-stop assault of powerful and continuous cravings is exhausting and our resolve weakens when we are tired, but while fighting off the cravings takes enormous effort the launching of them requires none; it happens completely automatically. Our addiction is propelled by automatically generated urges and these urges are not only compelling (that is their express purpose) they also never get tired. Our mind’s ability to launch cravings is limitless, but our resolve is finite. While we must expose ourselves to triggering circumstances in order to de-power the triggers we also need to manage our exposure to them so that we do not completely deplete our resolve because the fight against cravings goes on for months. The intensity of the cravings rises to a peak during withdrawal but only descends very slowly from there and we need to manage our exposure to triggers if we are to maintain sufficient resolve to prevail. It takes a huge and determined effort to confront and break down the strength of the cravings but over time it does happen.

Cravings are the main focus of our early struggle, but while we are completely absorbed by the severity of this challenge there are other changes that happen without any direct effort on our part or even our awareness. The flight-or-fight response steps down quite quickly but the other changes due to alcohol-tolerance persist throughout the discomfort of withdrawal and also through the first weeks of resisting the cravings. The altered GABA and glutamate have our mind racing and the reduced serotonin and dopamine keep us feeling low, stressed and alone. But when we stop drinking these four neurotransmitters are once again not at their best levels for optimal brain performance. Their displacement from the ideal is disadvantageous but it doesn’t place us in peril like those changes to the flight-or-fight response so the urgency of adjusting them is lesser, but they do change over time. All of the changes that occurred to offset the regular and large quantities of alcohol are suddenly unhelpful when we stop drinking and the brain recognises once more that its effectiveness and efficiency are sub-par. The levels of dopamine, serotonin, GABA, glutamate, cortisol, adrenaline and noradrenaline are once again sub-optimal and as our days of abstinence lengthen these all begin to revert to pre-drinking levels. But none of these chemicals, neurotransmitter or hormone, has a single function; each performs many roles and these are all inter-related. These seven chemicals do not simply keep us performing better while drinking heavily they also play a part in regulating our mood, appetite, alertness, vigour and anxiety, and each now has to find a new level. Serotonin for example creates a sense of wellbeing and happiness but is also involved in digestion and regulation of sleep. Noradrenaline has other roles in the formation and retrieval of memory as well as glucose release, and cortisol also helps manage blood sugar levels and controls our salt and water balance. All of the main chemicals involved in alcohol-tolerance are linked to the others, working co-operatively for some purposes and competitively for others, and when they all start changing their base levels at the same time then there are some chaotic outcomes. While this is happening we experience very significant emotional turbulence. The period following withdrawal is an emotional roller coaster and as our brain works to find new optimal levels for each of the key chemicals of addiction we are also constantly exposed to massive cravings. But just as these slowly subside so too do the consequences of alcohol-tolerance.

Without the daily sedatory effects of alcohol we are quite suddenly exposed to emotions in ways that we haven’t felt in a long time and they appear dramatic and vivid. We also experience alternate periods of high-alertness, lethargy, feeling good, feeling low, and so on. These fluctuations are a completely normal response to the sudden and complete absence of alcohol; they are caused by our neurotransmitter and hormone levels adjusting to find a new equilibrium. But these fluctuations also show us that our mind and body are un-doing the adaptations that were made when we became alcohol-tolerant. We don’t have to do anything to make these changes happen and they continue to correct themselves for as long as we don’t drink again. We tend not to notice these longer term changes because the changes are slow moving but there are a few exceptions to this, times that we do notice that something is different. The return of good sleep is one of them but another that is very pronounced (and quite obvious once we are alerted to it) is often referred to as the “pink cloud”.

Shortly after stopping drinking we may experience a dramatic change in our demeanour; we become calm, bright and happy. This is partly due to the realisation that stopping drinking is actually possible (we are actually achieving what we previously thought was impossible), partly to do with the emergence of hope (hope that the future really can be better), but for the most part it is to do with changes to the release rates of the four neurotransmitters regulating our mood and brain speed; serotonin, dopamine, glutamate and GABA.

While we drank regularly and heavily our brain recognised it was over-producing serotonin and it reduced the amount being released and also the number of receptors detecting its presence. This led to us feeling miserable, stressed and anxious when we were not drinking. Our brain also released more glutamate (the accelerator pedal) and less GABA (the brake pedal) and these two combine to leave our minds racing and agitated. The release rates of dopamine, serotonin, GABA and glutamate each adjusts itself independently of the others but in the absence of alcohol they all reset themselves at the same time. As each seeks a new optimal level it first over-corrects, then under-corrects, then over-corrects again and so on in decreasing increments before settling onto its best release rate. When all of these reverse their positions simultaneously then this releases more serotonin more GABA and less glutamate, and these changes keep going until they become disadvantageous… they go too far. The effect of this first overshoot is quite dramatic. Our mind was accelerated and agitated but with more serotonin more GABA and less glutamate it becomes calm, and our mood that was for so long depressed, stressed and anxious gives way to feeling relaxed, happy and care-free. Our mind stops racing and our mood becomes bright. This is the ‘pink cloud’: a feeling of cheerful and calm well-being where everything in the world seems good. The first overshoot in particular is perfectly noticeable and if we experience it it puts us into an elevated state for an extended period; often several weeks.

The intensity and duration of the pink cloud varies enormously from person to person. Some have more alcohol-tolerance to correct than others, in some the changes happen faster or slower than others, and in some the changes will happen largely in unison but in others they won’t be quite so synchronous. There is no way to know when it will begin, how heightened it will be, or how long it will last as this varies enormously from individual to individual, but the change to how we feel is perfectly apparent to anyone that experiences it.

The pink cloud shows that our brain is re-adjusting and undoing the adaptations made to offset the consequences of alcohol impairment. Our brain is adapting to being alcohol-free once more and is recovering, but it is not a smooth transition. During the pink cloud the world is a happy place and our troubles seem small. We have got through the fiercest phase of withdrawal and cravings seem to have receded somewhat, but this last point is incredibly misleading. Many of our most powerful drinking triggers are bound to distress; being unhappy, feeling alone, agitated, anxious and so on. But while we are on the pink cloud we feel neither unhappy nor distressed so while the pink cloud persists we are not triggered to drink so often… but this doesn’t last. Our brain again recognises that the release rates of these four neurotransmitters level still isn’t ideal and it adjusts them back a little. But this next time everything goes rather dull.

After the pink cloud period there comes a more sombre period. Our serotonin level dips a little, our cheerfulness drifts off to become a mild dissatisfaction with life and the cravings seem to come back. This can be an extremely challenging time and many fail to negotiate this dip. While on the pink cloud it seems like we have beaten our addiction but this is an illusion, there is still a long way to go. While on the high of the pink cloud everything is good and easy but when it fades we really feel the daily chore that staying sober has become and the effort no longer seems to bring the rewards that it did before. During this low phase it is typical that we doubt that our effort is worthwhile. The cravings still come very regularly and our brain still constantly insists that drinking is good, but we aren’t happy like we were before. The cravings lack the ferocity they first had but they are still there and the daily grind of fighting them off takes its toll. We also suffer a drop in enthusiasm for our decision. When we first decided to stop drinking we had an extraordinary boost of determination that came from the desperate need to escape our hopelessness. But once our brain begins to undo the mood changes caused by alcohol-tolerance then that despair disappears and so too does the extra determination that it brought. Our ability to recall the depths of our distress is further diminished by Fading Effect Bias which actively reduces our recall of emotionally bad experiences. As our despair fades into the past then so too does the urgency of our cause. Our determination declines and this lowering of resolve combines with a shift in the psychological manoeuvres that our mind presents. As the distress caused by drinking fades our mind presents the idea that control has been restored and two new themes of self-sabotage emerge: “you’ve beaten it now, perhaps you can have just one” and “maybe you weren’t that bad after all”.

The mood dip after the pink cloud is a very significant test and many that persevered though withdrawal will fall at this hurdle. But just like the pink cloud passes so does this lull and after that the fight settles into a more stable and progressively less demanding challenge… most of the time.

If you are trying to help someone with a drinking problem or if you are trying to stop drinking yourself then you are most welcome to read Lying Minds here or download a free copy of the eBook on the button below. The download will begin immediately; no form, no questions, no sign-up; just the book.

Chapter One: Introduction

Chapter Two: Alcohol and the Reward System

Chapter Three: How Alcohol Affects us

Chapter Four: Alcohol-Tolerance

Chapter Five: The Psychological Burden of Addiction

Chapter Six: Denial

Chapter Seven: Who Becomes an Alcoholic?

Chapter Eight: Withdrawal

Chapter Nine: After Withdrawal

Chapter Ten: The Following Months

Chapter Eleven: If we Drink Again

Chapter Twelve: The Last Words

Bibliography: Additional Reading

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