Summary: Early treatment and support for alcohol addiction is important because changes caused by alcohol addiction in key brain areas are most pronounced in the first days of abstinence/discontinuation of alcohol use.
Key Points:
- Anyone with alcohol addiction/severe alcohol use disorder (AUD) knows that the early stages of recovery can be extremely challenging.
- Research shows changes in the brain related to cravings are most pronounced in the first days of abstinence
- Research shows impaired/heightened responsiveness to stress is most pronounced in the first few days of abstinence
- Professional support and care during this early period reduces risk of relapse
Beginnings: Early Treatment and Support for Alcohol Addiction Promotes Successful Outcomes
We say above that the first few days of sobriety can be challenging. However, anyone who’s been in recovery for a while will go further and say the first few weeks or months can be tough. And most who stay in recovery for years and/or decades learn that recovery is a lifelong process, and that the core skills they learned – or didn’t – at the beginning of their recovery journey had a significant impact on their long term recovery, sobriety, and abstinence.
Those who make it through the difficult beginning stages of seeking sobriety often report that the treatment they receive during early treatment and support for alcohol addiction is important, and can make all the difference in establishing a firm foundation for long-term recovery.
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 are at risk of experiencing severe withdrawal symptoms, which can cause extreme discomfort, and which, in some cases, can be life-threatening: that’s medical fact, not exaggeration.
We recommend that anyone with alcohol addiction, AUD, or who has been regularly drinking for an extended period of time seek medical advice before quitting on their own. 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 in the American Journal of Psychiatry sheds light on why seeking early treatment and support for alcohol addiction 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 over 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.
In the study “Association of Prefrontal-Striatal Functional Pathology With Alcohol Abstinence Days at Treatment Initiation and Heavy Drinking After Treatment Initiation,” researchers from the Auburn University Department of Psychology and Yale University School of Medicine 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 to how and why humans identify, seek, and experience rewarding experiences. If we vastly oversimplify this – which helps 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.
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 areas of the human brain:
Brain Function in Early Recovery: What’s Going On?
- 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 at first.
Professional Support: Establishing New Habits
What we know from offering early treatment and support for alcohol addiction matches what the data above tell us. The first days and weeks can be hard, but over time, the cravings, the reactivity to stress, and the heightened responsivity to alcohol-related environmental cues fades.
When people receive professional treatment and support during this early period, two things are true:
- They have medical support to safeguard their physical health in the event of adverse events associated with alcohol withdrawal.
- As their brain returns to typical function, they learn to replace patterns of thought and behavior that promote alcohol seeking with patterns of thought and behavior that promote abstinence, sobriety, and long-term recovery.
As the brain and body heal, a person who engages in treatment early can heal and rebuild with one goal in mind: a successful treatment experiences. Surrounded by expert treatment professionals and recovery peers, and person early in treatment can learn effective skills to manage cravings, identify and manage triggers, and – day by day – build the daily habits necessary to not only achieve abstinence and sobriety, but also increase the likelihood of relapse.
What This Research Means
First, let’s circle back and translate the data from the study into simpler 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, partial hospitalization treatment, intensive outpatient treatment, or through peer support groups like AA, SMART Recovery, and others.
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.
When those physical processes occur in tandem with evidence-based psychosocial support, including therapy, counseling, complementary support, and peer support, outcomes improve.
Finally, this data also supports what many people in recovery learn themselves: with time, commitment, and effort, it gets better.
