Saturday, July 24

Near Beer, Trigger, and Chemistry

Why is it that recovering persons with alcoholism should not drink near-beer (beer with little or no alcohol)?..
 On a list of AA slogans, #298 (out of 407) is "Don't hang around wet places and wet faces."  (I'm sure there are many variations.)  There is a reason it has become a slogan.  Several reasons, actually.  From Neural systems of reinforcement for drug addiction: from actions to habits to compulsion [Barry J Everitt & Trevor W Robbins, Nature Neuroscience 8, 1481 - 1489 (2005)]...
The mechanism for alcohol withdrawal (PDF) is well-known.  Alcohol boosts the effect of GABA (primarily at the GABAa receptors).  GABA is the most abundant inhibitory neurotransmitter in the human brain.  It is like the brake on an automobile.  Chronic consumption of alcohol causes the brain to adapt.  One of the adaptations is to cut back on the production of GABA.  That is like putting your foot on the accelerator.  So if someone drinks a lot and develops tolerance to the alcohol, it is like they have one foot on the accelerator and one on the brake.  If they stop drinking, it is like taking the foot off the brake, leaving a foot on the accelerator.  The neural activity in the brain accelerates rapidly, and the person develops symptoms of alcohol withdrawal.
The mechanism for alcohol withdrawal is reasonably straightforward, but the mechanism for conditioned withdrawal is not so simple.  From Kindling in Alcohol Withdrawal (PDF) [Howard C. Becker, Ph.D., Alcohol Health & Research World, Vol. 22, No. 1, 1998]  During a conditioned withdrawal response, environmental stimuli that are repeatedly associated with withdrawal symptoms (e.g., a physician’s office or hospital) may themselves become cues that trigger the neurochemical changes resulting in the physical and psychological withdrawal symptoms. Conditioned withdrawal related responses, which reflect a kindlinglike process, may represent the biological basis for cue-induced alcohol craving in these circumstances...
In other words, the conditioning mechanism is similar to the mechanism of posttraumatic stress disorder (1, 2, 3).  So the slogan "Don't hang around wet places and wet faces" has a biological substrate.  If you drink a lot, and especially if you've been in withdrawal a lot, your brain gets wired to have conditioned desire and conditioned withdrawal responses.  Alcoholics with a bit of experience -- or education -- know this.  They know that they shouldn't drink near-beer for the same reasons they should avoid other reminders of drinking alcohol.

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