11 August 2021
Part of many check-ins, during SMART Recovery meetings, is a discussion of withdrawal symptoms. When a person decides to leave her drug of choice behind, things start happening. And most of them are painful. Here’s why.
Tolerance is what happens as your body adjusts to using psychoactive (or other) drugs. (All drugs discussed in addiction are psychoactive, as they affect the central nervous system (CNS), thereby affecting behaviour.) You know your tolerance for alcohol is changing when you need to drink more to feel the desired effects. Within your nervous system, you’re establishing a new normal every time you increase your dosage or amount of alcohol consumed. This is neuroadaptation.
The old normal was based on the number of nerve cells able to transmit dopamine. Dopamine is one of the feel-good transmitters naturally travelling through your CNS from one nerve cell to the other, as you encounter various situations in life. For example,
“…food seeking can increase brain dopamine levels in some key brain centres by 50 percent. Sexual arousal will do so by a factor of 100 percent, as will nicotine and alcohol” (Maté, 2018, p. 145).
Before you used alcohol, your body had a consistent number of dopamine receptors. The number varies person to person. (Significantly, those with troubled childhoods, trauma, or dysfunction have fewer dopamine receptors.) As you increased alcohol consumption, your CNS adjusted (increased) the number of dopamine receptors to accommodate the increased quantity of dopamine transmission created by the neurochemical action of the alcohol. Your new normal meant that the more alcohol you regularly consumed, the greater the number of dopamine receptors on standby awaiting more alcohol-induced dopamine transmission. This allowed you to feel the way you wanted to feel—your new normal. This is neuroadaptation.
But, now that the capacity has increased, anytime the alcohol is absent, you know it in a very big way. This is withdrawal and yes, a hangover is the first sign of withdrawal commencing. Your body is literally screaming its request to increase dopamine levels via alcohol use. That scream takes the form of physical, emotional, and mental pain coming at you through anxiety, agitation, restlessness, irritability, and sleeping troubles.
However, the reason I’m starting the blogs on withdrawal with alcohol is that it can be life-threatening. Yes, you read that right—unsupervised acute withdrawal from chronic alcohol use can kill you. Suddenly stopping alcohol use may trigger:
It may also trigger Delirium Tremens (“the DTs”) which, in the past, killed as many as 20% of those with untreated serious alcohol withdrawal (Matua Raki, 2012). Signs of the DTs include agitation, confusion, disorientation, hallucinations, fever, heavy sweating, high blood pressure, and changes in heart rate. Though the DTs are mostly associated with severe alcohol withdrawal, the same symptoms can appear from severe withdrawal (i.e., sudden cessation after heavy use) from other drugs such as GHB, benzodiazepine, or inhalants. So, while you may be ready to go cold turkey and get this chump off your back, your doctor may well advise you to taper down your usage—please listen to her or pay attention to this blog: it could save your life.
Remember neuroadaptation from above? As your withdrawal process commences, the first two weeks will be really tough. And urges will come—those urges are evidence of the dopamine craving. Each time you resist an urge, you’re instructing your body to decrease the number of dopamine receptors calling for alcohol or a substitute i.e., neuroadaptation hurts you going down but helps you re-building toward healthfulness.
Dan Chalykoff is working toward an M.Ed. in Counselling Psychology and accreditation in Professional Addiction Studies. He writes these blogs to increase (and share) his own evolving understandings of ideas. Since 2017, he has facilitated two voluntary weekly group meetings of SMART Recovery.
Dan,
This was really informative. In simple terms you could apply this to any form of addictive behaviour increasing dopamine levels? I see myself with food here. If you can get past the first two weeks, you have a chance allowing your body to help your brain make healthy decisions.
Julie
Yes, Julie, you’ve got the idea. Even with alcohol, it’s not dopamine alone so, with other drugs, it can involve other neurotransmitters as the primary and secondary agents. I’ll write on cocaine, cannabis, and methamphetamine, probably more but, yes, the concept is accurate. I’m really glad it was informative. Thanks for taking the time to read it and comment.
This post really spelled things out in black and white for me, Dan. It’s a scary read, but, as you stated, it could save someone’s life. It’s so important to know the full effects of going cold turkey.
Which is precisely why it’s the first of the withdrawal series.
Thanks for that, Trish.