Navigating the alcohol come down

What is a comedown?

What goes up must come down.

The term ‘comedown’ is usually reserved for stimulant or psychedelic drugs like speed, cocaine or MDMA. These drugs have profound effects on our brain’s neurotransmitters, and when the drug wears off these neurotransmitters must be rebalanced. This causes many of the symptoms of a comedown.

MDMA, for instance, is well known for its effects on serotonin – but it also affects dopamine and norepinephrine. The serotonin release caused by MDMA increases sociability, emotional openness and mild hallucinations, while dopamine and epinephrine boost energy and excitability. In the comedown phase, these neurotransmitters are depleted – and the effects are reversed. Users feel depressed, anxious, irritable, exhausted (after an initial period of insomnia), fatigued, unmotivated and empty.

While alcohol hangover or withdrawal symptoms can be very physical, there is also a significant drop in mood – and much of this can be attributed to how alcohol affects neurotransmitters. This same process of increased neurotransmitter activity followed by a crash is also seen during an alcohol comedown.

What happens during an alcohol comedown?

To properly describe an alcohol comedown, we need to know which neurotransmitters are affected by alcohol consumption.

Inhibitory and excitatory neurotransmitters

Gamma-aminobutyric acid (GABA) is the brain’s main inhibitory neurotransmitter – it calms down neuronal activity. Benzodiazepines also affect GABA, and this is why they are commonly prescribed for their sedating and anxiolytic effects. Alcohol binds to our GABA receptors and makes it more effective, calming the brain down.

GABA isn’t the only inhibitory neurotransmitter involved in this process – some studies have found alcohol also increases the activity of glycine (in the spinal cord and brainstem) and adenosine.

Alcohol also decreases the effects of excitatory neurotransmitters, like glutamate and aspartate. The effects of increasing inhibitory and decreasing excitatory neurotransmitters are calmness, anxiety reduction, and sedation.

During the alcohol comedown, this process reverses. Inhibitory and excitatory neurotransmitters exist in a balance – and alcohol tips the balance towards inhibitory neurotransmitters. Once it wears off, the brain see-saws into a state dominated by the excitatory neurotransmitters – and the brain goes into overdrive.

During an alcohol comedown, this brain state is implicated in many of the unpleasant emotional effects – anxiety, irritability, being easily startled and sleep disturbances. This state is also responsible for many of the life-threatening withdrawal symptoms seen in people quitting after leaving for a long time, like seizures, delirium and hallucinations.

The dopamine reward system

Drinking causes dopamine levels to rise, particularly in the nucleus accumbens, part of the brain’s reward system. This is one of the reasons we experience alcohol as pleasurable and rewarding.

During the alcohol comedown, we experience a dopamine crash. Being in a dopamine deficit feels extremely unpleasant – you lack drive, feel tired, moody and anxious, struggle to concentrate, feel depressed and experience disturbed sleep.

In the same way that inhibitory and excitatory neurotransmitters become more unbalanced after repeatedly consuming alcohol, this process becomes more pronounced the more we drink. Over time, your receptors compensate for the large amounts of dopamine released when you drink and become desensitised. This means these unpleasant comedown symptoms become more intense and last for a longer time when withdrawing from alcohol, leading to severe depression, demotivation, anhedonia and longer-term sleep disturbances. This is one of the main processes that causes post-acute withdrawal syndrome – lingering symptoms that can continue for a long time after you have gone through the acute withdrawal stage of quitting alcohol.

Serotonin

This process can also be observed with serotonin. Serotonin levels rise when you drink – higher levels of serotonin metabolites can be detected in the blood and urine after alcohol consumption, indicating enhanced serotonergic activity. This contributes to alcohol’s euphoric and mood-altering effects.

During the alcohol comedown, serotonin levels drop, leading to low mood and irritability. This also becomes more pronounced over time, with chronic alcohol use leading to adaptive changes in serotonin receptors. Blocking certain receptors implicated in this process, namely the 5-HT2 receptor, has been shown to reduce anxiety during alcohol withdrawal.

This pattern of a rise or increased sensitisation to neurotransmitters, then a fall or desensitisation to them during comedown, happens to a whole range of neurotransmitters. Alcohol affects adrenaline, cortisol, the endocannabinoid system, endorphins, corticotropin-releasing factor, acetylcholine and endorphins. It powerfully disrupts many neurochemical mechanisms in the brain, causing it to feel pleasurable when consumed and extremely unpleasant when the effects wear off, and it’s time for the brain to rebalance.

Emotional and mental health during an alcohol comedown

As long as you are not chronically abusing alcohol, these neurotransmitter disruptions are temporary and can be managed with self-care. Water, electrolytes, nutritious food and plenty of rest are the best ways to take care of your body and brain and ensure it’s given an optimal environment to recover. Your brain needs time to come back into balance.

Multiple-day hangovers, with emotional comedown symptoms that can last several days, can happen. These can be affected by your individual ability to process alcohol and by age. Have patience, be kind to yourself, and remember that this will pass. Don’t be tempted to drink again to get the feel-good neurotransmitters back – this can lead to developing a dependence.

Preventing alcohol comedowns

Other than abstaining entirely, or drinking in moderation, there is no way to prevent an alcohol comedown.

Tips for preventing severe hangovers, like eating a good meal before you drink, pacing yourself, drinking plenty of water and getting to bed at a normal time, also apply to preventing a severe alcohol comedown. Ultimately, pacing, moderation and self-care are key.

When does a comedown indicate an addiction?

The anxiety and mood disturbances of an alcohol comedown usually pass within a few days – but if you’re drinking too much and too often, these affective states can become pervasive. Your brain is becoming adapted to the neurochemical changes induced by alcohol consumption, and this can cause long-term changes to your baseline emotional state.

If you’re feeling worse after you drink and find yourself drinking more often to stave off the comedown, it’s time to reach out for help.

Ending the comedown

The emotional symptoms of alcohol addiction can be some of the most difficult ones to deal with. They can be stubborn, taking a while to alleviate, making reaching for a drink to make them go away tempting. But this isn’t the answer – only leaving alcohol behind forever will help to end these symptoms.

Our comprehensive alcohol addiction treatments include a range of therapies, so you can talk through your feelings, get emotional support and navigate your way to a healthier, happier life.