Relapse is when a person in recovery or abstinence from alcohol or other drugs use disorders starts drinking or using again.

I discuss five reasons people relapse after years of sobriety in my post of this same name. These include:

• Not understanding the basics of how the brain works
• Not understanding relapse is a hallmark of this brain disease
• Not treating the entry points to this disease nor understanding what constitutes effective treatment
• Not understanding the power of stress to trigger a relapse of the disease, and
• Family members, friends, coworkers and society as a whole not understanding all of the above.

There’s another reason that helps explain why people relapse — especially during early recovery. And that is not understanding PAWS – Post-Acute Withdrawal Syndrome.

What is Post-Acute Withdrawal Syndrome (PAWS)?

According to UCLA’s Semel Institute for Neuroscience and Human Behavior’s website on this topic,

Post-Acute-Withdrawal Syndrome (PAWS) refers to a set of impairments that can persist for weeks or months after the abstaining from a substance of abuse. PAWS may also be referred to as post-withdrawal syndrome, prolonged withdrawal syndrome, or protracted withdrawal syndrome. The condition is marked by symptoms similar to those found in mood disorders and anxiety disorders, including mood swings, insomnia, and increased levels of anxiety even without any apparent stimulus.

PAWS symptoms most commonly manifest after a withdrawal period from alcohol, benzodiazepines and opioids, but have been known to occur with (cessation of) use of other psychoactive substances. It is estimated that 90 percent of recovering opioid users experience the syndrome to some degree as do 75 percent of recovering alcohol and psychotropic abusers. The precise mechanisms behind PAWS are still being investigated, but scientists believe the physical changes to the brain that occur during substance abuse and are responsible for increased tolerance to the substance are responsible for the recurring symptoms.

According to Hazelden Betty Ford Foundation’s October 31, 2019 article on PAWS titled, “Post-Acute Withdrawal Sydrome, The lingering effects of drug and alcohol withdrawal, and how you can manage them,”

Post-acute withdrawal, whether mild or serious, is a necessary process in early recovery from alcohol or other drug dependence. Think of the withdrawal syndrome as the brain’s way of correcting the chemical imbalances suffered during active addiction. PAWS occurs most commonly and intensely among individuals with alcohol and opioid addiction, as well as in people with addiction to benzodiazepines (or “benzos,” which are commonly prescribed for the treatment of anxiety and panic attacks), heroin (an opiate) or medically prescribed pain medication. 

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Often, symptoms are triggered by stress or brought on by situations involving people, places or things that remind the individual of using. Many people in recovery describe the symptoms of PAWS as ebbing and flowing like a wave or having an “up and down” roller coaster effect. In the early phases of abstinence from substance use, symptoms can change by the minute. As individuals move into long-term recovery from alcohol or drug dependence, the symptoms occur less and less frequently.

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In order to minimize the risk of relapse [emphasis added], it’s important to recognize that many of the unpleasant or uncomfortable sensations and feelings you experience in early recovery could be symptoms of PAWS. It’s also important to understand that PAWS symptoms are temporary. Here are some of the most common symptoms:

• • • Foggy thinking/trouble remembering 

    • Urges and cravings

    • Irritability or hostility

    • Sleep disturbances—insomnia or vivid dreams

    • Fatigue

    • Issues with fine motor coordination

    • Stress sensitivity

    • Anxiety or panic

    • Depression

    • Lack of initiative

    • Impaired ability to focus

    • Mood swings 

How Often Does Relapse Occur?

The following excerpt from my latest book, 10th Anniversary Edition If You Loved Me, You’d Stop! (p. 119-20), explains how common is relapse from alcohol or other drug use disorders,

The current research for people treating their substance use disorders, like alcoholism, shows that more than 60 percent experience relapse within the first year.(1) At one to three years in treatment, relapse rates drop to about 34 percent. And at five+ years in treatment, relapse rates drop to less than 15 percent.(2) And remember, “in treatment” refers to any one or more of the suggestions listed above or any other programs or practices your loved one has found helpful.

I know these numbers may sound depressing, but they are very similar to relapse rates of other chronic diseases, like cancer, for example.

The key takeaway, here, is that along the way, your loved one’s brain is changing, rewiring, remapping, and healing. This means your loved one’s brain health, thoughts, feelings, and behaviors are absolutely changing for the better – a better, healthier, happier life – as recovery progresses. And if relapse does occur, they can adjust their treatment and try again. 

Bottom Line

Alcohol and other drug use disorder recovery is complicated because developing the disorder (disease) is complicated. To get the complete picture — including what is considered effective treatment — consider reading my latest book — whether you’re the person with the disease; the person who loves them; or the educators; treatment and medical professionals; family law practitioners; juvenile and criminal justice professionals; community, business, and public policy leaders and others whose work involves substance use disorders and their impacts on family members, co-workers, and the community-at-large.

And, as always, feel free to contact me at lisaf@BreakingTheCycles.com to arrange a phone call (no charge) to talk about concepts you’d like to better understand.

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