March 21, 2014
Many symptoms of alcohol and drug withdrawal are the result of the toxic effects these chemicals have on the brain and the body.
In the first days and weeks following cessation of drug and alcohol use, individuals may experience acute withdrawal symptoms, which can be more severe for some than others and will vary depending upon the drug of choice among other factors.
As acute withdrawal symptoms fade, post-acute withdrawal symptoms (PAWS) may be an issue for people in recovery. These symptoms, too, will vary in characteristic and degree based upon a number of factors. In general, however, many clients in recovery report experiencing some or many of the following post-acute withdrawal symptoms for up to two years after detox:
- Irritability and hostility
- Mood swings
- Low energy and fatigue
- Sleep disruption, including insomnia
- Limited ability to focus or think clearly
- Lack of libido
- Inexplicable chronic pain
The good news is that professional detox services can help to mitigate the experience of acute and post-acute withdrawal symptoms in clients and reduce the risk of relapse during this critical period of recovery. Through medical detox and long-term therapeutic intervention and support in recovery, clients will have access to the resources they need to effectively manage PAWS.
Drug of Choice and PAWS
In addition to the post-acute withdrawal symptoms listed above, those in recovery from specific drugs may also, or instead, experience various issues, as outlined below:
- Marijuana: A number of studies support the existence of acute as well as post-acute withdrawal symptoms during marijuana detox. One study suggests that sleep disruption including intense dreams may persist up to 45 days or longer.
- Cocaine: Impulse control continued to be a struggle for study participants after four weeks of sobriety, according to a study published in the journal Drug and Alcohol Dependence.
- Methamphetamine: Long-term issues with executive control function were shown to be a persistent issue for people in recovery from methamphetamine abuse, according to a study published in the journal Addiction.
- Opiates: There are a number of post-acute withdrawal symptoms that have been reported in the weeks and months following opiate detox, including sleep disruption, anxiety, and depression, as well as decreased executive control functions.
- Benzodiazepines: People in recovery from benzodiazepine abuse and addiction often struggle with reemergence of the symptoms that originally created the need for the prescription in addition to post-acute withdrawal symptoms. Any new symptoms that occur during the post-acute detox period are generally identified as post-acute withdrawal, even if they occur after a long period of being asymptomatic. For example, extreme anxiety, panic, and symptoms that often look like other mental health disorders may wax and wane during the months following detox but gradually dissipate as long as abstinence is maintained.
Physical and Psychological Issues That Exacerbate PAWS
The following is a list of conditions that tend to inform and/or worsen the experience of post-acute withdrawal symptoms:
- The drug or drugs of choice
- How long, how frequently, and how much of these substances the person uses regularly
- Acute emotional issues that arise during the first year or years of recovery
- Co-occurring physical and/or mental health conditions
- The support provided by substance abuse treatment professionals
Unfortunately, there are no clearly defined timelines for post-acute withdrawal symptoms. Some clients will not experience any significant issues following acute detox while others will experience ongoing post-acute withdrawal symptoms for years, and still others will have periods of being symptomatic followed by periods of being symptom-free. With personalized care and long-term support in recovery, clients can learn to manage post-acute withdrawal symptoms as they arise and remain active and successful in sobriety.