What Are Protracted Withdrawal Symptoms?

When someone has been using drugs or alcohol for a long period of time, stopping use can lead to withdrawal symptoms. Sometimes withdrawal symptoms can linger for months or more, which is called protracted withdrawal. If you are starting your recovery journey, it’s important to understand protracted withdrawal symptoms and how to manage them so that you can avoid relapse.

Acute Vs. Protracted Withdrawal

Acute withdrawal occurs almost immediately after substance use stops and can be very uncomfortable and even dangerous depending on the substance used. Symptoms vary by substance, and usually last from a few days up to two weeks. Acute withdrawal occurs because of brain changes that occur during active addiction. The brain has adapted to the substance and has come to expect it, so when use stops, the brain has to readjust, which leads to withdrawal symptoms.

Protracted withdrawal, sometimes known as post-acute withdrawal syndrome (PAWS), is when some of the withdrawal symptoms linger for more than two weeks, even lasting up to a few years. This occurs most often in the case of severe, prolonged addiction. This is because the brain changes that occurred due to substance use are more significant, making it take longer for the brain to readjust.

Acute Withdrawal Symptoms

Acute withdrawal symptoms vary by substance. Here are some examples.

Alcohol

• Shaking
• Increased heart rate
• Sweating
• Nausea or vomiting
• Irritability
• Insomnia
• Restlessness
• Agitation
• Nausea
• High blood pressure
• Cold sweats
• Hallucinations
• Seizures
• Delirium Tremens

Benzodiazepines

• Anxiety
• Agitation
• Sweating
• Increased heart rate
• Insomnia
• Hand tremors
• Hallucinations or other perceptual disturbances
• Seizures
• Delirium
• Rhabdomyolysis

Opioids

• Chills and fever
• Nausea, vomiting, diarrhea
• Achiness
• Anxiety
• Elevated heart rate
• Dilated pupils
• Sweating
• Insomnia
• Intense cravings

Cocaine

• Agitation
• Restlessness
• Depression
• Slowed movements
• Fatigue
• Increased appetite
• General sense of discomfort
• Nightmares

Protracted Withdrawal Symptoms

Protracted withdrawal symptoms also vary by substance. Examples are:

Alcohol

• Anxiety
• Depression
• Hostility
• Irritability
• Mood swings
• Insomnia
• Fatigue
• Difficulty concentrating
• Decreased sex drive
• Unexplained aches and pains

Benzodiazepines

• Anxiety
• Restlessness
• Insomnia

Opioids

• Anxiety
• Depression
• Sleep disruptions
• Fatigue
• Irritability

Cocaine

• Mood swings
• Fatigue
• Insomnia
• Cravings
• Difficulty concentrating

Treating Protracted Withdrawal

Treatment for addiction starts with medically supervised detox for acute withdrawal. This may include medications to manage the symptoms. After acute withdrawal, protracted withdrawal symptoms will be addressed if necessary. Often, medications such as antidepressants are used to help stabilize mood. For opioid withdrawal, naltrexone, methadone, or buprenorphine may be prescribed.

These medications may be prescribed long-term to help with protracted withdrawal and to help prevent relapse.

However, medications are only a part of treatment for addiction and protracted withdrawal. In treatment, which ideally should start with a 30 to 90 day inpatient program, you’ll receive intensive therapy.

The type of therapy most commonly used in addiction treatment is cognitive behavioral therapy (CBT). CBT teaches you to recognize your irrational thoughts and negative emotions and to challenge them using more realistic, positive thinking. It also teaches healthy coping skills to help you face challenges without substances. These skills can also help you to deal with your protracted withdrawal symptoms.

Most of the CBT will occur in group therapy. Group therapy is critical to the treatment process, giving you the opportunity to learn more about the nature of addiction, and to share emotions, experiences, and challenges with peers.  You’ll likely form mutually supportive relationships with some of these peers which may last beyond treatment. This can be extremely valuable in dealing with protracted withdrawal. You’ll have a support system of people who can share their strategies with you and provide a sounding board when you’re struggling.

Lifestyle Tips to Manage Protracted Withdrawal Symptoms

Certain lifestyle changes can help you to manage protracted withdrawal symptoms and support your recovery in general.

Exercise

Exercise is a natural mood booster, so working it into your schedule every day can help to manage anxiety, depression, stress, and mood swings. It’s also a healthy way to fill your time and distract yourself from cravings. It doesn’t have to be intense exercise. You can just go for walks in your neighborhood or at a local park. Being in nature can also help to relieve stress and improve your mood.

A Healthy Diet

Eating a healthy diet can keep your blood sugar stable, which helps with mood control. Eat regular meals at the same time every day, and focus on lean proteins, fruits and vegetables, whole grains, and healthy fats. Avoid sugar and processed foods. A healthy diet will also increase your overall sense of well-being, which can prevent cravings.

Sleep

Good sleep is also important for your overall well-being. Have regular sleep and wake times and aim for seven to nine hours. It’s also good to have a relaxing bedtime routine that will help you get to sleep. If you suffer from insomnia, you can try supplements like melatonin or speak with your doctor about other solutions.

Support Groups

Support groups like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) can be very helpful to support your recovery. It’s a way to stay connected with peers and to have a safe place to share your struggles and challenges.

Ongoing Therapy

If you are really struggling, going to individual therapy on a regular basis for the long-term can help to keep you on track. It will reinforce your coping skills and give you a dependable place to receive support.

In Closing

Protracted withdrawal symptoms do not have to impede your recovery. They can be treated and managed both in the short term and long term. The first step is to seek treatment in a facility that understands the challenges of protracted withdrawal.

At Bridges of Hope, we understand the challenges of addiction and recovery and are here to help with many treatment options and support resources. We are committed to providing comprehensive, compassionate care so that you can achieve the recovery success that you deserve. Give us a call today to learn more.