Withdrawal is a horrible experience that’s triggered by addiction to a particular substance and the subsequent attempt to detox. When you’re battling active withdrawal, it’s likely that your life has been affected by substance use disorder for quite some time.

If you’ve managed to make the first steps towards quitting but have relapsed as a result of the random return of withdrawal symptoms after detox – understand this is normal. Many people don’t have the proper education surrounding the condition known as post-acute withdrawal to prepare for it efficiently. It can take years and multiple attempts to achieve successful recovery for many users.

When Withdrawals Last Well Beyond Detox

After detox, which usually lasts around two weeks, people often wonder whether they will still feel different, especially since relapse rates tend to increase during the first few days after leaving treatment facilities. The good news is that most of us will enjoy relief from the most intense side effects of withdrawal.

However, certain users experience what’s known as post-acute withdrawal (PAWS). The difference here is that, unlike those conditions, post-acute withdrawal (PAW) occurs several months later. This means that while other ailments clear up within a week or so, PAW doesn’t go away until several months pass.

What Are Post-Acute Withdrawal Symptoms?

When someone quits using drugs or alcohol, their system goes through numerous physiological processes, including changes in brain activity, hormone production, blood flow, breathing, heart rate, metabolism, circulation, digestion, muscle mass, and nerve function.

During acute withdrawal, patients experience the most intense side effects of detox. As soon as the patient stops taking the drug, he/she begins seeking relief. Usually, this process occurs just 48 hours after the last ingestion (give or take).

How Long do Post Acute Withdrawal Symptoms Last?

Acute withdrawal normally lasts anywhere from one to four weeks, depending on the substance in question. The length of abuse and average amounts used also weigh heavily on the intensity of withdrawal symptoms.

However, anywhere from a few weeks to a couple of months, individuals may experience post-acute withdrawal symptoms. These symptoms are typically much less severe than the initial acute withdrawal symptoms, but certainly intense enough to cause discomfort and anxiety.

Individuals may experience the sudden return of intense cravings, insomnia, restlessness, diarrhea, cold chills/goosebumps, mood swings, rapid heartbeat, stomach cramps, and weakness. Intense, random periods of heavy sweating may also occur, along with a heightened sensitivity to hot or cold temperatures.

Most individuals don’t realize that they actually suffer from PAW because they aren’t even aware of such a condition and mistakenly believe they’re still in full-blown withdrawal. This can be demoralizing, especially after believing you’ve completed detox.

Post-Acute Withdrawal Symptoms

How Often Do Withdrawal Symptoms Occur After Detox?

Since PAW affects all aspects of human functioning, its duration varies according to various factors like age, gender, preexisting health issues, type of substance abuse disorder, etc. Some people may require longer treatment periods to fully prepare for the onset of post-acute withdrawals in a normal setting.

Exactly how often these post-acute withdrawal symptoms occur isn’t known. The answer is different for each user. However, as a general rule, most individuals have reported a frequency of about once every 10 days.

The substance of choice also has an effect on the regularity of PAWS and their intensity.

Do Certain Drugs Cause Post-Acute Withdrawal Symptoms?

Although post-acute withdrawal symptoms are possible with any substance, there seems to be a link between their regular occurrence and specific drugs. There seems to be a link between these substances, as well.

Normally, the substances that commonly cause post-acute withdrawal are opioids, alcohol, and benzodiazepines. What is the one thing that these drugs have in common?

Besides the fact that they’re all considered depressants, they all have intense physical withdrawal periods. With the exception of opioids, they also have the potential to cause death during the detox period.

The intense grip these substances have on users and the way they rewire the brains and behavioral patterns are most likely direct contributors to the existence of PAWS in so many users of these drugs.

It’s worth noting that all three of these substances cause intense psychological and physical withdrawal symptoms, which both carry over into the post-acute withdrawal phase.

Physical vs. Psychological Post-Acute Withdrawal

Physical and psychological post-acute withdrawal carries two separate types of side effects. The physical effects tend to last for a much shorter length of time than the psychological effects.

It’s important to be aware of the difference between the psychological effects of post-acute withdrawal and the long-term underlying mental health disorders associated with substance abuse disorder. Psychological effects of post-acute withdrawal will occur in spurts, lasting about a half-hour to an hour.

Effects that persist for days on end are most likely signs of an underlying mental health disorder that must be addressed.

It’s important to be aware of the difference between the two, and what exactly causes post-acute withdrawal syndrome.

What Causes Post-Acute Withdrawl Syndrome?

There are multiple reasons behind PAWS. A majority of them stem from the biological response caused by the abrupt removal of opiates or sedative-hypnotics.

Other possible triggers could be psychological stressors associated with chemical imbalances caused by long-term substance abuse. Once these imbalances occur, the mind sends out signals that prompt the attempted release of endorphins, often to no effect. Unfortunately, the absence of these chemicals leads to feelings of distress instead of happiness.

While researchers aren’t exactly sure what causes PAW, it seems plausible that it plays a role in triggering the pain matrix located deep inside the brain. Pain receptors send messages to parts of the cortex responsible for processing emotions like joy, sadness, pleasure, fear, anger, and surprise.

When released, these neurotransmitters affect both positive and negative emotions. Thus, the presence of endorphins helps reduce the impact of emotional stimuli, while their absence makes them worse.

Why Does Post Acute Withdrawal Persist for Some People

Why Does Post Acute Withdrawal Persist for Some People?

Another reason why PAW becomes chronic involves epigenetic mechanisms that influence gene expression. Epigenetics refers to any environmental factor that influences genes without changing DNA sequences.

For example, smoking cigarettes alters gene expressions related to nicotine dependency. Researchers suspect that exposure to stressful situations increases levels of cortisol, leading to an increased risk of developing major depressive episodes.

Some psychologists argue that the main source of PAW stems from the inability of the organism to adapt to drastic lifestyle changes. According to them, it reflects the body’s natural drive to maintain homeostasis.

On the contrary, some experts insist that PAW primarily originates from the brain’s reward pathways associated with dopamine transmission. They claim that the latter theory proves more accurate since stress rarely contributes to cravings and subsequent abuse. Regardless of the exact mechanism involved, it’s safe to say that both theories play a significant role in precipitating PAW.

How Are PAWS Treated?

Because the precise causes of PAW remain unknown, finding effective treatments for this problem isn’t easy. There are currently only a handful of medications that help alleviate some of the symptoms of PAW.

Most of these interventions deal with relieving depression, managing anxiety, and controlling sleep disturbances. Others treat gastrointestinal disorders and relieve restless leg syndrome. Others manage hypertension as a diagnosable component of related post-acute withdrawal symptoms.

Though research continues to uncover new methods of treating post-acute withdrawal, the best way to combat this difficult challenge is to seek immediate assistance from licensed healthcare professionals.

Remember, every day that passes brings fresh reminders of the damage done by excessive consumption of alcohol and substance abuse. Take advantage of resources available online to learn about proper ways to cope with this condition.

What Are Coping Strategies for PAWS?

As mentioned above, there are multiple sources online for new types of coping strategies for PAWS. However, some of the most effective methods include the following:

  • Group recovery meetings play a key role in dealing with the effects of PAWS and helping to avoid relapse. Studies have shown that regular attendance in meetings produces a much lower relapse rate than the alternative.
  • Mending damaged relationships with friends and family before entering recovery can also be very therapeutic. A certain level of mental weight is lifted from holding yourself accountable for toxic behavior and asking for forgiveness. This strategy taught in 12-step programs seems to provide significant benefits.
  • Many individuals choose to participate in activities such as yoga and other physical therapeutics. Aromatherapy and other alternative and all-natural forms of healing can provide a calming effect and promote mental wellness.
  • Finding healthy hobbies can be a form of therapy in itself. Art therapy is a common practice in rehab facilities and can be effective if carried over into a client’s time after graduating.

Is Lasting Recovery From PAWS Possible?

At Pathfinders Recovery Centers, with locations in Arizona and Colorado, we believe in lasting recovery from PAWS and other substance abuse-related issues. We place emphasis on comfort and a relaxing environment during the treatment process, aiding in the best possible atmosphere for recovery.

It’s our responsibility to give clients the tools they need to remain successful after treatment, helping them prepare for the possibility of post-acute withdrawal symptoms. We’re confident that the experience and expertise of our staff give clients a fighting chance at long-term recovery.

To find out more about our programs, contact a member of our admissions staff today.


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