Post-Acute Withdrawal Symptoms

I haven't written much about addiction issues, which is surprising since I've worked long and often with people who struggle breaking free of addictive behaviors. I had a conversation with a client today about Post-Acute Withdrawal Symptoms (PAWS), so I thought it would be a good thing to write about.

The immediate symptoms that occur when breaking free of an addiction typically include withdrawal, craving, anxiety, depression, mood swings and so forth. These will gradually and eventually lessen in intensity. What some people fail to appreciate is that more subtle symptoms can remain in force for many months after the addictive behavior stops. These are the post-acute symptoms and in my experience they occur along two dimensions: thoughts and emotions.

1. Thoughts. A brain that is no longer being clouded by drugs or other addictive input is going to think more clearly.....eventually. Especially for long-term addicts, the brain has become quite accustomed to operating in a state of impairment. When the source of the addiction is removed the brain must re-adjust, and like an out-of-tune car engine it will sometimes rev and sometimes stall. This means that a person may have periods of exceptionally sharp thinking alternating with times when it is hard to put two thoughts together.

2. Emotions. Similarly, a person in the initial months of recovery may find times when his or her emotions are experienced very intensely (whether positive or negative). At other times that same person may feel very emotionally numb for a period of time.

When these two dimensions are put together it creates four quadrants. The first is a period of sharp thinking and intensely positive emotions. This can lead to what people in A.A. often call a "pink cloud" or a feeling of being "happy, joyous and free". The opposite is when negative feelings predominate, which people in A.A. often refer to as "restless, irritable and discontent."

It's also possible that the same person can go though times when his or her mind is cloudy or negative and the emotions are intensely experienced. This can lead to rash decisions that are later regretted. There is also what I call the "dead zone" when it is very difficult to either think or feel effectively.

Eventually both thoughts and emotions will level out and become more consistent, but from time to time it is likely that a "revving" or "sagging" will occur along either dimension. This is a physiological effect of recovery, not merely a psychological sense of distress.

The importance of this concept is for a recovering addict to check out his or her thoughts and emotions regularly with trusted resources such as a sponsor or other 12-step members. There is a saying in A.A. that "my best thinking got me here" which warns against relying too much on self-assessment as a basis of decision making.

Eventually, usually within a year or so, PAW symptoms will diminish in frequency, intensity and duration. Until then, it's important to give the brain time to adjust to healthy living after having been beaten up for so long by alcohol, drugs or other addictive influences.
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