Key points

• “It gets worse” isn’t a threat about your morals or character; it describes what withdrawal does to the nervous system.
• Each withdrawal leaves neurotransmitter receptor sites more sensitive, so the next withdrawal is harder.
• Rodent studies provide empirical evidence; it’s how many times you’ve gone through withdrawal, not the amount of alcohol you’ve consumed, that brings on more severe shakes, headaches, the sense of terror and pending doom, and frequency of seizures.
• Withdrawal can be fatal; the risk rises with each repetition. Don’t even try to do it alone; get a team to help.

Rachel found herself sitting in an Alcoholics Anonymous (AA) meeting, shaking, everyone’s words hitting her ears in a kind of rhythm.

“I kept hearing all these crazy slogans, coming at me like a sing-song story.”

Ninety meetings in ninety days.

Keep coming back, it works if you work it.

“One slogan scared me the most. They said it over and over: It gets worse. Every time it’ll end up worse.”

“How could it get worse? Impossible. How could anything be worse than this?”

Withdrawal from benzodiazepines, Rachel told me, gave new meaning to the word fear.

“It was sheer terror, out-of-your-mind kind of terror.”

“It’s nothing like the anxiety I felt before my doctor gave me a script for the “safer” mother’s little helper. He said: “You’ll sleep better, you’ll feel better.”

When Rachel was first prescribed Valium, she was told it really is a safer medicine, though her doctor vaguely warned her, “Use with care, or it might be addictive.”

Clinical studies of thousands of people have since verified those first-person accounts. The problem has not gone away.

In 2020, the FDA added a warning about abuse, dependence, and withdrawal to accompany every benzodiazepine being dispensed, but they’re still prescribed widely, disproportionately to older women.

Only a month ago, September 29, 2026, the San Francisco Chronicle ran a story about seniors taking drugs with particular attention to the benzos.

In people age 75 and older, prescribed use rose from 12% in 2020 to 13% in 2024. In pharmacies in long-term care facilities, benzo prescription rates more than doubled.

More disturbing yet, about a third of the users were taking the drug for longer than six months — a sure-fire recipe for addiction. It’s almost creepy the way the situation is worded — prescribers say longer-term use may cause addiction and withdrawal.

“When you come off them, you may develop withdrawal symptoms (Olfson, S.F. Chronicle).”

Withdrawal from alcohol might be slightly easier, but it’s also violent. When it really gets bad, just like benzos, you might end up with seizures, and in the most severe cases, you could end up dead.

If you’ve ever been loaded, or really blind drunk, you likely endured a really awful morning after.

Waking up the next morning with a terrible headache, you’re sick to your stomach, anxious, and shaky. A dark cloud of guilt and a feeling of pending doom descends on you. You call a friend, timidly:

“What did I do last night? I half remember. Tell me in detail, just in case there’s something I should know.”

That’s a bad hangover. And if you’ve had one, you know a tiny sliver of what alcohol withdrawal might feel like. And a withdrawal from benzodiazepines feels even worse and lasts longer.

It gets worse

When you hear “It gets worse,” you think you’re hearing a dire warning about your moral character or your addictive personality. Go back out, and you’ll sink lower, lose more, behave worse than last time. It sounds like a moral prediction — if you drink or use drugs again, you’ll end up in the gutter; you’ll be on the street.

In fact, it’s not advice about your morals, your character, or your values.

It’s a warning about the state of your nervous system; while it’s said as a slogan, it’s neurologically accurate. It really does get worse.

What actually happens

Each time you withdraw from alcohol or from a benzodiazepine, the withdrawal itself is a violent experience; it really changes the brain. It’s not the return to drinking. Not the using. It’s the withdrawal.

When someone puts alcohol or other sedating chemicals into the brain, receptors adapt. Alcohol and benzodiazepines both work on GABA, the system that quiets things down. Use them long enough, and the brain compensates: it turns down the person’s own naturally present calming system and turns up glutamate, the excitatory system, to keep some kind of balance.

Take the drug away, and that compensation is suddenly unopposed. The brain is left screaming with nothing to quiet it down. That’s withdrawal: tremor, sweating, racing heart, wild anxiety, and at the far end, seizures and delirium.

Researchers call this kindling, borrowing the word from epilepsy, where repeated small stimulations eventually produce a seizure from a stimulus that once produced nothing. Ballenger and Post proposed it for alcohol withdrawal in 1978, and it’s been replicated many times since, in people and in non-human animals. It’s particularly well documented for benzodiazepines.

Kindling now appears in the American Society of Addiction Medicine’s current clinical practice guideline on alcohol withdrawal, described in terms of increasing nervous system excitability across withdrawal episodes.

Ostensibly withdrawal is better managed now — so it’s hard to understand why a middle-aged man with two years sober, in recovery from alcoholic drinking, can’t find help with getting off Klonopin and Ativan first prescribed fifteen years ago.

Someone has quit five times, and five times they’ve cleaned up. Each time they relapse, they’re starting with a more sensitive nervous system than before. Each withdrawal is harder than the last. The threshold moved while they weren’t looking.

That’s the opposite of what’s been assumed, including by the person it’s happening to. Every time they fail, they think, “At least I tried,” as though it cost them nothing.

It cost something.

A hangover is withdrawal, just smaller and milder. It’s not a metaphor. It’s the same rebound, the same unopposed excitation; it’s scaled down and lasts for fewer hours.

A person who’s gone through a thousand hangovers over thirty years has suffered a thousand small withdrawals. This probably kindles too, quietly, long before anyone calls it a problem.

This is the picture clinicians see all the time but can’t explain: the drinker whose withdrawal is far worse than what their alcohol history predicted.

The best evidence is still found in rodents:

Maier and Pohorecky studied alcohol withdrawal in rats they’d made alcohol-preferring. Ordinarily, when offered both alcohol and water, rats will select water every time. But after repeated exposure to alcohol, they change, becoming alcohol-preferring. Meaning: when offered water and alcohol, they’ll select alcohol and ignore the water.

When the rats were addicted to alcohol and then withdrawn, in repeated cycles of drinking followed by withdrawal, each episode of withdrawal was worse than the last.

Becker and Hale added a control aiming to find out whether it was continued exposure to alcohol, or the repeated withdrawal, that made it worse. They gave one group of rodents a continuous period of intoxication and withdrew them once. They gave another group the same amount of alcohol, broken into cycles, with withdrawals in between.

Same amount of alcohol. Different number of withdrawals.

Here’s their results: Only the animals who endured repeated episodes of withdrawal had more severe seizures.

They called it an animal model of alcohol withdrawal kindling. Becker went further, asking whether the number of withdrawals itself made the difference: The more prior withdrawals, the worse the seizures. Working through nine cycles, he showed severity and duration rising progressively, with blood alcohol levels equal across all groups before testing.

The conclusion: it can’t be the total amount of alcohol. It’s the starting and stopping.

You can’t accuse rodents of having an “addictive personality” or “weak moral character.” Rodents can’t tell a sad story about why they relapsed; so far as we know, they experience neither shame nor guilt, and they have no explanation of their failures. What they have is a threshold that drops.

Another commonly used drug today, opiates of all varieties, when overdosed, are a killer. But opiate withdrawal, while miserable, is rarely deadly. Alcohol and benzodiazepine withdrawal can be deadly, and the risk goes up with each relapse. Anyone who thinks or says “You could just tough it out,” is speaking from ignorance — or paying no attention to which drug is involved.

Why this is still an animal finding

Here is the part we should pay close attention to, but rarely do:

Our clinical studies may be important, but we have to face their limitations.

You can’t randomize people to go through repeated withdrawal. Clinical studies are limited to correlational designs. For example, in a study of 6,818 men undergoing inpatient detoxification at Veterans Affairs medical centers, those who had seizures or other withdrawal complications had gone through significantly more previous detoxifications. That’s a real finding pointing in the same direction, but it says nothing about causation.

We still need non-human animal studies to address important foundational questions. I am as squeamish as anyone about research using our fellow mice and rats. But if we want to know if damage is coming from drug use or from withdrawal — a question that changes what we tell people in recovery — the studies with animals are where the answer lies, and there’s no politically comfortable substitute.

Furthermore — when I’ve tried to explain the effects of withdrawal to people in recovery, the rat studies are usually what they remember. Their eyes glaze over when I talk about the research on receptor sites or the diagrams showing how long withdrawal lasts in thousands of people.

They remember the rats.

And it doesn’t always end when the withdrawal does

The benzodiazepine literature has moved in the last three years, and it has moved toward what people coming off them have been saying all along.

Ritvo and colleagues surveyed 1,207 benzodiazepine users and found that 76.6 percent reported symptoms persisting a year or longer. The mean withdrawal duration was 9.5 months. They proposed a new term — benzodiazepine-induced neurological dysfunction, or BIND — because what they were describing often did not respond to reinstating the drug, which is not how withdrawal is supposed to happen.

A scoping review followed, examining 46 studies: 61 percent showed signals of a protracted withdrawal phase.

These studies are focused on two different things. Kindling is about each withdrawal being worse than the last. BIND is about symptoms that don’t resolve. While different, they come to the same obvious conclusion: coming off these drugs is not a minor event, it should not be done alone, and people who’ve been saying it’s devastating are not exaggerating.

And we might all consider how long this took. Anyone who has sat with people coming off benzodiazepines has known for decades that it runs to a year and a half. It took until 2023 for a survey to report nine and a half months, and for the field to report it as a discovery.

What this amounts to

I have spent a career working with people who were addicted, or in withdrawal, or finally, in recovery — to alcohol and other drugs, by prescription, from a dealer they knew, or from the street. I’ve concluded from studies we ran in our lab: addicts are often not the fragile ones.

Everyone is suffering. Addicts are usually trying to do something about it. Darryl Inaba has said for years that addicts tend to be the brighter people in the room, and from my experience, I agree.

Some of the sharpest, funniest, most observant people I’ve worked with were men forced to withdraw from benzos cold in prison, and they lived to describe it precisely.

Alcoholics and other drug addicted people continue to be routinely diagnosed as borderline, psychopathic, crazy, manipulative. But after time in recovery, they often take off like rockets — finding stable relationships, careers they love, thriving. Despite our massive anecdotal data, finally officially illustrated in clinical studies, addiction is still one of the most stigmatized diagnoses, even by (or especially by) mental health providers.

As a group, addicts post-recovery don’t suffer from other diagnoses more than any other group of people. They’re people who found something that worked, until it stopped working.

In the end, they’re locked in a chemical prison, unable to get free because the process is difficult, painful, and so very frightening.

Sadly, few good, affordable resources are available to help them.

However, no matter how many times someone has tried, recovery and learning to live again is always worthwhile. Advances in addiction medicine have made withdrawal somewhat less difficult, less horrendous, less painful.

No one should try it alone. It’s much better to have a team doing it with you.

Which brings it back to the slogan.

What you, or someone you know and love, can do

If you’ve stopped drinking or using, or you’re close to someone who has: Physiology argues for staying sober; it’s not that relapse makes you a failure, it’s because the next withdrawal will be worse.

The AA slogan says, “It gets worse”—believe it.

Ninety years of people watching each other get sober, without a lab, led to a neurotransmitter-receptor-site mechanism, boiled down to three words.

“It gets worse.” It really does.

References

American Society of Addiction Medicine. (2020). The ASAM Clinical Practice Guideline on Alcohol Withdrawal Management.

Ballenger, J. C., & Post, R. M. (1978). Kindling as a model for alcohol withdrawal syndromes. British Journal of Psychiatry, 133, 1–14.

Becker, H. C. (1994). Positive relationship between the number of prior ethanol withdrawal episodes and the severity of subsequent withdrawal seizures. Psychopharmacology, 116(1), 26–32.

Becker, H. C., Diaz-Granados, J. L., & Weathersby, R. T. (1997). Repeated ethanol withdrawal experience increases the severity and duration of subsequent withdrawal seizures. Alcohol, 14(4), 319–326.

Becker, H. C., & Hale, R. L. (1993). Repeated episodes of ethanol withdrawal potentiate the severity of subsequent withdrawal seizures: an animal model of alcohol withdrawal “kindling.” Alcoholism: Clinical and Experimental Research, 17(1), 94–98

Maier, D. M., & Pohorecky, L. A. (1989). The effect of repeated withdrawal episodes on subsequent withdrawal severity in ethanol-treated rats. Drug and Alcohol Dependence.

Olfson, M., quoted in San Francisco Chronicle, September 29, 2026.

O’Connor, L., & Berry, J. W. (1990). The drug-of-choice phenomenon: Why addicts start using their preferred drug. Journal of Psychoactive Drugs, 22(3), 305–311.

O’Connor, L. E., Berry, J. W., Morrison, A., & Brown, S. (1992). Retrospective reports of psychiatric symptoms before, during, and after drug use in a recovering population. Journal of Psychoactive Drugs, 24(1), 65–68.

O’Connor, L. E., & Weiss, J. (1993). Individual psychotherapy for addicted clients: An application of Control Mastery Theory. Journal of Psychoactive Drugs, 25(4), 283–291.

O’Connor, L. E., Esherick, M., & Vieten, C. (2002). Drug- and alcohol-abusing women. In S. L. A. Straussner & S. Brown (Eds.), The Handbook of Addiction Treatment for Women: Theory and Practice (pp. 75–98). San Francisco: Jossey-Bass.

Ritvo, A. D., Foster, D. E., Huff, C., Finlayson, A. J. R., Silvernail, B., & Martin, P. R. (2023). Long-term consequences of benzodiazepine-induced neurological dysfunction: A survey. PLOS ONE, 18(6), e0285584.

Shade, K. N., Ritvo, A. D., Silvernail, B., Finlayson, A. J. R., Bressi, J. E., Foster, D. E., Martin, I. J., Piper, C., & Martin, P. R. (2025). Long-term neurological consequences following benzodiazepine exposure: A scoping review. PLOS ONE, 20(8), e0330277.

U.S. Food and Drug Administration. (2020). FDA requiring boxed warning updated to improve safe use of benzodiazepine drug class.

“It Gets Worse,” An AA Slogan’s Real Neurochemistry was originally published in Publishous on Medium, where people are continuing the conversation by highlighting and responding to this story.

Key points

• Some people who experience high levels of guilt and shame are attracted to those who fail to display (or even feel) these normal — if distressing — emotional states.
• A psychopath’s lack of moral compass makes them dangerous partners, business colleagues, and political leaders.
• A large group of people calling themselves “Christian Nationalists” lack normal social morality — i.e. fundamentally, they are psychopaths —these are the most terrifying political leaders. Because they lack shame and guilt, normal, guilt-laden people are drawn to them.
• Guilt-prone victims feel trapped, though they hope to learn to be less guilt- and shame-prone.
• Even groups of people suffering from excessive guilt and rigid self-critical hyper-scrupulosity and over-the-top moralism (including some calling themselves Christian Nationalists) seem to have been attracted to the bad boy /psychopathic type leader.
• Individual and/or group psychotherapy for victims can help break this pattern.
• By learning to be less self-critical, to reduce distressing moralism-on-overdrive and by developing self-compassion, you can become less vulnerable to excessive guilt and shame.
• When a woman who found the bad boy hopelessly attractive stops thinking she needs to be more like him, she overcomes the problem and finds the nice guy far more interesting.

Introduction

Most of us know what is meant when someone speaks of the bad boy. The guy with the outrageous charm — the perfect lover, until he isn’t. He’s the guy your mother warned you against.

Bad boys are on a continuum — on one end of the spectrum, the bad boy may be a heartbreaker, but he’s only mildly dangerous. Despite his bad-boy tendencies, he’s capable of empathy.

On the other end of the spectrum is the psychopath. The bad boy, heading into the psychopathic end of the spectrum, fails to feel empathy. And most relevant to the guilt-prone women falling for his charm, he’s never bothered by guilt or shame.

(Note: psychopathy is technically classified as antisocial personality disorder. My terminology here underscores the fact that this is a complex spectrum, and while those who are high in psychopathy —the truly antisocial — are rare, traits or characteristics of ‘bad boys’ are seen and emulated more widely.)

When the Bad Boy/Psychopath Also Shares Features with the Paranoid Personality Diagnosis

That said, it may sometimes be difficult to know — with total confidence — if you’re dealing with a real psychopath/sociopath, especially if he or she also shows features of the paranoid personality disorder.

When the bad boy also demonstrates paranoid traits, he may easily infect others, especially with his tendency to believe in conspiracy theories.

Theories sounding nutty to a normal person may appear realistic or even compelling to someone in whom paranoia has been evoked, by proximity to a psychopathic paranoid.

This occurs because psychopathy and paranoia both have a contagious quality.

And to some extent, that’s what vulnerable women and followers are seeking — like the bad boy lover or leader, they want to feel less guilt and shame; they want to be more like the “bad boy” they find so attractive.

It’s the very upstanding and altruistic nature of people who fall for psychopathic (and paranoid) boyfriends, lovers, and/or political leaders that makes them particularly vulnerable.

When a political leader’s personality exhibits psychopathy and paranoia, in addition to an infectious charisma, he or she can be particularly dangerous. We’ve been seeing far too much of this in our current high and low-profile national politicians. (See Fighting for Our Democracy from Our Empathic Nature, November 3, 2016)

The Knock-Off Bad Boy

While it’s impossible to know at a glance if you’re dealing with a knock-off bad boy — the one who's not the real thing — he’s imitating the psychopathic bad boy, thinking it makes him “cool.”

The problem is, the imitation bad boy may not entirely capture you. That irresistible thing that attracts so many women isn’t quite there.

Psychopathic/Sociopathic/Antisocial Bad Boy Traits

At a glance, bad boys often appear gorgeous (at least to some), charismatic, and successful in business, academia, athletics, politics, etc.; they promise to be good providers and protectors.

They’re usually womanizers, though they may briefly hide their misogynistic tendencies.

The real bad boys don’t hide their psychopathic edges. That’s part of their charm. Maybe that’s the heart of their attraction.

The psychopathic bad boy is different. And rare. He’s wired differently from the rest of us.

In laboratory experiments, it was found that psychopathic subjects failed to exhibit normal signs of anxiety and fear when exposed to fear-inducing stimuli.

Psychopathic/antisocial bad boys never feel guilt — they’re never ashamed.

These important prosocial emotions are an essential part of how we stick together in groups, marriages, friendships, and communities. For most of us — however terrible it feels to suffer from guilt and shame — we know we need these emotions as much as we need joy and pride.

However, guilt-prone women may desperately want to feel less guilty; they’re often struggling with an overload of guilt and shame. They want to be a little more like that guy they find so attractive.

Most people dislike hurting others’ feelings. Psychopaths seem unaffected by causing harm to anyone they’ve had enough of. They never apologize because they never think they’ve done anything wrong. They think nothing of hurting a romantic or business partner. Even innocent animals — beloved household pets — are in danger.

The Heart-Broken Bride

Rachelle was a lovely young architect who came to see me a mere six months after she’d married the man of her dreams. He was an up-and-coming businessman with political aspirations that she’d met at a friend’s party, and he swept her off her feet. Soon, they were a couple and living together.

Only a month married, one night he came home drunk from an after-work meeting with some friends and seemed to be in an angry mood. She asked him what was bothering him, and instead of answering, he picked up his cat and threw her across the room. She freaked out.

A woman who loved animals, her voice quivering, she said: “Don’t ever do that again.” She couldn’t forget it — and it should have been a strong warning. Soon, he was coming home in that angry mood more often. Further, he was coming home later and later, and she began to feel like he was seeing another woman. He was.

When she came to see me, she quickly confessed she knew she’d made a mistake marrying the guy. But awash with guilt, she felt like she couldn’t leave him. She knew something was wrong with him and felt obliged to stick by his side. She was also suffering from terrible shame — her parents had instantly disliked him and begged her not to marry him. “How could she have ignored their warnings?”, she quietly asked herself.

Psychotherapy was helpful. Rachelle realized she’d been attracted to him because he never suffered from guilt and shame. She recognized she’d thought she wanted to be more like him.

She’d always felt responsible for loved ones’ suffering. She’d often feel guilty for things over which she had no control. She hated the guilt-proneness she’d lived with. Once she’d had that insight, she also recognized that she now felt responsible for him. Even the thought of leaving him filled her with guilt.

Then, one night, he came home and, without a word, hit her in the face. Sobbing and swollen, she left. She escaped to her parents, trying to ignore how ashamed she felt at having chosen to marry him. She never went back.

But why have so many perfectly intelligent women done exactly the same thing?

People burdened by guilt and shame are attracted to the psychopath who feels neither. Like the unhappy young bride, they hope to get some of that if they can get close enough to the psychopath. They dream about meeting him in person.

Many women I meet with recognize this problem. Some are still in the grips of their psychopathic charmer. While they may have been ready to leave him long ago, they felt trapped, guilty, and surprisingly sorry for the man they used to think they loved madly.

By the time they start seeing me, most have gone through a temporary phase of falling for charismatic characters. They’d endured several unhappy relationships before they began to look for kindness, generosity, and intelligence in potential partners. And finally, they were ready to reject the psychopath-tinged affairs with bad boys; they were ready for longer-lasting love.

How much progress might we make as a society if we recognized our attraction to psychopaths for what it is? And, instead of following blindly the bad boys somewhere on the spectrum, the victims of the psychopath could get over it in therapy aimed at lowering their guilt-proneness.

Most of us are wired with prosocial motives and altruistic intentions. Why not learn to avoid the charmer and instead fall in love with the guy deserving of affection?

Originally published at https://www.psychologytoday.com.

Why Do Women Go for “Bad Boys”? was originally published in Process Notes: The Personal is Political on Medium, where people are continuing the conversation by highlighting and responding to this story.