Beyond Detox: Navigating the Complex Journey of Post Acute Withdrawal Syndrome (PAWS)

Welcome back, lovelies. In our last discussion, we discussed the complexities of addiction, revealing how it's not just a struggle with substances like drugs, alcohol, and nicotine, but also behavioral addictions such as gambling and excessive social media use. We dove into the brain's mesolimbic dopamine pathway and its critical role in driving addictive behaviors. Remember how dopamine, our "pleasure chemical," gets entangled in this web, escalating impulsivity and embedding rewards into our habits? Now, let's venture deeper into the recovery landscape. Once the chains of immediate physical addiction are broken, the journey is far from over. Here, we encounter Post Acute Withdrawal Syndrome (PAWS), a phase that extends the challenges of recovery, often lasting up to two years after initial detox.

Stages of Withdrawal

Understanding the Journey Through Post Acute Withdrawal Syndrome (PAWS)

In the aftermath of conquering the immediate physical dependencies of addiction, many believe the hardest part is over. However, the reality is that recovery is an intricate journey, extending beyond initial withdrawal. Once the cords of immediate physical addiction are broken, the brain begins its remarkable journey to recalibrate and heal. This recalibration process involves the gradual normalization of neurotransmitter levels and receptor sensitivities that were altered by addiction.

Neurotransmitters such as dopamine, serotonin, and gamma-aminobutyric acid (GABA) play pivotal roles in mood regulation, decision-making, stress response, and pleasure experiences.

Addictive substances manipulate the brain's natural neurotransmitter activity, leading to altered states of consciousness, mood, and physical sensation. For instance, substances that provide a sense of calm or sedation, such as opioids or alcohol, do so by enhancing the activity of inhibitory neurotransmitters like GABA or by reducing excitatory neurotransmitter activity. Conversely, stimulants like cocaine or amphetamines increase alertness and energy by boosting dopamine, norepinephrine, and other neurotransmitters associated with arousal and reward.

Post-Acute Withdrawal Syndrome (PAWS): Symptoms

During the recovery process, as the brain works to restore its natural neurotransmitter functions, individuals may experience symptoms that are directly opposite to those induced by their drug of choice:

• From Calmness to Anxiety: For those who relied on substances that induced calmness and sedation, the PAWS phase might bring about heightened levels of anxiety and restlessness. This is due to the brain's adjustment period, where it is recalibrating the neurotransmitter systems responsible for relaxation and stress reduction.

• From Alertness to Fatigue: Similarly, individuals who used stimulants to achieve heightened states of alertness and energy may find themselves grappling with fatigue and decreased motivation during PAWS. This contrast reflects the brain's efforts to balance out the overstimulation previously induced by substance use.

Managing Withdrawal Symptoms

Developing a Healthy Coping Plan: Navigating Post Acute Withdrawal Syndrome (PAWS)

Statistics indicate that approximately 75 percent of individuals in recovery may experience a relapse during their first year. This high rate underscores the critical need for effective strategies to navigate through cravings and difficult days that are part of the PAWS experience. Developing a healthy coping plan is a proactive approach to fortify one's commitment to recovery, offering tools and techniques to manage the urge to return to substance use.

A comprehensive coping plan might include:

• Identifying Triggers: Recognizing the emotional, environmental, or social cues that increase cravings can help in avoiding them or preparing to face them with strength.

• Building a Support System: Engaging with support groups, therapy, or trusted individuals who understand the journey can provide encouragement and advice during vulnerable moments.

• Practicing Mindfulness and Relaxation Techniques: Activities such as meditation, deep-breathing exercises, or yoga can reduce stress and enhance emotional regulation, helping diminish the power of cravings.

• Staying Physically Active: Regular exercise not only improves physical health, but also boosts mood and mental well-being, making it easier to navigate through tough days.

• Having a Hobby or Creative Outlet: Dedicating time to interests and hobbies can redirect focus and provide a sense of fulfillment and distraction from cravings.

Embracing these strategies as part of a healthy coping plan enhances the ability to face the unpredictable nature of PAWS with confidence. It’s about equipping oneself with a toolkit that not only addresses the immediate challenges of cravings, but also contributes to a holistic recovery process, reducing the likelihood of relapse and paving the way for a resilient, substance-free future.

PAWS and Relapse

A Final Note:

The unpredictable nature of PAWS can be particularly disheartening for those in recovery. Just when one believes they are turning a corner, they might find themselves grappling with a sudden onset of depression or an inexplicable craving. This rollercoaster of symptoms is not just a test of physical endurance but a profound psychological battle against the shadows of former habits.

Armed with an understanding of Post Acute Withdrawal Syndrome, individuals navigating this phase can approach it with informed optimism. Recognizing that these challenges are temporary and part of the healing process can empower recovery with a sense of purpose and direction. It's important to remember that this phase won't last forever, and that each day brings you closer to reclaiming your mental and physical well-being.

Until Next Time,

Jena

Your certified mental health advocate

Sources:

Alsheikh, M. Y. (2021). Post-Acute Withdrawal Syndrome: The Major Cause of Relapse among Psychoactive Substances Addicted Users. Archives of Pharmacy Practice¦ Volume, 12(4).

Butehorn, L. (2017). Post–Acute Withdrawal Syndrome, Relapse Prevention, and Homeopathy. Alternative and Complementary Therapies, 23(6), 228-230.