The After Detox Detox: Post-Acute Withdrawal Syndrome

The detox process is uncomfortable and painful. But for patients who are dependent on certain drugs (like alcohol and benzodiazepines), it can be fatal if not done properly. Individuals are relieved when the process is over and the intense symptoms of withdrawal disappear. Some patients who successfully detox from alcohol or drugs, however, may be surprised to find that they still experience some symptoms of withdrawal or discomfort after all substances are out of their system. The set of symptoms that may plague successfully detoxed patients long after they are finished with the withdrawal process is called post-acute Withdrawal Syndrome, or PAWS.

What is Post-Acute Withdrawal Syndrome?

Prolonged drug use or alcohol consumption fundamentally alters the way that the brain processes information. Although this process isn’t necessarily permanent, the chronic consumption of substances changes the wiring of the brain and how the nervous system signals the body.

As an individual increases their use of drugs or alcohol, the brain’s “reward system” becomes dependent on substances. The production of the brain chemicals dopamine and serotonin become dependent on the use of substances because over time the brain loses its ability to produce these chemicals on its own. This is what causes tolerance and addiction. Serotonin and dopamine are the two brain signals responsible for regulating functions like our mood, sexual function, appetite, sleep, memory, learning, social behavior, cognition, attention, pleasure, motivation, as well as some of the physical functions of some organ systems (like the cardiovascular and muscular system.) When the drugs or alcohol are removed from the system, the brain’s inability to produce these chemicals on its own causes the symptoms we know as withdrawal.

How Long Does Post-Acute Withdrawal Last?

Post-acute withdrawal syndrome occurs because even after the substances are cleared from the body and brain and acute withdrawal is over, the brain system takes a longer time than a detox period to fully recover. As the reward system in the brain repairs itself, post-acute symptoms show up as the result of long-term changes in the brain. In order to regain fully normal functioning after detox, the brain needs a long period of time to repair itself. This can take anywhere from six to eighteen months, depending on the individual patient and the duration and details of their substance use. During this time, the individual will likely experience some post-acute withdrawal symptoms as the brain heals.

Common Symptoms of Post-Acute Withdrawal

Post-acute withdrawal symptoms are not as intense as symptoms during the detox process, but they can be disruptive and uncomfortable. For patients who are unaware of post-acute withdrawal syndrome, these symptoms can be alarming. Fortunately, they are not permanent. Some of the most common symptoms of post-acute withdrawal syndrome are:

• Anhedonia (inability to derive joy/happiness from any normally pleasurable activities, like hobbies, eating, etc.)
• Depression
• Mood swings
• Impaired social function (lack of social skills, experiencing social anxiety, difficulty in interpersonal relationships)
• Poor concentration and memory
• Lack of motivation
• Low or fluctuating energy levels
• Cravings
• “Foggy” thinking patterns or racing thoughts
• Emotional disturbances- feelings of numbness and/or emotional overreactions
• Problems with sleep- insomnia, sleep disturbances (such as nightmares) or sleeping too much
• Impaired coordination
• Increased stress and pain sensitivity
• Anxiety
• Fatigue

Are These Symptoms Permanent?

For a patient who is unaware of post-acute withdrawal syndrome, there may be a fear that they are suffering permanent damage from drug or alcohol use and that their brain and body will never return to normal. Fortunately, these symptoms are signs of a brain that is slowly healing itself- they are not permanent. The longer an individual goes without using drugs or alcohol, the more time the brain and nervous system have to adjust and return to normal functioning. With sustained abstinence and sobriety, the brain resumes normal functioning and these symptoms slowly dissipate. The trick is to resist the cravings and give the brain time to heal.

Dealing with Post-Acute Withdrawal Syndrome

The best treatment for post-acute symptoms is time. The longer the brain and body go without substances like alcohol and drugs, the more they repair themselves. During the six to eighteen month period of post-acute withdrawal, however, there are some things that recovering individuals can do to mitigate the more unpleasant effects of this syndrome. To reduce these symptoms, it helps to:

• Establish and stick to a healthy sleep routine, including making time for 8 hours of rest per night
• Exercise regularly, in order to build physical strength, reduce anxiety, and promote the production of dopamine and endorphins, both of which are released during physical activity.
• Adhere to medical recommendations, including taking prescribed meds.
• Receive proper nutrition, which can promote healthy brain activity and make up for any deficiencies caused by substance abuse.
• Attend support groups or therapy sessions, which can help patients to manage the mood swings of post-acute withdrawal syndrome.

Healing in the Long-Term

Ultimately, the only “cure” for post-acute withdrawal syndrome is long-term, sustained abstinence from drugs and alcohol. In order to heal from prolonged substance abuse, the body needs time to adjust. Additionally, it needs time to live without the substances of an individual’s active addiction. This can be a long and difficult process, but giving oneself the chance to heal and stay sober will result in healthy brain function and the ability to live a fulfilling life without the aid of drugs and alcohol.

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