Roadblocks on the recovery journey: How to get around post-acute withdrawal

What is post-acute withdrawal?

Post-acute withdrawal syndrome (PAWS) affects people who have quit using substances and have already gone through the acute phase of withdrawal (detox). Detox sometimes involves intense physical symptoms such as nausea, tremors, and sweating. 

Unlike acute withdrawal, which generally lasts for a few days to a few weeks depending on the substance, PAWS can last for an extended period of time, complicating your recovery process and increasing your risk of return to use. For this reason, PAWS can be challenging for people who have decided to quit, or moderate, their use of substances.

Psychotherapy can support you through post-acute withdrawal, helping you stay on track with your wellness goals.

Post-acute withdrawal symptoms

People experience PAWS differently. This has a lot to do with the substance involved and each person’s biopsychosocial history. However, common manifestations include:

1. Mood Swings: You may experience episodes of depression, anxiety, irritability, poor impulse control, and sudden mood changes.
2. Changes in emotional intelligence: You may have difficulty understanding your own emotions, and the emotions of those close to you. It may be especially hard to understand others’ emotions about your actions.
3. Cognitive Impairment: You might experience difficulty concentrating, memory problems, and difficulty making decisions.
4. Sleep Disturbances: You may have difficulty sleeping, or sleep too much. You might also have vivid dreams, nightmares, or using dreams¹. 
5. Physical Symptoms: Disrupted sleep my lead to fatigue during the waking hours. You might also have headaches, changes in hand-eye coordination¹, and experience stomach or gut problems.
6. Cravings: One of the most surprising things that can happen is sudden intense cravings. You might be scared, confused, or sad when this happens.

If you are having experiences like those listed above, it’s important to get support to maintain your wellness goals. Psychotherapy is a space where you can safely explore the thoughts, feelings, and memories that emerging during post-acute withdrawal. 

What causes post-acute withdrawal?

It’s not easy to pin down cause of PAWS because there are likely multiple causes. Even researchers disagree about the exact nature of post-acute withdrawal. One cause might be changes in brain chemistry and neural pathways that happen while using substances or engaging in risky behaviors. However, factors such as the duration and intensity of substance use, individual biology, and your mental health can influence the severity and duration of PAWS.

More research is needed to fully understand post-acute withdrawal.

Managing PAWS on your recovery and wellness journey

PAWS poses significant challenges to maintaining long-term changes in substance use and risk-taking behavior. This is mainly because when you experience post-acute withdrawal, you may feel like it’s a setback and get discouraged or down on yourself. When you’re feeling this way, it’s important to get support to maintain your wellness goals. Psychotherapy is a safe place to explore these thoughts and feelings.

Ways to manage post-acute withdrawal

You have several options for managing post-acute withdrawal experiences. They include:

1. Medication-Assisted Treatment (MAT): Certain medications may be prescribed to alleviate symptoms such as depression, anxiety, or insomnia.
2. Therapeutic Interventions: Cognitive-behavioral therapy (CBT), mindfulness techniques, and support groups are effective in helping individuals manage cravings, improve coping skills, and address underlying psychological issues.
3. Lifestyle Modifications: Adopting a healthy lifestyle that includes regular exercise, balanced nutrition, and stress-reduction techniques can promote physical and emotional well-being during recovery.

Clinical considerations

Healthcare providers play a critical role in recognizing and addressing PAWS. Regular monitoring and assessment are essential to identify symptoms early and adjust treatment plans accordingly. Holistic approaches that integrate medical, psychological, and social interventions are most effective in supporting sustained recovery and minimizing the risk of a return to use.

Conclusion

Post-acute withdrawal syndrome is a critical phase in the recovery journey of individuals who decide to make changes in their substance use. Understanding the nature, symptoms, and management of PAWS is essential for healthcare professionals, support networks, and people who are considering changing how they use substances. Addressing the unique challenges posed by PAWS can enhance recovery outcomes and promote long-term wellness to those who want to live their lives differently after making the decision to quit using substances.

References

1. Rosenfeld, J. (2021). Neuroscience informed interventions. https://www.naadac.org/assets/2416/fall_2021_joseph_rosenfeld_neuroscience_informed_interventions.pdf

Further reading

These annotated bibliography entries provide a range of perspectives on post-acute withdrawal syndrome, emphasizing pharmacological interventions, treatment strategies, and the broader implications for managing substance use disorders.

Hser, Y. I., Mooney, L. J., & Saxon, A. J. (2017). High mortality among patients with opioid use disorder in a large healthcare system. Journal of Addiction Medicine, 11(4), 315-319.

• This study examines the high mortality rates observed among patients with opioid use disorder (OUD) within a large healthcare system. While not solely focused on PAWS, it highlights the significant health risks associated with substance use disorders, including the challenges of managing withdrawal and preventing relapse during recovery. The findings underscore the importance of comprehensive care, including addressing PAWS, to improve long-term outcomes for individuals with OUD.

Bodkin, J. A., Zornberg, G. L., Lukas, S. E., & Cole, J. O. (1995). Buprenorphine treatment of refractory depression. Journal of Clinical Psychopharmacology, 15(1), 49-57.

• The study suggests that medications like buprenorphine could play a role in managing PAWS symptoms effectively, thereby supporting recovery from opioid and possibly other substance use disorders.

Gonzalez, G., Sevarino, K., Sofuoglu, M., & Poling, J. (2007). Effects of buspirone on the subjective and reinforcing effects of intranasal heroin administration. Behavioural Pharmacology, 18(5-6), 539-544.

• This study provides insights into pharmacological approaches that could be beneficial in managing PAWS by targeting neurochemical pathways involved in withdrawal and craving.

Kleber, H. D. (2007). Pharmacologic treatments for opioid dependence: Detoxification and maintenance options. Dialogues in Clinical Neuroscience, 9(4), 455-470.

• This review article emphasizes the challenges associated with PAWS and the importance of long-term management strategies to prevent relapse. The article provides a comprehensive overview of medications commonly used to address PAWS and their efficacy in supporting recovery.

Sullivan, M. A., & Vosburg, S. K. (2006). The safety and efficacy of buprenorphine in the management of acute and chronic pain conditions. Journal of Pain and Symptom Management, 31(1 Suppl), S58-S67.

• This article includes implications for using buprenorphine in treating pain associated with PAWS, suggesting its potential utility in addressing both physical discomfort and withdrawal symptoms during recovery.