Alcohol detox and withdrawal typically occur in two distinct phases. The early stage of alcohol detox is largely characterized by intense and potentially dangerous physical withdrawal symptoms. This is known as acute withdrawal.
For most people, the acute withdrawal period lasts between one and two weeks. With medical management and the right interventions, the body can safely and successfully adjust to living alcohol-free.
However, after this important step in recovery has passed, many people experience what is known as post-acute withdrawal syndrome. The symptoms of post-acute withdrawal syndrome (PAWS) are largely psychological in nature.
Symptoms of PAWS can last for months or years. Throughout this time, they may appear suddenly and seemingly without provocation. Given their very nature and the length of their duration, PAWS symptoms rank among the greatest risk factors for relapse in alcohol addiction recovery.
Defining Post Acute Withdrawal Syndrome
PAWS often arises just when people expect to feel better. If you’ve recently detoxed from alcohol, you may have a noticeably improved sense of physical well-being. However, long-term alcohol use has a lasting impact on both brain functioning and brain chemistry.
In fact, prolonged heavy drinking can even affect the brain’s size. Recovery from these changes doesn’t happen overnight or even within a matter of weeks.
When people drink or use drugs, they trigger the release of neurotransmitters. Often referred to as “feel good” chemicals, neurotransmitters are responsible for the heightened confidence, sense of relaxation, and general euphoria that being high or being intoxicated produce. Part of the brain’s reward center, neurotransmitters largely exist to encourage beneficial behaviors. When you do something good for yourself, your brain rewards you by emitting several chemicals that promote feelings of happiness and ease.
For example, if you engage in physical exercise, you’ll likely get a nice neurotransmitter surge once your workout is complete. The more that specific activities are associated with the release of neurotransmitters, the more people are likely to repeat them. Sadly, heavy drinking conditions the brain to associate alcohol use with feelings of elation. Over time, it comes to recognize drinking as a beneficial behavior.
PAWS is the stage of recovery in which the brain is relearning how to balance its reward center, and how to distinguish truly rewarding behaviors from those that are detrimental. While this learning happens, recovering alcoholics often suffer from depression, lack of motivation, and intense feelings of apathy.
Post-acute withdrawal symptoms can be disheartening, to say the least. At a time when people need to feel motivated, driven, and connected with the world around them, their brain chemistry is unable to support these things. Although acute alcohol withdrawal can be physically dangerous for many people when attempted alone, trying to navigate the challenges of PAWS without proper support can be just as detrimental.
After having made tremendous progress in their journeys to wellness, many people find themselves feeling suddenly defeated. Most recovering alcoholics are conditioned to drink in order to alleviate feelings of depression, anxiety, and other negative emotions. PAWS can also be a time of intense cravings.
Common Symptoms of PAWS from Alcohol
It’s not uncommon for people to ask the question, “What’s wrong with me?” when experiencing PAWS. Despite their best efforts to get well, their feelings of accomplishment, empowerment, and general happiness tend to be very short-lived.
They may be attempting to practice good self-care in an effort to keep cravings, temptations, and other challenges at bay. Unfortunately, due to the nature of PAWS, self-care isn’t always easy. Among some of the more common physical symptoms of PAWS are:
- Insomnia
- Low appetite
- Lack of energy
- Decreased focus
People can also be plagued with intense depression, diminished libido, suicidal thoughts, and even poor impulse control. PAWS is a time of intense mood swings. Worse still, it doesn’t have a definite beginning or end.
How Long Does PAWS Last?
PAWS is most intense at its start which is often two to three weeks after a person has stopped drinking. It’s also strongest one to two weeks after their initial acute withdrawal symptoms have passed. The good news is that PAWS becomes increasingly less intense over time. For most recovering alcoholics, PAWS lasts between one and two years.
One of the many dangers of detoxing alone and attempting long-term alcohol recovery without support is the often unexpected challenge that PAWS presents. Although people may be committed to stop drinking when experiencing acute withdrawal, the psychological challenges of abstinence can make the physical symptoms of withdrawal pale in comparison.
In rehab, people learn about PAWS, its causes, its duration, and the best strategies for dealing with it. They are taught new coping skills, and how and when to leverage these skills. People who quit drinking often expect to feel immediately better after the widespread physical distress of acute withdrawal has abated.
Unfortunately, PAWS can delay these improvements. Moreover, as PAWS gradually declines over time, there is still the potential for experiencing surprising bouts of depression, low energy, lack of motivation, and malaise.
Coping Strategies for Working Through PAWS
Alcohol addiction recovery is an ongoing, lifelong process. Much of what people are taught in addiction treatment is geared towards helping them successfully navigate the challenges of PAWS. The risk of relapse is believed to be at its highest during the first year of recovery. PAWS is one of the greatest reasons why.
Fortunately, there are many effective strategies for overcoming PAWS and for making it through this challenging time. The first of these is to never become too confident in recovery. Although every day spent sober is an impressive accomplishment indeed, it’s vital to continue using solid addiction management strategies, and to continue receiving recovery support.
Immediately returning to old environments, relationships, stressors, and challenges, often places people at unnecessary risk. Continued inpatient treatment, enrolling in an extended outpatient program, or participating in relapse prevention services is often advised. There is even the option of spending time in sober living facilities after formal addiction treatment has ended. The more structured support that recovering alcoholics receive, the easier it is to successfully prevent relapse during PAWS.
Although good self-care can be a challenge when people lack motivation, energy, and focus, it is still of the utmost importance. Among some of the most effective measures for avoiding relapse during PAWS are:
- Seeking treatment for insomnia
- Establishing good sleep hygiene by setting a sleep schedule and sleep routine
- Engaging in regular physical exercise
- Eating a balanced, healthy diet
- Participating in a diverse range of stress management activities.
Exercising releases “feel good” chemicals. It offers a natural way to trigger the brain’s reward system. It also sets the pattern for ensuring that the brain is again rewarding truly beneficial behaviors.
Yoga, meditation, and art therapy are all great ways to alleviate depression and relieve stress. Many of these activities can also have an important social component. In PAWS, it is never a good idea to spend too much time in isolation. People in PAWS are additionally encouraged to take part in:
- Journal writing
- Continued individual and group therapy sessions
- Family therapy
It’s important to have someone you can talk to about your feelings. It’s also important to take it easy on yourself. While you might have high expectations for your new life of sobriety, successfully managing and making it through PAWS is an important and often unavoidable step in recovery.
It is okay to not feel okay at times, and it is definitely okay to have low motivation and low energy. These are signs that your brain and your brain’s chemistry are adapting, re-balancing, and healing. Remember, this part of the healing process takes time.
Treating Post-Acute Withdrawal Syndrome With Us
At Mississippi Drug and Alcohol Treatment Center, we offer a diverse range of therapies and services for supporting our clients in PAWS. Although the initial acute withdrawal symptoms that are experienced in alcohol detox are guaranteed to be challenging, PAWS can be incredibly challenging as well.
Our goal is to ensure that our clients are safe, comfortable, and well-supported throughout all phases of the withdrawal process. To find out more about our options in addiction treatment or to speak with an admissions counselor, call us today.
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