The Dry Drunk Syndrome:

A Toximolecular Interpretation

Mark Worden1, and Gayle Rosallini1

emotional storm." M.E. goes on to provide a The Dry Drunk Syndrome: A Toximolecular Interpretation graphic account of the barometric flip-flops characterizing a dry drunk: The emotions of an alcoholic can fluctuate much Dry Drunk (A.A.) Irritability, , or in the manner of weather fronts... Take aggressiveness in an alcoholic during a period a particularly difficult day with a sufficient of abstinence, supposedly accompanied by number of negative events, mix in normal some signs resembling intoxication. amounts of 20th century stress, give this dose to a (Keller & McCormick, 1968) fatigued alcoholic and you have a nice dry drunk in the making. Of course, we can help it along How I could feel so bad, both emotionally and by skipping lunch, rushing at a double-time physically I just could not understand. After all, I pace all day long and engaging in the have not touched a drop. Why had this thing doubtful luxury of such emotions as anger and happened to me? worry. (E.D., 1974) There is, however, a suggested antidote: The Twelve Steps, a set of principles that The term "dry drunk" appears to have form the cornerstone of the A.A. philosophy originated sometime during the evolution of the Fellowship of . Like many (Alcoholics Anonymous 1952). other notions, the dry drunk became part of the Another A.A. member, M.U., describes an conventional wisdom of A.A. and was applied to emotional drunk that often occurs during the a variety of emotional experiences, attitudes, and of the A.A. neophyte: My present was maladaptive cognitive processes taking place so cluttered up with rubbish from the past and during recovery. phantoms of the future I had no room for the Although the concept of the dry drunk present. I was truly out of control, dealing with originated in Alcoholics Anonymous, it did not self-pity, resentments, and stinking-thinking. I appear in A.A. literature until 1962. According to was staggered, in fact, by my imagination M.E. (1962), "a dry drunk is an instead of alcohol. (M.U. 1964) The importance of inattention to A.A. principles in the dry drunk process was emphasized by E.D. as follows: / had forgotten to put the Steps into practice ... because I did not do those things, just said them, 'Douglas County Council on , P.O. Box I got back all my self-pity, 1121, Roseburg, Oregon, USA 97470. 41 ORTHOMOLECULAR PSYCHIATRY, VOLUME 9, NUMBER 1, 1980, Pp. 41-47

resentments, and doubts. (E.D. 1974) Borrowing rather than functional in origin, and he also from a popular antacid television claims that late withdrawal symptoms were commercial, S.K. comments: A dry drunk is the reduced in severity when the patient spent ten alcoholic blahs ... Intense preoccupation with hours in bed each night for two weeks (Wellman self and lack of concern with others seems to be 1955). the outstanding characteristic of a dry drunk. In the same report, Wellman pointed out that (S.K. 1975) for remedial action, S.K. suggests many of the problems arising during the period that the proper way to sober up from a dry drunk of time that the recovering alcoholic seems most is for the alcoholic to engage in self- susceptible to onslaughts of a dry drunk stem inventories, talking it out, prayer, and working from marital conflicts and working out new with newer A.A. members. relationships, problems of dominance and During the 1950's, professionals became authority in the unstable ecology of shifting interested in the concept and incorporated it into roles, expectations, and responsibilities. then-current accounts of the alcoholism recovery Concurrently with Wellman's papers, Flaherty, process. For example, Wellman (1954a), McCuire and Gatski (1955) grew curious about identified the dry drunk as a composite of "late the experiences reported by patients and A.A. withdrawal symptoms that includes irritability, members as the dry drunk. They constructed a depression, insomnia, fatigue, restlessness, a 41-item questionnaire devised to explore the sense of aloneness and distractibility." He also personal perceptions of the dry drunk as it observed that when the dry drunk syndrome is occurs in recovering alcoholics. In effect, the severe it may mimic the physical signs of investigators were attempting to define the drunkenness. connotations of the term "dry drunk" as it is used Wellman gave due credit to alcoholics for in ordinary language, and as it is perceived by developing a picturesque and descriptive recovering alcoholics presumed to have some depiction of the effects of late withdrawal. He familiarity with the concept. Flaherty and his proposed a gradient of intensity, with the milder colleagues distributed the questionnaire to 111 form corresponding to "stinking-thinking" at one members of an A.A. group. There was a great extreme and the more intense experience of the deal of variability in the responses to the dry drunk at the other end of the continuum questionnaire. Where Wellman found the dry (Wellman 1954a). drunk most likely to occur in the second six In a subsequent paper, Wellman (1954b) made months of sobriety, Flaherty and his colleagues several recommendations for the management of found, "in nine of our participants, the onset of the late withdrawal symptoms of alcohol the dry drunk occurred from 12 to 72 months addiction. He suggested the use of benzedrine after cessation of drinking". Thirty-seven of the sulphate, sodium bromide, and mephenesin to 52 total respondants had experienced mental and relieve symptoms of depression, confusion, emotional changes recognized as being jumpiness, irritability and restlessness. He indicative of a dry drunk. recommended additional drug management in the Alcoholics answering the questionnaire tended form of ten to thirty units of insulin to give relief to apply a wide variety of meanings to the dry from the thirst for alcohol. And, finally, he drunk concept: indecision regarding taking a advocated prescribing sodium phenobarbital for drink or the obsessive desire to drink; insomnia and an antacid for symptoms of depression; malaise similar to hangovers after . Wellman's drug-oriented management of excessive drinking; mental/emotional confusion; the late withdrawal syndrome appears to be negative thinking; self-pity; craving for an founded in large part on the assumption that the emotional lift. "Nervousness was the most fatigue experienced during the second six months frequently expressed feeling used to sum up the of abstinence was more likely organic fatigue dry drunk experience." Interestingly, three of 42 THE DRY DRUNK SYNDROME the respondants felt that what happens to an deception, rationalization and other alcoholic during a dry drunk is "no different from indicators of psychological interpretations negative mood swings that are experienced by predominate. Tiebout (1962) represents a nonalcoholics" (Flaherty, McGuire&Gatski, paradigm example of this type of thinking: The 1955). possibility of a return of his infantile ego must While 31 of the 52 respondants felt that the dry be faced by every alcoholic. If it does return, he drunk syndrome could be helped prior to or may refrain from drinking but he will surely go during the experience, their suggestions for on a "dry drunk" with all the old feelings and coping with the dry drunk experience were attitudes once more asserting themselves and primarily psychological and spiritual, in making sobriety a shambles of discontent and marked contrast to Wellman's drug oriented restlessness. Thus, the dry drunk experience is therapy: The means suggested to combat the dry attributed to psychic misbehavior; the acting out drunk included attendance at A.A. meetings, of a severely spoiled, preadolescent ego. contacting A.A. members, activity to change Attribution is an attempt to provide satisfying or one's thoughts, praying, seeking help from a acceptable explanations for behavior (Jones, physician or a psychiatrist, resigning oneself to Kanouse, Kelley, Nisbett, Valins, Weiner his inability to drink (Flaherty etal,1 955). there 1971). Mahoney, a self-styled "thinking was no suggestion that symptoms should be behaviorist" who has the temerity to examine treated with drugs, nothing to indicate that "biological relevancies" noted the implications dramatic changes in thought and mood might be of the attribution process: The fact that we due to metabolic or organic causes. assign causes to our actions is perhaps less than In summary, these authors concluded that the earthshaking; its clinical relevance lies in the majority of alcoholics who maintain sobriety over nature of those causal attributions. For example, an extended period of time will experience a dry if we infer that our migraine headache and drunk. Another major conclusion was that " 'inner dizziness are due to an imminent psychotic life' is largely responsible for precipitating a dry break rather than the accidental inhalation of drunk," an articulation of what has become an insecticides on the way home from work, our exclusively psychodynamic interpretation of the subsequent behavior may vary dramatically... If dry drunk syndrome. our obesity, smoking or depression are seen as Another example of persistent efforts to caused by heredity, addiction, or disease, we formally characterize the dry drunk syndrome as may be much less likely to instigate an active a manifestation of deviant psychological self-improvement enterprise (Mahoney, 1979). processes, rambunctious cognitions, symbolic Mahoney's observations have a good deal of maladaptations, and so on, may be seen in experimental support, particularly from the Jellinek's (1959) brief interpretation of the late studies of Schacter and Singer, who summarized withdrawal symptoms as "indications of their findings in a review of cognitive, social and insufficient adaptation on the symbolic level to an physiological determinants of emotional states: alcohol-free life." Given a state of physiological arousal for which More recently, Solberg writes that the person on an individual has no immediate explanation, a dry drunk is grandiose, judgmental, impulsive, he will "label" this state and describe his childish, easily bored, distracted and feelings in terms of the cognitions available to disorganized, and "seems to be constantly him. (Schacter and Singer, 1962). dissatisfied with his life." With the term "dry drunk" and its presumed Solberg's analysis of dry drunk behavior psychodynamic accoutrements, the sober consists of a set of inferences about the alcoholic who is suffering emotional and underlying psychological causes: lack of personal physical discomfort has insight; poor impulse control; self-

43 ORTHOMOLECULAR PSYCHIATRY, VOLUME 9, NUMBER 1, 1980, Pp. 41 -47 acceptable labels for these experiences in terms of from a biochemical malfunction instead of cognitions derived from A.A. and intrapsychic from ordinary varieties of neurosis, as psychological theories. However, these labels, was previously supposed (Hoffer and when considered in purely psychological terms, Osmond,1968). may actually hinder individuals from dealing with Hoffer and Osmond reported that use of their symptoms as effectively as they might nicotinic acid alleviated many of the because an exclusively psychological and distressing symptoms of the dry drunk psychodynamic interpretation distracts from the syndrome. They recommended that biochemical substrata of behavior, almost as if the attention also be given to a treatment emotionally intoxicated organism consisted of a regimen which included a diet devoid of junk set of independent psychological processes foods and, in appropriate instances, nutritional existing at a truly symbolic level, yet able to exert supplements. action on bodily functions in much the same In view of what is known about the mysterious fashion as Descartes' incorporeal relationship of nutritional and diet-related mental substance interacted with the pineal gland. factors to behavioral functioning (Worden and Although Wellman (1955) and M.E. (1962) Rosellini 1978; 1979), it seems appropriate to made brief mention of possible organic factors and offer a toximolecular interpretation of the dry contributing behaviors such as skipping lunch, drunk syndrome. The term "toximolecular functioning under high pressure and other stresses, medicine" was coined by Rimland (1977) to these observations were never fully expanded. indicate "the process of attempting to cure Let us compare the commonly reported disease by administering sublethal doses of symptoms of the dry drunk with the symptoms toxic substances." that are known to be caused by such biochemical Rimland proposed the term as a deliberate problems as food allergy and hypoglycemia: satirical contrast to the Orthomolecular model (Pauling 1968). However, the term toximolecular seems useful in a more serious Dry Drunk Hypoglycemia & Allergy context. As an example, a toximolecular interpretation Irritability Irritability of the dry drunk would make use of the Depression Depression frequent observations that recovering alcoholics Aggressiveness Aggressiveness continue to abuse their bodies in a number of Insomnia Insomnia ways by using extraordinarily large amounts of Fatigue Fatigue tobacco, caffeine-containing beverages, and Restlessness Restlessness sugar. Meals are usually made up of "junk" Confusion Confusion foods that are high in refined carbohydrates, Desire to Drink Desire to Drink fats, and salt; low in high quality protein; and Nervousness Nervousness devoid of fresh fruits and vegetables and whole grains. This type of diet can lead to blood sugar The similarity is obvious but has instability in susceptible individuals and, largely been ignored. It was not until 1968, that indeed, it is claimed upwards of 95 percent of two Canadian psychiatrists foreshadowed a alcoholics suffer from low blood sugar (Meiers more comprehensive approach to the dry drunk 1973). syndrome: Some alcoholics had long noted that The symptoms of low blood sugar (hypo- although dry, they remained unhappy, tense, glycemia) are similar to the symptoms reported depressed or in many ways "neurotic." by individuals who claim to be suffering from a Some would remain dry for a while and then, out dry drunk. The hapless sober alcoholic, reeling of sheer desperation, return to drink. It made in emotional and sense that many of this group might be suffering 44 THE DRY DRUNK SYNDROME physical discomfort, attempts to compensate by fudge until it was gone. The following day, no smoking cigarettes excessively and drinking doubt experiencing the after effects of pro- enormous amounts of coffee, usually liberally nounced blood sugar fluctuations, David laced with sugar. Pockets and purses may be interpreted his emotional state as a dry drunk stashed with candy bars for use when a "quick lift" brought on by the "time of year", enduring and is needed. regularly recurring existential problems, and Both nicotine and caffeine cause an outpouring psychogenic malaise. of adrenalin, which raises blood sugar levels David found it easy to ignore the fact that he temporarily, as does sugar. As the blood sugar had been diagnosed as having blood sugar level rises, the discomfort decreases. levels so unstable that he was both diabetic and Unfortunately, the relief is shortlived. Glucose hypoglycemic and that sugar was clearly levels may plunge rapidly, again bringing on the contra-indicated for his condition. unwanted symptoms. At this time, the alcoholic usually reaches for another cigarette and a cup of Another example of symptom misattribution coffee. This seems to be a perfect example of the occurred with Pamela: A secretary, and an process of attempting to cure the symptoms of the alcoholic with five years of continuous dry drunk "by administering sublethal doses sobriety, Pamela began to feel extremely upset of toxic substances." (It was reported that during shortly after arriving at work on a Monday the Denver Alcoholics Anonymous Convention morning. Within one half hour, she was quite held in 1976, plumbers had to be called in to rig up depressed, experienced symptoms of de- a special large boiler to make coffee and also to fix personalization, and began to have hal- up wall-to-wall spigots to provide access for the lucinations. She became physically weak and heavy demand). weepy, and her gait was unstable. She became As we have noted previously (Worden and so disoriented that she was taken to the Rosellini 1978; 1979), alcohol and drug emergency room of a local hospital by a co- counselors tend to concentrate their diagnostic and worker. She was administered Benadryl and treatment efforts on psychosocial analyses to the her symptoms subsided. When she returned to exclusion of other factors playing a vital role in the office, the symptoms recurred within a attaining, maintaining, and enhancing sobriety. matter of minutes. Pamela, a long-time member However, this tendency is not restricted to the of A.A., interpreted her experiences as helpers. Clients, too, have been weaned on being symptomatic of a dry drunk. Further in- psychological explanations for all mental and vestigation disclosed that the office space she emotional mood swings. This propensity for had been working in had been painted the psychologizing the determinants of behavior is previous weekend. Although the paint was dry, readily apparent from the following example in a the fumes were still quite noticeable. The paint court-mandated client: distributor telephoned the manufacturer in David, a tall, obese alcoholic who had a history of California and discovered that the paint base on-again-off-again sobriety, had a counseling contained a chemical known to elicit appointment shortly after Christmas. During the allergic responses frequently. When Pamela session, he became very emotional about the was allowed to work in a different office until holiday season, saying that he barely was able to the fumes completely dissipated, she suffered hold on and that he might not make it through the no further symptoms. holidays. He was confused, tremulous, and shortly It is clear that in Pamela's case the attribution began to sob. Further inquiry disclosed that the of the dry drunk syndrome provided her with a previous night his girlfriend had visited him, satisfying and acceptable label for her bringing sweets for the sweet, in the form of two experience. Although satisfying and acceptable, pounds of divinity fudge. David nibbled at the the 45 ORTHOMOLECULAR PSYCHIATRY, VOLUME 9, NUMBER 1, 1980, Pp. 41-47 label was nonfunctional; that is, by attributing the and entirely another thing to point out that experience to a dry drunk, Pamela was convinced certain lifestyle behaviors cause biochemical that her experiences were due to some personal changes in the body that can result in disabling failing, some unresolved psychological problem physical and emotional symptoms. The that could be rectified by taking a "personal admonishment to become less resentful does not inventory" and behaving in a more mature fashion. prescribe a course of action, but serves as a In fact, when Pamela discussed this problem with functional equivalent to "shape up" or "get your some of her A.A. friends, they were convinced that head together." she had either been drinking or taking some kind It should not be inferred from the above of drug. This reaction fits our observation that the discussion that the A.A. strategies for coping attribution of the dry drunk syndrome to a set of with the dry drunk are wrong, misguided, or unusual and unpleasant experiences does not in- utterly ineffective. In fact, the strategies are eluctably provide clearcut ways of coping with that often useful, as seen from the testimony of A.A. behavior. Where misattributions prevail, one's members who have weathered the emotional coping responses become fortuitous, akin to the storms. The analysis of dry drunk presented in superstitious behavior of Skinner's pigeons (1959). this paper does not displace A.A. strategies, but Consequently, it becomes questionable whether the instead, supplements them with a more inclusive attribution of the dry drunk syndrome—the label explanatory framework, one based on an and the attendant cognitions—represent any Orthomolecular conception of behavioral advance over demons, gremlins, or fairies. functioning. We suggest that the use of the A.A. David and Pamela, like many other people, program, (or other cognitive restructuring have been acculturated in what Gross (1978) techniques), combined with attention to terms the "psychological society." The idea that nutrition, control of blood sugar instability, one's moods and emotional discomforts may be diminished smoking and caffeine intake, and directly related to dietary practices, nutritional de- exploration of environmental and food allergies ficiencies, excess caffeine and nicotine, or can not only bring a dry drunk under control, environmental allergies—this idea is somehow too but can prevent the occurrence of the simple. It is banal, prosaic, not complicated phenomenon. * enough, and lacks the catchy, anthropomorphic antics of the inner, psychodynamic goings-on of an immature ego. Summary Alcoholics Anonymous teaches not only the label As psychologist/philosopher William James "dry drunk," but also gives an explanatory wrote: There is nothing improbable in the sup- framework, with a set of assumptions about the position that an analysis of the world may yield psychological processes leading to a dry drunk. a number of formulae, all consistent with the The Twelve Steps of A.A. provides the struggling facts ... A Beethoven string-quartet is truly, as alcoholic with a framework for restructuring someone has said, a scraping of horses' tails on destructive attitudes and a coping method to keep cats' bowels, and may be exhaustively described galloping emotions under a tight rein, while in such terms, but the application of this offering no solutions to prevent or stop the description ■ in no way precludes the si- emotional and physical stampede of a dry drunk. multaneous applicability of an entirely different The type of explanation offered for the dry drunk description. (James 1948). To claim that the dry syndrome often dictates special recommendations drunk stems only from unmanageable bad to prevent or relieve the symptoms. For example, it attitudes, resentment, self-centeredness, and is one thing to suggest that a recovering alcoholic other dysfunctional should be less resentful, grandiose, and immature; 46 THE DRY DRUNK SYNDROME psychological processes is to make a very small tail wag a mastiff. ARDELL, D.B.: High Level Wellness. Emmans, Pa.: Rodale Press, 1977. A toximolecular interpretation of the dry drunk syndrome does not exclusively concentrate on E.D.: Dry drunk. The AA Grapevine, p. 5, October, 1974. psychological man, but leads to a closer scrutiny of FLAHERTY, J.A., McGUIRE, H.T., and GATSKI, R.L.: The Psycho-dynamics of the "Dry Drunk." The American Journal of Psychiatry 112: 460-464,1955. the total behavioral functioning of the recovering GROSS, M.L.: The Psychological Society. New York: Random House, 1978. alcoholic. This, in turn, provides the counselor and HOFFER, A. and OSMOND, H.: New Hope for Alcoholics. New York: University the client with additional tools to smooth out the Books, 1968. unpredictable roller-coaster of recovery. JAMES, W.: The Sentiment of Rationality. In: Castell, A. (Ed.) Essays in Pragmatism by William James. New York: Hafner Publishing Co., 1948.

JELLINEK, E.M.: The Withdrawal Syndrome in Alcoholism. Canadian Medical Association Journal 81:536-541,1959.

JONES, E.E., KANOUSE, D.E., KELLEY, H.H., NISBETT, R.E., VALINS, S., and WEINER, B., (Eds.): Attributions: Perceiving the Causes of Behavior: Morristown, N.J.: General Learning Press, 1971.

KELLER, M. and McCORMICK, M: A Dictionary of Words About Alcohol. New Brunswick, N.J.: Rutgers Center of Alcohol Studies, 1968.

MAHONEY, M.: Cognition and Behavior Modification. Cambridge, Mass.: Ballinger, 1974.

*This is not intended to imply that the factors we M.E.: Ever Been in a Dry Drunk? The AA Grapevine, pp. 17-19, April, 1962. have detailed are the only ones-they are simply MEIERS, R.L: Relative Hypoglycemia in Schizophrenia. In: Hawkins, 0. and important means to consider re the dry drunk. Pauling L, (Eds.) Orthomolecular Psychiatry. San Francisco: W.H. Freeman, 1973. There is a growing trend toward health promotion- M.N.: An Emotional Fall. The AA Grapevine, pp. 26-29, April, 1964. the notion of "wellness", and health care practitioners are increasingly becoming aware of PAULING, L: Orthomolecular Psychiatry. Science 160:265-271,1968. the role of life-style in preventing or minimizing RIMLAND, B.: Orthomolecular vs. Toximolecular Medicine. Paper presented at health problems. Ardell (1977) provides an Huxley Biosocia! Research Institute Conference, New York City, June 25,1977. excellent review of "wellness" centered around five SCHACTER, S. and SINGER, J.E.: Cognitive Social and Physiological Determinants of Emotional State. Psychological Review 69: 379-399, 1962. major wellness dimensions: S.K.: Dry drunk. The AA Grapevine, p. 11, March, 1975. * Self-responsibility

* Nutritional awareness SKINNER, B.F.: Cumulative Record. New York: Appleton-Century-Crofts, 1959. * Physical exercise SOLBERG, R.J.: The Dry-Drunk Syndrome. Center City, Minn.: Hazeldon. * Stress management TIEBOUT, H.: The Wily Ego. The AA Grapevine, December 17,1962. * Environmental awareness WELLMAN, M.: The Late Withdrawal Symptoms of Alcoholic Addiction. Canadian Medical Association Journal 70:526-529,1954a.

WELLMAN, M.: Management of the Late Withdrawal Symptoms of Alcohol. Canadian Medical Association Journal 71:360-365,1954b.

WELLMAN, M.: Fatigue During the Second Six Months of Abstinence. Canadian Medical Association Journal 72: 338-342,1955.

WORDEN, M. and ROSELLINI, G.: Role of Diet in People-work: Uses of Nutrition in Therapy with Substance Abusers. The Journal of Orthomolecular Psychiatry REFERENCES 7:249-257,1978.

WORDEN, M. and ROSELLINI, G.: Applying Nutritional Concepts in Alcohol and ALCOHOLICS ANONYMOUS: Twelve Steps and Twelve Traditions. New York: Drug Counseling. Journal of Psychedelic Drugs, 11: 173-184,1979. Alcoholics Anonymous World Services, 1952.

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