Whether mildly unpleasant or seriously uncomfortable, withdrawal symptoms come with the territory when you're in early recovery from alcohol or other drug addiction. In fact, post-acute withdrawal symptoms that persist or pop up during the first months of recovery can become a risk factor for relapse.
We asked clinicians at the Hazelden Betty Ford addiction treatment centers to discuss post-acute withdrawal syndrome (PAWS): the cause, warning signs, duration and coping strategies. Here's what you need to know about the process of drug and alcohol withdrawal, including acute withdrawal symptoms and post-acute syndrome.
Following medically supervised detox from alcohol, opiates, marijuana, cocaine, benzodiazepines or other highly addictive substances, most people experience a short phase of physical discomfort, otherwise known as acute withdrawal. Symptoms often include muscle ache, nausea, headache and increased heart rate. Acute withdrawal can produce more dangerous health consequences—even life-threatening complications—if detox isn't done in a supervised setting. But there's more to drug and alcohol withdrawal than physical symptoms of discomfort. While acute withdrawal refers primarily to the body's process of healing, a second phase of withdrawal symptoms, known as post-acute withdrawal syndrome, or PAWS, occurs as the brain recalibrates after active addiction. These symptoms, unlike the first stage of acute withdrawal, typically involve more of the psychological and emotional aspects of withdrawal. Depending on the duration and intensity of alcohol or other drug addiction, this secondary withdrawal syndrome can occur a few weeks into recovery or a few months down the road. More important, even though PAWS is a temporary condition, the symptoms can become a driving factor in relapse. This is true even for people who are fully committed to staying clean and sober.
Post-acute withdrawal, whether mild or serious, is a necessary process in early recovery from alcohol or other drug dependence. Think of the withdrawal syndrome as the brain's way of correcting the chemical imbalances suffered during active addiction. PAWS occurs most commonly and intensely among individuals with alcohol and opioid addiction, as well as in people with addiction to benzodiazepines (or "benzos," which are commonly prescribed for the treatment of anxiety and panic attacks), heroin (an opiate) or medically prescribed pain medication.
Often, symptoms are triggered by stress or brought on by situations involving people, places or things that remind the individual of using. Many people in recovery describe the symptoms of PAWS as ebbing and flowing like a wave or having an "up and down" roller coaster effect. In the early phases of abstinence from substance use, symptoms can change by the minute. As individuals move into long-term recovery from alcohol or drug dependence, the symptoms occur less and less frequently.
In order to minimize the risk of relapse, it's important to recognize that many of the unpleasant or uncomfortable sensations and feelings you experience in early recovery could be symptoms of PAWS. It's also important to understand that PAWS symptoms are temporary. Here are some of the most common symptoms:
While avoidance of post-acute withdrawal syndrome isn't possible, you can effectively manage your symptoms. By learning to successfully manage post-acute and acute withdrawal symptoms, you will feel better physically and emotionally, improve your self-esteem and reduce the risk of relapse.
Most symptoms last for a few days at a time, although this is dependent on the type of alcohol or drug addiction, and the amount and frequency of substance use (every person's withdrawal pattern is a little different). Typically, the brain recalibration process takes anywhere from six months to two years before the brain once again naturally produces endorphins and dopamine.
Here are 10 practical tips for successfully managing the symptoms of post-acute withdrawal syndrome:
If you or a loved one is in need of help managing PAWS in addiction recovery, or seeking treatment for co-occurring mental health or substance use disorders, there is help and there is hope for you at the Hazelden Betty Ford Foundation. Together, we will overcome addiction.