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Drinking that increases after leaving an abusive relationship is usually doing a job. It is managing a nervous system that has not yet stood down and a set of feelings that were not affordable while you were still in the house. Going up rather than down after leaving is a common pattern, not a sign that you have failed at the part that was supposed to be easy.
This page does not tell you whether you have a problem with alcohol, does not tell you to stop, and does not tell you to continue. One thing it does need to say early, because it is a matter of physical safety: if you drink heavily every day, stopping suddenly and without medical supervision can be dangerous, and that is a question for a physician rather than for willpower. Nothing on this page is an assessment of anyone.
What has the drink actually been doing for you?
The drink has been doing something, and what it does is the first thing worth naming, before anything about what it costs. In almost every case it is shortening a gap — the distance between the moment the day ends and the moment your body is willing to stop bracing. That is a real piece of work, performed reliably, on demand, for the price of a bottle.
The mechanism has a name and it is not weakness. Negative reinforcement is behavior maintained by the removal of something aversive rather than by the delivery of something pleasant. Nobody keeps doing something for years because it is nice. They keep doing it because it works, and what it works on is the thing they cannot otherwise switch off. The psychiatrist Edward Khantzian, who developed the self-medication hypothesis, put the emphasis exactly there: people with substance problems are not chasing euphoria so much as seeking relief from unbearable states, and the useful clinical question is not why do you drink but what does the drink do for you (Khantzian, 1997).
Khantzian’s model is not settled science and deserves to be reported that way. It is a clinical theory, decades old, and the research testing it has produced mixed rather than uniform support — some people drink to relieve distress, some drink for other reasons entirely, and the two often coexist in one person. What it does supply is the right first question.
Women describe the job differently and the descriptions are remarkably consistent. It gets me to sleep. It stops me listening for the car. It makes the recap in my head slow down. It lets me be in the same room as him without my face doing anything. It is the only twenty minutes in the day that belongs to me.
Almost nobody can say what the drink does for them on the first attempt. They can say what it costs — fluently, in detail, with dates. The cost has been rehearsed for years, usually out loud, usually by somebody else. The function has never once been asked about, and it is where the work actually starts.
Why did it get worse after I left?
Drinking often increases after leaving because leaving removes the danger without removing the demand, and because it makes available a set of feelings that were previously too expensive to have. Both of those arrive at once, usually somewhere between the second and the twelfth month, which is exactly when everyone around you has decided the hard part is over.
The direction of that pattern is documented. In a systematic review and meta-analysis of 55 studies producing 102 estimates, nine longitudinal studies contributing 15 estimates found that experiencing intimate partner violence was followed by increased odds of subsequent alcohol use in women, with a pooled odds ratio of 1.25 (95% CI 1.02 to 1.52) (Devries et al., 2014). That is a modest association measured across populations, not a prediction about anybody. What it establishes is that drinking following abuse is a real and repeatedly observed pattern rather than a private failing.
The demand does not end at the door. Handovers, messages, the schedule, the money, a lawyer’s invoice, his mother — if he is still generating input into your week, the thing the drink was managing is still running, which is why he still seems to be running your week. Meanwhile the feelings that could not be afforded inside the house arrive with the safety. Rage, grief, humiliation and the specific horror of realizing how long it went on are not calm emotions, and they turn up in a woman who has spent years becoming extremely good at not having visible feelings.
There is a further turn in the mechanism, and it is the one that catches people. George Koob’s work on the neurobiology of addiction describes an opponent process: with repeated use, the balance shifts, so that drinking moves from producing relief toward preventing a distress the drinking itself now generates in its absence. Under that shift, the same two glasses buy less and less, and skipping them costs more and more. Nothing about your character changed. The arithmetic did.
Does the research say my drinking caused the abuse?
No. The research does not say that, and this is the point at which the literature gets misused most often, so it is worth being precise about what it actually shows. The same review that found abuse followed by increased odds of drinking also found the reverse pattern: across seven longitudinal studies producing twelve estimates, women’s alcohol use was followed by increased odds of subsequent intimate partner violence, pooled odds ratio 1.27 (95% CI 1.07 to 1.52) — a figure almost identical in size to the one running the other way, 1.25. You will find that second number if you look the paper up, and you should know it is there. What the authors themselves conclude from having both is that the temporal direction of causality remains unclear (Devries et al., 2014). Cross-sectional studies show the strongest association, 1.80, and are the weakest design, because they photograph two things at once and cannot say which came first.
Two ordinary features of observational research explain most of what remains. Reverse causation means an association read in the convenient direction is often running in the other one — the drinking following the abuse rather than preceding it. Confounding means the two are being pushed by something else that sits behind both: poverty, isolation, untreated trauma, a childhood that contained the same things. Neither of those is a subtle statistical point. They are the reason a pooled odds ratio drawn from dozens of studies of populations cannot be pointed at one woman in one kitchen.
Underneath the statistics there is a plainer sentence. Nothing anyone drinks causes another person to isolate her, monitor her, degrade her or frighten her. Those are a course of conduct, chosen and maintained over time — what coercive control actually is — and courses of conduct have authors. A man who is controlling when his wife drinks is a man who is controlling.
The question underneath this one is often the reverse: he’s only like that when he drinks — is it the alcohol? That is a real question, it has a real answer, and the answer is not simple enough for one paragraph here. Alcohol is genuinely associated with the timing and severity of violent episodes, and it is neither necessary nor sufficient — men who are abusive when drunk are, in the overwhelming majority of cases, still controlling when sober, because control is not something a person only does while drinking.
If you are in immediate danger, call 911.
National Domestic Violence Hotline — 1-800-799-7233, 24 hours · text START to 88788 · thehotline.org
988 Suicide and Crisis Lifeline — call or text 988
SAMHSA National Helpline — 1-800-662-4357, 24 hours, free and confidential, for substance use and mental health — treatment referral and information, in English and Spanish.
Deaf, DeafBlind and hard-of-hearing callers: National Deaf Domestic Violence Hotline videophone 855-812-1001, 24 hours (a partnership between the National Domestic Violence Hotline and Abused Deaf Women’s Advocacy Services).
Calling leaves the number in your call log and texting leaves the thread in your messages. Both can be deleted afterwards. If that is not something you can do safely, a friend’s phone or a payphone is the safer route.
Why does everyone want the drinking fixed first?
Everyone wants the drinking fixed first because services were built that way, not because the evidence requires it. The design is called sequential treatment: deal with the substance use, then, once that is stable, deal with the trauma. It is administratively tidy, it lets two sets of professionals stay inside their own funding, and it puts the woman with both problems at the back of both queues.
You can see the split in the plumbing. The therapist directories let you filter for domestic abuse and filter for substance use — two separate boxes, on the same page, that almost nobody ticks together. Abuse and drinking are discussed in two different rooms, and the result is that you have been telling half the story in each of them: the shelter worker who does not want to hear about the wine, the treatment program that treats the marriage as a relapse trigger rather than as the thing being survived.
The evidence does not support the sequence. In a secondary analysis of a randomized trial run across seven community treatment programs in the NIDA Clinical Trials Network, 353 women with co-occurring PTSD and substance use disorders were followed weekly through treatment and out to twelve months. Reductions in PTSD severity were more likely to be followed by improvement in substance use, with minimal evidence of the reverse — substance use improving did not, in general, improve the PTSD (Hien et al., 2010). The arrow, in the data, runs the way you have been telling people it runs.
The evidence for treating both together is real and it is honest about its own limits. A Cochrane review of 14 studies with 1,506 participants found that individual trauma-focused therapy delivered alongside substance use treatment reduced PTSD more than treatment as usual, both immediately and at three to seven months, with small effects and a small reduction in substance use at follow-up; the reviewers rated the evidence low to very low quality and noted higher dropout from the trauma-focused arms (Roberts et al., 2016). That is not a triumphant finding. It is a sufficient one: doing both at once is supported, it does not blow people up, and the fear that drove the sequential model has not been borne out.
Abuse recovery, whatever has been getting you through, and the anger are not three problems queued behind one another. They are one account, and a clinician trained across all three does not require any part of it to be left at the door. Whether the trauma side of it amounts to emotional abuse causing PTSD is a separate and answerable question.
I stopped drinking and now I feel everything — what is that?
Stopping and then feeling everything is the single most common thing women report after the first fortnight, and it is almost always explained to them as post-acute withdrawal alone. Part of it is. The rest of it is the material the alcohol was holding down, arriving on schedule, and the difference between those two explanations changes what you do next.
The withdrawal part is real and has a name. Hyperkatifeia — a term coined in George Koob’s group, from the Greek for dejection — describes the heightened sensitivity to emotional distress that follows sustained substance use, in which the brain’s stress systems are left running above baseline for weeks or months after the substance is gone (Koob, 2020). It was developed mainly in the opioid literature and extended to alcohol. It accounts for the flatness, the irritability, the sense of being sandpapered.
What hyperkatifeia does not account for is the specificity. It predicts that you will feel worse. It does not predict that what surfaces will be his voice on a particular Tuesday, or the sound of a car door, or the exact temperature of a kitchen in 2019. That specificity is trauma affect, and it was being suppressed, not processed. This is the part that everything else written on this subject leaves out, and it is why the anger arrived after you got out, and part of why your body waited until it was safe.
Two mechanisms sit under that, and both should be reported with their limits attached. Alcohol suppresses REM sleep early in the night and disturbs sleep architecture for a long time into abstinence — which matters because REM is heavily implicated in the processing of emotional memory, so years of drinking is also years of interference with the machinery that would ordinarily have digested this (Colrain, Nicholas & Baker, 2014). And in mice, chronic intermittent alcohol exposure impaired fear extinction and physically remodeled neurons in the medial prefrontal cortex, the region that normally allows a learned fear to be switched off (Holmes et al., 2012). That is animal work and it is not a finding about you. What it suggests is that the alcohol may not only have postponed the processing. It may have been interfering with the equipment.
Feeling everything, when it starts, is not the treatment failing. It is the beginning of material becoming available. That is exactly the point at which having somewhere to take it stops being optional.
What would the work actually look like?
The work starts with a functional analysis rather than with a target date. That means establishing what the drinking is doing, when, and in place of what — which evenings, which hour, after which kind of contact — before anything is taken away. Removing a coping strategy from somebody who still needs it, without replacing it, is not treatment. It is subtraction.
Medical safety comes before anything psychological. If you drink heavily every day, withdrawal can involve seizures and delirium and is occasionally fatal, and it is managed with medication by a physician. This is not a moral matter and it is not a strength-of-character matter. A primary care doctor can assess it in one appointment, and the SAMHSA National Helpline — 1-800-662-4357, free, confidential, 24 hours — will find local options without asking you to commit to anything.
Skills before memories. The regulation capacity has to exist before the material is opened, which is the same sequencing principle that governs trauma work generally and is more important, not less, when something has been holding the feelings down for years.
The memories come next, when the floor is stable. EMDR is a trauma therapy built for the memories that talking about has not touched — the ones that still arrive in the body as though the thing were happening now. It is not a first step and no honest clinician offers it as one.
Harm reduction is a legitimate clinical position, not a failure of ambition. Reduction, safer patterns, and stopping altogether are all real outcomes, they are chosen by the person doing them, and the evidence does not require abstinence as the price of getting help with anything else.
What this page can tell you, and what it cannot
This page can tell you what a drink does in a nervous system that has not stood down, why the pattern often worsens after leaving, what the epidemiology does and does not establish about cause, why the sequential model of care is not evidence-based, and why feeling everything after stopping is more than withdrawal. This page cannot tell you whether your drinking has become a disorder, what your body would do without alcohol, or what you should do next. Those require a person, and in the case of your body, a physician.
One thing said plainly, because you may have been told the opposite by someone who meant well. Your drinking did not contribute to what he did. It is not a mitigating factor, a shared responsibility, or a thing to be weighed against his conduct. It is a strategy you built, under pressure, for a situation you did not create, and it worked well enough to still be there.
A next step does not have to be stopping. It can be one week of noticing which hour it happens in and what happens in the hour before. If you want to talk to somebody now: National Domestic Violence Hotline, 1-800-799-7233, 24 hours, or text START to 88788. For the drinking specifically: SAMHSA National Helpline, 1-800-662-4357.
Abuse and substance use are sorted into separate boxes by almost every directory, which means one person who works with both takes asking to find — so it is worth knowing what to ask and what a real answer sounds like.
Whatever’s been getting you through isn’t a separate problem you have to fix first. The work doesn’t start by taking it away. It starts with what it’s been doing for you.
SOURCES
- Khantzian, E.J. (1997). The self-medication hypothesis of substance use disorders: A reconsideration and recent applications. Harvard Review of Psychiatry, 4(5), 231–244. Journal record
- Devries, K.M., Child, J.C., Bacchus, L.J., Mak, J., Falder, G., Graham, K., Watts, C., & Heise, L. (2014). Intimate partner violence victimization and alcohol consumption in women: A systematic review and meta-analysis. Addiction, 109(3), 379–391. doi:10.1111/add.12393
- Hien, D.A., Jiang, H., Campbell, A.N.C., Hu, M.-C., Miele, G.M., Cohen, L.R., Brigham, G.S., Capstick, C., Kulaga, A., Robinson, J., Suarez-Morales, L., & Nunes, E.V. (2010). Do treatment improvements in PTSD severity affect substance use outcomes? A secondary analysis from a randomized clinical trial in NIDA’s Clinical Trials Network. American Journal of Psychiatry, 167(1), 95–101. doi:10.1176/appi.ajp.2009.09091261
- Roberts, N.P., Roberts, P.A., Jones, N., & Bisson, J.I. (2016). Psychological therapies for post-traumatic stress disorder and comorbid substance use disorder. Cochrane Database of Systematic Reviews, 4, CD010204. doi:10.1002/14651858.CD010204.pub2
- Koob, G.F. (2020). Addiction as a coping response: Hyperkatifeia, deaths of despair, and COVID-19. American Journal of Psychiatry, 177(11), 1031–1037. doi:10.1176/appi.ajp.2020.20091375
- Shurman, J., Koob, G.F., & Gutstein, H.B. (2010). Opioids, pain, the brain, and hyperkatifeia: A framework for the rational use of opioids for pain. Pain Medicine, 11(7), 1092–1098.
- Holmes, A., Fitzgerald, P.J., MacPherson, K.P., DeBrouse, L., Colacicco, G., Flynn, S.M., Masneuf, S., Pleil, K.E., Li, C., Marcinkiewcz, C.A., Kash, T.L., Gunduz-Cinar, O., & Camp, M. (2012). Chronic alcohol remodels prefrontal neurons and disrupts NMDAR-mediated fear extinction encoding. Nature Neuroscience, 15(10), 1359–1361. doi:10.1038/nn.3204
- Colrain, I.M., Nicholas, C.L., & Baker, F.C. (2014). Alcohol and the sleeping brain. Handbook of Clinical Neurology, 125, 415–431. Record
- SAMHSA National Helpline — 1-800-662-4357, 24 hours, free and confidential. samhsa.gov/find-help/national-helpline
Educational content. Not therapy, legal, medical, or financial advice. Nothing on this page is an assessment or a diagnosis of any person.