When our clinicians facilitate group counseling sessions and other meetings involving people in treatment for alcohol use disorder (AUD) and/or substance use disorder (SUD), they often hear participants ask about a phenomenon known informally as Pink Cloud Syndrome.
Pink Cloud Syndrome – they’ve heard – is something that might happen early in recovery. In a nutshell, it’s akin to a honeymoon phase, but for recovery. It’s associated with positive feelings, an optimistic outlook, and a sense of euphoria and elation about recovery and about the future.
That all sounds like a good thing.
However, it also sounds suspiciously like pseudoscience to us: something that appears legitimate, has plenty of anecdotal support, but has no real evidence base in scientific literature or peer-reviewed journal articles that focus on research on treatment for AUD and/or SUD.
Recently, however, a member of one of our recovery groups shared two articles they found:
- Published in Forbes, the article What is Pink Cloud? discusses Pink Cloud as if it’s a known and identified medical condition associated with the early stages of recovery
- Published in the online health advice website healthline, the article Navigating the Pink Cloud Phase of Recovery also discusses Pink Cloud as if it’s a known and identified medical condition associated with the early stages of recovery
When we followed up with our medical staff – i.e. our thoroughly trained and licensed nurses and physicians – they all gave us some variation of this answer about Pink Cloud:
“I’ve heard people talk about it in 12-step meetings but never seen any published data. My personal experience with early recovery and reports from most of my patients are consistent with prolonged painful experiences mitigated by counseling and mutual help meetings.”
We trust our clinicians. We have faith in our docs and our nurses. That answer above says nothing about the euphoria and elation we read about in the healthline article or the Forbes article. Therefore, we decided to get to the bottom of the matter, and research the question we pose in the title above:
Is Pink Cloud Syndrome a real thing?
Before we dive in, we should mention that both articles above say Pink Cloud is a mixed bag: on the one hand, it’s good that some people feel positive emotions early in recovery, but on the other hand, both articles say that when Pink Cloud passes, the emotions that follow – which are often the opposite of elation, positivity, and euphoria – increase risk of relapse.
That’s one reason we’re exploring this topic. If Pink Cloud is real, and increases risk of relapse, we need to know about it.
Pink Cloud: Origins of the Phrase and Concept
When we started our research, we found the two articles we mention above. But we knew about those already, because they’re what caused us think about this subject in the first place. We also found an organization that runs sober living homes that uses the phrase as their name.
Then we found something consequential: the source of the phrase. It first appeared in an article written in 1955 by a psychiatrist and early advocate and participant in Alcoholics Anonymous (AA), Dr. Harry Thiebout.
The article was called “The Pink Cloud and After.”
Here’s how Dr. Thiebot described the Pink Cloud phenomenon in 1955:
“This blissful state is a logical aftermath of surrender. The ego which has been full of striving, just quits and the individual senses peace and quiet within. The result is an enormous feeling of release and the person flies right up to the pink cloud, and think they have found Heaven on earth.”
That aligns with the symptoms described in the healthline article:
- Feelings of euphoria/joy
- Hope, positivity, and optimism about treatment and recovery
- A sense of peace and calm
- Confidence about staying sober
- Constant talking about the benefits of sobriety
- Excitement about beneficial lifestyle changes
- Glossing over the hard, painful aspects of recovery
But healthline – although a valuable resource for general medical information – is not a peer-reviewed scientific journal. Nor is Forbes. At that point, we thought Pink Cloud might be what we thought: pseudoscience. What kept us looking was the origin of the phrase. In the recovery community, old-school AA wisdom carries weight.
So, we kept looking.
Mention of Pink Cloud In a Respected Source
The first mention we found – after the Forbes, healthline, and older AA article – was from a well-respected, credible organization: the National Institutes of Health (NIH). The Substance Abuse and Mental Health Services Administration (SAMHSA) – a division of the NIH – briefly mentions the phrase pink cloud in the publication “Treatment for Stimulant Use Disorders.”
Here’s how SAMHSA describes the phenomenon:
“During the stage sometimes termed “the pink cloud,” patients enter a euphoric state. This often occurs around the 1-month mark following withdrawal and completion of detoxification, when the brain is overproducing dopamine. Patients may express a sense of positivity and self-confidence (“I am never g going to use drugs again!”). However, this period quickly subsides as the brain begins to underproduce dopamine, and patients typically fall into a depression at the 3- to 6-month mark, when they have a high likelihood of return to use.”
The second mention of pink cloud in a scientific or academic context we found was published in the Journal of Nursing and Health Care in 2019. The article, “Pink Cloud Syndrome Among Ruled Drug Users in Iligan City Drug Treatment and Rehabilitation Center (ICDTRC),” adds a modicum of scientific and academic weight to this concept.
We’ll leave the information from SAMHSA for you to consider. The paragraph above is all they have to say on the topic. What we’ll do next is take a closer look that that second article: we’re curious about Pink Cloud Syndrome and want to know all we can about it.
If there’s valuable data there, we’ll use it to help the people we work with every day.
Pink Cloud: New Research on Early Recovery and Risk of Relapse
The study we found was conducted by a group of researchers at The Iligan Institute of Technology at Mindanao State University in the Philippines, in collaboration with the Iligan City Drug Treatment and Rehabilitation Center (ICDTRC).
Mindanao State University and The ICDTRC are legitimate institutions whose credibility and validity we do not question. However, the study size and design dilute the findings somewhat: it included 22 participants and used metrics that are relatively new and have yet to stand the test of time.
With that said, the researchers treat Pink Cloud as a legitimate medical syndrome related to recovery, and label it by its informal name: Pink Cloud Syndrome (PCS). The authors describe PCS as a common phenomenon reported by people in the early stages of recovery. Characteristic experiences associated with PCS include:
- Reduced capacity to meet the reality of one’s situation
Those symptoms align with what we read about Pink Cloud in the initial AA article from the 50s and the recent articles in Forbes and healthline.
The goal of the research effort was to assess the Advanced Warning Signs of Pink Cloud Syndrome (PCS), which researchers define as synonymous with risk of relapse, and to determine whether advanced signs of PCS correlated with any identifiable demographic variables. Additionally, researchers sought to determine the motivation and wiliness of the study participants to engage in treatment and recovery. To assess PCS and motivation for recovery – and determine any correlation with demographic factors – the study authors took the following steps.
The PCS Study: Methods
- Recruited 22 individuals from the Iligan City Drug Treatment and Rehabilitation Center (ICDTRC) who met criteria for substance use disorder (SUD) as defined in the Diagnostic and Statistical Manual of Mental Disorders, Volume 5 (DSM-5)
- Collected detailed demographic data from participants
- Administered the “The Advanced Warning Signs of Pink Cloud Syndrome Questionnaire”
- A score of 112 or higher indicated warning signs for PCS and increased risk of relapse
- A score of 111 or lower indicated no warning signs for PCS and no increased risk of relapse
- Administered a “Circumstances, Readiness, and Motivation for Treatment (CMRT) Scale” assessment
- Scores were divided into four categories: low, medium, high, and very high
- The categories describe the relative level of readiness and motivation for treatment for each participant
- Analyzed and cross-referenced the demographic data and the data collected in both questionnaires
Here’s what they found.
Risk of Relapse: The PCS Assessment
- 59% – a total of 13 – recorded a score of less than 112
- This correlates with the absence of PCS symptoms and low risk of relapse
- 41% – a total of 9 – recorded a score of higher than 112
- This correlates with presence of PCS symptoms and increased risk of relapse
- Female respondents have greater PCS scores than males
- This may indicate a need for a gender-specific approach to relapse prevention in the early stage of recovery
- Younger participants were more likely to report a score over 112, indicating an elevated risk of relapse for this demographic
- Participants with lower income were more likely to report a score over 112, indicating an elevated risk of relapse for this demographic
- Participants with higher levels of educational attainment were more likely to report a score over 112, indicating an elevated risk of relapse for this demographic
Motivation for Treatment: The CMRT Scale
- 27% – a total of 6 – reported low motivation for treatment
- 31% – a total of 7 – reported medium/moderate motivation for treatment
- 31% – a total of 7 – reported high motivation for treatment
- 9% – a total of 2 – reported very high motivation for treatment
- Participants who unmarried were more likely to report medium, high, or very high motivation for treatment
- Younger participants were more likely to report medium, high, or very high motivation for treatment
- Participants who were unemployed were more likely to report medium or high motivation for treatment
This is the only peer-reviewed data available on the topic of Pink Cloud Syndrome (PCS). As we mention above, the small data set and relatively untested metrics dilutes these results, somewhat: it’s difficult to generalize from small groups and new metrics. Nevertheless, the researchers conducted a study, performed statistical analyses, submitted the paper for peer review, and saw it published. What they found informs and directs any future research efforts:
- The presence of PCS symptoms increases likelihood of relapse: this finding needs additional research. If verified, it can inform the way we approach the early stages of treatment and recovery: we can screen for PCS, and tailor treatment accordingly
- Younger participants reported more PCS symptoms, indicating a higher risk of relapse. If verified, we can screen for PCS in our younger treatment populations, and tailor treatment accordingly
- Participants with a lower monthly income reported high rates of PCS symptoms. If verified, we can screen for PCS among our lower-income treatment population, and tailor treatment accordingly
The takeaway: we need more research and more data in order to apply the concept of PCS in clinical treatment for alcohol or substance use disorder.
That doesn’t mean the concept is useless, however.
How Talking About Pink Cloud Can Help People in Recovery
We’ll repeat: evidence confirming the scientific validity of Pink Cloud Syndrome is inconclusive, but the evidence we do have is informative.
While we won’t make PCS Treatment part of our clinical methods just yet, we see the value in discussing the subject in group process meetings, group counseling sessions, and individual therapy/counseling sessions.
Because we do see people who are, for lack of a better phrase, on cloud 9 in the early phases of recovery. They’re excited about sobriety, they’re excited about recovery, and they’re excited about the lifestyle changes they’ve made. They feel good. They feel great. And we love that for them. But we do have to warn them that many people experience these feelings in the early phases of recovery, and there’s even an informal name for it: Pink Cloud Syndrome. We can warn them that if this honeymoon feeling wears off, what they need to do is focus on the brass tacks of recovery: work their program, go to meetings, apply their coping skills, and apply their relapse management skills.
In closing, we can say that for the people who experience feelings of elation and unbridled optimism in the early phases of early recovery, the concept of Pink Cloud is helpful in that they need to be ready for it to fade, which, according to anecdotes, it inevitably does. When it fades, they can use the skills they work hard to learn. They can apply the practical, durable habits and skills associated with successful recovery.
Evidence-Based Treatment: Tried and True Methods
- Counseling and/or therapy
- Medication if indicated
- Peer/community support meetings
- Lifestyle changes: healthy eating, staying active
- Trigger management: avoiding people and places that remind them of drinking or using drugs
We know those things work. When researchers publish more evidence about Pink Cloud, we’ll review the evidence and use what we learn to support people in recovery. For now, our position is that whether or not Pink Cloud is real, the best thing for a person in recovery to do is follow the treatment plan. Or, as they say in AA, keep working your program.