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Why ‘one day at a time’ works for recovering alcoholics

“One day at a time” is a mantra for recovering alcoholics, for whom each day without a drink builds the strength to go on to the next. A new brain imaging study by Yale researchers shows why the approach works.

Photo by Joyce McCown from Unsplash.com

“One day at a time” is a mantra for recovering alcoholics, for whom each day without a drink builds the strength to go on to the next. A new brain imaging study by Yale researchers shows why the approach works.

Imaging scans of those diagnosed with alcohol use disorder (AUD) taken one day to two weeks after their last drink reveal associated disruptions of activity between the ventromedial prefrontal cortex and striatum, a brain network linked to decision making. The more recent the last drink, the more severe the disruption, and the more likely the alcoholics will resume heavy drinking and jeopardize their treatment and recovery, researchers report in the American Journal of Psychiatry.

However, the researchers also found that the severity of disruption between these brain regions diminishes gradually the longer AUD subjects abstain from alcohol.

“For people with AUD, the brain takes a long time to normalize, and each day is going to be a struggle,” said Rajita Sinha, the Foundations Fund Professor of Psychiatry and professor in the Child Study Center, professor of neuroscience and senior author of the study. “For these people, it really is ‘one day at a time.’”

The imaging studies can help reveal who is most at risk of relapse and underscore the importance of extensive early treatment for those in their early days of sobriety, Sinha said.

“When people are struggling, it is not enough for them to say, ‘Okay, I didn’t drink today so I’m good now’,” Sinha said. “It doesn’t work that way.”

The study also suggests it may be possible to develop medications specifically to help those with the greatest brain disruptions during their early days of alcohol treatment. For instance, Sinha and Yale colleagues are currently investigating whether existing high blood pressure medication can help reduce disruptions in the prefrontal-striatal network and improve chances of long-term abstinence in AUD patients.

Former Yale postdoctoral researcher Sarah K. Blaine, now at Auburn University, is lead author of the study.

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Alcoholism is a big issue in the LGBTQIA community.

In 2017, for instance, a study noted that bisexual people had higher odds of engaging in alcohol use behaviors when compared with people from the sexual majority. This study also found that bullying mediated sexual minority status and alcohol use more particularly among bisexual females.

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