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Protracted Withdrawal

Last Updated on January 24, 2024 by Carol Gillette

Alternative to Meds Editorial Team
Medically Reviewed by Dr John Motl MD

If you are reading this article, you may, or suspect you may be suffering symptoms of protracted withdrawal. One may have experienced the tremendous difficulties of ceasing drug or alcohol use while continuing to suffer debilitating and relentless withdrawal symptoms. Clinicians often refer to protracted withdrawal as PAWS (post-acute withdrawal syndrome) or PWS (protracted withdrawal syndrome). Below we’ll cover how to know more about the symptoms of protracted withdrawal and measures that can help navigate through these challenges.


monitored guidance for protracted withdrawal
Are You Dealing with Protracted Withdrawal?
While medical consensus is as yet not clearly decided on a clear-cut definition, there are commonly reported symptoms that should be known about protracted withdrawal.1-4 Alternative to Meds has led the world on substance withdrawal for 17+ years. We have published evidence regarding our success. We have found that addressing underlying issues is a primary factor. Overlooked medical conditions and misdiagnoses or premature diagnoses are not at all uncommon in the absence of vigilant observation.
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What is Protracted Withdrawal?

Protracted withdrawal treatments at Alternative to Meds Center are designed to allow safe cessation while significantly reducing or eliminating painful and lingering withdrawal symptoms.

Common signs and symptoms of protracted withdrawal can include:
  • protracted withdrawal help sedona drug rehabWithdrawal symptoms lasting longer than the expected timeline for withdrawal
  • The rebound of original symptoms after cessation
  • Emergence of new symptoms
  • Tendency to self-medicate even after cessation
  • Relapse
  • Cravings or other physical or psychological reactions when exposed to drug-related stimuli
  • Lingering anxiety, depression, dysphoria
  • Sleep disturbances, insomnia, over-sleeping
  • Hyper-reactivity to stress

Physical symptoms may rebound or newly emerge and intensify, including muscle aches, cramps, brain zaps, chills, fever, pain, nausea, crying spells, other emotional distress, sleepless nights, nightmares, appetite changes, weight loss or gain, energy deficit, depression, anxiety, and many others. There can be so many variations that it is not easy to directly link them to one specific drug withdrawal syndrome, but some patterns are commonly observed.

For instance, when withdrawing from a CNS depressant such as a benzodiazepine, an antidepressant, or an opiate, the calming and pleasant feelings that it initially provided are now reversed, so the euphoria is now depression. The pain relief is now pain. The calm feeling may now reverse into anxiety, a panic attack, or the dread of one about to occur. It can be life-threatening, in fact, to try and withdraw too quickly from a number of drugs. Except in certain medical emergencies where immediate cessation is needed to save the person’s life, once dependence or addiction has developed, it is not a good idea to cease any substance suddenly, including chronic heavy alcohol use.

Alcohol cessation in particular needs clinical oversight and medication to avoid cardiac arrest, coma, or other life-threatening emergencies. In most cases, sudden cessation can overwhelm the various systems in the body and can be life-threatening. Abrupt withdrawal is a common precursor to protracted withdrawal symptoms that may linger and even worsen for months and even years without going away.

Protracted Withdrawal Solutions

The best solution is to seek medical assistance and guidance before attempting cessation. Guidance is recommended during and even after the process to ensure the path to recovery is smooth and safe. However, in too many cases, even with medical oversight there may have been too many factors that needed addressing well before the tapering process was attempted. At Alternative to Meds Center, we place great importance on seeking root causes for original symptoms so that these do not continue to plague the person unnecessarily.

Some of the most commonly overlooked areas are listed below.
  • help finding root causes sedona drug rehabNutrition 5
  • Unresolved toxin exposure 6
  • Unresolved psychological trauma 7
  • Lack of emotional (familial or peer) support 8
  • Unsatisfactory lifestyle 9
  • Overlooked/untreated medical conditions such as hypoglycemia, infection, injuries, illnesses, or other physical conditions 10
  • Genetic factors 11

Through the use of lab testing, we can discover nutritional deficiencies or imbalances that can be fixed by correcting the diet, eliminating offending foods that are contributing to symptoms, and providing targeted supplementation to rectify nutrition-related conditions.

Neurotoxic accumulations can also be tested for and purged safely from the body to allow neurotransmitter rehabilitation naturally.

CBT and other genres of counseling can be provided to alleviate the burdens of past trauma, and allow for restructuring and optimizing one’s lifestyle, so that life can move forward with optimism, confidence, and hope.

Diet and supplementation can also mitigate genetic polymorphisms and other factors that have possibly contributed to one’s symptoms even before drug or alcohol use needed treatment.

Protracted Withdrawal Help

In general, where long-lasting withdrawals are occurring, the cessation was likely exacerbated by the shock of abrupt cessation, and other overlooked health factors. A thorough medical check-up can be crucial to isolate physical injuries or other conditions that should be treated as part of a full recovery program. protracted withdrawal inpatient helpWhere certain drugs are concerned, even very small incremental cuts can set off reactions that are intolerable. There are several effective strategies to get stabilized before resuming a safe and slow taper if lingering withdrawals have caused the process to go off the rails. You can read more about tapering methods and adjunct therapies used at Alternative to Meds Center that can be tailored to an individual’s exact profile and medical history for a much more tolerable and even enjoyable cessation and recovery.

It is recommended to always seek medical monitoring when deciding to taper off any substance whether prescribed or otherwise. It is unsafe to try it without medical oversight. Be safe and seek medical help with alcohol or drug withdrawal planning. Even under a general practitioner’s care, the symptoms associated with protracted withdrawals can become intolerable, and puzzling to a medical practitioner who is unfamiliar with proper drug withdrawal. However, one must not despair, because there are better solutions available for recovery.

Don’t Give Up, We are Here to Help

Please call us for more information about a comfortable and safe cessation to avoid or get relief from protracted withdrawal symptoms. Our staff has helped literally thousands go through their withdrawal process with success. We are here to assist and we do understand the problems and how to avoid protracted withdrawal symptoms. We have many families who have successfully had a loved one complete their taper and recovery with Alternative To Meds Center without suffering from symptoms of protracted withdrawal.

1 (800) 301-3753 for Protracted Withdrawal Help

Sources:

1. Satel SL, Kosten TR, Schuckit MA, Fischman MW. Should protracted withdrawal from drugs be included in DSM-IV? Am J Psychiatry. 1993 May;150(5):695-704. doi: 10.1176/ajp.150.5.695. PMID: 8097618. [cited 2022 Aug 26]

2. Hengartner MP, Schulthess L, Sorensen A, Framer A. Protracted withdrawal syndrome after stopping antidepressants: a descriptive quantitative analysis of consumer narratives from a large internet forum. Ther Adv Psychopharmacol. 2020 Dec 24;10:2045125320980573. doi:10.1177/2045125320980573. PMID: 33489088; PMCID: PMC7768871. [cited 2022 Aug 26]

3. Heilig M, Egli M, Crabbe JC, Becker HC. Acute withdrawal, protracted abstinence and negative affect in alcoholism: are they linked? Addict Biol. 2010 Apr;15(2):169-84. doi: 10.1111/j.1369-1600.2009.00194.x. PMID: 20148778; PMCID: PMC3268458.[cited 2022 Aug 26]

4. Gupta M, Gokarakonda SB, Attia FN. Withdrawal Syndromes. [Updated 2022 May 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459239/ [cited 2022 Aug 26]

5. Jeynes KD, Gibson EL. The importance of nutrition in aiding recovery from substance use disorders: A review. Drug Alcohol Depend. 2017 Oct 1;179:229-239. doi: 10.1016/j.drugalcdep.2017.07.006. Epub 2017 Aug 4. PMID: 28806640.

6. Brown JS Jr. Psychiatric issues in toxic exposures. Psychiatr Clin North Am. 2007 Dec;30(4):837-54. doi: 10.1016/j.psc.2007.07.004. PMID: 17938048.

7. Simmons S, Suárez L. Substance Abuse and Trauma. Child Adolesc Psychiatr Clin N Am. 2016 Oct;25(4):723-34. doi: 10.1016/j.chc.2016.05.006. Epub 2016 Aug 2. PMID: 27613348 [cited 2022 Aug 26]

8. Tracy K, Wallace SP. Benefits of peer support groups in the treatment of addiction. Subst Abuse Rehabil. 2016 Sep 29;7:143-154. doi: 10.2147/SAR.S81535. PMID: 27729825; PMCID: PMC5047716. [cited 2022 Aug 26]

9. Magill M, Ray L, Kiluk B, Hoadley A, Bernstein M, Tonigan JS, Carroll K. A meta-analysis of cognitive-behavioral therapy for alcohol or other drug use disorders: Treatment efficacy by contrast condition. J Consult Clin Psychol. 2019 Dec;87(12):1093-1105. doi: 10.1037/ccp0000447. Epub 2019 Oct 10. PMID: 31599606; PMCID: PMC6856400. [cited 2022 Aug 26]

10. NHS Information letterLow blood sugar (hypoglycemia) [cited 2022 Aug 26]

11. Stevens AJ, Rucklidge JJ, Kennedy MA. Epigenetics, nutrition and mental health. Is there a relationship? Nutr Neurosci. 2018 Nov;21(9):602-613. doi: 10.1080/1028415X.2017.1331524. Epub 2017 May 29. PMID: 28553986. [cited 2022 Aug 26]

Originally Published Sep 13, 2018 by Diane Ridaeus


This content has been reviewed and approved by a licensed physician.

Dr. John Motl, M.D.

Dr. Motl is currently certified by the American Board of Psychiatry and Neurology in Psychiatry, and Board eligible in Neurology and licensed in the state of Arizona.  He holds a Bachelor of Science degree with a major in biology and minors in chemistry and philosophy. He graduated from Creighton University School of Medicine with a Doctor of Medicine.  Dr. Motl has studied Medical Acupuncture at the Colorado School of Traditional Chinese Medicine and at U.C.L.A.

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