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Post-Acute Withdrawal Syndrome (PAWS)

So maybe you have decided that you have had enough. You have bounced around 12-step meetings for the last few weeks, and somehow even though you are still drinking or using, you have come to grips with step one.

If only to yourself, you have admitted that you are an alcoholic and/or addict and that your life has become truly unmanageable. Or maybe you have talked to a few people at AA or NA meetings, and you tell them that you are ready to stop drinking or using, and they kindly buy you a Big Book and give you a meeting directory, along with a list of their phone numbers and tell you to keep coming back.

Or maybe you have decided to go to a local church and get the advice of a pastor. You tell him that you are an addict and that you need help. He gives you a Bible, mentions Celebrate Recovery, and then schedules weekly spiritual meetings with you. He also says that Christ will have your back.

But maybe the drinking and/or using goes on a bit longer, and then finally, there’s that night when you drink a gallon of cheap wine and pop a few Vicodin, and you get so sick that you end up throwing up all over the place, and collapsing on the floor. You realize, upon awakening, that the alcohol and the pills are not making things better. If anything, life has gotten a hell of a lot worse, and instead of getting giddy and happy and stupid, you feel like every time you drink or use, you want to die.

So you decide that you are completely done and will quit cold turkey, even though you have been drinking and using for the last decade.

So what’s next?

What is Acute Withdrawal?

It is welcome to acute withdrawal, or as it’s usually referred to, leave, which occurs immediately after an alcoholic or addict stops drinking or using.

By the way, withdrawal can be dangerous if a person decides to quit cold turkey.

Withdrawals from heavy alcohol drinking last between five and seven days and withdrawals from benzodiazepines (benzos) last between one and four weeks, or between three and five weeks if the person is tapering off.

Both benzos and alcohol withdrawals can cause severe symptoms, including delirium tremens (DT’s), seizures, hallucinations, and heart attacks.

Opioid withdrawals last between four and ten days unless the addict is on methadone, and in that case, leaves can last up to 21 days. Believe it or not, opioid withdrawals are very uncomfortable but not as dangerous as alcohol and benzodiazepine withdrawals. On the other hand, if the addict was prone to mixing opioids with alcohol or tranquilizers, well, those withdrawals are going to be wrong, too.

But on average, acute withdrawals last about two weeks.

After initial withdrawals are over, a newly clean and sober individual usually goes into an emotional rollercoaster ride. Welcome to post-acute withdrawal syndrome (PAWS).

Believe it or not, PAWS can last up to two years after a person stops drinking and/or using. Sometimes post-acute withdrawals peak at about six months.

Symptoms of Post-Acute Withdrawal Syndrome (PAWS):

  • Stress
  • Depression
  • Exhaustion
  • A brain fog
  • Memory loss
  • Coordination problems
  • Insomnia
  • Cravings
  • Guilt
  • Anxiety
  • Social anxiety disorder
  • The onset of obsessive-compulsive disorder

Other people experience anhedonia, which is almost as bad as it sounds. Anhedonia is when people lose complete interest in life. They don’t want to do anything fun, including participating in hobbies, going out with friends, having sex, listening to music, or even going to the movies.

Anhedonia-type people often want to sleep all day and not get out of bed. And if they develop insomnia, which is another PAWS symptom, they stay up all night like vampires. The next morning, they crash, and the cycle begins all over again.

Other people experiencing post-acute withdrawal syndrome become serious exercise freaks or workaholics. In other words, instead of drugs and alcohol, they overdo it when it comes to working out or just working.

The Pink Cloud Syndrome in Recovery

And then we have the “pink cloud” people. They walk around at meetings with benevolent grins on their faces and share about how dandy life is. They are experiencing “pink cloud syndrome,” which is, once again, part of the emotional rollercoaster that addicts experience in early recovery. These individuals seem to be the lucky ones, but the truth is, their brain chemistry is stuck on happiness.

What goes up usually must come down, and when the pink cloud people crash, chances are they become agitated. At that point, they might relapse because, during their pink cloud period, they had stopped going to meetings and stopped doing the necessary work that newly clean and sober people must do to maintain their recovery.

Besides the pink cloud people, the others described here are also at risk for relapse. Those who are on the treadmill five hours a day or those who start working 80 hours a week, or those who are sick of being vampires might decide, in the end, that being clean and sober is just not worth the hassle of feeling the way that they do.

And what is the best solution here?

Reducing the Risk of Relapse

The solution is that you need to get the right help. Going into the proper residential treatment facility, which often offers detox, is the best thing to do. And that decision might not only save your life but also will put you on the right track in recovery.

During intake, you will undergo a comprehensive assessment, which will determine if you need detox or not. During detox, some addicts are prescribed medication-assisted treatment, which eases the symptoms of withdrawal. Once you go into a good residential treatment facility, you will receive individual and group therapy, nutritional counseling, exercise, trauma-focused therapy, and attend 12-step meetings. The beauty of going into comprehensive drug rehab is that you will have licensed drug and alcohol counselors, psychologists, and medical doctors who will help you get better and feel better.

If you were having any other medical problems, wouldn’t you go to a qualified doctor who could help you? If you needed heart surgery, chances are you would go to a cardiologist, right? If you needed dental work, hopefully, you would book an appointment with a dentist.

Well, guess what. Alcoholism and drug addiction is a disease. It requires the help of licensed professionals.

When you receive the proper inpatient care and your transition back into society, you will be better equipped to handle Post-acute withdrawal syndrome. And by having an aftercare program, which probably includes going to meetings, you will learn essential recovery tools that will make you feel grounded. While a pink cloud might be fleeting, serenity will become a permanent part of your psyche.


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