One step at a time

Post-Acute Withdrawal (PAWS)

There are two stages of withdrawal. The first stage is the acute stage, which usually lasts at most a few weeks. During this stage, you may experience physical withdrawal symptoms. But every drug is different, and every person is different.
The second stage of withdrawal is called the Post Acute Withdrawal Syndrome (PAWS). During this stage you'll have fewer physical symptoms, but more emotional and psychological withdrawal symptoms.
Post-acute withdrawal occurs because your brain chemistry is gradually returning to normal. As your brain improves the levels of your brain chemicals fluctuate as they approach the new equilibrium causing post-acute withdrawal symptoms.

Most people experience some post-acute withdrawal symptoms.
Whereas in the acute stage of withdrawal every person is different, in post-acute withdrawal most people have the same symptoms.

The Symptoms of Post-Acute Withdrawal
The most common post-acute withdrawal symptoms are:

  • Mood swings
  • Anxiety
  • Irritability
  • Tiredness
  • Variable energy
  • Low enthusiasm
  • Variable concentration
  • Disturbed sleep

Post-acute withdrawal feels like a rollercoaster of symptoms.

In the beginning, your symptoms will change minute to minute and hour to hour. Later as you recover further they will disappear for a few weeks or months only to return again. As you continue to recover the good stretches will get longer and longer. But the bad periods of post-acute withdrawal can be just as intense and last just as long.

Each post-acute withdrawal episode usually last for a few days.
Once you've been in recovery for a while, you will find that each post-acute withdrawal episode usually lasts for a few days. There is no obvious trigger for most episodes. You will wake up one day feeling irritable and have low energy. If you hang on for just a few days, it will lift just as quickly as it started. After a while you'll develop confidence that you can get through post-acute withdrawal, because you'll know that each episode is time limited.
Post-acute withdrawal usually lasts for 2 years. This is one of the most important things you need to remember. If you're up for the challenge you can get though this. But if you think that post-acute withdrawal will only last for a few months, then you'll get caught off guard, and when you're disappointed you're more likely to relapse.

How to Survive Post-Acute Withdrawal

Be patient.
You can't hurry recovery. But you can get through it one day at a time. If you resent post-acute withdrawal, or try to bulldoze your way through it, you will become exhausted. And when you're exhausted you will think of using to escape.
Post-acute withdrawal symptoms are a sign that your brain is recovering. Therefore don't resent them. But remember, even after one year, you are still only half way there.

Go with the flow.
Withdrawal symptoms are uncomfortable. But the more you resent them the worse they'll seem. You'll have lots of good days over the next two years. Enjoy them. You'll also have lots of bad days. On those days, don't try to do too much. Take care of yourself, focus on your recovery, and you'll get through this.
Practice self-care. Give yourself lots of little breaks over the next two years. Tell yourself "what I am doing is enough." Be good to yourself. That is what most addicts can't do, and that's what you must learn in recovery. Recovery is the opposite of addiction.
Sometimes you'll have little energy or enthusiasm for anything. Understand this and don't over book your life. Give yourself permission to focus on your recovery.

Post-acute withdrawal can be a trigger for relapse.

You'll go for weeks without any withdrawal symptoms, and then one day you'll wake up and your withdrawal will hit you like a ton of bricks. You'll have slept badly. You'll be in a bad mood. Your energy will be low. And if you're not prepared for it, if you think that post-acute withdrawal only lasts for a few months, or if you think that you'll be different and it won't be as bad for you, then you'll get caught off guard. But if you know what to expect you can do this.

Being able to relax will help you through post-acute withdrawal.
When you're tense you tend to dwell on your symptoms and make them worse. When you're relaxed it's easier to not get caught up in them. You aren't as triggered by your symptoms which means you're less likely to relapse.
Remember, every relapse, no matter how small undoes the gains your brain has made during recovery. Without abstinence everything will fall apart. With abstinence everything is possible.

Recovery and Relapse Prevention Strategies
For more techniques on how to get through withdrawal and post-acute withdrawal look at the pages on recovery skills and relapse prevention strategies. You can recover from addiction.
The Stages of Relapse

Relapse is a process, it's not an event.
In order to understand relapse prevention you have to understand the stages of relapse. Relapse starts weeks or even months before the event of physical relapse. In this page you will learn how to use specific relapse prevention techniques for each stage of relapse.

There are three stages of relapse.
  • Emotional relapse
  • Mental relapse
  • Physical relapse


Emotional Relapse
In emotional relapse, you're not thinking about using.
But your emotions and behaviours are setting you up for a possible relapse in the future.
The signs of emotional relapse are:
  • Anxiety
  • Intolerance
  • Anger
  • Defensiveness
  • Mood swings
  • Isolation
  • Not asking for help
  • Not going to meetings
  • Poor eating habits
  • Poor sleep habits

The signs of emotional relapse are also the symptoms of post-acute withdrawal.
If you understand
post-acute withdrawal it's easier to avoid relapse, because the early stage of relapse is easiest to pull back from. In the later stages the pull of relapse gets stronger and the sequence of events moves faster.

Early Relapse Prevention
Relapse prevention at this stage means recognising that you're in emotional relapse and changing your behaviour. Recognise that you're isolating and remind yourself to ask for help. Recognise that you're anxious and practice relaxation techniques. Recognise that your sleep and eating habits are slipping and practice self-care.
If you don't change your behaviour at this stage and you live too long in the stage of emotional relapse you'll become exhausted, and when you're exhausted you will want to escape, which will move you into mental relapse.

Practice self-care.
The most important thing you can do to prevent relapse at this stage is take better care of yourself. Think about why you use. You use drugs or alcohol to escape, relax, or reward yourself. Therefore you relapse when you don't take care of yourself and create situations that are mentally and emotionally draining that make you want to escape.
For example, if you don't take care of yourself and eat poorly or have poor sleep habits, you'll feel exhausted and want to escape. If you don't let go of your resentments and fears through some form of relaxation, they will build to the point where you'll feel uncomfortable in your own skin. If you don't ask for help, you'll feel isolated. If any of those situations continues for too long, you will begin to think about using. But if you practice self-care, you can avoid those feelings from growing and avoid relapse.

Mental Relapse

In mental relapse there's a war going on in your mind.
Part of you wants to use, but part of you doesn't. In the early phase of mental relapse you're just idly thinking about using. But in the later phase you're definitely
thinking about using.

The signs of mental relapse are:
  • Thinking about people, places, and things you used with
  • Glamorising your past use
  • Lying
  • Hanging out with old using friends
  • Fantasising about using
  • Thinking about relapsing
  • Planning your relapse around other people's schedules

It gets harder to make the right choices as the pull of addiction gets stronger.

Techniques for Dealing with Mental Urges

Play the tape through.
When you think about using, the fantasy is that you'll be able to control your use this time. You'll just have one drink. But play the tape through. One drink usually leads to more drinks. You'll wake up the next day feeling disappointed in yourself. You may not be able to stop the next day, and you'll get caught in the same vicious cycle. When you play that tape through to its logical conclusion, using doesn't seem so appealing.
A common mental urge is that you can get away with using, because no one will know if you relapse. Perhaps your spouse is away for the weekend, or you're away on a trip. That's when your addiction will try to convince you that you don't have a big problem, and that you're really doing your recovery to please your spouse or your work. Play the tape through. Remind yourself of the negative consequences you've already suffered, and the potential consequences that lie around the corner if you relapse again. If you could control your use, you would have done it by now.

Tell someone that you're having urges to use.

Call a friend, a support, or someone in recovery. Share with them what you're going through. The magic of sharing is that the minute you start to talk about what you're thinking and feeling, your urges begin to disappear. They don't seem quite as big and you don't feel as alone.
Distract yourself.
When you think about using, do something to occupy yourself. Call a friend. Go to a meeting. Get up and go for a walk. If you just sit there with your urge and don't do anything, you're giving your mental relapse room to grow.
Wait for 30 minutes.
Most urges usually last for less than 15 to 30 minutes. When you're in an urge, it feels like an eternity. But if you can keep yourself busy and do the things you're supposed to do, it'll quickly be gone.
Do your recovery one day at a time.
Don't think about whether you can stay abstinent forever. That's a paralysing thought. It's overwhelming even for people who've been in recovery for a long time.
One day at a time, means you should match your goals to your emotional strength. When you feel strong and you're motivated to not use, then tell yourself that you won't use for the next week or the next month. But when you're struggling and having lots of urges, and those times will happen often, tell yourself that you won't use for today or for the next 30 minutes. Do your recovery in bite-sized chunks and don't sabotage yourself by thinking too far ahead.
Make relaxation part of your recovery.
Relaxation is an important part of relapse prevention, because when you're tense you tend to do what’s familiar and wrong, instead of what's new and right. When you're tense you tend to repeat the same mistakes you made before. When you're relaxed you are more open to change.

Physical Relapse
Once you start thinking about relapse, if you don't use some of the techniques mentioned above, it doesn't take long to go from there to physical relapse. Driving to the liquor store. Driving to your dealer.
It's hard to stop the process of relapse at that point. That's not where you should focus your efforts in recovery. That's achieving abstinence through brute force. But it is not
recovery. If you recognise the early warning signs of relapse, and understand the symptoms of post-acute withdrawal, you'll be able to catch yourself before it's too late.


Collaboration with Your Physician
The information in this website is meant to support your doctor-patient relationship and not to replace it. The information is NOT complete. You should ALWAYS consult your physician when making decisions about your health.
who we are
We are a Christian Charity providing assistance to individuals that seek help to overcome any form of addiction. (Alcohol, Drugs, Sex, Gambling, Overeating etc).

We also provide training to any organisation seeking to implement a recovery centre in their community.

Reg. Charity No. 1150229
contact us
RHM Recovery
Head Office
Selby Street Mission
Selby St
Hull
East Yorkshire
HU3 3PB

Telephone: (+44)7817035430
Email: office@rhm.org.uk
what we do
We provide addiction recovery help for anyone that is struggling in their battle to quit any kind of substance or negative behaviour.