Post Acute Withdrawal

How Long Do Cravings Last After You Stop Using?

“I still have strong cravings to use, so my question is, does it get easier with time and treatment, or will I feel like this forever?”

The cravings that you feel should moderate soon.  It would be nice to be able to give you a simple yes or no, but you need to know a bit about what addiction actually is before you get our answer.

Drugs (including alcohol) make us feel good by imitating or increasing the levels of chemicals in the brain that act on the brain’s reward center. Different drugs do it in varied ways, but the overall effect is to overstimulate that part of the brain that gives us pleasurable sensations.

When over-stimulation occurs, our bodies try to bring things back into balance by reducing the natural production of those chemicals (neurotransmitters). Often, when the drugs wear off, we feel uncomfortable until the natural production of the chemicals resumes. We call this period of withdrawal a “hangover.”

With continued presence of the drugs, the body takes further steps: it begins to increase the number of receptor sites for the specific neurotransmitters in order to use up the surplus. Because of this, continued drug use causes “tolerance.” We need more of the drugs to fill up those extra hungry receptors, and we begin to feel uncomfortable when we don’t have them present in our bodies, or if they are present at too low a level. The process of addiction has begun.

Further drug use doesn't only increase the receptor sites. In its attempts to bring things back to normal, the brain slows production of the natural neurotransmitters. That means that when we stop the drugs, there are insufficient natural neurotransmitters, and we feel cravings and other symptoms of acute withdrawal. These vary, depending on how the drugs affected us to begin with, but they are generally the opposite of however we felt when we were using.

These feelings are most acute during the time the drugs are leaving our bodies, and begin to subside within days. However, the fun isn’t over. As George Carlin said, “Just because the monkey’s off your back, it doesn’t mean the circus has left town.” We will continue to feel discomfort until the body has shut down the extra receptor sites so that they are no longer begging for drugs, and until the natural production of neurotransmitters has resumed. This can take several months, and is referred to as Post-Acute Withdrawal.

Many authorities believe that the extra receptor sites just shut down, and don’t go away. They believe that they can easily be re-activated if drugs are reintroduced into the body.  That certainly seems to fit what we observe in real life.  That’s why we recommend abstinence. In most addicts, any drug use seems to slow and soon reverse the recovery process.

Because of this continued potential for discomfort, if we don’t take care of ourselves physically and mentally during the post-acute period, our risk of relapse is high. However, the discomfort tends to come and go, with good days and bad. Eventually the good days become more common, and the bad ones tend to occur less often and with reduced discomfort, until things are more-or-less back to normal.

You can most certainly look forward to a time when you no longer have the cravings, and those that you have will begin to ease off within a few more days. If you stay clean, eventually the discomfort will disappear entirely. Naturally, as addicts we want to feel better immediately, but it doesn’t work that way. We spent months or years getting our bodies used to drugs, so it’s hardly surprising that it takes quite a while to get over the effects.

Another Letter From A Suffering Alcoholic

“Sunrise” just wrote:

I am 2 1/2 months sober from alcohol. I found this article after sitting here at the computer, feeling horrible for my over reactions . I was sitting down crying feeling like a drink and scared I was actually going to go and get some wine. I was so shocked at my over reaction towards my husband being late taking my daughter to soccer practice , that I stood in stunned silence when they left the house. I prayed, and started to search the web and found this article about PAWS. I am a 44 year old women who is also dealing with early menopause, so I am not sure what is happening to me. my brain seams to be all jumbled and I cannot remember things. I get stressed over really anything extra in my life. So thank you for this article….I will continue to reread it and most importantly reach out to people and not isolate myself. I do not want to drink!
I guess this must be my “peak” time between the 3-6 month period?

I replied: [Read more…]

The Effects Of Pot Can Linger A Long Time After Getting Clean

I get a lot of letters on a personal site regarding an article I wrote about Post Acute Withdrawal Syndrome (PAWS).  It’s one of the primary causes of relapse, and a subject that is poorly-covered in a lot of treatment facilities.  Because there's also very little about it on the Internet, the article gets a lot of traffic.

PAWS refers to a collection of symptoms, related to the use of alcohol and other drugs, that continue for quite some time after we get clean and sober.  It’s too complex to go into in detail here, but suffice it to say that it can be the cause of a lot of discomfort and — if not dealt with constructively — can often lead to circumstances where it seems as though we might as well use, since we’re so miserable anyway.

I bring this up because I ran across another article, rhapsodizing about the benefits of smoking marijuana, that totally ignored the downside.  I find that extremely annoying.  While it may be true that it is no more harmful than alcohol, that’s begging the issue since alcohol can be horribly destructive.  So I offer the following letter for your consideration, along with my reply. [Read more…]

PAWS Can Smack You Upside The Head If You’re Not Ready For It

You can hang around recovery groups for a long time without hearing people mention PAWS, or Post Acute Withdrawal Syndrome.  That's too bad, because it is one of the major causes (if not the major cause) of relapse in the first couple of years. Without getting into a lot of detail here, let's talk about PAWS for a little bit.

Addiction occurs because physical changes take place in our brains when we use drugs.  They cause us not only to crave greater amounts of drugs, but also to need the presence of the drug to keep from getting sick (withdrawal). The symptoms of withdrawal vary, depending on the drug, but they are generally comprised of feelings and physical symptoms that are more-or-less the opposite of those caused by the drugs themselves.

These symptoms begin within a few hours of quitting the drug, and last for several days to about three weeks, depending on the specific drug or drugs that were used. Taken together, they make up acute withdrawal. That's what we deal with in detox.

Post Acute Withdrawal occurs after the acute phase and can last for up to two years, off and on, in “waves.” Why so long? Well, we exposed our brains to drugs for a long time, and it took quite a while for our brains to become completely used to them. Doesn't it make sense that it takes our brains quite some time to recover?

The difficulty is that we addicts have taught ourselves that it's not OK to be uncomfortable. We know just how to deal with unwanted emotions and physical discomfort: we use drugs. The discomfort of PAWS can lead us to make some bad decisions, because much of it occurs in parts of the brain where we can't just “think” it away. That's why “Just Say No”…Just Doesn't Work, and it's the reason for a lot of relapses.

It's also the reason that long-term maintenance with Methadone or Suboxone is problematic.  Since the addiction is constantly fed, and since physical recovery never really begins, we still have months of PAWS to deal with when we finally do try to get off the maintenance.  Without proper support, we may find that to be more than we can handle.

PAWS is best dealt with by getting plenty of rest, eating well, watching our intake of sweets, taking a couple of multivitamins a day, exercising, going to meetings, and hanging out with our supports. It doesn't have to be the end of our sobriety, especially if we know it's coming and are prepared to accept it and get through to the other side.

If you're interested, you'll find more information about Post Acute Withdrawal Syndrome here.