19 Feb Post-Acute Withdrawal Syndrome
Post-acute withdrawal syndrome (PAWS) is a condition that frequently appears in alcoholics and drug addicts who stop active drug or alcohol use. It differs from the acute (short-term) forms of withdrawal that commonly occur when alcohol or drugs leave an addict’s body, and can occur intermittently for a period of months or years during addiction recovery. If left unaddressed, the symptoms of PAWS can seriously impair the recovery process and contribute to a return to drinking or drug use. People experiencing the syndrome can take a number of steps to ease its effects and increase their chances of remaining sober or drug abstinent.
The amount and frequency of drug or alcohol use required to produce addiction inevitably makes long-term alterations in the way the brain does its job. In particular, drug and alcohol addiction change the way in which the brain maintains its levels of chemicals called neurotransmitters, which travel between the brain’s nerve cells (neurons) and help form the communication network between these cells that allows the brain to work in an effective, coordinated manner. Important neurotransmitters affected by drug and/or alcohol addiction include substances called dopamine, glutamate and gamma-aminobutyric acid (GABA). Over time, substance-related increases in dopamine levels help foster the onset of addiction. Substance-related increases in glutamate levels speed up the communication rate between individual neurons to an abnormal degree and create a state of brain overexcitement. Substance-related decreases in GABA levels prevent the brain from slowing down the increased rate of neuron communication and limiting the effects of glutamate.
The level of neuron excitement created by substance-related glutamate increases makes the brain develop cravings for the substance in question. If those cravings aren’t fulfilled, excessive excitement in the brain will lead to the onset of short-term (acute) withdrawal symptoms in the addicted individual. Common examples of these symptoms include increased sweat output, sleeplessness, restlessness, anxiety, unusual muscle tension, involuntary muscle twitches or tremors, headaches, depression, social withdrawal, loss of mental clarity and concentration, nausea, vomiting, breathing problems, chest tightness, and diarrhea. Acute withdrawal from some substances can also produce serious or potentially fatal problems such as delirium tremens (in alcohol withdrawal) and respiratory failure (in cocaine withdrawal).
Post-Acute Withdrawal Syndrome Basics
Depending on the individual, the substance in question and the severity of addiction involved, acute withdrawal symptoms can last anywhere from roughly two days to two weeks. As its name indicates, post-acute withdrawal syndrome occurs in the aftermath of acute withdrawal. Factors that can contribute to its occurrence include continuing problems with excessive glutamate production and insufficient GABA production in the brain, the presence of serious addiction-related nutritional deficiencies, long-term alterations in the body’s ability to successfully cope with stress, and emotional inconsistencies associated with an emergence from substance-influenced states of mind.
Common symptoms of PAWS include ongoing cravings for the substance used during active addiction, absence of the normal capacity for pleasure, lack of drive or motivation, loss of normal emotional responsiveness, an unusual degree of emotional fragility, and variations of the symptoms that typically appear in people going through acute substance withdrawal. In the initial stages of the syndrome, these symptoms can vary in type and intensity over a matter of minutes or hours. As the recovery process continues, post-acute withdrawal symptoms commonly fade away for short periods of time before returning. In more advanced stages of recovery, symptoms of the syndrome may disappear for a period of weeks or months before reemerging. Eventually, the symptoms of PAWS stop altogether. It can take anywhere from a few months to one or two years before this process is complete. In some cases, it takes even longer.
Coping With PAWS
Doctors can treat recovering alcoholics suffering from post-acute withdrawal syndrome with a medication called acamprosate (Campral). This medication balances out the brain’s levels of glutamate and GABA, and thereby eases some of the underlying mechanisms that can contribute to PAWS. Medications that may ease the effects of the syndrome in recovering drug addicts include the antidepressant trazodone (Trazorel, Desyrel) and the anticonvulsant carbamazepine (Tegretol, Epitol). People who develop prominent cravings during post-acute withdrawal sometimes benefit from a form of psychotherapy called cognitive behavioral therapy (CBT). Additional steps that can ease the effects of the syndrome include correction of any nutritional deficiencies, maintenance of a balanced diet, regular participation in appropriate exercise, meditation breathing exercises and ongoing participation in some sort of 12-step program.
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