February 24, 2021

Prospect Sconsultation

The health experts

Hyperkatifeia & How It Influences Our Drinking

4 min read

It’s well documented that alcohol has a profound impact on the brain. Almost immediately alcohol disrupts communication between neurons, and over time, heavy drinking can lead to damage that takes several forms. Despite that knowledge, alcohol use and misuse has been a problem in America for a long time. In fact, pre-pandemic the Americas where the only region of the world where drug use was a top 10 contributor to disability and death, with a three-fold increase in death between 2000-2019. More specifically, alcohol-related deaths doubled from 1999 to 2017.  

But since the start of the Covid-19 pandemic, there has been an increase in alcohol consumption. Although in many places around the country bars have been closed or restricted in capacity, overall alcohol sales had increased more than 20% by June of 2020. Whether it’s because people have more leisure time, feel more isolated, more stress, or all of the above, it’s clear that alcohol has been a coping mechanism for many individuals in the past year. And that has caused great concern for the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the agency tasked with understanding the causes and consequences of alcohol use.

During the NIAAA’s 50th Anniversary symposium Dr. George Koob, Director of the NIAAA used his opening remarks to talk about hyperkatifeia, what he calls “deaths of despair,” and Covid-19. Given that fewer than 10% of the estimated 14.5 million American’s that suffer from alcohol use disorder (AUD) receive treatment, the implications of increased drinking as a coping mechanism during the coronavirus pandemic could be devastating. Which means, as he highlighted, there is no time to waste in understanding what is happening psychologically and physically as a result of increased alcohol use as a coping response.

What Is Hyperkatifeia?

According to Dr. Koob, hyperkatifeia is a, “high intensity and sensitivity to negative emotional states associated with withdrawal from alcohol (or for that matter, any drug of abuse).” He goes on to describe it as the equivalent of hyperalgesia (experiencing an enhanced sensitivity to physical pain), but in the negative emotional domain as opposed to the physical pain domain. 

What this means is that despite often thinking of withdrawal as a set of physical responses, key components of withdrawal that motivate people to use alcohol further include “anxiety, dysphoria, pain, irritability, sleep disturbances, and general malaise.” While some of these symptoms can also be directly linked to physical disturbances, the real issue involves changes to the brain’s reward and stress systems. And it seems, that these changes in the brain’s reward and stress systems creates an additional source of motivation to drink.

Thus, alcohol initially reduces stress-related brain function as well as emotional discomfort, but that leads to adaptations in the brain. As with any addiction, the result is the need for more and more doses of alcohol to have the same effect. But, it further alters the emotional state of the user when the drug wears off. According to Dr. Koob people are getting a, “muted response to drinking during the pandemic, yet are continuing to drink to try and maintain a sense of equilibrium.”

The Impact On Alcohol-Related Deaths

Dr. Koob and colleagues recently authored Addiction as a Coping Response: Hyperkatifeia, Deaths of Despair, and Covid-19 in the American Journal of Psychiatry. As researchers, he and colleagues described not only the neurobiology of hyperkatifeia, but the “deaths of despair” that are a result of drug and alcohol overdoses, liver disease and suicide.

As previously noted, alcohol temporarily reduces negative emotional states, thus providing short-term relief. That by its very nature is strong reinforcement to continue drinking. But over time, the changes to the brain’s reward systems increase the misery felt when not using. And, these feelings of negativity and misery are pronounced in the deaths we see related to despair. For example, alcohol is linked to an estimated 15% of all drug overdoses, 26% of suicides and 50% of deaths from liver diseases.

With the pandemic still very much a part of our everyday lives, the repercussions of continued isolation, stress and lack of treatment options concerns those at NIAAA. But, Dr. Koob notes that we have seen significant progress in the last 50 years in our understanding of the causes and consequences of alcohol use. And, with greater knowledge about the mental, emotional and physical implications of alcohol use and misuse much can be accomplished in prevention, treatment and care. He also notes that new definitions are important. Like hyperkatifeia, as the intersections of neuroscience and alcohol are better identified, we can make more informed decisions knowing why we make the alcohol choices we do, and alter the behaviors that negatively impact our health, safety and wellbeing.

If you or a loved one are concerned about alcohol use or misuse, you can learn more by visiting:

The NIAAA’s resources page for the effects of alcohol on health

The CDC’s Alcohol Basics page

Visiting the Substance Abuse and Mental Health Services Administration (SAMHSA) website

Calling SAMHSA’s National Helpline: 1-800-662-HELP (4357)

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