is it that recovering persons with alcoholism should not drink
near-beer (beer with little or no alcohol)?
had been dry for several weeks thanks to a radical withdrawal program,
but a simple walk past Pete’s Tavern on any given night almost erased
his will to abstain. During the daytime he did not feel a craving for
alcohol, but when he passed the bar in the evening–when he saw the
warm light through the windows and heard the glasses clinking–he would
be sorely tempted to run inside for a beer. Addiction researchers call
this phenomenon “conditioned desire.” If a person had always consumed
alcohol in the same situation, an encounter with the familiar stimuli
will make the feeling of need for the substance almost irresistible.
Then, even after years of abstinence, consuming a single drink can set
off a powerful longing to imbibe more and more… (link)
Is this real? How does this work?
First, is this real? 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)]
yeah, it is real. That leaves the question of how it works.
We need to understand both conditioned desire, and (even more
intriguing), the phenomenon of conditioned
a fruitless argument, Ken left. While
standing on the subway platform for a train home, he suddenly began to
sweat, twitch and feel sick. What he really wanted was a bottle. Before
he had given up drinking, he would have automatically taken a swig
whenever he faced a tense situation. After the argument, his
brain–shaped by experience–expected the calming effect of alcohol.
When the drug did not come, he began to suffer what experts call
“conditioned withdrawal” symptoms…
In order to understand conditioned desire and withdrawal, we need to
understand what alcohol does to the brain, and what alcohol withdrawal
for alcohol withdrawal (PDF) is well-known. Alcohol
boosts the effect of GABA (primarily at
the GABAa receptors).
GABA (image to left) 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.
that the mechanism presented above is an oversimplification.
There are other systems involved, primarily glutamate
(image to right) is involved as well. Check the first link in
above for details.
The mechanism for alcohol withdrawal is reasonably straightforward, but
the mechanism for conditioned withdrawal is not so simple.
in Alcohol Withdrawal (PDF) [Howard C. Becker,
Ph.D., Alcohol Health & Research World, Vol. 22, No. 1, 1998]
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
…AW activates the HPA axis, and the levels of hormones secreted by
the adrenal cortex (i.e., corticosteroids) increase. Research indicates
that this withdrawal-induced increase in corticosteroid levels is
enhanced and more sustained in animals with a history of multiple
withdrawal episodes (Becker and Littleton 1996). One group of
corticosteroids, the glucocorticoids, influence neural excitability by
interacting with certain receptors in the brain. Prolonged stimulation
of these receptors as a result of elevated glucocorticoid levels in the
blood may not only alter seizure susceptibility but also may produce
neural damage, particularly in brain structures such as the
In other words, the conditioning mechanism is similar to the mechanism
posttraumatic stress disorder (1,
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.