We all know that most relapses occur in the first few months after we get clean and sober. Many of them are related to Post-acute Withdrawal Syndrome. We talked about PAWS in a previous post, but I wanted to go into it more specifically here.
Although there are differences in the way they act, all addictive drugs function by either stimulating or imitating the chemicals of the brain’s reward system — giving us too much of a good thing.
In an attempt to return our brain chemistry to normal (homeostasis), the brain builds more receptor sites for those particular neurotransmitters. This allows it to deal with the higher-than-normal levels, leading to tolerance: the need for more drugs to fill up the additional receptors so that we can continue to get high.
When we get clean and sober, those extra receptors clamoring to be filled up are what causes withdrawal: acute withdrawal while the drug is clearing out of our system, and post-acute withdrawal during the period when the brain is deactivating the extra receptor sites and returning to normal. Some authorities believe that it never normalizes entirely, which may be why any use usually leads back to full-blown addiction.
There is a double-whammy effect, too. When the drug is removed, there is a “rebound.” We begin to experience many feelings and physical symptoms that are the opposite of the way the drugs made us feel. Removal of the drugs’ stimulation causes the production of the reward chemicals to drop to below normal, and they return to their pre-addiction levels slowly. During this period we may be antsy, anxious, depressed, manic, or combinations of those feelings. We may feel as though our recovery is hopeless, and that we might as well use.
That’s PAWS. The duration varies depending on the drug(s) used and individual physical differences. It can — but usually does not — last for up to two years. Ordinarily it will peak and then slowly subside within the first few months. During that period (and in most cases for the rest of our lives), use of addictive drugs can put us back on the merry-go-round quickly. It will also prolong the period of PAWS. It can even set us back completely, because it interferes with the brain’s repairs.
So, in early recovery we need to be prepared for a prolonged period of slowly feeling better, with setbacks when our bodies need that additional bit of natural feel-good and don’t get enough, usually when we are under stress. Stress aggravates PAWS symptoms because the natural “drugs” that help us to cope aren’t back to full strength yet.
The good news: it always gets better, slowly but surely.
The best medicine for Post-acute Withdrawal Syndrome is time, aided by mild exercise, good nutrition, rest, stress avoidance, and distractions. We need to have some fun. We need the support of people who know where we’re coming from, and who know how to deal with people in early recovery.
That’s why we recommend meetings, fellowship, halfway houses, long-term treatment, and some time away from the old grind and the old stresses. They help us deal with PAWS, while we’re getting into the habits that lead to long-term recovery.
As George Carlin used to say, “Just because the monkey is off your back, it doesn’t mean the circus has left town.”
If you’ve had your own experiences with PAWS, how about sharing in the comments? Questions? Feel free!