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post-actute withdrawal syndrome

Not progressing as fast as you’d hoped? Post-acute withdrawal symptoms

Blenheim’s Medical Director Dr. Matthew Johnson talks about what Post-Acute Withdrawal Symptoms or PAWS is, and how it can be treated.

Changing our drinking is deceptive. We know it is bad for us, and we have had enough of the draining hangovers. We have taken the courageous step to say enough is enough: I am cutting down or taking some time off!

But then when you, do you feel worse. Get a cold, crave water, desire sleep… Surely the idea was to feel better? You may have been hit with something known as post-acute withdrawal symptoms.

Just like reducing the use of any drug (from coffee to heroin) you are likely to feel the effects of stopping using it. As alcohol affects so many bits of you (from the brain to your metabolism) the effects of withdrawal are many and varied, and can also depend on how much you were drinking and your own physiology.

It’s complex stuff so we have teamed up with Blenheim CDP, a leading charity that are experts at working with people with alcohol and substance misuse, to write this blog.

What is post-acute withdrawal symptoms?

We are used to seeing scenes of people in ‘recovery’. Most of us know or have seen in films or on the TV someone in the grips of addiction going cold turkey and experiencing delirium tremors*. The symptoms of withdrawal from any substance can be very unpleasant (alcohol is one of the most dangerous drugs to detox from) and last much longer than a few days; in fact, withdrawal symptoms can last for a couple of years. Regardless of how much you drink, and whether your goal is currently cutting down or quitting, you may still feel withdrawal symptoms which can explain why you may not be feeling as perky as you hoped!

Two stages of post-acute withdrawal symptoms from alcohol

 There are two stages of alcohol withdrawal; the acute withdrawal phase and the post-acute withdrawal (PAWS) phase. The first phase, the acute stage, can last several weeks after stopping drinking; however, PAWS can last up to two years.

The first stage is characterised by much more physical symptoms which can be very severe, even life-threatening, but which usually start to ease off after a week or two. So if you are dependent on drinking this is a really important time to get some help. If you feel you need a drink when you wake up in the morning, get shakes when you are not drinking, then look here for your local specialist providers.

The second stage of post-acute withdrawal symptoms tends to be less severe but can be equally as challenging, dominated by more psychological symptoms and they can last a while – increasing your ambivalence about alcohol and make you wonder why you stopped in the first place – which can challenge your resolve!

It takes time for your brain to repair

The brain has a tremendous capacity to heal but this is not a quick process. When alcohol is consumed it affects the levels of neurotransmitters in the brain, adjusting the way it functions and causing it to become tolerant of and primed for alcohol. If you stop drinking, the brain has to readjust and find a new balance and it is this lag time which contributes towards post-acute withdrawal symptoms

Alcohol-related nutritional deficiencies, long term-alterations to the body’s ability to cope with stress, and emotional inconsistencies due to spending large amounts of time intoxicated and suppressing feelings are also contributions.

PAWS symptoms usually peak around four to eight weeks after cutting out booze – so whilst some people may be dancing around about the joy of being alcohol-free, you may still feel like you want to hide under the duvet. But stay strong, your body is moving towards a new balance and functioning within a normal range!

Things you may feel after quitting the bottle

Whilst individual experiences vary, some of the most commonly reported symptoms include:

  • Attacks of anxiety
  • Irritability
  • Sudden mood swings
  • Fatigue
  • Lack of motivation
  • Insomnia
  • Inability to concentrate
  • Obsessive thoughts
  • Fluctuating energy levels
  • Memory loss
  • Difficulty in solving problems and thinking clearly
  • Depression.

Symptoms can differ in intensity and they can come and go

So if you are feeling off-par you could be feeling any of these things to a different degree. The important thing is that it is not unusual!

Post-acute withdrawal symptoms can vary in type and intensity over a matter of minutes or hours, and emotional turmoil is normal. As your healing process continues, PAWS symptoms usually fade away for short periods of time before returning.

As time passes, the frequency and duration of the symptoms will gradually reduce, as a result of the brain slowly reorganising and rebalancing itself.

What can you do?

  1. Eat a balanced diet and take nutritional supplements as prescribed by your GP.
  2. Get Moving: Regular exercise is beneficial for both physical and mental well-being and is, therefore, a good idea.
  3. Meditation and breathing exercises are a great way to manage stress, improve concentration, and promote relaxation.
  4. Staying close to the Club Soda community will also help. You are not alone in feeling this way. We know what you are going through and will share advice and tips.
  5. Do talk to your GP – they can refer you to services that can help, such as cognitive behavioural therapy (CBT). It helps you manage your problems by changing how you think and behave, by breaking down problems that feel overwhelming into smaller parts, helping you have more control over your problems. A medication called Acamprosate (Campral) can also be prescribed to you by a GP to help with the effects of post-acute withdrawal symptoms. This medication balances out the brain’s levels of glutamate and GABA, and therefore eases some of the underlying mechanisms that can contribute towards PAWS. Your GP may also discuss and prescribe anti-depressants to ease some of the effects of PAWS.
  6. Read a book! From other people’s stories to books on CBT and diet – learning about the process your body is going through will arm you with the knowledge you need to keep you on track to your goals.

* Delirium tremens (DTs) is the rapid onset of severe withdrawal symptoms, usually occurring two to three days into detox. The symptoms may include visual and auditory hallucinations, shaking, shivering, and sweating. Alcohol is one of the most dangerous drugs to detox from.

You can find more information including factsheets and details of free and confidential alcohol services in London on Blenheim’s website.

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