What You Need To Know About Dry Drunk Syndrome

Dry drunk syndrome is experienced by someone who has quit drinking but is still experiencing the issue and behaviors similar to when they were drinking. Dry drunk is considered a stigmatizing term, and symptoms associated with it are often described as part of post-acute withdrawal syndrome (PAWS) or protracted withdrawal syndrome.

What Is Dry Drunk Syndrome?

Dry drunk syndrome is a term created by the founders of Alcoholics Anonymous (AA). It was a term AA used to describe someone who had quit drinking but had not dealt with the issues or behaviors that had caused them to abuse alcohol. [1] This term is considered to be stigmatizing, and it is no longer in use in the substance abuse field.

Alcohol use disorder (AUD) is a medical condition where the person is unable to stop or control their alcohol use, even if it is hurting their social interactions, work situations, or their health. [2]  AUD is a brain disorder that can be mild, moderate, or severe. Alcohol use disorder includes conditions that are referred to as alcohol abuse, alcohol dependence(not to be confused with alcohol intolerance), alcohol addiction, and alcoholism.

Causes of Dry Drunk Syndrome

If you are sober, meaning you are no longer drinking, but you are not receiving any treatment for your alcohol use history and are struggling with craving or feeling on edge, you may be struggling with the emotional and psychological issues that caused you to misuse alcohol.

If you are sober but not receiving treatment, you may be at risk of replacing your alcohol addiction with a different addiction. This is due to not dealing with the underlying issue that led you to start drinking in the first place. For you to be able to move from being sober to being in successful recovery, you must deal with any trauma or mental health issues that contributed to your alcohol use disorder.

As research and knowledge in the field of substance use disorders grow, there has been a shift in how we discuss and label different aspects of recovery. Symptoms once described as dry drunk syndrome are now more accurately categorized under post-acute withdrawal syndrome (PAWS) or protracted withdrawal. PAWS and protracted withdrawal are when a person experiences withdrawal symptoms for a longer period than is generally expected. [3]

Symptoms of Dry Drunk Syndrome (Protracted Withdrawal)

Everyone’s withdrawal experience is different. Frequently reported symptoms of protracted withdrawal include:[4]

• Alcohol cravings
• Wanting to be the center of attention
• Feeling like you’re always the victim
• Difficulties communicating with others
• Mood swings, irritability
• Depression, Anxiety,
• Fear that you can’t change
• Frustration over time wasted due to alcohol abuse
• Viewing sobriety as boring or romanticizing past use
• Not acknowledging the problems your alcohol abuse caused
• Feeling jealous of people who appear to be in healthy recovery
• Believing you always know what’s best
• Refusing to accept constructive criticism, feeling anger and resentment toward your support system
• Difficulty concentrating, making decisions, or focusing on tasks
• Short-term memory problems
• Difficulties sleeping
• Persistent fatigue & anhedonia
• Unexplained physical complaints
• Reduced interest in sex

Acute Withdrawal Versus Protracted Withdrawal

Acute Withdrawal

Acute withdrawal is what is normally referred to as withdrawal. It is the onset of a predictable set of symptoms a person experiences when they abruptly stop or quickly decrease the dosage of a substance. Depending on the substance, the symptoms of withdrawal can begin within hours to days of stopping the substance and will pass in a similar predictable time frame according to the substance. For example, acute alcohol withdrawal usually happens and ends in five to seven days.[5]

Protracted Withdrawal

Protracted withdrawal is the presence of substance-specific acute withdrawal symptoms beyond the generally accepted time acute withdrawal symptoms are experienced. There are also situations where people experience protracted withdrawal symptoms in which they persist, evolve, or even appear past the expected timeframe someone would normally experience withdrawal symptoms. [6]

Many people report, and healthcare providers observe, symptoms of withdrawal beyond the acute withdrawal timeframe. However, there is limited research on protracted withdrawal, and it is not yet included in the Diagnostic and Statistical Manual of Mental Disorders.

How do protracted withdrawal symptoms develop?

Using alcohol over an extended period causes changes in the cellular, molecular, and neurocircuitry of the brain, which affects emotions and behaviors beyond the acute withdrawal timeframe.[7]  The body makes adaptive changes in the central nervous system (CNS) to accommodate for the alcohol use that then lingers beyond acute withdrawal.

Research shows anhedonia (a person’s decreased ability to experience pleasure) in people in recovery from alcohol and other substance use is a symptom of protracted withdrawal and not linked to any other psychological or psychosocial factor in the people’s lives who were in recovery.[8]

How long do symptoms last?

Common protracted alcohol withdrawal symptoms include anxiety, hostility, irritability, depression, mood instability, fatigue, insomnia, difficulties concentrating and thinking, reduced interest in sex, and unexplained physical complaints, especially of pain. [9] It appears that symptoms can last upwards of two years after the last use of alcohol, with some case studies reporting symptoms being experienced longer. Sleep study research on people recovering from alcohol use disorder has found that sleep abnormalities can last one to three years after stopping alcohol use. Abnormalities included problems falling asleep, decreased total time asleep, and sleep apnea.

How to Cope with Dry Drunk Syndrome

Quitting drinking without changing your lifestyle, behaviors, or thought processes isn’t enough. Most people struggling with alcohol use disorder started drinking as a way to cope with a problem. Everyone drinks for different reasons, but frequent themes why people start drinking are: [10]

• Social conditioning
• Trauma
• Unable to cope with a situation or event
• Negative beliefs about yourself or your life

Recognizing that you may be experiencing dry drunk syndrome or protracted withdrawal is the first step toward getting help. Once you’ve identified that this may be what you are experiencing, you can reach out for help from your healthcare provider, support groups, 12-step programs, and your loved ones. Connecting with people who can help support you in establishing new healthy coping skills can help you progress through protracted withdrawal.

Healthy coping skills can include:[11]

• Finding or reestablishing creative self-expression such as music, art, or writing.
• Rekindling friendships with people, you lost touch with due to your drinking.
• Explore spiritual activities you find meaningful.
• Establishing a new exercise routine.
• Signing up for a class to learn a new skill or hobby.
• Volunteering.
• Furthering your education.
• Starting a business.

The Dual Diagnosis Connection

Often, people who experience symptoms associated with dry drunk syndrome also have a co-occurring disorder, such as depression or anxiety. This is known as a dual diagnosis, where an individual struggles with alcohol use disorder as well as a mental health disorder. You may have had anxiety or depression before your substance abuse disorder; it may have even contributed to your drinking.

Having a co-occurring disorder can exacerbate each diagnosis and make it harder to treat. Finding an integrative treatment program that addresses both disorders at once can help address your mental health condition while supporting your recovery.

There are many different treatment approaches; some that have positive results in treating dual diagnoses include:[12]

• Cognitive Behavior Therapy (CBT): This approach helps you examine how your thoughts and feelings impact your behaviors and vice versa.
• Dialectical Behavior Therapy (DBT): this therapeutic approach helps you to decrease your negative behaviors, including self-harm.
• Motivational Enhancement: this approach helps you increase and maintain your motivation to create positive changes in your life.
• Contingency Management: This is an approach that provides you with incentives and rewards for meeting your treatment goals.
• Mutual Support Groups: These groups are for people with similar diagnoses to support each other towards positive change.

Don’t Let Protracted Withdrawal Keep You From Your Highest Potential

‘Dry drunk syndrome’ is a stigmatizing term no longer used in the field of substance use treatment. It was initially used to describe someone who is no longer drinking but has some of the same behavioral issues and difficulties they experienced when they were drinking.  It is now recognized that people can experience extended withdrawal for numerous reasons, and receiving behavioral health and addiction treatment congruently can help recovery from protracted withdrawal.

At our Maryland Addiction Treatment Center, we offer personalized care programs designed to meet your specific needs. If you would like to learn more about our programs, please do not hesitate to contact us for more information.