Why am I craving alcohol after a blackout?

Dear Unchanged by Poisoning,

Two parts horrible hangover and three parts scary blackout is enough to shake up many people into considering swearing off alcohol. It’s helpful to remember, though, that alcohol use exists on a continuum from complete abstinence to occasional use to dependence. While continuing to drink after having an episode of blacking out may be considered a criterion for alcohol use disorder (the medical diagnosis for what many think of as alcoholism), it doesn't necessarily mean the person suffers from an alcohol problem. There may be a number of explanations as to why you feel inclined to drink again after a bout of alcohol poisoning. So it may be worthwhile to reflect on what this experience means to you and the role alcohol may play.

As you’ve experienced, drinking alcohol has risks, especially when a large amount is consumed over a short period of time. Alcohol consumption may lead to drunkenness, feelings of nausea, vomiting, and even blacking out. In severe cases, people may experience alcohol poisoning, which may lead to stopped breathing or even death. Additionally, many people confuse the terms blacking out and passing out. Blacking out happens when you don’t remember all or part of what happens (such as full or partial amnesia) while you’re drunk. This happens because drinking decreases the electrical activity of the neurons in the hippocampus (a part of the brain responsible for memory), which disrupts the formation of short-term memory. After a night of drinking you may wake up with gaps in your memory, even though on the outside you were conscious and appeared to be just drunk. Passing out, on the other hand, means you become physically unconscious. Passing out has the potential to lead to other serious complications (such as choking on vomit or decreased breathing) and may coincide with a black out as well. 

You may be comforted to know that you’re not alone when it comes to blacking out. Over half of individuals who currently consume alcoholic beverages report blacking out at least once before. However, blacking out doesn’t automatically imply that someone has an alcohol use disorder. Alcohol use disorder ranges from mild to severe depending on the number of criteria met. For instance, another criterion for alcohol use disorder is a strong craving or urge to drink. However, before jumping to any conclusions, it may make sense to look a little deeper into other reasons for why you specifically might "already be craving alcohol again.” You might consider:

• What do you mean when you describe your attitude towards alcohol as "craving?"
• What are the reasons behind your decision to drink?
• When you drink, what do you hope will be the result?
• How does drinking affect your behavior? Your feelings about yourself? Your interactions with other people?

Perhaps you’re craving the feelings that you attach with drinking, such as relaxation, escape from everyday problems, or fun with friends. Stress is another factor that may trigger alcohol cravings as a way to alleviate some of that stress. It’s been shown that stress-related emotional responses are associated with increased cravings for alcohol. Reading Drinking for stress relief — A problem? may provide you additional information on this topic.

Smart, safe, and responsible alcohol consumption can help folks enjoy alcohol without it turning into a problem. In fact, some studies show potential health benefits to drinking moderate amounts of alcohol. For many people who have had an unpleasant experience while drinking, the incident serves as motivation to stay aware of their limits. Checking out Rethinking Drinking from the National Institutes of Health may be a place to find more information to help you decide what your limits might be. Recognizing that you're craving alcohol shows you’re very in-tune with your body. Noticing these changes and perhaps re-evaluating your relationship with or without alcohol may be a good first step at determining if alcohol consumption may or may not be causing distress or harm. You may also find it useful to speak with a health care provider or mental health professional if you’re concerned about your relationship with alcohol or have trouble making any changes that you’re trying to implement. Change may happen slowly, but it seems like you're looking into a brighter direction free of blackouts!