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What do you do if your withdrawal symptoms don’t end when they’re supposed to?

Well, firstly, know that protracted withdrawal are normal and they will pass in time …you will get better eventually!

But when you’re unprepared and you get blindsided by symptoms that just won’t quit – or by symptoms that come back even months after you think you’re in the clear, it’s easy to get discouraged and relapse back to drinking or drug use.

So get prepared - read on to learn more about the second phase of the withdrawal process, something that can last for many months or even years after your quit date – and be ready to make it through to the other side.

Acute vs. Protracted Withdrawal

Acute Withdrawal

When you suddenly stop using a drug you’ve become addicted to you experience a brief period of generally unpleasant withdrawal symptoms.

The time frame can vary a bit, but in general, acute withdrawal will endure:1

Substance Acute Withdrawal Timeframe
Alcohol 5 to 7 days
Benzodiazepines 1 to 4 weeks; 3 to 5 weeks with tapering (i.e., reducing dosage gradually)
Cannabis 5 days
Nicotine 2 to 4 weeks
Opioids 4 to 10 days (methadone withdrawal may last 14 to 21 days)
Stimulants (e.g., amphetamines, methamphetamine, cocaine) 1 to 2 weeks

 

Acute withdrawal symptoms should largely disappear by the end of the predicted withdrawal duration.

Protracted Withdrawal (Post Acute Withdrawal Syndrome - PAWS)*

So withdrawal symptoms are supposed to end at the end of the acute withdrawal period – but sometimes they don’t!

When your withdrawal symptoms continue on for longer than they’re supposed to and/or when you also start experiencing more general (non-substance specific) withdrawal symptoms that persist for longer than the acute withdrawal period - you are in protracted withdrawal.

* Another common name for protracted withdrawal is post acute withdrawal syndrome (PAWS).

Does Everyone Get Protracted Withdrawal Symptoms?

No.

  1. Some people experience no withdrawal symptoms after the end of the acute withdrawal phase
  2. Some people find that acute withdrawal symptoms last for far longer than they’re ‘supposed’ to
  3. Some people feel a lot better at the end of the acute withdrawal period and then a month or two later withdrawal symptoms come back, as if out of nowhere

Common Protracted Withdrawal Symptoms

Not everyone will go through protracted withdrawal and individual symptoms will vary depending on the drug(s) of abuse, your physical and mental health and other factors.

But that being said, some common protracted withdrawal symptoms include:2

  • Insomnia and other sleep problems
  • Chronic fatigue
  • Irritability
  • Anxiety
  • Anhedonia (an inability to feel pleasure, or as much pleasure as you used to)
  • Short term memory problems
  • Drug or alcohol cravings
  • Concentration problems
  • Depression
  • Aches and pains
  • A loss of libido

Why Do You Get Protracted Withdrawal Symptoms?

When you use drugs or alcohol for a long time your brain changes (an adaptation) and researchers can see these changes at the molecular and cellular levels and through changes to neurocircuitry (how the brain communicates).

These changes can affect your emotions, thinking capabilities and ability to resist impulses, and it can take a long time for your brain to revert back to a pre-addiction state of functioning.

Basically – through a long period of heavy use you induce some significant changes to your brain’s structure and functioning, so it’s not totally surprising that your brain needs a few months or longer to get back to normal!

Getting Through Protracted Withdrawal

Even if there is full recovery from the withdrawal symptoms, the actual devastation to a person's life during a long withdrawal, lasting for months, can be ruinous. 

What's more, protracted withdrawal increase your risk of relapse – so to keep your recovery on the right track, even when passing through the doldrums of post acute withdrawal symptoms, make sure to:3

Understand that things will get better – Though it may seem like you’ll never feel like your old self again, even protracted withdrawal will pass and in time. Understand that brain healing occurs slowly, but surely, and with patience and perseverance you will make it through.

Maintain good sleep habits – Since protracted withdrawal can lead to sleeping problems and sleep deficits can lead to relapse it’s important to make a good night’s sleep a priority. If protracted withdrawal has you tossing and turning, lean more about good sleep hygiene and habits and make a few simple but effective changes to improve your odds of a restful night’s sleep.

Stay involved with community support groups (like AA) – The support, encouragement and knowledge you find at community mutual self help groups can help you to stay on the right track and to identify dangerous habits before the pull you down to relapse. At community meetings, you’ll also get advice and encouragement from a group of people who understand exactly what you’re going through.

Stay active – Exercise relieves stress, increases positive emotions, promotes healthy sleeping and helps distract you from triggers and cravings…all in all, exercise is a must-do

Reduce stress – Getting through the initial recovery period is tough enough, so give yourself some room to breathe by minimizing your outside commitments and responsibilities for a while. This way you can take care of the most important thing…yourself.

Consider medications – Certain medications, like acamprosate for alcohol and methadone or Suboxone for opiates, can alleviate some or all of the protracted withdrawal symptoms you may experience. Talk to your doctor or therapist about the pros and cons of adding medications to your recovery program.

Consider therapy – certain therapies, like cognitive behavioral therapy, teach skills that help you to compensate for the diminished cognitive functioning and poor impulse control that are typical to many recovery efforts.

Warnings and precautions about protracted withdrawal must be part of any pharmacological treatment plan. Don't go through protracted withdrawal without medical support.

References
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Page last updated Jan 29, 2016

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