The Dangers of Post-Acute Withdrawal
Reconsider your belief that alcohol and drug detoxification will eliminate withdrawal symptoms.
“I’ve quit smoking thousands of times; it’s easy.” — Mark Twain
Many people—who have an addiction, their loved ones, friends, and even some medical and behaviouralhealth professionals—share the widespread misconception that life will improve noticeably and return to “normal” functioning as soon as the offending substances are removed from the body (after detoxification or acute withdrawal). If only that were accurate.
The withdrawal procedure consists of two stages. The second stage of the withdrawal process begins when detoxification and acute withdrawal are completed. The duration and severity of active addiction, which refers to the frequency, amount, and duration of use of substances that alter mood and thought processes, determine how long this second phase lasts, sometimes even months after the person stops using. Post-acute withdrawal is the term for this phenomenon (sometimes referred to as protracted withdrawal). Post-acute withdrawal, or PAW, is a collection of frequently excruciatingly painful symptoms that linger long after the body and brain have entirely cleared of all physical traces of alcohol and drugs.
Many people who are just beginning to abstain from various substances experience these symptoms. Still, a disproportionately high number of people who have a history of long-term opioid use experience them. This is one of the reasons why patients with chronic pain who have been treated with opioid painkillers often experience significant withdrawal symptoms when they try to stop taking those drugs.
The severity and length of post-acute withdrawal differ from person to person; once again, these factors are typically correlated with the level and duration of substance use and the physical condition of the individual. Its symptoms can vary widely in intensity, occurring in waves of recurrences and affecting energy, focus, memory, energy span, appetite, sleep, and mood. For instance, individuals may experience anxiety, irritability, anger, and depression, as well as physical symptoms such as tremours, sweating, and nausea.
Even though it can be difficult, post-acute withdrawal is a vital phase that all individuals in early recovery must experience as their bodies and minds start to heal and adjust to living without alcohol or other drugs.
A consequence of the profound alterations in brain chemistry and anatomy that occur during active addiction is post-acute withdrawal. The brain’s innate capacity to handle stress is compromised, and its reward system is completely rewired. When someone uses opiates or opioids, such as heroin or medically prescribed painkillers, their brain adapts by producing fewer endorphins naturally and more opioid receptors. This makes one more sensitive to pain and makes it more difficult to enjoy life when not using.
The brain’s dopamine and endorphin reserves are drastically reduced during the early stages of abstinence. Dopamine is a neurotransmitter that regulates mood and is required in specific amounts to sustain a “normal” mood. It floods the brain during drug use to produce titanic highs. Dopamine deficiency is the cause of depression with a biochemical basis. The brain needs four weeks to six months to naturally produce enough dopamine and endorphins to fill its stockpile of these essential molecules.
The peripheral nervous system (PNS) and the central nervous system (CNS) are the two primary components of the human nervous system. The brain and spinal cord are parts of the central nervous system (CNS). The primary function of the PNS is to transmit information back and forth between the CNS and the rest of the body, utilising nerves. The peripheral nervous system includes the autonomic nervous system (ANS). The ANS typically operates below the level of conscious awareness and serves as a control mechanism for most internal organs.
The fight, flight or freeze response is a physiological reaction that responds to perceived threats. When the body perceives a threat, the sympathetic division of the autonomic nervous system becomes active, initiating a series of survival-focused physiological reactions that prime the body for either ‘fight or flight’ (or freezing). These automatic, unconscious reactions alert the body and mind, preparing the body for action through dilating pupils, hypervigilance, heart rate increase, blood vessel constriction, blood pressure rise, and inhibition of digestion.
The fight, flight, or freeze response is activated in response to perceived threats. However, the physiological reactions themselves cause additional stress, which can become chronic in active addiction. The stress switch appears to be stuck in the “on” position. This strains numerous bodily systems, resulting in wide-ranging fatigue, a weakened immune system, increased susceptibility to sickness, and, yes, increased stress. And stress is the number one suspect for relapse.
During post-acute withdrawal, this chronic stress response persists and only gradually lessens and resets. People, therefore, enter recovery under the influence of higher physiologically innate stress levels, along with increased susceptibility to stress. Early recovery, however, can be a very stressful process in and of itself. There will inevitably be a variety of stressful situations. On top of that, the already stressful conditions of post-acute withdrawal symptoms—such as frustration, confusion, and excruciating discomfort—will compound to cause even more distress.
PAWs and relapse
Post-acute withdrawal is a significant contributing factor to many relapses, even in cases where individuals have sincere intentions to abstain. Despite this, PAW is frequently overlooked, and its effects are underestimated. People with an addiction and the people who love them are often conditioned to think that once the drugs are stopped, things will quickly get better. There may be severe disappointment and upheaval when reality does not meet this irrational expectation. Those going through post-acute withdrawal often react as follows:
“I can’t stand this!”
“This is just too awkward. I’d prefer not to handle it.
“If being clean feels this bad, I might as well use.”
While post-acute withdrawal can feel like an eternity, it’s important to remember that it’s always temporary. Enduring this phase is a necessary part of the recovery journey, and knowing that it will eventually pass can bring hope and optimism.
Early recovery can be a minefield. Many people can successfully navigate obstacles when they are conscious of what those obstacles are and where they are. Thankfully, comfort does not have to be a requirement for healing.
Preventing relapse
Many people are tempted to discontinue treatment after detox. They want to “move on” with their lives after successfully quitting drinking, using drugs, or engaging in harmful behaviour. This is natural, but they forget that addiction is a chronic and progressive illness with no permanent cure or treatment.
AddictionsUK provides clients with a customisedrelapse prevention programme after they have completed their agreed-upon recovery programme. This includes extended coaching or counselling sessions, introduction to peer-mentoring groups, and access to a 24/7 helpline, all to ensure long-term recovery.
If you or your loved one is struggling with an addiction-related issue, call Freephone at 0800 140 4044
Freephone: 0800 140 4044
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