For an addict, it seems that there is no undertaking more daunting – and no accomplishment more gratifying – than getting sober. With drugs and alcohol out of the way, the possibilities are endless.

While this is true for many people in early recovery, there are exceptions. Particularly in the first year, some recovering addicts experience “dry drunk syndrome” – a period when they become inexplicably angry, depressed and distant and are at increased risk of relapse. Much to the dismay of loved ones, a new way of life that began in treatment can take a reversal, resulting in even greater dissatisfaction and instability than before the addict stopped drinking or using.

Not to be confused with the inevitable ups and downs in early recovery, dry drunk is a high-risk stage marked by drug cravings, distorted thinking and emotional dysregulation. Although the recovering addict manages to abstain from drug or alcohol use, they either haven’t made the changes in other areas of their lives essential for a fulfilling, productive and sober lifestyle or they made progress only to return to long-held negative attitudes and patterns.

A dry drunk is characterized by:

Getting an addict into drug rehab isn’t always an easy task. Getting them to stay there can be even harder. Here are five of the most common reasons people leave drug rehab against medical advice, along with suggestions to help the addict stay committed to their recovery.

1. “Detox is too painful.”

Research shows that the first week of drug rehab is the time when most addicts ask themselves, “What the heck am I doing here?” Withdrawal symptoms, drug cravings and an unfamiliar environment can fill the addict with anxiety at the same time they are deprived of their primary coping mechanism: drugs. Some addicts rationalize that they felt better when using drugs and give up on rehab before treatment really begins.

Prevention Tip: Detox can be made more comfortable with medication and alternative therapies such as neurofeedback, acupuncture and massage. Even if the addict isn’t feeling great, they should try to get involved in as many treatment activities as possible.

Rather than isolating, their peers will help them realize they are not alone and see the hope that treatment brings. The earlier the addict develops trust and rapport with a therapist, the more likely they will listen to the therapist’s recommendations and push through the uncertainty.

Decades of research have shown that alcohol severely damages the brain, causing blurred vision, slurred speech, slowed reaction times and impaired memory. Alcoholism causes cognitive deficits in 50 to 80 percent of alcoholics. Interestingly, memory loss worsens when an alcoholic stops after a prolonged period of drinking, whether that involves binge drinking or continuous drinking as seen in chronic alcoholics.

Repeated periods of alcohol use followed by withdrawal seem to have the most significant impact on memory. Withdrawal isn’t limited to severe symptoms such as seizures associated with the sudden cessation of alcohol use after an extended period of drinking. It can be as subtle as the sweatiness and shakiness people often feel when they wake up after a night of drinking. If someone drinks every day and stops every night, they are going to experience withdrawal every morning. And that’s the kind of withdrawal that injures memory.

So when alcoholics say, “I don’t think my memory was this bad before I stopped drinking,” they are observing a genuine scientific phenomenon. Stopping drinking causes a toxic reaction in the brain that significantly worsens memory deficits. Of course, the answer is not to continue drinking. Research also shows that medication, alcohol addiction treatment and 12-Step recovery can minimize the effects of drinking.

The Impact of Alcoholism on Memory

As a result of animal studies, we know that alcohol-related memory impairments appear to be related to changes in the gray matter of the brain as well as changes in hippocampal volume, a structure specifically associated with memory.

When rats are placed in a cage with objects they’ve never seen before, they are attracted to the novelty. They sniff and paw at the objects to determine if they are of any interest. Once they learn what the object is, they lose interest. This is called object recognition.

When a patient discovers that they have an illness, one of their first questions is, “How long until I get better?” In the field of addiction treatment, there is an ongoing debate about what the answer should be. Some feel the only way to instill hope for recovery is to define a specific endpoint at which patients can consider themselves fully recovered.

But this ignores the true nature of addiction. Unlike a cold or a broken bone, research has confirmed that addiction is a chronic brain disease akin to heart disease or diabetes. There is always hope for recovery – a hope I see fulfilled every day through education and treatment. But for hope to be authentic, it must be directed toward living a healthy, fulfilling life while managing the disease, not blind hope for curing it.

Understanding that addiction recovery is a lifelong process, it benefits patients to understand what their journey may look like. What are the stages of recovery, and how long does each take? These questions can be answered any number of ways, but the following descriptions align with the guidelines set forth by the National Institute on Drug Addiction (NIDA).

Treatment

This stage begins the day the addict stops drinking or using drugs. For many, this happens in a drug or alcohol treatment program where they learn to address addiction holistically as a disease of mind, body and spirit.

Last month, the Substance Abuse and Mental Health Services Administration (SAMHSA) set forth a working definition of recovery. After consulting the behavioral health community and soliciting comments, SAMHSA declared that recovery is “a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.”

According to SAMHSA, the four dimensions that support recovery are health, home, purpose and community. The administration also enumerated 10 guiding principles, which explain that recovery:

• Emerges from hope;
• Is person-driven;
• Occurs through many pathways;
• Is holistic;
• Is supported by peers and allies;
• Is supported through relationships and social networks;
• Is culturally based;
• Is supported by addressing trauma;
• Involves the individual, family and community; and
• Is based on respect.

Several of these guiding principles align with the values many of us in the treatment field have long held, including hope, respect, and the importance of individualized treatment and social support. Although some critics assert that recovery must have an endpoint – a measure of success by which someone knows definitively if they have recovered or not – SAMHSA embraces the well-researched and now widely accepted disease model of addiction. Because addiction is a chronic, progressive illness similar to heart disease and diabetes, recovery is a lifelong process; it is a journey, not a destination.

Recovering from an addiction is probably one of the most difficult tasks a person can do in their lifetime. There is a whole industry that specifically addresses helping people overcome an addiction, whether it be from a drug, alcohol, or now, even a behavior.

Drug and alcohol addiction remain a serious problem in this country, as well as many others. Surprisingly, nearly 75 percent of all adult illicit drug users are employed, as are most binge and heavy alcohol users, according to the National Institute on Drug Abuse. In the United States, it’s estimated that companies and organizations lose up to $100 billion a year due to employee alcohol and drug abuse, according to the The National Clearinghouse for Alcohol and Drug Information. The destruction to a person’s private life, relationships, friends and family is often immeasurable.

Substance abuse and alcohol abuse treatments are effective and do work. Not only does it help the abuser, it also begins the recovery process to help them repair their relationships with others.

So learning more about how addictions work and what methods are used in their treatment seems like a good idea. That’s why I’m happy to welcome Dr. David Sack, a board-certified addiction psychiatrist and CEO of Elements Behavioral Health. He’ll be blogging here on the topic of addiction and addiction recovery. You can learn more about him here.

Please give a warm Psych Central welcome to Dr. Sack!