Understanding the Differences betwee Acute and Post Acute Withdrawal

In simple terms, the primary difference between acute and post acute withdrawal is the severity and potential consequences of related symptoms. As the key words indicate, acute withdrawal is generally more severe than post-acute withdrawal. However, both conditions are in actuality different stages of the disease of addiction: first comes active addiction, followed by cessation and acute withdrawal and finally transitioning to post acute withdrawal. Although part of the same disease, these conditions should be made distinct to addicts and those in recovery and the people who support them.

Primary Difference: Risk of Serious Medical Complications

The most important difference between acute and post acute withdrawal is the potential consequences of symptoms that may arise. During acute withdrawal syndrome or AWS, symptoms can be severe; in fact, symptoms of detox and withdrawal from some drugs can cause life-threatening complications. These include alcohol, (Louis A. Trevisan, M.D., Nashaat Boutros, M.D., Ismene L. Petrakis, M.D., and John H. Krystal, M.D. Complications of Alcohol Withdrawal National Institute on Alcohol Abuse and Alcoholism) benzodiazepines (Lann MA, Molina DK, A Fatal Case of Benzodiazepine Withdrawal National Center for Biotechnology Information) and barbiturates. For some people withdrawing from these substances can cause seizures, respiratory depression, heart attack, coma, delirium tremens and rarely, death.

While post acute withdrawal symptoms do not generally pose risk of death or even serious medical symptoms, the condition does cause severe disruptions in the lives of many people in recovery. In some cases symptoms may require medication in order to successfully manage, while in others a healthy diet and plenty of exercise allow for a strong recovery plan. In fact, some people in recovery report little to no PAWS symptoms at all.

Acuity of Urge to Abuse Substances

One of the most troubling symptoms of both AWS and PAWS is a strong, compelling desire to use drugs or drink again. These types of powerful feelings are strongest during the early stages of acute withdrawal and slowly taper off over a period of about 5 days to 2 weeks. After this time drug or alcohol cravings may still arise and they may even be consistently present, however, they are rarely as compelling during PAWS as during acute withdrawal.

However, like AWS, the desire to abuse drugs is often at its peak during the early stages of PAWS and slowly lessens over time. This is one of the reasons that most people attend treatment in the following manner:

Stage 1: Immediate drug abuse cessation and resulting acute withdrawal, with potential for serious medical complications. Treatment consists in most cases of a professional detox program lasting for 5 to 10 days.

Stage 2: Upon completion of detox (drugs are no longer in the person's system) patients attend longer-term treatment, during which time post acute withdrawal symptoms set in. These symptoms theoretically are at their worst levels during this time. Most rehab programs post-detox are around 30-90 days in duration, by which time the severity of PAWS symptoms should have subsided enough to safely permit the person to reintegrate with their communities. (Wexner Medical Center, Ohio State University Post Acute Withdrawal Syndrome)

Stages of the Same Disease

In reality there is little true difference between acute withdrawal and post withdrawal: they are both part of the disease of addiction. In the early days of recovery, symptoms are at their most severe points. As recovery progresses, symptoms lessen, gradually shifting away from physical symptoms, and instead transitioning into longer-term mental and emotional symptoms. While these symptoms may not prompt the need for serious medical care, they do cause many addicts to relapse and thereby start the entire cycle all over again.

Ultimately, addiction is the disease and AWS and PAWS are merely stages. Unfortunately, few addicts recognize or appreciate the difference, and therefore many are unprepared, do not have the proper expectations, do not work a daily recovery program and subsequently doom themselves to relapse. If this sounds like you or someone you love, the time to act is now. Each progressive relapse episode is generally more severe and damaging than the last as a result of what is known as the Kindling Effect, so there's not a moment to waste.