Understanding the Addiction Cycle
Alcohol use disorder, hereafter known as AUD, is a lifelong disorder. People with it are prone to return to drinking because it involves a compulsion, often to the detriment of the person doing the drinking. Its pull is such that people will drink to excess no matter the personal, professional, or medical consequences of doing so. It’s not that the person chooses to drink. Rather, it’s that the person will drink regardless of personal choice. The disorder ranges from mild to severe in intensity.
Alcohol use disorder is not a personal failing. The American Psychological Association considers “alcoholic” to be an ableist term. Similarly, the term “alcoholism” is quickly falling out of favor.
As previous cited by the Canadian Alcohol Use Disorder Society, substance use disorder, or SUD, of which AUD is a subgroup, is a mental-health condition, and the people who experience it are neither “less-than” nor “defective.” In the same vein, the United States Congress approved name changes for three federal agencies related to substance use and SUD. One of those three is the National Institute on Alcohol Abuse and Alcoholism, which was renamed the National Institute on Alcohol Effects and Alcohol-Related Disorders, or NIAEAD.
When it comes to the cycle of AUD, the stigma attached to it often exacerbates people’s negative emotions, which can lead to them returning to drink and perpetuating the cycle of AUD. The government-level move away from the condition being a personal failing and toward it being a disability, as well as a mental-health condition, reduces the stigma and negative emotions people experience. Reducing the stigma and negative emotions around AUD then removes a barrier to people seeking and receiving help.
The Effect of AUD on the Brain
Alcohol affects the pleasure center of the brain and reduces the effect of negative emotions. It also inhibits impulse control. This feeling of “being free” and/or “feeling no pain” is a huge draw. According to the dictionary, the phrase “drive me to drink” is an idiom that means a person’s behavior or an unpleasant situation is so disquieting that you have to drink to excess just to forget about them. That amusing quip is rooted in the sobering truth, pardon the pun, that people often self-medicate with alcohol because of the pleasurable effects it creates.
Those pleasurable effects come with negative consequences, however. Those consequences include the misfiring of neurotransmitters, such as serotonin, in the brain. Someone who has drunk alcohol has impaired senses of both balance and judgment. If they drink too much, then they also forget things, slur their speech, and might injure themselves because of the lack of balance. Taken to extreme, alcohol can cause complete memory blackouts or even be fatal through either alcohol poisoning or developing delirium tremens during withdrawal.
Delirium Tremens
In severe cases of AUD, delirium tremens, or “the DTs,” is a life-threatening condition that is part of alcohol withdrawal. People who have it experience a dangerous rise in blood pressure, tremors and seizures, and even sudden cardiac arrest or sudden cardiac death. In addition to the physical symptoms, people with the DTs also experience hallucinations that affect all five senses.
With the DTs, you will need hospitalization. While there, you’ll be treated for each of the symptoms with a different drug, such as antipsychotic medications to treat the hallucinations or anticonvulsives to stop the seizures. If your case is particularly severe, the doctors might even put you into a medical coma until your symptoms stop.
Untreated, delirium tremens has a mortality rate of up to 37%. Conversely, the mortality rate is just 5% with early and correct treatment.
Only Temporary Relief
The sad part is that the relief offered by alcohol is only temporary. The unpleasantness that “drives people to drink” is still there, and the person then turns to more alcohol to keep from facing the unpleasantness. Alcohol can cause negative emotions, such as anxiety, stress, and even suicidal ideation, which might not be present when you’re sober. Sometimes, too, alcohol causes yo-yo-ing between emotional states. Alcohol withdrawal, with all its unpleasantness, can lead to more drinking to stave off the withdrawal symptoms. This is the vicious cycle of AUD.
Perhaps worst of all, sustained excessive drinking can lead to permanent changes in the brain. Not only are these changes pronounced, but they’re also progressive. They even persist if the person is successful in reaching recovery. As previously cited by the NIAEAD, these changes in the brain are the chief reason that people in recovery return to drinking. The changes include loss of memory, impulse control, and high-level cognitive functions. Sleep deprivation is also common.
The Three Stages of the Cycle
All information on the three stages in the following section, and its subsections, comes from this source.
In addition to AUD being mild, moderate, or severe, there are also three stages of the cycle of the disorder. Each of the stages is connected to the others. There are also three areas of the brain that alcohol affects: the basal ganglia, the prefrontal cortex, and the extended amygdala. It’s important to note that someone can go through all three stages in a single day, and people experiencing severe AUD can actually go through all the stages multiple times a day. Also, as previously cited, AUD is a lifelong condition. If a person continues to drink, then the daily effects of alcohol on the brain will continue. Once the person decides to stop drinking and to get help, then the cycle is broken. Yet, the person must continue to be aware of the possibility of cravings and a return to drinking.
Stage 1: The Binge
During this stage, the person who drinks will experience the “reward” of drinking, which includes euphoria, the forgetting of negative emotions and experiences, and the ease of being social without inhibitions.
By drinking, the person activates certain pathways in the basal ganglia that reinforce the behavior of drinking. This is what makes people drink even after terrible withdrawal, negative job and social effects, and health problems. The person’s drinking becomes routine, hence the term “binge.”
The routine nature of the person’s drinking also becomes intertwined with people, places, and things. In much the same way that smokers “can’t have a cup of coffee without a cigarette,” someone who develops AUD “can’t attend a party without having a drink.” The person could also develop multiple triggers, which would, in turn, create more compulsion to drink in more situations than ever.
Stage 2: Withdrawal
After the binge, there comes the period of withdrawal, which is colloquially known as a “hangover.” When it comes to AUD, the withdrawal that follows a period of drinking produces effects that are the exact opposite of those imparted during the “reward” stage. These include sleep disturbances, feeling sick, and becoming irritable. If the person started drinking to numb some kind of pain, physical or emotional, then during the period of withdrawal, the person will also begin to realize that the bad things are still there and that the alcohol was only a temporary relief.
The effect of alcohol on the basal ganglia also hampers a person’s ability to derive pleasure from everyday life. Things that you’ve previously enjoyed, such as hobbies, jobs, or relationships, could no longer provide the same joy that they once did. You notice this lack of joy during this withdrawal period, which could be an incentive to drink again. Eventually, after a period of binge-withdrawal episodes, the “reward” is no longer attractive, and the person drinks simply to mask the lack of joy and other negative feelings and emotions.
Stage 3: The Cravings and the Loss of Executive Function
This is what used to be known as “relapse.” When someone returns to drinking after a period of sobriety, the pull of the cravings became so strong that the person does it even if the person knows how bad it can be to do so. In these cases, the person sees everything as immaterial other than the need for the next drink. Examples include hiding a fifth of whisky somewhere in the home, ignoring responsibilities to drink, or even stealing alcohol. Prolonged AUD can affect the person’s decision-making ability and organizational skills through damage to the prefrontal cortex. So, even a person who “would never steal anything” could conceivably steal the alcohol because of the change in the person’s impulse control.
Hyperkatifeia
While less dangerous than the DTs, hyperkatifeia is a serious emotional side effect to alcohol withdrawal. It’s a negative emotional response to the already-existing negative emotional responses to the withdrawal ad the original negative emotions that were the catalyst that led to the person beginning to drink in the first place. It’s one of the chief causes of people returning to drinking despite even long-term success during recovery.
How to Break the Cycle
According to AA, the mantra of, “You can’t help someone with AUD unless the person admits the problem,” still rings true after many, many years. It’s the first step: admitting that you’re powerless against alcohol and that you have to surrender and get help. Fortunately, if the person with AUD admits the need for help by surrendering, there are many options available today in addition to the Twelve Steps of AA. It can be daunting for you to try to figure out what to do, where to go, and how to get help.
Fortunately, resources like the National Rehab Hotline are there to point you in the right direction. While we might not be able to provide direct help in treating your AUD, we can certainly lead you to the various available resources and facilities to get that help. The NRH maintains a list of resources available by state, and you can either call us directly or find those resources on our website.
We also offer advice on how to speak to loved ones and friends who might need the help but are unable to seek it for themselves. The hotline is available 24/7/365 so that you never have to worry about hearing, “Please call again later,” or hearing a busy signal. You can get help for the struggle ahead, and there is hope. If you even think that you might need that kind of help, then call the NRH immediately.