Post-acute withdrawal syndrome (also known as “PAWS” or “protracted withdrawals”) refers to a suite of symptoms related to chronic drug abuse that persist after acute detox from a physically addictive drug*, sometimes for weeks or years into abstinence. The length and severity of PAWS depends on the type and amount of drug abused, as well as the duration of the abuse. Most of the research on PAWS has centered around alcohol, opioids, and methamphetamine. Post-acute withdrawal syndrome generally refers to protracted withdrawals from drugs that cause physical dependence, but abusers of other recreational drugs (including psychedelics and cocaine) may share some of the symptoms of PAWS, especially in early abstinence. Healthcare providers and addiction treatment teams often fail to adequately prepare recovering addicts for post-acute withdrawals, even though PAWS may be one of the leading causes of relapse in early abstinence.
This phenomenon is not limited to recreational drugs, either. Certain pharmaceuticals, namely benzodiazepines (Valium, Xanax, Klonopin, Ativan, and others) as well as antidepressants can cause debilitating and protracted withdrawal symptoms if abruptly stopped. The worst side effects include seizure, suicidal ideation, and psychosis, but flu-like symptoms, headache, sweating, nausea, and anxiety are very common. Similar to protracted withdrawals caused by recreational drugs, the length and severity of withdrawals depend upon the dose and length of time drug was used. Prescribing doctors are often aware of this risk and help patients gradually taper from these drugs.
Due to the ongoing opioid and methamphetamine epidemics in America, their impacts on personal and societal health, and the abysmal lack of access to affordable and effective treatments for addiction, we have a social and humanitarian responsibility to identify treatments for post-acute withdrawals that could lessen the likelihood of relapse for those attempting lifetime abstinence from these powerfully addictive drugs.
A variety of therapies may be helpful, including medication, twelve-step meetings, psychological therapy, vitamin and amino acid supplementation, and lifestyle changes. These can all assist in the recovery process, but fundamentally, PAWS refers to biochemical changes due to drug use that take time to heal. While certain pharmaceuticals have been investigated for their effectiveness in lessening certain symptoms of post-acute withdrawals - sleep, in particular - these can have harmful or even frightening side effects. There is currently no well-tolerated pharmaceutical option with little to no side effects that addresses most of the symptoms those in early recovery from addiction experience.
Could CBD (cannabidiol) be the "silver bullet" solution to this problem? Let's look at the facts: the symptoms of post-acute withdrawal often include anxiety, depression, irritability, increased pain, and insomnia. These are the exact symptoms that most people use CBD to treat, according to a recent survey published in Cannabis and Cannabinoid Research. Even more promising, the vast majority of people report that they find relief without any side effects, unlike the pharmaceuticals prescribed for the same purpose. Those side effects that are reported are often very minor and caused by unnecessarily high doses of this well-tolerated cannabinoid.
Moreover, CBD has been shown to inhibit cravings associated with familiar cues--what are colloquially known as “triggers” - specifically by altering how memories are activated and reconsolidated around stimuli that cause craving.
CBD has also shown promise in helping smokers give up cigarettes; importantly, cigarette smoking has been identified as a strong predictor of relapse, though obviously not all who smoke cigarettes will relapse on their drug(s) of abuse. By helping smokers quit, CBD may give recovering addicts a better chance in maintaining sobriety over the long term.
CBD presents an astounding array of potential benefits to those in recovery from addiction: alleviating symptoms associated with post-acute withdrawals, managing triggers, and helping individuals give up behaviors that predict relapse. Further research is being done on CBD's effects on those with addictive behaviors and mental illness, as well as how CBD can regulate the effect produced by other drugs--for example, by making morphine less rewarding and serving as a fast-acting antidepressant with few to no side effects.
Many people already use CBD to manage pain, stress, and a variety of physical and psychological disorders. It is becoming increasingly common for customers to come to us on the advice of their healthcare professional. If you are in recovery from addiction, and in light of all the evidence supporting the use of CBD to assist in the recovery process, why wouldn’t you add CBD to your toolkit?
*while alcohol is the most socially-acceptable drug worldwide, it is still a drug, and the term "drug(s)" when used in this article should be understood to include alcohol.
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