Hangover Versus Withdrawal

Nearly everyone who’s tried alcohol has contracted what doctors call veisalgia: headache, dehydration, nausea, diarrhea, muscle aches, loss of appetite, anxiety, fatigue, a poor sense of well-being. Most people call it a hangover.

Alcohol dilates blood vessels, accounting for the feeling of warmth it produces. It’s also a central-nervous-system depressant, inducing the languor of intoxication. However, in reaction to alcohol’s depressant qualities, the body boosts countervailing excitory systems. The hyperactivity in these systems remains after the alcohol has been metabolized and it takes time for the body to normalize. As a result, as the euphoria of intoxication dissipates, it leaves the residual stimulative effects, felt as some of hangover’s symptoms.1

Alcohol lowers the body’s blood sugar, causing lightheadedness and weakness, and suppresses deep-sleep cycles, resulting in the exhaustion of the morning after.2 It’s also a diuretic; it induces urination which leads to dehydration.3 Alcohol is broken down — at a rate of about two ounces per hour — in the liver, which needs large amounts of water to metabolize it. If necessary the liver draws water from other parts of the body, contributing to dehydration.4

Non-alcohol impurities called “congeners” are perceived by the body as foreign and stimulate an immune response akin to fighting a virus. The resulting inflammation accounts for headache and other flu-like ills. However, the immune response to intoxication is more muted than to the flu: hangovers typically last less than a day, about one-fourth the flu-recovery period.5

Hangover isn’t just a physical malady; it also affects cognition. Hungover test subjects demonstrate delayed reaction times, difficulties in concentration and coordination, and deficits in visual/spatial perception.6

The cumulative effect of hangovers illustrates the depth of America’s alcohol problem. One study estimated lost productivity associated with alcohol, primarily from hangovers, at a whopping $148 billion per year, or about $2,000 for every adult in the workforce.7 A study of college students reported that 25% had a hangover in the previous week.8

Hangovers are the body’s acute response to sporadic intoxication, and normal drinkers’ reaction, especially to their first hangover is usually, “I’ll never do that again.” Few live up to that vow. Rather, most learn how to moderate intoxication to avoid hangovers most of the time.

Withdrawal, by contrast, is recuperation from the long-term damage of alcohol abuse. Months after my detox, I heard one of my rehab’s doctors tell an AA meeting how debilitating detox was. “Medically, you’re in a state of extreme fluctuation,” he said. “Your heart rate fluctuates, your blood pressure fluctuates, your moods fluctuate. Let’s face it, you’re all fluct up.”

Key to withdrawal is tolerance, one of the body’s defensive reactions to drug abuse. Prolonged drug use causes the brain to adapt. Eventually, it comes to expect, then need drugs to feel normal, requiring a baseline of constant intoxication. Thus, the difference between hangover and withdrawal is the contrast between having too much alcohol and having too little. Hangover is the aftermath of having had too much; normalcy returns from clearing alcohol out of the body. In contrast, withdrawal results from having too little left in the body after intoxication ebbs to satisfy the adapted brain’s continuous need; normalcy returns only from drinking.

Withdrawal is actually the second of two shocks to the brain. The first, long-term alcohol abuse, forces brain cells to develop tolerance, requiring more and more drugs. The second shock, complete abstinence, compels the adapted brain cells to react again, but this time quickly and in the diametrically opposite direction, one of the reasons it’s so hard.

Just as there’s no silver-bullet cure for hangover, withdrawal is largely a process that has to be endured. Vitamins, anti-depressants, tranquilizers, liquids, decent sleep, and eating properly for the first time in months help, but the most important factors are removing the alcohol intake and time. Though many addicts start to feel human after several days, those who enter treatment in the shape I did take a lot longer. I wasn’t officially released from detox until 11 days after I arrived and I remained pretty shaky several days beyond that. Returning to the physical and mental states that were normal before alcoholism, I was told, would take me at least a year.

Reading scientific treatises on withdrawal can be an odd experience for an addict. It’s not that what they say isn’t true; of course, it is. However, it’s limited by observation rather than experience. For example, addiction scientists and doctors say most withdrawals are relatively manageable — the pain and discomfort isn’t as severe as many other conditions. Objectively, that’s true. Subjectively, however, it’s an entirely different story. To an addict in withdrawal it seems like there couldn’t be anything worse.

In the years I volunteered at my rehab I witnessed many people go through the rigors of detox from the usual suspects: heroin, meth, coke, crack, booze, pot, synthetic opiates. You name it, I saw it. Scientists’ observe that heroin withdrawal is usually relatively easier than alcohol detox and though I’d generally agree with them, try telling that to a detoxing heroin addict. The key word is “relative.” Addiction researchers talk about withdrawal on average, while addicts feel it individually. It’s easy to categorize pain as relatively moderate — when it isn’t yours. When it is, it’s indescribably unbearable. Comparing your agony to another’s, though done constantly in rehab, is only useful in passing the time.

Most importantly, the physical pain of withdrawal is only part of the story and the easier part at that. As a serial self-detoxer and the survivor of an 11-day hospital withdrawal from hell, I can attest that the bodily discomfort, even when severe, pales beside the psychological panic an addict confronts while detoxing. When you’re convinced your drug of choice, your medicine, is more important than eating and sleeping and bathing, jobs and friends, and even your closest loved ones, contemplating giving it up is beyond disorienting, it’s unfathomable. Extreme trepidation stems from the depth of the identity crisis impending sobriety provokes. Those who have built entire lives around obtaining and using drugs haven’t a clue what life will be like without them and it’s hard to overestimate the terror of that prospect. It isn’t easily quantifiable scientifically, but it’s so daunting, most addicts will do almost anything to avoid it.  (For more on this subject, click on The Terror of  Withdrawal, Detox: Physical, and Detox: Emotional.)

The best analogy I’ve heard to illustrate the physical pain and emotional upheaval of detox is this: Imagine being dumped by your one-and-only true love while suffering from the worst flu you’ve ever had, a flu so bad you want to die. Take your worst broken-hearted rejection, your worst identity crisis, add physical pain in every part of your body, stir in an unhealthy dose of existential panic, and you can begin to comprehend the depth and breadth of the torment, anguish, dislocation, and bewilderment of detox.


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1. Raw Eggs? Hair of the Dog? New Options for the Besotted, New York Times, Dec.7, 2004.
2. The Big Bang, San Francisco Chronicle, Dec. 25, 2003.
3. A Few Too Many, The New Yorker, May 26, 2008
4. The Big Bang, San Francisco Chronicle, Dec. 25, 2003.
5. The Big Bang, San Francisco Chronicle, Dec. 25, 2003.
6. A Few Too Many, The New Yorker, May 26, 2008.
7. A Morning-After Pill for Hangovers? New York Times, Dec. 27, 2000; Shopping Around, Wall Street Journal, Dec. 30, 2004; The Alcohol Hangover, Annals of Internal Medicine, June 6, 2000.
8. The Alcohol Hangover, Annals of Internal Medicine, June 6, 2000.


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