What is acute withdrawal?
When you stop drinking or using, you may immediately experience the physical symptoms of withdrawal, which often last between three and ten days. These symptoms, including muddled thinking, forgetfulness, sensitivity to stress, elevated or numb emotions, sleep disturbances, lack of physical coordination, shakes, sweats, and other flu-like symptoms, are called acute withdrawal. Some recovering people get past the symptoms of acute withdrawal and feel their physical health return quickly. For these people, the worst of the physical symptoms of withdrawal are over. But for other recovering people, the transition back to physical health is slower. These people will move from acute withdrawal into post acute withdrawal.
What is post acute withdrawal syndrome (PAWS)?
Post acute withdrawal syndrome (PAWS) symptoms typically occur seven to fourteen days into abstinence and can last for another six to eighteen months. These longer-term symptoms of withdrawal from alcohol or drugs are the result of the toxic effects of these chemicals on the brain. It’s important to remember that this damage is usually reversible, meaning that with time the major symptoms will go away. With a healthy recovery program, this damage to the nervous system will repair itself over a six- to twenty-four-month period.
Why is PAWS worse for some people?
PAWS is more severe for some recovering people than it is for others. At times of low stress you may hardly notice PAWS symptoms, but when a stressful situation arises, the symptoms can return severely. In other words, you may feel fine one minute, but as soon as a stressor comes into your life, your brain seems to have “checked out.” Recovering people often refer to this feeling as a “toxic fog” or feeling “out to lunch.” During PAWS you may feel as if you are not able to think clearly, that you forget things, and that your emotions seem out of control.
If you aren’t aware of these symptoms and prepared for them, you may feel as if you are losing your mind or that you are not working your program properly. It’s important to remember that you are not alone; PAWS symptoms affect most recovering people. Each individual will experience the symptoms slightly differently in severity and duration.
As a person in recovery, you may have been exposed to certain conditions that resulted in disrupted brain function, which leads to more severe PAWS.
You are more likely to experience severe PAWS if you have a history of the following conditions:
- combined use of alcohol and drugs or use of different types of drugs
- regular use of alcohol or drugs before age fifteen or abusive use for a period of more than fifteen years
- history of head trauma (from car accidents, fights, falling, etc.)
- personal or family history of a metabolic disease such as diabetes or hypoglycemia
- personal history of malnutrition, usually due to substance use disorders
- physical illness or chronic pain
In addition, there are certain psychological and social conditions that worsen PAWS, including the following:
- childhood or adult history of psychological trauma (e.g., participant in or victim of sexual or physical violence)
- mental illness or severe personality disorder
- high-stress lifestyle or personality
- high-stress social environment
The four stages of withdrawal
Stage one: withdrawal (0–15 days)
During stage one you may find that you sleep more, act impulsively, or feel irritable, depressed, anxious, shameful, fearful, confused, or filled with self-doubt. Your cravings to use can still be very strong, and you may have trouble concentrating or dealing with stress.
Stage two: honeymoon (16–45 days)
During the honeymoon stage you may begin to feel better physically, with increased energy, optimism, and confidence about your life. You may begin to feel that your addiction is “under control” or “over.” Some recovering people relapse during this stage because they drop out of treatment early or stop recovery activities, such as attending Alcoholics Anonymous (AA), Narcotics Anonymous (NA), or other Twelve Step meetings.
Stage three: the wall (46–120 days)
This stage of your recovery is often seen as a major hurdle in recovery. During this time you may become more vulnerable to relapse because you feel a loss of physical or sexual energy or because you feel depressed, anxious, irritable, or bored. You may have trouble concentrating and feel strong cravings or thoughts about using.
Stage four: adjustment (121–180 days)
When you get through the previous stages, you will probably feel a powerful sense of accomplishment. Your life begins to feel as if it’s getting back to normal as you adjust to your new lifestyle changes. Although your mood has improved, you may continue to feel bored, and you may even feel lonelier than you did in the previous stages. Your cravings to use will probably occur less frequently and intensely, and you may even begin to question whether you really have an addiction. This is dangerous thinking and can lead you to put yourself in high-risk situations that increase your risk of relapse.
What recovery tools can help you get through PAWS?
Working the Twelve Steps can help you get through PAWS, no matter the severity or duration of your individual symptoms. It’s important to remember that your withdrawal symptoms are temporary and will gradually disappear as you establish more “clean time” and work toward maintaining a healthy lifestyle.
Recovery from addiction is a long-term process that involves abstinence plus change. Recovery involves changing yourself (internal) and your lifestyle (external). You will need to develop new coping skills for change to occur and for your abstinence to continue over time. Recovery is not an easy or painless process. It takes hard work, commitment, discipline, and a willingness to examine the effects of addiction on your life. At first it isn’t unusual to feel impatient, angry, frustrated, or unsure that you want to change.
The specific changes you need to make will depend on how addiction has affected you and other people in your life, your motivation to change, and what you see as important to change to recover from your addiction. During your recovery, keep in daily contact with other sober people, go to Alcoholics Anonymous (AA), Narcotics Anonymous (NA), or other Twelve Step meetings, and make sure you visit with your sponsor. Proper nutrition, exercise, and stress management techniques will also help you manage and recover from PAWS symptoms. An open attitude and a willingness to learn will always remain essential parts of your recovery.
Withdrawal Journal Activity
Following are some questions to help you begin planning your recovery strategies:
1. list any physical and emotional withdrawal symptoms that you experienced when you reduced or stopped using alcohol or other drugs. For example: “When I quit booze, I had some tremors, felt sick to my stomach, lost my appetite, and couldn’t sleep very well.”
2. list several benefits of your recovery. For example, you might list the following:
3. list two changes you need to make in your recovery from addiction. For example, you might say:
- “I can’t hang out with people I got high with or people who will try to get me to use drugs or alcohol.”
- “I need to control my anger and not use it as an excuse to use cocaine or drink alcohol.”
4. Choose one of the changes you listed above to begin working on now, and list two or more action steps to take to make this change happen. For example, your change may be “I can’t hang out with people I got high with or people who will try to get me to use drugs or alcohol.” Some possible action steps would be to
- cut ties with users
- socialize with NA/AA friends after meetings
- start a hobby that doesn’t put you at risk to use