Detox Aftercare Can Help Post Acute Withdrawal Syndrome (PAWS)

Many people mistakenly believe that as soon as you fully detox from substance use, you will feel good, normal and fully capable of functioning well every day. Unfortunately, this isn’t how recovery works. Even after the acute phase of detoxification is over, you will experience another phase of withdrawal while your brain and body continue to heal. This phase is known as protracted withdrawal, protracted abstinence, persistent post use symptoms, chronic withdrawal, or Post Acute Withdrawal Syndrome (PAWS).

Detox and Beyond

No matter how much support you have, or how great your motivation, or even how much strength and willpower you possess, detoxing and recovering from drug and alcohol misuse without professional help is a nearly impossible task. Counseling and medications guard against relapse, which becomes increasingly dangerous after detox. This is because your tolerance to your drug of choice has been lowered, which can transform your “usual” dose into a fatal overdose. The U.S. is experiencing an overdose epidemic; in 2016, there were over 60,000 overdoses from fentanyl alone.

Post Acute Withdrawal Syndrome makes individuals incredibly vulnerable to relapse, and therefore, to overdose.

We all Need to Understand PAWS

Even people recovering in intensive treatment programs may not know about Post Acute Withdrawal Syndrome. Some treatment providers don’t explain it to their patients because it hasn’t yet been recognized by the Diagnostic and Statistical Manual of Mental Disorders, while others are afraid of intimidating or overwhelming a patient they want to make feel hopeful.

The problem with keeping patients in the dark is that the experience of this very real condition can more readily push someone to relapse if they don’t understand what is happening. If they do understand, then they can seek Post Acute Withdrawal Syndrome treatment, while implementing self-care and behavioral changes to help them successfully navigate this difficult, sometimes debilitating, time.

Anyone in recovery for substance use disorder or alcohol use disorder needs to be made aware of Post Acute Withdrawal Syndrome, because odds are, they’re going to experience it. A recent publication from the University of Florida’s Department of Psychology states that Post Acute Withdrawal Syndrome develops in 75% of individuals recovering from stimulants, sedatives, and alcohol; and in 90% of those recovering from opioids like heroin, fentanyl, or hydrocodone.

What is Post Acute Withdrawal Syndrome?

The first stage of drug or alcohol withdrawal is the acute stage, which is usually over in one to three weeks. During this time, people in recovery suffer from a range of physical withdrawal symptoms, often similar to a severe case of the flu. Post Acute Withdrawal Syndrome, or PAWS, is the second stage of withdrawal. This phase can last another month, or even a year or two, depending upon circumstances. Those experiencing PAWS have few physical symptoms, but may have a range of intense emotional and psychological symptoms.

Post Acute Withdrawal Syndrome will last for as long as it takes your brain to heal the damage done by repeated substance use, and your brain chemistry to work through fluctuating levels of neurotransmitters before finally returning to a consistent, healthy functioning. In the meantime, you experience Post Acute Withdrawal symptoms, such as sleep difficulty, concentration problems, low energy and enthusiasm, inconsistent energy, irritability, anxiety, and mood swings.

Individuals experiencing PAWS should be told that while the syndrome will improve, it won’t do so at a steady, even pace. Rather, the symptoms of Post Acute Withdrawal Syndrome tend to come and go. You may experience no symptoms at all for a week or two, only to have them abruptly return. If you aren’t prepared for this, you are more likely to indulge in catastrophic thinking, which fools you into believing that you’ll never get better, so you may as well start using again.

Understanding the fluctuating nature of PAWS, and the fact that it can take up to two years to fully resolve, can prepare you for a prolonged, though not permanent, struggle, during which your progress should be measured from month to month, and not week to week or day to day.

The Advantages of Medical Detox

Detox is a shock to both your brain and body, which have come to completely depend upon your drug of choice as an aspect of daily functioning. Medically supervised detox, especially in an inpatient facility, is the best way for anyone to begin their recovery. It not only will it keep you more comfortable and prevent unnecessary suffering, it will provide you with immediate medical attention if you develop any dangerous health complications due to withdrawal.

Professional treatment should continue after the initial, acute phase of withdrawal, to help with the Post Acute Withdrawal Syndrome that the majority of people in recovery experience. Early on, PAWS symptoms can change from hour to hour—even minute to minute—but over time, symptoms improve, and the good stretches without any symptoms at all will get longer and longer.

Although PAWS symptoms usually peak four to eight weeks after quitting, some individuals may not experience the second phase of withdrawal for weeks or months after finishing the first phase. Suddenly experiencing Post Acute Withdrawal Syndrome after many months of feeling good can be discouraging, but it won’t be devastating if you understand what is happening to you.

Signs You are Suffering from Post Acute Withdrawal Syndrome

The symptoms of PAWS include, but are not limited to:

• Pain or other physical problems without a clear cause
• Impulsivity
• Difficulty monitoring and controlling behavior
• Difficulty making decisions or focusing on tasks
• Problems with memory and concentration
• Inconsistent energy levels
• Chronic and lasting fatigue
• Decreased interest in sex
• Decreased ability to feel pleasure
• Sleeping problems
• Depression
• Anxiety or panic attacks
• Irritability
• Mood swings
• Drug and alcohol cravings

The increased impulsivity can be a particular challenge in recovery because it puts you at greater risk of relapse. If you are suffering Post Acute Withdrawal Syndrome, you need to be aware that you may struggle to control yourself, and therefore take extra steps to avoid the temptation to use, and to prepare yourself to respond healthfully to any trigger situations you cannot avoid.

What exactly causes PAWS?

Drugs stimulate the release of massive amounts of dopamine and endorphins—that’s why the initial “high” feels so good. Regular drug use not only depletes your brain’s supply of these neurochemicals, it causes your brain to start producing less of them, which creates a biochemical state of depression. It can take between four weeks and six months for your brain to replenish these chemicals, and even longer to be able to keep them consistent. This leads to the many emotional and mental symptoms of Post Acute Withdrawal Syndrome.

Another aspect of Post Acute Withdrawal Syndrome results from an overactive automatic nervous system. Our bodies respond to perceived threats with a chain of physiological responses that put our minds and bodies on high alert—this is known as the “fight, flight, or freeze” response. This kind of stress response is, in itself, stressful to experience, and when it has been activated too often due to repeated drug or alcohol use, the automatic nervous system can get “stuck” in high gear. This creates a chronic state of high alert that taxes the brain and body, making you feel both wide awake and exhausted. It also runs down your immune system, diminishes your cognitive abilities, and makes you more vulnerable to stress.

The automatic nervous system can be repaired and reset, but only gradually, over a long period of time.

The Importance of Aftercare in Addiction Treatment

Recovery is like a living thing that has to be nurtured to survive. Aftercare is a crucial part of this nurturing, and anyone receiving treatment for substance or alcohol use disorder should have a strong aftercare plan in place before they are discharged. Aftercare should not only provide treatment for issues that underlie addictive behaviors—such as co-occurring mental or behavioral health disorders—it also provides additional accountability to support abstinence.

How Detox Aftercare can help Post Acute Withdrawal Syndrome

Remember that PAWS is temporary and there are supports available to you.

The most important thing to remember about coping with PAWS is to be patient. There are things you can do to help you successfully navigate Post Acute Withdrawal Syndrome while it lasts, but there is no way to force your way through it, and trying to do so will only exhaust your already depleted strength.

Here are eleven more tips for coping with Post Acute Withdrawal Syndrome:

1. Try to go with the flow.

PAWS symptoms are bad, but they’ll feel much worse if you resent them, deny them, or get angry at yourself. Enjoy your good days, and on the bad days, do your best to accept your experience and work with the symptoms, not against them. For example, learn to do less on low energy days, and give yourself permission to prioritize your recovery over other responsibilities when necessary.

2. Practice good self-care.

Give yourself breaks when you need them—even a quick pause to tell yourself that you are doing the best you can and things will get better can make a big difference. Be kind to yourself, both mentally and physically.

3. Maintain medical support.

Even after leaving a treatment program, you should stay in touch with your care providers, and/or find new ones to support your continued sobriety. You need a professional to monitor your symptoms so you can get whatever treatment you need, whether your issues are a result of addiction or a different physical illness.

4. Take medications if you need them.

Whether you need methadone or buprenorphine maintenance treatment, naltrexone to prevent alcohol misuse, or antidepressants to boost your depleted neurotransmitters, make sure to keep taking any medications you may need for as long as you need them.

5. Learn to relax.

Chronic stress will only make your Post Acute Withdrawal symptoms worse. Finding ways to relax—through mindfulness, exercise, and good self-care—will help you cope with your symptoms instead of being triggered by them.

6. Do everything you can to get good sleep.

Mental and physical health requires quality sleep. Look after your sleep by figuring out how much sleep you really need, by going to bed and getting up at the same time each day, and by limiting caffeine and nicotine, especially late in the day. Insomnia and disturbed sleep are common aspects of Post Acute Withdrawal Syndrome, but natural supplements like melatonin and magnesium can help.

7. Acknowledge and celebrate your accomplishments.

When you’re feeling bad, it’s easy to focus on your flaws and mistakes. Try to shift your focus to the positives in yourself and your life, and allow yourself to celebrate recovery milestones.

8. Get plenty of exercise, water, and nutritious food.

Staying hydrated, well-nourished, and physically fit will make your body more capable of dealing with PAWS symptoms. In addition, exercise is a wonderful stress reliever that also increases the production of crucial, mood-boosting neurochemicals like dopamine, serotonin, and endorphins.

9. Counseling/therapy doesn’t end when your treatment program ends.

Most people have complicated minds and experiences that require more than just a few months of exploration. Counselors and therapists can help you work through issues, past trauma, and current challenges, while helping you develop new patterns of thought and behavior that support long-term recovery success.

10. Join an addiction support group.

Support groups remind you that you are not alone and allow you to give and receive emotional support—both of which are equally beneficial to recovery. Support groups also help you make new, sober, social connections.

11. Stay connected and active.

Coping with Post Acute Withdrawal Syndrome is a lot easier when you have strong relationships and a full life. Maintain your connections with others and make sure to find hobbies and activities that you enjoy.

Remember, It’s Only Temporary

Post Acute Withdrawal Syndrome does last a long time, but it does not last forever. Remember that PAWS is a natural part of recovery, and as long as you keep taking good care of yourself, it will eventually go away.

For more information on Post Acute Withdrawal Syndrome, or for help finding an aftercare program in your area, call  800-996-6135(Who Answers?) today!