The withdrawal process from substance abuse can be conceptualized as having two stages. The first stage is what can be called the acute stage in which physical withdrawal symptoms are experienced and can last up to a few weeks, depending on the type of drug being abused. The second stage of withdrawal is called post-acute withdrawal syndrome (P.A.W.S.). In this stage, the physical symptoms may become fewer and experienced with less intensity, but the emotional and psychological symptoms associated with withdrawal will emerge and come to the forefront.
Post-acute withdrawal occurs because your brain chemistry is gradually returning to normal and as the brain improves the levels of your brain chemicals will start to fluctuate as they approach the new equilibrium thus causing these types of withdrawal symptoms. In comparison to the acute stage of withdrawal where every person may have different physical withdrawal symptoms, in post-acute withdrawal most people have the same symptoms.
The Signs of P.A.W.S.
The most common post-acute withdrawal symptoms are:
- Mood swings
- Variable energy
- Low enthusiasm
- Variable concentration
- Disturbed sleep
Experiencing the symptoms associated with P.A.W.S. can feel like the individual is going on a rollercoaster ride. In the beginning, symptoms will change minute to minute and hour to hour. As an individual continues to recover the periods where the symptoms are minimized or not present will get longer and longer, but the bad periods of post-acute withdrawal can be just as intense and last just as long. The periods where these symptoms are triggered can last for a few days and there are no apparent reasons as to why these symptoms appear. Post-acute withdrawal syndrome can last for up to two years.
Getting Through P.A.W.S.
While the withdrawal symptoms associated with post-acute withdrawal syndrome can be long-lasting and psychologically uncomfortable, there are some things to keep in mind that will help people get through this transition phase.
Patience—Recovery can’t be rushed and the best way to conceptualize that is to adopt the common recovery mantra of one day at a time. Trying to punch through this phase impatiently can lead to mental exhaustion and with that exhaustion comes the urge to use again.
Taking it as it comes—While there will be bad moments during this phase of recovery, there will be plenty of great moments that contain small victories. Focusing on recovery is essential and the realization that recovery in itself is a process.
Being Able to Relax—Dwelling on the symptoms associated with post-acute withdrawal syndrome will make them worse. Adopting a relaxation mindset makes it easier to not get caught up in them. Therefore, an individual isn’t as triggered by these symptoms which means there is less potential to relapse.
Post-acute withdrawal Can Be a Trigger for Relapse— Someone who is in recovery may go weeks without any withdrawal symptoms, and then one day they will wake up and withdrawal will hit them. There may be a lack of sleep and nutrition or an individual may experience wide swings in mood. If there is no preparation for what may come then people can get caught off guard.