When I was in training, more years ago than I care to count, my mentors warned me not to float away on the “pink cloud” likely to envelop patients in the early stages of recovery from substance use disorders. I was told that the initial rockiness of stopping alcohol and/or other psychoactive drugs is often followed by feelings of elation and great expectations for the future. In this irrationally exuberant state, recovery can feel essentially effortless and treatment activities may seem like an unnecessary waste of precious time. The danger, of course, is that abandoning these activities leaves one defenseless when the pink cloud vaporizes. At some point, the hard work of sustaining sobriety in the face of the wreckage wrought by addiction seems daunting if not overwhelming, and those who are going it alone and who fail to anticipate the transience and fragility of the pink cloud experience often take it hard when their mood darkens, and are vulnerable to relapse.
Clinical experience has taught me that some people do pass through a pink cloud after negotiating the acute withdrawal phase of recovery, but I’ve also learned that the first year(s) of recovery are a jarring and complex mix of emotional highs and lows for most people. And I’ve found that some people never catch a glimpse of the pink cloud in the early going. They just feel chronically down, out, scared and hopeless for months on end.
Today, the treatment and recovery communities offer more detailed guidance to practitioners, recovering individuals and family members about the array of difficult and highly individual challenges people face during the first months and years of abstinence from alcohol and drugs. And they caution that it can take a good deal of time for mood, thinking and behavior to improve and stabilize. Terms likes “Protracted Withdrawal” and “Post-acute Withdrawal Syndrome (PAWS) are used to describe the psychological and physiological phenomena that can destabilize and derail people in recovery for an extended period after drug and alcohol use end.
For example, The Substance Abuse and Mental Health Service Administration (SAMSHA) warns thatlow feelings are to be expected for most people in early recovery and that protracted withdrawal may persist for “weeks, months, and sometimes years”. In a 2010 Advisory SAMSHA explained that:...