You know that feeling. The blinding headache, the "why did I do this" nausea, and the desperate search for a greasy bagel. We call it a hangover. But for someone struggling with severe alcohol use disorder, the morning routine looks a lot different. People often wonder, do alcoholics get hangovers, or does their body just get used to the poison?
The answer isn’t a simple yes or no. It’s actually kind of terrifying.
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Most social drinkers experience a hangover as the body's reaction to alcohol leaving the system and the toxic byproduct, acetaldehyde, hanging around too long. For a chronic heavy drinker, the body has moved past "annoyed" and into "dependent." When the blood alcohol concentration (BAC) drops, they don't just get a headache. They go into withdrawal.
The shift from hangovers to withdrawal
Honestly, the line between a hangover and withdrawal is incredibly blurry. To a casual observer, they look the same: sweating, shaking, maybe some vomiting. But biologically? They’re worlds apart.
A standard hangover is mostly about dehydration, electrolyte imbalance, and inflammation. Your inflammatory cytokines are spiking. It's a short-term crisis. However, for an alcoholic, the brain has physically rewired itself. It has produced more excitatory chemicals like glutamate to counter the sedative effects of the booze. When the alcohol stops, the brain is suddenly stuck in overdrive.
This is why you'll see some people "hair of the dog" their way through the morning. For a social drinker, a Bloody Mary might dull the pain of a hangover. For an alcoholic, that morning drink is often a medical necessity to stop their hands from shaking so hard they can't tie their shoes.
They aren't "getting over" a hangover. They are staveing off a neurological collapse.
Why tolerance changes everything
Have you ever met someone who can crush twelve beers and still hold a coherent conversation? That’s tolerance. But here’s the thing: tolerance is a liar. It makes the drinker feel like they are "immune" to the effects, but the organs are still taking the hit.
As tolerance builds, the "hangover" symptoms often morph into something called Alcohol Withdrawal Syndrome (AWS).
- The First Stage: Usually starts 6 to 12 hours after the last drink. This is where the "do alcoholics get hangovers" question gets answered with a "no, they get something worse." It’s anxiety, insomnia, and tremors.
- The Danger Zone: After 24 to 72 hours, things can get life-threatening. This is where Hallucinosis or Delirium Tremens (DTs) can kick in.
A regular person gets a hangover because they drank too much. An alcoholic gets sick because they stopped drinking. It's a complete inversion of how the body is supposed to work.
The science of the "Immune" alcoholic
Dr. George Koob, the director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), has spent years looking at how the brain’s "reward" and "stress" systems flip-flop during addiction. He talks about a concept called allostasis. Basically, the body creates a new "normal."
In this new normal, being drunk is the baseline. Being sober is the state of physiological emergency.
So, do they feel the headache? Sometimes. But often, the sheer volume of alcohol in their system never actually hits zero. If you never let your BAC reach zero, you never technically finish the "processing" phase that leads to a traditional hangover. You're just constantly in a state of varying intoxication or early-stage withdrawal. It's a grueling cycle.
It’s also worth noting that chronic drinkers often have severely depleted B vitamins, specifically Thiamine (B1). This leads to something called Wernicke-Korsakoff syndrome. It isn't a hangover. It's permanent brain damage. When we ask about hangovers in this context, we're really looking at the tip of a very dark iceberg.
What most people get wrong about "High Functioning" drinkers
There's this myth of the high-functioning alcoholic who never seems to have a "rough morning." You see them at the office at 8:00 AM, coffee in hand, looking sharp.
They’re likely just very good at masking.
High-functioning drinkers often experience what’s known as "kindling." Each time they go through the cycle of drinking and withdrawal (the "hangover" phase), the next withdrawal becomes more severe. The brain becomes increasingly sensitive. What started as a mild headache in their 20s becomes a full-blown panic attack and heart palpitations in their 40s.
They aren't avoiding the hangover. They are just living in a constant state of managed misery.
The role of Congeners and cheap booze
It’s not just the ethanol. Hangovers are worsened by congeners—impurities found in darker liquors like bourbon or red wine. Many people struggling with deep-seated alcoholism eventually gravitate toward "cleaner" spirits like cheap vodka because it produces a "cleaner" buzz with slightly fewer impurities.
But even then, the body can only process about one standard drink per hour. When you're consuming twenty a day? The math just doesn't work. The liver is constantly backed up. The "hangover" becomes a permanent resident in the body.
The physical toll you can't see
If you're asking do alcoholics get hangovers because you’re worried about someone, look at the physical cues that go beyond a simple headache.
- Kindling: Watch for increasing irritability or "jumpiness" when they haven't had a drink for a few hours.
- Gastrointestinal issues: Chronic inflammation of the stomach lining (gastritis) means they might be nauseous all the time, not just after a big night.
- The "Sweats": Night sweats are a classic sign that the body is struggling to regulate its temperature as alcohol leaves the system.
Breaking the cycle
If the "hangovers" have turned into tremors, or if "hair of the dog" is the only way to function, this isn't a lifestyle choice anymore. It's a medical situation.
Detoxing from alcohol is one of the few drug withdrawals that can actually kill you. Unlike opioid withdrawal—which feels like dying but usually won't kill a healthy person—alcohol withdrawal can cause seizures and cardiac arrest.
Actionable steps for moving forward
If you or someone you know is stuck in this cycle where hangovers have evolved into something more sinister, here is how to actually handle it:
- Don't quit cold turkey alone: If there are tremors (the shakes), professional medical detox is non-negotiable. Benzodiazepines are often used in clinical settings to prevent seizures during the first 72 hours.
- Monitor the "Morning-After" Symptoms: If the symptoms include confusion, seeing things that aren't there, or a heart rate over 100 BPM, get to an ER immediately. This isn't a hangover; it's a medical emergency.
- Replenish Vitamin B1 (Thiamine): Chronic drinkers are almost always deficient. Doctors often prescribe high-dose Thiamine to prevent permanent neurological damage during the recovery phase.
- Look into Naltrexone: This is a medication that can help break the "reward" cycle by blocking the endorphins usually released by alcohol. It can make the "hangover" cycle less inevitable by reducing the urge to over-drink.
- Acknowledge the Psychological Gap: A hangover is physical. Addiction is physical and emotional. Treatment has to address the reason the person is trying to avoid being sober in the first place.
The reality is that alcoholics don't get hangovers in the way most people understand them. They live in a world where the "morning after" never really ends. It just evolves into a constant battle against their own nervous system. Recognizing that this isn't just a "bad morning" but a physiological shift is the first step toward actually getting better.
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It’s a hard road, but the brain does have a remarkable ability to heal once the cycle is broken. The "normal" morning—where you wake up without needing a drink just to stop the shaking—is possible. It just takes more than an aspirin and a glass of water to get there.
Resources for Help:
- SAMHSA’s National Helpline: 1-800-662-HELP (4357)
- Alcoholics Anonymous (AA): Local meetings available globally for peer support.
- SMART Recovery: A science-based alternative to traditional 12-step programs.