— What happens when an addicted person stops using?
Withdrawal effects can appear as unpleasant physical or emotional sensations. Imagine someone who smokes for three years and then quits abruptly; the brain no longer receives the familiar substances, leading to discomfort that can vary in intensity. The experience depends on the substance, how long it was used, the daily amount, and other factors that shape the withdrawal syndrome.
Alcohol withdrawal, in uncomplicated cases, typically lasts two to seven days. Sleep loss and occasional hallucinations may occur, and in some situations the person becomes ill enough to require hospital care because of serious risk. Yet withdrawal has a definite arc. After a period of relative relief, mood often worsens. Concentration falters, mood dips, irritability rises, and anxiety and depression may appear. This phase is known as post-abstinence syndrome PAS or subacute withdrawal.
– What does this look like in practice?
From the brain’s perspective, inadequate function associated with addiction can persist for months. In alcohol use, PAS can last roughly six to twenty-four months. The most common signs are poor attention, memory and thinking difficulties, irritability, and anxiety. Some people also report compulsive thoughts about use. A lighthearted comparison sometimes used is that PAS resembles a form of premenstrual syndrome.
– Why does it happen?
Neuroscientist George Koob explained this by comparing brains of healthy and addicted subjects who had stopped consuming alcohol. He found structural changes in the amygdala, a region tied to memory and emotions, among those with subacute withdrawal. Research from the 1970s proposed that when the brain is in a good state, systems work to restore baseline; in addiction, mood fluctuations emerge, swinging between highs and lows.
Alcohol and other substances disrupt the brain’s balance, shifting mood from a two-way swing to a downward trend. The individual no longer feels good even when not intoxicated, and the urge to use can persist for months after cessation.
– How can this be managed?
The best remedy for PAS is sobriety, since abstinence allows progress to continue rather than resetting it. Rest, medical consultation, and, in some cases, prescribed medications can help ease symptoms. Severe subacute withdrawal may involve depressive episodes, in which antidepressants might be considered under medical supervision.
— What about the crisis an abstainer might experience, including alcohol users?
From an addict’s viewpoint, relapse can seem like a rapid reversal after a period of abstinence. Yet evidence points to a process that begins well before any use resumes and is signaled by 37 identifiable indicators. Scientists T. Gorski and M. Miller cataloged these in a study of 125 relapse cases. The first sign is a concern about well-being, often accompanied by emptiness and anxiety, even without a desire to use. The second sign is resistance to this concern, with the person arguing with themselves that everything is fine. The third involves insistence that they will never lose their temper, a claim made during conversations even when no malfunction is observed. The fourth is heightened concern for others, such as a spouse or family member, which can foreshadow a collapse. In total there are 37 indicators focused on psychological and emotional states rather than substance use, and many addicts keep a diary to track them. More changes correlate with a higher relapse risk.
— How does a malfunction unfold, and what is its progression?
Consider two brothers who once drank heavily but stayed sober for three months. One remains sober, the other relapses. Initially, life seems normal, but pressures mount—work, relationships, sports—creating strain. Subtly, seemingly unrelated decisions accumulate to undermine resolve. These micro-decisions, described as SIDs (seemingly unrelated decisions), pave the way for relapse. A mini-crash may occur when a quitter slips back to drinking for a moment and then stops, repeating a few times. This is the abstinence-violation effect, a step toward full relapse, until old patterns reemerge and uncontrolled use resumes.
– Could you share examples of decisions that led to relapse?
Personal cases illustrate the pattern. One patient began visiting a familiar Irish bar and gradually progressed from coffee to non-alcoholic beer, then to regular beer. Another patient, years of sobriety intact while watching videos, found himself drinking kvass after six months, which then escalated back toward beer. A third example shows social invitations evolving from not drinking to offering others a drink, eventually leading to drinking again.
— What pushes a person into a breakdown?
Determinants of relapse are categorized into personal and interpersonal factors. The framework, introduced by A. Marlatt, emphasizes a dynamic model based on nonlinear interactions. Six personal factors stand out. First is self-efficacy, the belief in the ability to stay sober. Strong self-efficacy improves coping prospects. Second is positive expectations from use; when the brain fixates on the pleasures of use and ignores consequences, relapse risk climbs. Third, the craving force resembles thirst. Fourth, motivation is crucial; weak motivation makes quitting unlikely. Fifth, relapse prevention skills are essential, and the sixth is the emotional state of the quitter.
Interpersonal determinants, though not fully finalized by Marlatt, have been developed by later researchers. The social environment matters greatly, and many psychosocial rehabilitation programs succeed by providing mutual support among peers.
— How can relapse be prevented?
Relapse prevention plans involve environmental control, attention management, and working with dependent thoughts. Environmental control means removing triggers from surroundings, such as not frequenting places where alcohol is present or ensuring social circles do not enable use. Attention management involves redirecting focus when thought patterns drift toward drinking. Dependent thoughts can be addressed in three ways. First, dialogue with oneself is a challenge; the brain holds competing thoughts about use and sobriety and must be reminded of addiction’s consequences. Second, it helps to observe dependent thoughts without arguing with them, watching how they arise and disappear. Third, treating thoughts of use as signals of unmet needs, such as thirst, hunger, or fatigue. Behavioral techniques also help: leaving triggering environments when necessary, or seeking support from a trusted sober ally who shares every sober day. These tools support longer-term sobriety by reducing exposure to triggers and strengthening coping skills.
— Does longer sobriety reduce the risk of a breakdown?
In general, the risk declines with time, but interpretation matters. If 100 people quit drinking, estimates suggest about 80 relapse within a year. Of the remaining 20, roughly half relapse in the second year. About 15% of those who reach five years of continuous abstinence may still experience relapse. The trend indicates that longer periods of sobriety reduce relapse likelihood, and reaching five years without use is a strong indicator of recovery.
— What should someone do if a breakdown occurs?
The guidance is pragmatic: rise, dust off, and proceed. If a relapse happens but does not cause physical harm, it becomes an opportunity to analyze the situation, take responsibility, draw lessons, and continue the path toward sobriety.