It’s a common misconception that after detox and withdrawal, life returns to “normal,” when in reality, detox is merely the first step toward recovery, not the solution.

There are two phases of the withdrawal process. After detox, the second phase of withdrawal sets in: post acute withdrawal (PAW). In this phase, a combination of prolonged symptoms can persist for weeks or even months after all physical traces of drugs or alcohol have been cleansed from the body.

Post-acute withdrawal symptoms (PAWS) can affect anyone in the early stages of sobriety, but they’re known to be particularly persistent among people who have used opioids for extended periods of time. PAWS include:

  • Fatigue
  • Inability to focus
  • Memory problems
  • Sleep problems
  • Decreased appetite
  • Anxiety
  • Irritability
  • Anger
  • Depression

How Addiction Affects the Brain & Body

Addiction alters the brain’s reward circuit, and in turn, its ability to handle stress. Over time, the brain gradually stops producing endorphins, making it difficult to experience pleasure without the substance.

In the earliest stages of sobriety, the brain’s levels of endorphins and dopamine are at an all-time low. A certain amount of dopamine, the chemical that produces euphoric highs, is necessary to feel “normal.” Once the brain’s supply is depleted, it can lead to a chemically-induced depression, and it can take anywhere from 4 weeks to 6 months for the brain to replenish its supply of endorphins and dopamine.

Addiction also compromises the nervous system, which includes the autonomic nervous system (ANS), which stimulates the body’s fight-or-flight response. In active addiction, fight-or-flight responses occur automatically and the body prepares by initiating hypervigilance, increasing heart rate and blood pressure, and dilating pupils.

It takes time for the mind and body to re-adjust to life without substances. Post-acute withdrawal is an uncomfortable, difficult phase of recovery, but it’s temporary–and necessary to achieve permanent sobriety.

Post-Acute Withdrawal & Relapse

In active addiction, these physical responses create a state of chronic stress, which is exhausting and continues during PAW until the body naturally resets over time. This makes the early stages of recovery that much more fragile. People who are new to recovery are already dealing with higher levels of stress and an inability to cope with it, and the stressful circumstances of early recovery and PAWS lead to even more stress.

Post-acute withdrawal often leads to relapse, even among people who truly want to stay sober. It’s a common and frankly dangerous misconception that once a person stops drinking or using, their life automatically “gets better.” When recovery fails to immediately meet those unrealistic expectations, the disappointment and discomfort can be debilitating.

It’s important to remember that post-acute withdrawal is temporary. Getting through it is challenging, but it does get better and symptoms will eventually subside. Engaging in treatment that eases symptoms and counseling that builds awareness of the obstacles in front of you helps many people overcome this phase of the recovery process.

Immersion Recovery Center’s recovery programs have helped thousands of men navigate the challenges of detox, withdrawal and early recovery. For more information about how our evidence-based services and holistic modalities can help you or someone you love recover, contact a Recovery Specialist at 561.419.3349.