Anyone with a severe alcohol use disorder (AUD) who tries to quit drinking knows the first few days can be tough.
Some would go further and say the first few weeks or months can be tough.
And most learn that recovery is a lifelong process – but that’s a different topic for a different article.
Those who make it through the difficult beginning stages of seeking sobriety often report that the treatment they receive during rehab makes all the difference. Those who don’t go to rehab and make it through those challenging early days report that the support they receive from peer groups like Alcoholics Anonymous (AA) or SMART Recovery help them stay sober when all they want to do is return to drinking.
A quick note here. People with severe AUD who quit cold-turkey risk of experiencing severe withdrawal symptoms. Withdrawal can cause extreme discomfort, and in some cases, can be life-threatening. We recommend that anyone with AUD seek medical advice before quitting. If that medical advice includes medically monitored or medication-assisted detox, we strongly encourage them to take that advice. It could quite literally be the difference between life and death.
Now, back to the topic: the early stages of abstinence and sobriety. A study published by Yale University in August 2020 sheds some light on why seeking treatment and support is crucial, and why the first few days, weeks, or months can be so difficult.
Disruption and Dysfunction in the Brain Reward System
It’s been almost thirty years since the disease model of addiction began to supplant the moral failing/lack of willpower model of addiction in the addiction treatment community. Since then, researchers have explored various ways the reward circuit in the human brain develops maladaptive patterns due to long-term exposure to substances of disordered use, such as alcohol.
This year, researchers at Yale identified significant functional disruption between two brain areas that play a central role in our reward circuit: the ventromedial prefrontal cortex and the striatum. To put this in context, the reward circuit refers, broadly, to how and why humans identify, seek, and experience rewarding experiences. To vastly oversimplify this – because very smart people spend a lifetime studying reward circuitry, and most admit they barely scratch the surface in understanding how things work – our current understanding is that the striatum is involved in motivation and assigning value to a particular goal, behavior, or thing, while the prefrontal cortex is involved in how we regulate, modulate, and control our behavior relative to input from the striatum.
And to put it even more simply, the prefrontal cortex helps us modulate impulses and emotions, while the striatum generates those impulses and emotions.
Here’s what the Yale researchers found about these two brain areas:
- They identified maladaptive communication between these two brain areas in people with AUD, compared to control groups without AUD.
- The more severe the AUD, the more maladaptive the communication between the two brain areas.
- The more recent the presence of alcohol in the brain, the more severe the maladaptive communication between the two brain areas.
- Over time – in the absence of alcohol – the maladaptive communication decreased.
For people in recovery, this data supports the subjective experience of almost everyone who tries to stop drinking: it’s really hard in the beginning.
What This Research Means
First, let’s translate that data into plain language:
- Alcohol impairs the ability to modulate alcohol-related impulses
- This impairment leads to the decision to drink, a.k.a. relapse
- The longer alcohol is absent from the brain, the less powerful the impairment
That third point implies this point: the more recent the presence of alcohol in the brain, the more powerful the impairment. Therefore, the earlier a person is in recovery, the harder it is for them to resist alcohol-related impulses.
That’s why treatment and support – especially in the early stages of recovery – is vital. The brain data shows that in those first few days and weeks, the brain is functionally impaired. During this time, the more support a person receives, the more likely they are to resist the impulse to drink. Professional and peer support can help them understand what’s going on in their brain – and why they shouldn’t act on their impulses. This support may come in the form of residential treatment for AUD, partial hospitalization treatment for AUD, intensive outpatient treatment for AUD, or through support groups like AA.
The data also shows that over time, the maladaptive communication between brain regions gradually fades. Typical, effective communication between brain regions is restored – as long as the person remains abstinent from alcohol.
What this means for people early in recovery is that yes – it can be tough, since their brain allows them to prioritize alcohol over sobriety. However, as time passes, the brain recalibrates and allows them to prioritize sobriety over alcohol. It doesn’t happen immediately, but it does happen: that’s why seeking support and sticking with it in the early phases of recovery is essential.
Finally, this data supports what many people in recovery learn themselves: with time, it gets better.