When entering into addiction treatment for substance use, most addicted individuals do not immediately start feeling better once they have removed drugs and alcohol from their system. Depending on various factors (such as patterns of use), these symptoms are liable to provide a level of discomfort to the client in treatment. These symptoms are more than common in the realm of drug and alcohol treatment. These levels of discomfort are known as Post-Acute Withdrawal Syndrome. (Sometimes referred to as Protracted Withdrawal)
What is Post-Acute Withdrawal Syndrome?
Commonly referred to by the acronym PAWS, Post-Acute Withdrawal Syndrome refers to a continued period of withdrawal symptoms experienced by those who have quit using substances. Symptoms of PAWS usually show after the initial withdrawal symptoms. However, regardless of the substances, PAWS has become common for most people in their early years of recovery. Several of these symptoms are similar to depression and anxiety, and can often times have slight physical effects on a person. A clear and concise understanding of what these symptoms are gives the individual in recovery knowledge and peace of mind.
When we refer to this syndrome of withdrawal, we are speaking separately from acute withdrawal, which the American Society of Addiction Medicine refers to as “the onset of a predictable constellation of signs and symptoms following the abrupt discontinuation of, or rapid decrease in, dosage of a psychoactive substance.” (SAMHSA) These symptoms typically mimic opposite effects of intoxication for substances, such as a dilation of pupils during opiate withdrawal as opposed to constriction. These symptoms can occur as soon as a few hours after cessation of use, and vary from substance to substance: (Note: These time frames are approximate measures)
- Alcohol = 5-7 Days
- Benzodiazepines = 1-4 Weeks; 3 – 5 Weeks with tapering
- Cannabis = 4 Days
- Nicotine = 2-4 Weeks
- Opioids = 4-10 Days (methadone withdrawal may last 14-21 days)
- Stimulants = 1-2 Weeks
Once the acute withdrawal symptoms have been “walked through” protracted symptoms start to appear soon after, and are generally expected to persist beyond the above timeline for acute withdrawal. These possible symptoms include, but are not limited to, anxiety, sleep difficulties, depression, fatigue, and irritability.
Assisting Those In Withdrawal
Now the question remains for those in the addiction help field. What can we do to assist those who are newly clean and sober and experiencing symptoms of withdrawal?
Educate the Client: Addicted individuals in recovery need to be reminded that this is a process. However, it’s not one they have to walk through alone. By providing information, you can arm them with self-assurance and confidence to overcome withdrawals.
Understand and Asking About Sleep Deprivation: Rest is very important for an individual in detox programs. Issues with sleep could vary from poor sleep habits to off sets from protracted withdrawal. Educating the client about proper sleep habits can potentially lead to more long-term success with recovery.
Encouraging Clients to Remain Active: Exercise is extremely useful. Both mental and physical exercise have worked wonders in helping clients avoid triggers, improve their coping skills and relapse prevention.
Encourage Clients to Join Mutual Support Group: A sense of community, overcoming a common struggle on common ground is one of the most valuable tools a person in recovery can utilize such as 12-Step Based Support Groups and similar support groups.
These items listed above are just a brief example of encouragement, understanding, and education which you can offer to your clients. Once they realize that they do not have to walk through any sort of withdrawals, acute or not, alone, they can begin to understand just how valuable a system of support can be to them.
-J. Dalton Williams. BA.
SAMHSA. July 2010. “Substance Abuse Treatment Advisory: Protracted Withdrawal.”