The symptoms of Post Acute Withdrawal Syndrome (PAWS) can cause a person in recovery from drugs or alcohol addiction to relapse. To help us understand PAWS and its connection with relapse, please find the following guest post by James F. Davis, CAS.

James Davis is a Board Certified Interventionist and an expert on Post Acute Withdrawal and the Kindling Effect.  He is also the founder of a rehab center in South Florida that focuses on PAWS treatment and is himself a recovering cocaine addict and alcoholic with more than 32 years of sobriety.  Davis also operates an extensive not-for-profit website dedicated entirely to sufferers of PAWS, PostAcuteWithdrawal.org

 

Why We Relapse: Post Acute Withdrawal Syndrome Explained by James F. Davis, CAS

If you’ve ever relapsed from drugs or alcohol, chances are that it was symptoms of Post Acute Withdrawal Syndrome that caused you to “fall off the wagon.” But chances are also great that throughout your course of addiction treatment, PAWS was never addressed. As a result, in your newly sober state you weren’t prepared to re-integrate with your community because you didn’t have the knowledge or the resources needed to properly manage PAWS symptoms and prevent relapse. Educating yourself in this regard could mean the difference between a successful recovery and a relapse episode that could cost you everything.

What is Post Acute Withdrawal Syndrome?

PAWS is a set of symptoms and impairments caused by prolonged substance abuse. These symptoms usually appear immediately after detoxification and last for less than one year for most people in recovery.

PAWS symptoms are largely the result of neurological and behavioral changes that occur when mind-altering substances are abused to the point of tolerance and physical/psychological dependence. According to Terence Gorski, a leading addiction expert and founder of the CENAPS approach to addiction treatment, PAWS is a long-term brain dysfunction that is largely reversible given sufficient time. (1)

Symptoms vary significantly from person to person and include sleeplessness, depression, headaches/migraines, tingling in the hands and feet, restless leg syndrome, irritability, mood swings, tinnitus, poor gross and/or fine motor skills, anxiety and other symptoms that can significantly impair a person’s ability to remain sober.

However, none of these symptoms are as persistent and compelling as the acute, illogical urge to use drugs or drink again despite severe consequences.

What Causes Post Acute Withdrawal Syndrome?

*Evolutionary Response

The human body is an astounding collection of evolutionary systems and adaptations. However, modern man has evolved scientifically, socially and philosophically much faster than natural evolution can account for. This means that sometimes, primordial, built-in evolutionary systems can backfire and cause significant personal and social disruptions.

In simple terms, the immediate and constant availability of drugs and alcohol was never factored into human evolution. Consequently, the brain still rewards and seeks to reinforce behaviors that “feel good” in an effort to goad us into repeating them; even if those behaviors negatively impact our health and social standing. This is because the brain and central nervous system interpret things that make us feel good as being necessary for survival. (2)

Drugs and alcohol make us “feel good” – albeit temporarily and at a huge cost – so the brain naturally wants us to repeat these behaviors. And repeat them, and repeat them. Unfortunately, science has not yet advanced sufficiently to “turn off” this evolutionary survival mechanism, but there are some treatments in development that may be close. For instance, some researchers believe they have developed a cure for meth addiction: http://safedrugdetox.org/is-there-a-cure-for-meth-addiction/.

*Conditioned Response

The case of Ivan Pavlov’s drooling dogs demonstrated that animals can be conditioned both psychologically and physiologically. (2) Pavlov was a brilliant Russian physiologist who earned a Nobel Prize for his work in 1904; a significant portion of which was based on research focused on dogs.

Pavlov initiated an audio or visual cue just prior to feeding the dogs used in his research. When applied consistently, this resulted in salivation – the dogs responded to the cue and food physiologically by drooling. However, with consistent application of this technique the dogs soon began to drool when the cue was initiated – even if food was not subsequently presented.

Pavlov called the behavior exhibited by the drooling dogs “conditioned reflex,” and his research has since taught us a great deal about human behavior. For instance, the same principles of conditioned reflex can be applied to PAWS.

Consider the cocaine user who follows a similar drug abuse routine. In time the routine becomes a series of “cues” that later – in sobriety – may act as a trigger that causes a relapse episode. Seeing an old drug-using friend, hearing a specific song, going to an environment associated with drugs or alcohol, smelling a scent that was often prominent while using drugs such as patchouli, butane, baking powder, etc; all of these are cues associated with the Conditioned Response to drug addiction.

Fortunately, conditioned response is mostly temporary. Considering that the original behaviors associated with substance abuse led to the conditioned response, there is hope for people in recovery in that new behaviors can be learned and practiced and thereby replace the old.

*Physiological/Neurological Response

Just as Pavlov was able to quantify conditioned reflex, PAWS can be measured through brain scans (3). The process of becoming addicted to a substance results in the disruption of important neurotransmitter systems throughout the human body, and this is clearly evident when viewing before-and-after brain scans of drugs users.

In simple terms, prolonged drug abuse changes the human brain.

Most of the changes occur at the neuronal level and in the central nervous system. Changes are often reversible in time, but it is unclear if the brain ever returns to its 100% original state.

Alterations, damage and change in neurons, neurotransmitters and nerve networks cause a reduced ability to manage stress of all types, resulting in many of the classic symptoms of PAWS. Additionally, neurons and other brain functions that were once suppressed through drug use may become overly excited or depressed, resulting in a number of uncomfortable physical symptoms such as headache, insomnia, poor motor skills (dry drunk) and tinnitus.

Treatment for Post Acute Withdrawal Syndrome

The science behind PAWS might cause some to feel hopeless, but there is much to be optimistic about, as PAWS can be managed, reduced and eliminated with a variety of different treatments. These treatments cover a diverse selection of therapies ranging from individual counseling to biofeedback therapy to massage, medication, acupuncture, diet & exercise, emotional intelligence coaching, music and many other methods of directly treating PAWS symptoms.

To learn more about treatment for PAWS, check back to BreakingTheCycles.com for the next installment in this series, which will expand in detail on the various treatment types available to people in recovery.

_________________________________

Sources:

(1) Gorski, Terence T.  Best Practice Principles In The Treatment Of Substance Use Disorders  GORSKI-CENAPS Web Publications  05/08/2003  http://www.tgorski.com/clin_mod/best_practices/Gorski%20Best%20Practice%20Standards%20010508.htm

(2) Durrant R, Adamson S, Todd F, Sellman D.  Drug use and addiction: evolutionary perspective.  Aust N Z J Psychiatry. 2009 Nov;43(11):1049-56. doi: 10.3109/00048670903270449.  Institute of Criminology, School of Social and Cultural Studies, Victoria University of Wellington, Wellington, New Zealand  http://www.ncbi.nlm.nih.gov/pubmed/20001400

(3) Ivan Pavlov – Biographical  NobelPrize.org  [From Nobel Lectures, Physiology or Medicine 1901-1921, Elsevier Publishing Company, Amsterdam, 1967] As published on: http://www.nobelprize.org/nobel_prizes/medicine/laureates/1904/pavlov-bio.html

(4) Gorski, Terence T.  WHAT IS THE POST ACUTE WITHDRAWAL (PAW) SYNDROME?  Focus Treatment Centers 04/11/2013  http://focustreatmentcenters.com/what-is-the-post-acute-withdrawal-paw-syndrome/