Going from addiction to sobriety is best thought of not as an event, but as a journey.
Initially, the focus of attention is on rehab: Is rehab really necessary? If so, what kind and for how long?
Rehab is thought of as the place where people get sober and turn their lives around, and this is true. It’s also true that the recovery process continues for several months after leaving an addiction rehab center.
This is why it’s so important to select a drug and alcohol treatment center that has an addiction recovery program that is designed to help clients learn how to manage their mental and emotional state through the period known as PAWS.
What Is Post-Acute Withdrawal Syndrome (PAWS)?
Post-Acute Withdrawal Syndrome (PAWS) refers to the lingering mental and physical symptoms of addiction that can persist long after the acute (severe) withdrawal symptoms have worn off.
Symptoms of PAWS can include:
- Mood Swings – experiencing emotional extremes, such as overreaction or apathy, often in an unpredictable manner
- Emotional Sensitivity – anxiety, irritability, etc.
- Difficulty with Thinking and Memory – trouble concentrating, difficulty thinking abstractly, getting caught up in circular thinking, short-term memory problems
- Sleep Disturbances – trouble falling asleep or staying asleep, nightmares, fluctuations in sleeping habits
- Variable Energy – sometimes very active and prone to boredom, other times experiencing low energy and low enthusiasm
- Problems with Physical Coordination – dizziness, balance problems, poor hand-eye coordination, slow reflexes
- Sensitivity to Stress – The emotional roller coaster of the other PAWS symptoms make a person more easily triggered by stress, which can lead to extreme reactions.
For example, bouts of sadness or depression during recovery are not necessarily an indication of long-term clinical depression, but are most likely due to a natural imbalance in the body and brain. Recovery programs like the one at Elevate are designed to ease the intensity of these symptoms until balance is restored.
In the early stages of recovery, PAWS symptoms may come and go frequently – within minutes or hours. As time goes on, PAWS symptoms may appear to go away completely – but then return with a vengeance a few weeks or months later. Post-acute withdrawal episodes typically last for a few days before subsiding again.
What You Don’t Know Can Lead to Relapse
People know to expect acute withdrawal symptoms when they first enter rehab, but they can be caught off guard by post-acute withdrawal symptoms because the thinking might be, “I went to rehab, so I should be better now.”
And then when problems come up again, it’s easy to think, “Maybe there’s more stuff wrong with me. Maybe sobriety isn’t possible for me.”
Such thinking can easily lead to relapse. That’s why it’s important to:
- Understand that PAWS is normal and that it is temporary.
- Know how to recognize and manage the symptoms of PAWs.
Those in recovery who have experienced PAWS often report that they were “a mess” in the first months after quitting their substance of choice. It’s normal for your mental and emotional state in early sobriety to be “all over the place.” This is why Elevate’s early recovery therapies are so focused on your mental state and helping you become confident in your ability to manage whatever you’re going through.
It is often difficult for those in recovery to distinguish between what is permanent mental or physical damage from drug and alcohol use and what is just a symptom of early recovery related to natural responses from the brain and body. With the support of caring therapists and counselors, you can learn how to recognize PAWS symptoms when they happen, and manage them so that they don’t derail your hard-earned sobriety.
How to Manage PAWS Symptoms
The recommendations for managing PAWS symptoms in order to prevent relapse fall into three major areas:
- A Circle of Support – the people around you who support and guide you
- Healthy Expectations – your internal way of dealing with what is going on
- Healthy Activities – things you can do to manage symptoms and deal with triggers
A Circle of Support
Surround yourself with trusted people. This can include therapists, counselors, peer mentors, sober friends, clergy, family members, etc.
The most important qualities to look for in your support are people who:
- Have compassion and respect toward you and your situation. Avoid people who judge, criticize or downplay your concerns.
- Are good listeners.
- Give solid feedback and advice based on what is best for you, not what they want from you.
- Genuinely care about your well-being and support you in achieving your goals.
- Understand addiction and recovery, at least to some degree.
When you experience PAWS symptoms, reach out to people in your circle of support to:
- Talk about what you’re experiencing and share your feelings and concerns about addiction and rehabilitation.
- Verify the accuracy of how you’re viewing a particular situation that is upsetting you. Do they think you’re over- or under-reacting? Ask for a reality check.
- Analyze the situation that led to the PAWS symptoms and create a plan for dealing with similar circumstances in the future.
Don’t panic when PAWS symptoms return. Know that they will be around for a few days, and then disappear as quickly as they came. Make adjustments in your life as needed to ride out this temporary period, and call upon your support people to help you weather the storm.
Cultivate acceptance of the situation and of yourself. Harboring resentment about the situation will cause you to focus on how bad your situation is and cause further upset, which could lead to poor decisions. Allow yourself to feel what you feel, and then let the feelings pass on.
Embrace living in the moment and be flexible. Enjoy the good days. On bad days, adjust your plans to accommodate what you’re going through. Don’t hold yourself to unrealistic expectations.
Be gentle with yourself. Practice self-care both physically and psychologically. Make sure that you’re getting plenty of sleep, eating nutritiously, have healthy ways to relax, and aren’t working too much. Do the best you can with whatever you’re dealing with at the moment, and accept that this is enough. Know that your capabilities will fluctuate during this period, and that’s OK.
Keep your plans modest. Expect this period to last for up to two years. Know that you will need days off and to avoid stress. Don’t get too ambitious with your goals. What counts as “too ambitious”? Ask someone from your support circle who has experience with addiction recovery to help you set realistic expectations.
Don’t over-analyze. Look for things that trigger the return of a PAWS episode, but don’t worry if you can’t identify the cause. Sometimes there is a clear trigger and sometimes there isn’t.
Practice patience. You can’t rush the recovery process. Be open to taking it one day, one hour, one minute at a time if necessary.
Find healthy physical outlets for your feelings. This often includes activities such as exercise, yoga, sports, etc. Even “bad” feelings like sadness and anger can be safe to experience when you have an acceptable way to channel and relieve those feelings so you can move on from them.
Prepare your go-to ways of relaxing and alleviating boredom. Stress and boredom are two of the major threats that can lead to relapse. Have multiple things you can do – activities you truly enjoy – whenever things start to get overwhelming or if you think about going back to substance use.
An Addiction Treatment Philosophy Focused on Mental Wellness
Although it may be disheartening to learn that you won’t be 100 percent cured after leaving rehab, it’s important to keep in mind that two years is still a short amount of time compared to the rest of your life.
At Elevate, we have designed our addiction rehabilitation and recovery program to include holistic approaches that assist in short-term treatment of the emotions and physical symptoms that often confuse or frighten people in their first experiences with sobriety. Furthermore, our addiction rehab specialists educate clients on how to manage their PAWS symptoms going forward.
Our inpatient addiction treatment program is offered for up to 90 days – much longer than you’ll find at most other facilities. We also provide a robust addiction aftercare program so that clients can continue to receive the addiction help and support they need after they leave our campus.