How long does it take your brain to return to normal in sobriety?
One question I see asked a lot within the recovery community is, “How long does it take for your brain to return to normal when you quit drinking/drugging?”. The answer I see given most often is one year, but like anything to do with the brain, the answer isn’t that simple. The truth of the matter is, some recovery of normal function will occur within 24 hours, whereas some synaptic pathways laid down during addiction may never change within a lifetime. This isn’t reason to despair – remember that every time we learn something/make a memory, there are changes in the brain that accompany that. So all the learning that occurs in addiction, such as all the associations between relaxing and drinking for example, or even between the label on your favourite brand of beer and getting drunk, those associations might potentially last for a lifetime. This is why you might hear old-timers 20 years into recovery suddenly reporting a craving after catching sight of a beer they used to drink, or the thought or drinking seeming to randomly pop into their head when celebrating an occasion or milestone.
I say this isn’t reason to despair, because we do a lot of learning in recovery too. We form new associations, new coping mechanisms, and new habits that counteract the old ones. All of these changes are also associated with plastic changes in the brain, such as new synaptic pathways, and the increased/decreased likelihood of an existing pathway firing. So what I’m saying is, we can and do change our brains for the better as we go through sobriety. Unfortunately, however, this learning isn’t always enough to prevent a relapse, although I do believe that through relapse we also learn, as I will explain.
As I mentioned in my first blog post, I have had a few relapses since I made the decision to quit drinking for good, perhaps 4 or 5. Perhaps 2 of these relapses have involved drinking over a few days, whereas the others were only a single day. In the recovery community it is often stated that relapsing is part of the journey, and I think that this is one area in which the science and recovery wisdom match up. Before I explain why, I want to say that I really don’t want anyone reading this to use this information as an excuse to relapse. I can’t have that on my conscience!! I am JUST talking about what I have learned from the relapses I have already had. I DO NOT intend on relapsing again ever.
In fact, whilst I was writing the first draft of this blog, something happened that really drove home to me how dangerous relapse can be. One of the lovely men in one of my online recovery groups relapsed after many, many years of sobriety, and he died. It actually makes me really sad to write that sentence, because although there are around 5,000 people in this particular group so it’s hard to know everyone, I had had some really lovely chats with this man. A lot of us had, and he had written a book as well as given an interview for a podcast, so a lot of us felt like we knew him. So of us did actually know him.
So PLEASE don’t read this and relapse! Don’t do it. OK? OK good thanks for that.
What does it mean to say relapse is a part of your journey?
When it is said that relapse is a part of your journey, it’s hard to know exactly what is meant. Like anything in recovery, it probably means different things to different people. I think part of it is probably intended to take the shame out of relapse. I see in the groups that people seem to suffer great shame when they relapse, and are very hard on themselves. If they can turn around and take the positives out of the experience, then it removes some of the shame. Also the identification of the fact that relapse is something most of us experience helps remove some of the shame. Personally I have never felt shame about my relapses, because I focus on how much sobriety I have had over the last year. A hell of a lot more than I had the year before that, that’s for sure! But I’ve also learned a lot from each and every incidence of relapse.
Incubation of craving – otherwise known as ‘romanticising of drinking/drugging’
My first relapse was a glass of wine I drank at a wedding, and it was because I was hungry. I was also angry, or “hangry” more accurately, and “Hungry, Angry, Lonely, Tired” are the common signs to watch out for in relapse. I was suffering two of them. OK, don’t to to weddings hungry. Lesson learned. My second relapse was at a 40th birthday. I didn’t start drinking until 10pm. I was stressed, and anxious, and lonely and wanted to hang out with my friends. Next time go home, post online, write. Wait until the morning and give my husband and daughter cuddles. Lesson learned.
The third time was different. I was stressed and working far too much, but that wasn’t the reason for the relapse. I had started romanticising drinking in my mind. I would see a glass of wine and I could almost taste it on my tongue, and it tasted like heaven, like nothing I’d ever had before. I started imagining this ‘old’ world in which I could drink and escape from all my problems for a few hours (never mind that alcohol was the thing causing a lot of these problems, and never mind that for the last few years it didn’t offer much of an escape anyway).
*Warning sciencey bit*
In the behavioural neuroscience literature this romanticising of drinking/drugging is known as ‘incubation of craving’. We can model this in rats. Of course we don’t know what the rats are actually thinking or feeling, but if a rat or mouse are trained to press a lever for ethanol (alcohol) or cocaine for example, and when the animal receives the drug, a light in the box will also turn on. If you then don’t give the animal the drug for 24 hours, then allow them to press the lever for the light they will press less than if it had been 3 weeks since they last had the drug. Similar effects have been shown when animals are tested 6 months later, which is a quarter of the lifetime of a rat or mouse, so these are long-lasting associations.
From this work we know that within the nucleus accumbens, there are changes in the way that neurons communicate with each other via synapses, and even the way in which particular neurons receive messages from other neurons, after long periods of withdrawal from drug. These are long-term plastic changes in the nucleus accumbens; specifically the way in which various types of glutamate receptors respond to neuronal inputs (see diagram of gluatamatergic synapse below). In this way it has been shown that addiction involves more than just dopamine as is commonly thought, but also involves changes in glutamate transmission, glutamate being main excitatory neurotransmitter of the brain.
What is especially exciting about this research is the possibility of developing medication that could specifically target these (metabotropic) receptors that have specific effects in incubation of craving weeks and weeks after withdrawal to prevent relapse. But that is still a way off into the future.
*End Sciencey bit*
Similarly, in my personal experience I found that after getting over the initially strong cravings, I honestly didn’t think about drinking that much. I thought I was cured! Yet at around the 4 month mark suddenly I would walk along the street and see someone in a café drinking a glass of wine out of the corner of my eye and it was like everything else in my vision went dark and I could only see the wine. I could almost taste it in my mouth and it tasted like heaven. I could feel the warmth as the wine trickled down my throat into my stomach, and I missed it. A lot.
I resisted these cravings for a long time, but then came a particularly stressful time at work and I couldn’t resist any longer. I needed a mental escape from my life. So I drank.