The timeline of recovery varies enormously from person to person. The physical recovery of the brain and body is guaranteed to happen in the absence of alcohol but this happens at our body’s own pace and each of us re-adapts at our own speed. There is no miracle moment in recovery that marks the end, indeed there is no end because there are things we need to do, and things to not do, for the rest of our lives. Recovery from addiction is a direction rather than a destination and there are some disciplines we need to maintain forever if we are to keep ourselves well. With practice they become simple to follow and require little from us on a day to day basis and while there is no end to recovery there are some clearly noticeable progress markers along the way.
When we first stop drinking we start to experience withdrawal and many of its effects are perfectly familiar to us. What we may not understand though is their causes; and there are lessons for us in them. While we drank heavily and regularly then our brain and body adapted to try to offset the debilitating effects of alcohol in our bloodstream. These defensive measures are changes to the release rates of key chemicals in our brain, nervous system, and body and their purpose is to try and keep us awake and alert while we drink. When we stop drinking abruptly then we suddenly feel the full extent of these changes, what our body had to do to keep us functional, and it is shocking. The shakes, sweats, and pounding heart are what our body did every day to try to keep us operating successfully while we drank. They are not the poisonous consequences of alcohol; they are what our body deliberately did to try to keep us going.
The initial effects of withdrawal are well known to us because we have experienced them first thing in the mornings and on occasions when, for whatever reason, we haven’t drunk for a day or so. The chemicals that kept us running while we drank now cause the shakes, anxiety, raised blood pressure, and stomach irritation. Without alcohol to deplete them then some of the chemicals that cause these symptoms can accumulate. The symptoms of withdrawal start within a few hours of our last drink and usually rise to a peak of intensity at three or four days and then fade, but for some people they can rise to a peak that is dangerous. About one in twenty people will experience such heart irregularity and elevated blood pressure that it causes other problems, and these can be serious. Anyone concerned about this should take professional advice. A doctor will give guidance on whether it is wise to be under medical supervision through withdrawal and may also prescribe a short course of medication to lower anxiety and heart activity through this period.
By day 3 we are already past the time that we are at most risk of suffering seizures and DT’s and by day 5 we should be past the peak intensity of withdrawal, but it seems to take forever to get there. One of the measures our body took against alcohol was to speed up brain activity. We are used to having a racing, tumbling mind whenever we didn’t drink, but this now becomes the whole time. A side-effect of this is that time seems to pass slowly and the first days of stopping drinking seem to last forever. This comes right over the next few weeks but it is not the first thing our body corrects. Our body starts to undo the measures it took against alcohol but just as it took years to build them up it takes time to bring them down again. The good news is that they correct themselves far faster than the time it took to build them up.
The defensive measures are removed according to how severely these measures themselves impair our performance once we don’t drink. Progress seems impossibly slow at first but it is happening. One of the things we can reasonably anticipate is that we aren’t able to sleep because we have known for a long time that if we don’t drink in the evening then we won’t sleep properly. We will lie awake tossing and turning in a sweaty heap while our mind races uncontrollably, or we will come suddenly wide awake in the middle of the night. This is what is going to happen for quite a while so expect it, it is normal. It is what our body did every night to offset the consequences of drinking and it takes a while for it to now be recognised as disadvantageous and something to be stepped down. While we are in withdrawal we feel hot, have a faster heartbeat, we are anxious, have a racing mind, and on top of these we are sleep deprived. This is what is supposed to happen and it confirms that stopping is necessary because we only get these withdrawal symptoms if we have developed alcohol-tolerance.
The slide into addiction is slow and seamless but the way out is nothing like that; it is raw and volatile. The most likely time to give up is in the first two weeks so steel yourself for this and plan to get through it. Do the things that will lower the number and intensity of the cravings that you will meet and do the things that will keep your resolve high. You do not have to sustain this forever because the position is guaranteed to improve. Our brain will undo the changes due to alcohol-tolerance and the intensity of the cravings will start to lessen. All we have to do is keep going.
One of the first signs we get that our body is correcting itself after years of being adjusted for drinking is that sleep returns. This usually happens at around two or three weeks after our last drink and is quite marked when it happens. Not only do we suddenly get to sleep again but the sleep is different: it leaves us refreshed and bright in a way that we aren’t accustomed to. While the first big change that we notice from stopping drinking is that sleep returns there are changes that others notice. Alcohol-tolerance causes us to operate with a heightened heart rate for an extended period, but it is quite specific in the way that this happens. Our mind and body are prepared as though there is some imminent danger that we need to be ready to react to. Our heart rate is accelerated and blood is diverted from the skin to our large muscles and this is the cause of our pale complexion. Our minds are made more alert and our senses constantly scan for danger, and this causes our restlessness and sense of something bad being about to happen. When we stop drinking then these precautions are stepped down and while we may not see them, others do: people start to comment that we are looking well. What they have noticed is that colour has returned to our complexion but there are two other less obvious changes and they are that we stand taller and our mood brightens. As the days since our last drink mount up then our sense of hopelessness starts to fade and our self-image lifts. We no longer feel the depth of worthlessness that we did and this is what causes the change in our posture and improvement in our mood. When colour returns to our complexion then good sleep is not far away because the elevated heart rate, alertness and the inability to sleep are all parts of the same process. While we drank our brain tried to keep us awake so that we could respond to danger but when that need disappears then it relaxes and we experience sleep that is unfamiliar: it is deep, satisfying and refreshing. If you are keeping a gratitude list and experience this new sleep then add it to your list because it is one of the great rewards of stopping drinking that is easily overlooked.
Alcohol-tolerance changes the release rates of seven key chemicals and in the prolonged absence of alcohol each of these re-adjusts to find a new normal. These chemicals are some neurotransmitters (chemicals in the brain and nervous system that operate between nerve cells) and hormones (chemicals carried in the blood that control the behaviour of our organs). Collectively this seven; dopamine, serotonin, adrenalin, noradrenalin, cortisol, GABA and glutamate cause all of the symptoms of alcohol-tolerance: restlessness, anxiety, hopelessness, fear, sleeplessness and a racing mind. When we stop drinking then all of these start finding new levels that will keep our brain and body functioning in an optimal state, but this is a tricky thing to achieve. Each of these chemicals has multiple roles in the brain or body and when they all adjust at the same time then this can cause some chaotic outcomes: our mood can be all over the place. Getting sober is a wild ride for our emotions and they leap from one extreme to another at the slightest prompting. We feel this so strongly because we aren’t used to emotions coming quite like this. For years we have smothered our emotions with alcohol but now we feel them raw and vivid. This isn’t a bad thing; this is how they are supposed to be. It shows us that we are getting better and that our brain and body are recovering, so when you experience them then acknowledge this. It is you recovering your proper emotions.
There is one notable experience in this process that happens to many people and this is often referred to as the “Pink Cloud”. As all the chemicals of addiction readjust their release rates then this inevitably affects our mood. Lowered serotonin release caused us to be depressed and withdrawn while we weren’t drunk but it now seeks a new level and for some people it heads towards its optimal position and then overshoots the mark. This leaves us with a feeling that all is well in the world. We are cheerful and bright, and although we are still confronted by regular and intense cravings the rewards of sobriety seems to far outweigh the difficulty of carrying on. Unfortunately the Pink Cloud doesn’t last forever and coming down from it we can start to feel the opposite. It seems that the hard work doesn’t bring the rewards that it used to.
By the time we get to a month or so then things are noticeably different. We still get very regular cravings and they are still strong but they aren’t as strong as they were and if we compare them to what the first week was like then we can see this change. But more noticeable than the decline in craving intensity is that most of consequences of alcohol-tolerance are fading. The worst of the anxiety has gone, sleep has returned, and while we still have a racing mind this too is calming down.
Once the defensive measures of alcohol-tolerance start to dissipate then we feel a lot different within ourselves and this in itself presents a whole new challenge. It should be that after a month or so, when the cravings are smaller and our mood has lifted markedly, that we are far more able to carry on and stay alcohol-free. But this is often not the case. Statistically the likelihood of relapse is highest early on and then it slowly falls over time. But then there is another bulge in the graph around one to three months before it tapers down again. The difficulty here is that the nature of the problem changes and if we carry on doing what we did in the first days then we can easily get caught out. The nature of problem changes and we need to change with it.
We drink again when we meet a craving to drink that exceeds our resolve not to. When we are in that one to three month period then we meet cravings that are smaller than when we started out so our challenge is not that the intensity of the cravings has risen, it is that the strength of our resolve has fallen. The risk is that with the intensity of the challenge appearing to fall away we feel growing confidence that we have won this contest and pay less attention to fighting it, but we do so at our peril. With less attention drawn to meeting the challenge then the self-sabotaging thoughts become more convincing and eventually they gnaw away at resolve and we fall. In the months following stopping drinking the focus of the problem migrates from cravings to resolve and we need to move with it. This will trip some people and for some it forms into a looping pattern of repeatedly doing the hard work of stopping only to relapse a few months later.
Stopping drinking is one challenge but staying stopped is another and it is quite different. When we first set out the challenge is fierce and constant but our effort is propelled onwards by the surge of strength we get from desperation. Over time the intensity of cravings subsides and the distress caused by alcohol-tolerance fades but relief from that despair steals the urgency from our cause. We need to steadily work at maintaining our resolve while at the same time it no longer seems necessary to do so. This is a step change in our path and it is a tricky one to negotiate.
So far this book has looked at what can do to help ourselves stop drinking. It now looks at what we have to do to stay stopped. Initially our sole challenge was to overcome the urges to drink but now we need to redirect our attention to a major cause of enduring cravings, and that is our emotional triggers. The unpredictability of the world guarantees that these powerful triggers will sometimes be fired for the rest of our lives, and we must learn to negotiate that. If our resolve is firm then we can get past sudden difficult events without too much difficulty, in fact our sobriety becomes an asset at these times. But if we experience persistent distress then this can steadily corrode our resolve until “a drink will make you feel better” sounds too attractive to resist. There are several things we can do about this. We can continue to work to keep our resolve high, we can deliberately act to improve our day to day emotional state, and we can remove some sources of enduring distress. If we do all of these then we will experience fewer cravings, those cravings will be short and spread well apart, and our capacity to overcome them will be greater. The challenge shifts from fighting cravings to removing what is going to cause them. If we do this successfully then we not only make ourselves happier we also remove the very things that are likely to cause relapse, because if we are content in our recovery then the need to drink simply doesn’t occur. Every time we improve the way we feel about ourselves and our place in the world we get a twofold gain; we feel happier, and we deny self-sabotage the opportunity to establish itself and grow.
Stopping drinking and recovery are two different things. Stopping drinking is abstinence and that is measured in continuous days of sobriety, whereas recovery is living a fulfilling life that is entirely independent of alcohol, and that is measured by a return to emotional wellness. They are quite different goals and we need to strive towards this new objective because failing to do so leaves the door open for relapse. We cannot rely on our sober-days count to keep us safe because no amount of abstinence prevents self-sabotage.
If we are to achieve an enduring sobriety then we must work at our emotional wellness from both ends. We need to remove things from our lives that cause us enduring distress and we need to enhance or insert things into our lives that increase contentment. We aim towards achieving a state where having a drink never appears to offer us any advantage, because if we do this then we render the self-sabotaging thoughts completely powerless. This is the challenge of staying stopped.
The goal of recovery is emotional wellness and it is characterised by these six qualities:-
Peace of mind. I have a calm clear head, even when the going’s tough.
Self-respect. I no longer have that appalling self-loathing and sense of complete worthlessness.
Hope. I am no longer trapped in a belief that I am doomed to a miserable end.
Freedom. I am free to do as I choose; I am no longer condemned to spending most of my days either incapacitated due to alcohol or serving its call. My time is mine to live how I choose.
A clear conscience. I am no longer bound to the shame and guilt of what’s gone before, nor do I spend my days making new things to be ashamed or guilty of.
Contentment. I am no longer permanently bound to feeling miserable and that my life is difficult. In its absence is a calm contentment with what I have and who I am. Recovery isn’t about the pursuit of some magical nirvana. For the most part the contentment we seek is what is left behind if we get rid of the unwanted baggage in our mind and concentrate on living today rather than in the past or the future. This direction change from fighting cravings to improving our mental well-being is a significant one but it is not something that suddenly happens. We don’t one day reach a point where we suddenly shift our effort from preventing ourselves from picking up a drink to changing how we live. What happens is that one becomes less important over time while the significance of the other increases. Nevertheless we must do this if we are to avoid relapse. Just as there are many moving parts in addiction there are many components in achieving this wellness, but essentially they fall into two parts; clearing up the past so that it no longer haunts us, and living in ways that improve rather than depress our daily experience. Many people will neglect or choose not to attend to these but it places them at risk because it leaves a burden of distress in place that encourages self-sabotage and relapse. Our lives need to be unshackled from the past if we are to be able to enjoy them freely, and when we are comfortable in our lives then the need to drink does not recur. But this does not happen without effort. We need to do things to make this happen.