For many of us, alcoholism is characterized by excessive alcohol use. Most of us associate that with chemical use disorder or chemical dependency – chalking up all problems to that chemical dependency. That’s why, when asked to quit, most people focus on cutting the alcohol and quitting at home. In fact, most people with alcohol use disorder have tried and failed to quit by going cold turkey at home – some of them as many as 4 or 5 times. But, a significant portion of people continue to show the same behavioral problems and maladaptive patterns when sober as when drunk.
In Alcoholics Anonymous, this syndrome is known as being a “dry drunk”. And, it’s an important part of the process of realizing that much of alcohol use disorder isn’t about chemical addiction.
It’s about behavioral addiction, habits, and learned, maladaptive patterns. Recovering from that requires significant treatment, including mental health treatment like cognitive behavioral therapy.
PAWS
Post-Acute Withdrawal Syndrome or PAWS is an alcohol-withdrawal syndrome where the symptoms and side-effects of withdrawal can continue for months after someone quits. In a medical setting, under medical monitoring, this syndrome can be recognized and treated to reduce the mental and physical impacts of long-term withdrawal. When people quit at home, they can receive no such treatment, often resulting in acting out, behavioral issues, and several weeks to months of real suffering. That can exacerbate maladaptive and antisocial behavior, leading to someone who is unpleasant, engages in outburst, and who has significant mood swings, even when at treatment or at Alcoholics Anonymous.
Eventually, Post-acute withdrawal syndrome affects anywhere from 0.1-8% of individuals. It’s also more common in individuals with significant underlying mental health problems and emotional regulation problems. Behavioral sensitivity for stress, or existing problems dealing with stressful situations, also exacerbates this situation.
Getting help and medical monitoring during detox is important to ensure you recover from alcohol safely. If you do have longer-term complications, detox ensures you get medical help to prevent symptoms, to allow you to live in a comfortable way, and to get the emotional and mental support you need to navigate it.
Behavioral Problems
While syndromes like PAWs can sometimes result in someone being labelled a “dry drunk”, that’s often not the case. Instead, people get clean or quit on their own or with minimal benefit from therapy and then go to AA. Here, they have no skills or emotional training, no counseling, and no behavioral therapy to identify and help with underlying problems. That can be a considerable handicap, because addiction is significantly more than a chemical dependency. Instead, addiction is largely a behavioral disorder, where people use drugs and alcohol as a coping mechanism for pain, stress, emotional dysregulation, and mental health disorders.
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Habits – The longer someone is addicted, the more they see their emotional pattern as normal. Someone with an alcohol use disorder might find it normal to behave with hostility, to treat people in ways that are not at all reciprocal, and to manipulate or lie to others. Unlearning those behaviors doesn’t just happen when you quit alcohol. And, without therapy and insight into those behaviors, many people might not even realize they have that. That self-denial is learned in addiction and continued after quitting alcohol – resulting in people who can maintain the behaviors and habits of addiction long after they physically quit.
Emotional Regulation – Alcohol use disorder can cause significant dysregulation of the reward circuit, serotonin production, and the gut.
All of these contribute to happy and healthy emotional regulation. Someone coming down from a long period drug or alcohol addiction might have trouble being happy, might have trouble feeling good about themselves, and might largely feel numb. That can result in severe mood swings and significant problems with anger management and stress management. And, while most people in AA can understand and have experienced that, most of us have hopefully also gotten help with that.
Underlying Problems – Most people don’t turn to drugs and alcohol because everything in their life is great. Instead, we use drugs and alcohol to cope with stress, mental health problems, loss, trauma, and pain. If you just quit drugs or alcohol without seeking out treatment for those problems, you’re still facing them, without help. And, if you just quit on your own, you’re facing them with the added disadvantage of emotional instability and physical health problems or financial instability caused by periods of addiction. That can make the early stage of recovery, often 6-12 months, incredibly difficult.
Eventually, it’s important to understand that people who behave in a “dry drunk” fashion aren’t deliberately trying to hurt anyone. Often, “dry drunk” is seen as heavily stigmatized word and it can be hurtful, it can drive people back to addiction, and it can alienate someone and push them into leaving. At the same time, it’s understandable that people who are actively working on themselves don’t want to be forced to interact with and manage someone who hasn’t gotten to that stage yet.
In fact, some experts suggest that nearly everyone recovering from alcohol goes through a “Dry drunk” phase. Here, an individual might experience anywhere from a few weeks to several months of hostility, emotional dysregulation, depression, frustration, and anger. It’s characterized by cravings, poor control of the mental state, and poor understanding or regulation of emotions. Those of us with more emotional regulation and emotional intelligence can recognize and begin to sort through those behaviors on our own. Most of us need help and that often means either input from groups like alcoholics anonymous, from counselors, or from therapists. Getting that input, including insight into underlying problems, coping mechanisms that don’t include drugs or alcohol, and emotional support can help even the worst “dry drunk” to find motivation to recover not just from physical addiction but also from behavioral addiction.
If you or a loved one is struggling, it’s important to get help. That means not only putting alcohol down but also seeking out mental health treatment, getting counseling, and getting insight into your problems. Modern rehab uses treatments like cognitive behavioral therapy to help individuals identify and cope with trauma and behavioral patterns, to build new behaviors, and to interact with the world in a safer and more comfortable way.
If you or your loved-one struggles from substance abuse please contact us today to learn more about our detox and residential treatment programs. We’re here to help you recover.
