Addiction is a complicated mental health disorder that requires the correct help in order to make a strong and lasting recovery. It is not enough to simply treat the dependency itself – underlying psychological factors that cause the addiction should always be addressed. This includes treating dual diagnoses such as:

• Depression
• Anxiety
• Post-traumatic Stress Disorder (PTSD)

'Dry drunk' is a concept which describes a person who no longer drinks or abuses drugs, but continues to behave in dysfunctional ways. Many people with a substance addiction often believe it is a matter of just stopping the 'evil compound' and while there is some truth in this, going beyond the addiction itself is most important in preventing relapse.

Understanding Dry Drunk Syndrome

In clinical practice, the behaviours that surround the consumption of a mood altering substance are often more revealing than the actual physical act of consuming the substance. They expose the nature of the relationship between the individual and their chosen 'poison'.

Rehabilitation is the process of helping an individual recover from an addiction. It looks at three main domains:

• Behavioural - the act of taking an addictive substance
• Psychological - the thoughts and feelings that are often alleviated by taking the substance
• Spiritual - the moral connection to others and the wider society

It is when the behavioural domain is rectified, but not the psychological or spiritual, that Dry Drunk Syndrome can creep up.

The loss of identity associated with addiction is not to be underestimated - most addicts will at moments, if not all the time, hate themselves. They also lose moral purpose, seeing themselves as bad or despised, making the assumption that others despise them too.

To avoid relapse into the above feelings, recovery should cover all three domains, be an ongoing process, and if the individual does not put a lot of effort into this, it can mean that they fail to progress.

Understanding that recovery is a lifelong commitment that requires continued change and effort is important. Recovering addicts need to be committed fully to improvement and to regularly monitor their own progress to remain sober.

Signs and symptoms of Dry Drunk Syndrome

The dry drunk may have corrected the behaviour in that they physically don't drink or take drugs anymore but what can sometimes be left is the moral vacuum which creates:

• Low mood
• Anxiety
• Compensatory affect seeking behaviours

Other important factors to look out for include:

• Becoming resentful towards the person who 'made' them quit drinking
• Being critical of recovery models such as the 12-step programme
• Returning to a negative, impulsive attitude
• Struggling to concentrate and being easily distracted
• Not being able to properly express themselves or accept the consequences of their behaviour
• Experiencing a sense of grandiose and excessive self-centeredness
• Struggling with honesty, and lies gradually increase again
• Being envious of those around them who seem to deal with life better
• Starting to think about drinking or taking drugs again

If a recovering addict is exhibiting any of the above, it is probably suggestive of potential relapse. Their recovery may be incomplete or as some would say: 'they are dry but not sober'. Switching to a less destructive, but equally absorbing occupation, will mean they remain shut-off from emotional life. This can include behaviour such as over-exercising or working longer hours.

Support for Dry Drunk Syndrome

Interventions in alcohol addiction and drug dependency all depend on the individual and what suits them. What can be best for some may not always be the most effective for others. Some addicts may require strict inpatient stays at a hospital, where as others may benefit more from weekly outpatient therapy. Where there is a physical dependency with withdrawal symptoms, some medical supervision may also be required.

Where an underlying psychological diagnosis is identified, more specialised care would be required for an addict. This can include therapies such as:

• Cognitive Behavioural Therapy (CBT)
• Dialectical Behavioural Therapy (DBT)
• Relapse Prevention Therapy

The individual would benefit from understanding the vulnerabilities they are potentially exposed to, in order to make the most successful recovery possible. Addiction therapy is effective but always depends on the motivation of the individual.

Step work is extremely advantageous in helping people with this process and is aimed at trying to connect the individual to a recovery narrative that is worldwide and broadly available. Step work groups such as the 12-step programme, is a process that provides both emotional support and moral nurturing. Not everyone can engage with this immediately but it is the mainstay of relapse prevention.

Statutory services provide comprehensive advice and sign posting. Most rehabilitation comes through the voluntary sector such as the AA. You can visit sites such as www.alcoholics-anonymous.org.uk or www.salvationarmy.org.uk/addiction-support to provide further information to your patients.

How Priory can help

Priory offers the whole range of interventions and therapies needed to make a strong and lasting recovery from addiction. Our specialists are experts in assessing, recognising, and treating dual diagnoses, and provide the tools our patients need to lead a happier and more fulfilling life. These interventions are available at our Priory hospitals ans wellbeing centres. 

Alcohol abuse is thought to be a factor in around 20% of general hospital admissions - ensuring prompt alcohol rehab treatment at places like Priory can have considerable health and economic benefits.