Likely the most common question people with Alcohol Use Disorder (AUD) or alcoholism ask when they are going into detox withdrawal or rehab is “Can I ever drink again?”. There are two main reasons for this. First, the emotional and psychological process of coming to terms with alcohol addiction is generally extremely difficult. Second, the social and biological habits of addiction are so powerful that it is not an easy road to overcome them.
In this article, I describe the essentials of the cycle of alcohol addiction to set the stage for answering this question in a number of ways. The prevailing answer is “No”. Surprisingly, that is not necessarily the case. “Maybe” and “Yes” are also valid choices worth considering, depending very much on your situation and preferences.
Alcoholism Recovery Process
Alcohol addiction is a chronic relapsing disorder. It is characterized by compulsive alcohol drinking, the loss of control over how much is consumed, and a negative emotional state when alcohol is no longer available. There is an impaired ability to stop despite adverse circumstances. Alcohol addiction refers to the moderate to severe end of the AUD spectrum.
Drinking over time causes changes to the structure and function of the brain. They can affect the brain in a way that causes the transition from controlled, occasional use to chronic misuse which can be difficult to control. These changes can endure long after you stop drinking and can contribute to relapse in drinking.
Addiction is understood to be a repeating cycle of three stages.
1. Binge/Intoxication Stage: Reward, incentives, and habits
During this stage, a person experiences the rewarding effects of alcohol, such as euphoria, the reduction of anxiety, and the easing of social interactions. Alcohol drinking behavior is reinforced in the brain, increasing the likelihood of repeated consumption. This happens with incentive salience neurocircuits which link the pleasurable, rewarding act of drinking with “cues” that become motivationally significant.
Changes are triggered in how you respond to stimuli associated with drinking alcohol, such as people, places, things and descriptions of drinking. Over time, these stimuli can trigger powerful urges to drink alcohol and become habit forming, contributing to compulsive use
2. Negative Affect/Withdrawal Stage: Reward deficit/stress surfeit
Here you feel anxious, uneasy and irritable. You feel you need alcohol for relief from discomfort and emotional pain. If you are addicted to alcohol and stop drinking, you experience withdrawal. The symptoms are the opposite to those when you are drinking—both physical and emotional. The negative feelings are thought to come from two sources:
- Lowered activation in the reward systems (reward deficit), makes it difficult to experience the pleasure of living.
- Increased activation of the brain’s stress systems (stress surfeit), contributes to anxiety, irritability and unease.
You now no longer drink alcohol for the pleasurable effects (“the high”), but rather to escape the “low” feelings of chronic alcohol abuse.
3. Preoccupation/Anticipation Stage: craving, impulsivity, and executive deficits
In this stage, after a period of abstinence, you seek alcohol and become preoccupied with finding it. The part of the brain responsible for executive function (planning, managing time, decision making) is compromised.
When Is a Person Considered “Recovered”?
Recovery is a dynamic process that’s unique to each individual. It consists of two primary goals: stopping heavy drinking and no longer experiencing AUD symptoms, except craving).
According to the National Institute on Alcohol Abuse and Alcoholism, if you achieve both goals and maintain them over time, you are considered clinically recovered. This brings with it many elements of well-being: physical, mental, social and spiritual. These are critical for recovery.
About half of AUD patients will have some withdrawal symptoms when they stop drinking. A small percentage will need medical “detox” care and monitoring to manage potentially dangerous symptoms.
In contrast to a widely held belief, most people with AUD reduce or resolve their drinking problems over time. While the first year can be challenging with setbacks and relapse, in the long run quality of life improves and psychological stress decreases..
Can Recovered Alcoholics Have a Drink?
The answer to this common question is “It depends”. Mostly it depends on you and on which method of recovery you follow. If you have more severe AUD, the answer is typically “no” because the habitual patterns are still well established in the brain. If you have a more moderate AUD, one of the methods described below may work, allowing you to consume alcohol in moderation or with medication.
Do You Have to Be Sober Forever?
There are currently three main models of recovery from AUD:
Total Abstinence: Alcoholics Anonymous (AA):
Has a foundation principle of total sobriety. The sponsor/mentor system and support groups (AA meetings) are designed to provide highly available peer support on an ongoing basis for life to assist you. There is some debate about the number of years members remain sober.
Variable Within Guidelines: Moderation Management:
This controlled drinking approach is likely best for those who have a problem with drinking but do not meet the criteria for moderate or severe AUD. Following its Guide to Moderation Management Steps of Change, this approach breaks the change process down into a number of smaller, more manageable steps, in order to build confidence.
“Moderate consumption” is 1-2 alcoholic drinks per day for healthy men and one alcoholic drink per day for healthy women. One drink is equivalent to 12 ounces of beer, 5 ounces of wine or 1.5 ounces of spirits.
It begins with a 30-day period of abstinence to be able to see what that looks like for you. Then using a journal and log book you keep track of your drinking within moderate guidelines and self-monitor. It makes extensive use of social media, chat rooms and listservs to help members communicate together.
No with Naltrexone.The Sinclair Method for AUD:
This evidence-based method was developed by Dr. D. John Sinclair around the prescribed use of Naltrexone, an opioid antagonist. Unlike traditional treatments that require complete abstinence from alcohol, the Sinclair Method allows you to continue drinking alcohol at the beginning of the treatment. In fact, treatment success depends on continued consumption of alcohol
Naltrexone is taken 1-2 hours before drinking.It blocks endorphins, naturally occurring opiates in the brain, from being released when alcohol is consumed. As a result, there is no “buzz’ or rewarding experience. So the alcohol doesn’t make you feel the pleasure that drives compulsive drinking. So your brain learns not to associate alcohol with pleasure. So you find it easier to drink less. This results in reduced cravings and improved control over alcohol use. The approach is less common in the US but is more widely used in Europe.
What Happens If I Drink After Sobriety?
It depends on the method, as described above. For AA, you likely will relapse into using alcohol. For Moderation Management, you have a supportive community to assist you. For the Sinclair Method, drinking is actually required initially to initiate the
Aftercare Process
Support groups and alumni resources are an important element of recovery.
With the exception of the Sinclair Method, each approach has support groups and social media to connect members.
Help Is Available
At The Encino Recovery and Detox Center, we don’t just treat addiction; we nurture the spirit, heal the mind, and empower individuals to reclaim their lives. If you or a loved one is on the precipice, seeking a way out of the darkness of substance abuse, remember that help is just a call away. Your journey to wellness, purpose, and a brighter tomorrow begins with that first step.
Sources
Neuroscience: The Brain in Addiction and Recovery 2022. National Institute on Alcohol Abuse and Alcoholism. .
The Cycle of Alcohol Addiction. 2021. National Institute on Alcohol Abuse and Alcoholism.
Alcohol Use Disorder: From Risk to Diagnosis to Recovery. 2022. National Institute on Alcohol Abuse and Alcoholism.
Guide to Moderation Management Steps of Change. Moderation Management.
