Post-Acute Withdrawal

There are two stages of withdrawal that a person addicted to drugs and/or alcohol experience. Most people are aware of the initial stage: acute withdrawal. Moderate symptoms of acute withdrawal may include sweating, heart palpitations, muscle tension, tightness in the chest, difficulty breathing, tremors, nausea, vomiting, and/or diarrhea. More extreme, and sometimes life-threatening, withdrawal symptoms may consist of grand mal seizures, heart attacks, strokes, hallucinations, and delirium tremens (DTs), all of which could possibly lead to death.

The second stage of withdrawal is known as post-acute withdrawal syndrome (PAWS). People who have gone through PAWS describe it as a whirlwind of emotions, or being on a rollercoaster, that occur periodically, without warning, and generally last several days. Episodes of PAWS can continue to occur from 18 months to two years after treatment. People in recovery often describe this episode as “hitting the wall.” Symptoms (as well as drug of choice) vary significantly from person to person and include mood swings, anxiety, irritability, tiredness, variable energy, low enthusiasm, variable concentration, disturbed sleep, and other symptoms that can significantly impair a person’s ability to remain sober1.

PAWS symptoms are largely the result of neurological and behavioral changes that occur when mind-altering substances are abused to the point of tolerance and physical/psychological dependence. According to Terence Gorski, a leading addiction expert, PAWS is a long-term brain dysfunction that is largely reversible given sufficient time.

In other words, post-acute withdrawal occurs because your brain chemistry is gradually returning to normal. As your brain improves, the levels of your brain chemicals, dopamine and serotonin, fluctuate as they approach what would be considered “normal,” thus causing a roller coaster effect of emotional and physical symptoms.

In the beginning, a person’s symptoms will change minute to minute and hour to hour. Later, as they recover further, symptoms will disappear for a few weeks or months only to return again. As the process continues over time the good stretches will get longer and longer.

Most of the time, just having knowledge of “what to expect” can be the best relapse prevention strategy of PAWS. Other suggestions to manage post-acute withdrawal symptoms include:

  • Talk about what you are experiencing with your Twelve Step peers, sponsor, counselor, therapist, or family.
  • Consider starting a journal to document your experiences and identifying alternative ways of responding next time.
  • Practice self-care by being good to yourself.
  • Relaxing with meditation or mindfulness helps the process of dealing with PAWS symptoms.

A quote by Steve Melemis sums this up nicely, “You don’t recover from an addiction by stopping using. You recover by creating a new life where it is easier to not use.”

Sharon Laudick is a licensed clinical marriage and family therapist and licensed clinical addiction counselor at Prairie View’s Newton office.