- Understanding PAWS (Post-Acute Withdrawal Syndrome)
- What Is PAWS (Post-Acute Withdrawal Syndrome)?
- PAWS Symptoms And Signs
- How Long Does PAWS Last?
- The Challenges Of PAWS
- How To Treat PAWS
- Post-Acute Withdrawal Symptoms and Relapse Prevention Strategies
- The Symptoms of Post-Acute Withdrawal
- How to Survive Post-Acute Withdrawal
- Recovery and Relapse Prevention Strategies
Understanding PAWS (Post-Acute Withdrawal Syndrome)
Enduring the physical symptoms of drug or alcohol withdrawal can be uncomfortable. Symptoms such as muscle aches, increased heart rate, nausea and vomiting are all common during the detox process. If managed correctly, these painful problems will lessen in severity over time and usually clear up within a matter of one to two weeks once the body has adjusted to the lack of substances.
Unfortunately, for many people in recovery, the withdrawal process is not limited to this short time frame. While the body may heal in the short-term, the brain will take months, or years, to recover from severe drug or alcohol abuse.
As the brain attempts to function without the help of a substance it’s grown reliant on; it’s typical for individuals to experience brain fog, intense cravings, sleep disturbances and a number of other psychological symptoms. This collection of symptoms is known as post-acute withdrawal syndrome or PAWS.
What Is PAWS (Post-Acute Withdrawal Syndrome)?
Post-acute withdrawal syndrome (PAWS) refers to a group of symptoms that some people will experience after a prolonged period of withdrawal. These symptoms are primarily psychological and mood-related and can continue for months or years after the acute period of withdrawal.
The acute period of withdrawal is typically when the body experiences the most physical effects of detox from drugs or alcohol and lasts for about one to two weeks. While post-acute withdrawal syndrome rarely involves body aches, stomach pains, increased heart rate, headaches or nausea, the symptoms can be equally as intense as acute withdrawal.
Post-acute withdrawal syndrome happens as a result of chemical imbalances in the brain.
When someone abuses drugs or alcohol for a prolonged period of time, their mind becomes reliant on these substances to produce certain chemicals to function correctly.
Once the drugs have been detoxed from the body, the brain will take time to correct the chemical imbalances and relearn to function without the assistance of drugs or alcohol.
PAWS Symptoms And Signs
There is an endless amount of symptoms that can be associated with post-acute withdrawal syndrome. Duration, intensity and combination of symptoms can vary a person’s drug of choice, length of abuse and overall health.
Despite these factors, some of the most common PAWS symptoms are:
- Inability to think clearly: Inability to concentrate, difficulty with abstract concepts and rigid or repetitive thinking patterns is often the first symptoms of PAWS. It is also often the most prominent symptom.
- Cognitive impairment: other PAWS symptoms, memory and mobility problems are caused by an imbalance in the brain’s chemistry that will resolve themselves over time. However, in severe and rare cases of alcohol abuse, there can be brain damage that affects memory and mobility permanently.
- Inability to feel pleasure (anhedonia): People who abuse drugs or alcohol typically rely on their substance of choice to produce the feel-good chemical in the brain, dopamine. Once drugs or alcohol are removed from the body, it can take some time for the brain to begin naturally producing normal levels of dopamine again.
- Insomnia or sleep disturbances: Drugs and alcohol can often mask underlying sleep problems, or majorly disrupt the body’s regular sleep cycle. Disturbing dreams are also very common early on in addiction recovery and can make falling or staying asleep nearly impossible. It can take months for the body to relearn to sleep without the assistance of substances.
- Mood swings: The brain of someone who repeatedly misuses drugs or alcohol becomes accustomed to a constant stream of mood-altering substances. As the brain is learning to rebalance itself without these substances, periods of depression and mania can occur for seemingly no reason.
- Extreme sensitivity to stress: After giving up their primary coping tool, many people in recovery find that their threshold for daily stressors is extremely low after detoxing from drugs or alcohol. Regaining confidence in problem-solving and stress management techniques takes time.
- Anxiety: Many commonly abused drugs inhibit the user’s brain activity in order to help them remain calm. When these drugs are removed from the system, this drastic shift can cause significant anxiety and panic attacks.
While these are some of the most common symptoms associated with PAWS, it is by no means a complete list. However, knowing these key signs of post-acute withdrawal syndrome puts those suffering in a better position to manage them.
How Long Does PAWS Last?
The overall duration of PAWS can be challenging to predict since it can fluctuate length of abuse, the frequency of substance abuse, amount of drugs or alcohol consumed, and an individual’s health.
PAWS symptoms usually begin to occur between seven to 14 days after the acute period of withdrawal. These symptoms reach a peak between three to six months after the start of abstinence and can continue up to two years after the acute withdrawal period.
The one prevailing theme among post-acute withdrawal symptoms is that they not consistent. Instead, they come and go intermittently, and each episode can last around two to three weeks. According to current research, many people experience these symptoms at regular intervals of 30-day, 60-day, 90-day, 120-day, 180-day, 1-year and 2-year sobriety dates.
The brain is going to take time and patience to heal once the acute withdrawal period is over, and everyone must work on their own timeline.
The Challenges Of PAWS
The most significant concern with those suffering from post-acute withdrawal syndrome is a relapse.
Due to the rewiring of the brain in active addiction, when someone seeks treatment for substance abuse and is no longer using, they can suffer from chemical imbalances. The fluctuating brain chemistry can make it difficult for recovering individuals to feel happiness, think clearly, sleep well or healthily manage stress.
The inability to feel peace of mind or positivity coupled with the stress and anxiety of life in recovery can create the perfect breeding ground for a relapse- especially for those in the early stages of sobriety who are still learning to cope with it long-term.
Adding to the challenges of PAWS is that fact that this syndrome is not universally recognized in the medical community and there is very little research on how best to manage this condition.
Although it is widely accepted by those it the addiction treatment community, it remains absent from the American Psychiatric Association’s Diagnostic Statistical Manual of Mental Disorders- the standard classification of mental disorders used by all mental health professionals in the US. These factors make it difficult for those suffering from PAWS to receive adequate help.
How To Treat PAWS
There is no definitive path to treating PAWS. However, since the mostly psychological and emotional, ongoing support from a therapist, a recovery group, family and friends is an essential part of reducing the stress of post-acute withdrawal syndrome.
Additionally, other methods that have proven to be successful in keeping clients on track in their recovery journey include:
- Educate clients on PAWS and what to expect in recovery
- Encourage exercise and a healthy diet
- Celebrate the small victories
- Identify triggers
- Find a therapist who can teach healthy coping strategies
- Practice impulse control
A helpful acronym for those struggling with post-acute withdrawal syndrome is H.A.L.T.
It’s a reminder for individuals take a step back and try to identify the emotions that are causing them to lash out instead of acting irrationally. Typically, it’s one of the four emotions that H.A.L.
T stands for- hungry, angry, lonely or tired. It’s these small but powerful reminders that help those in recovery maintain their sobriety even under stressful circumstances.
Most importantly, clients should remember that detox and treatment do not represent a “fix-all” for addiction. The brain will need time to heal and relearn how to function without the assistance of extreme drug or alcohol use.
While post-acute withdrawal symptoms can be frustrating, by showing themselves patience and kindness each day, those suffering will be able to manage their PAWS symptoms successfully in recovery.
Post-Acute Withdrawal Symptoms and Relapse Prevention Strategies
There are two stages of withdrawal. The first stage is the acute stage, which usually lasts at most a few weeks. During this stage, you may experience physical withdrawal symptoms. But every drug is different, and every person is different.
The second stage of withdrawal is called the Post Acute Withdrawal Syndrome (PAWS). During this stage you'll have fewer physical symptoms, but more emotional and psychological withdrawal symptoms.
Most people experience some post-acute withdrawal symptoms. Whereas in the acute stage of withdrawal every person is different, in post-acute withdrawal most people have the same symptoms.
The Symptoms of Post-Acute Withdrawal
- Mood swings, anxiety, irritability
- Tiredness, variable energy, low enthusiasm
- Variable concentration
- Disturbed sleep
These are the most common post-acute withdrawal symptoms.
Post-acute withdrawal feels a rollercoaster of symptoms. In the beginning, your symptoms will change minute to minute and hour to hour.
Later as you recover further they will disappear for a few weeks or months only to return again. As you continue to recover the good stretches will get longer and longer.
But the bad periods of post-acute withdrawal can be just as intense and last just as long.
Each post-acute withdrawal episode usually last for a few days. Once you've been in recovery for a while, you will find that each post-acute withdrawal episode usually lasts for a few days. There is no obvious trigger for most episodes.
You will wake up one day feeling irritable and have low energy. If you hang on for just a few days, it will lift just as quickly as it started.
After a while you'll develop confidence that you can get through post-acute withdrawal, because you'll know that each episode is time limited.
Post-acute withdrawal usually lasts for 2 years. This is one of the most important things you need to remember. If you're up for the challenge you can get though this. But if you think that post-acute withdrawal will only last for a few months, then you'll get caught off guard, and when you're disappointed you're more ly to relapse.
How to Survive Post-Acute Withdrawal
Be patient. You can't hurry recovery. But you can get through it one day at a time. If you resent post-acute withdrawal, or try to bulldoze your way through it, you will become exhausted. And when you're exhausted you will think of using to escape.
Post-acute withdrawal symptoms are a sign that your brain is recovering. Therefore don't resent them. But remember, even after one year, you are still only half way there.
Go with the flow. Withdrawal symptoms are uncomfortable. But the more you resent them the worse they'll seem. You'll have lots of good days over the next two years. Enjoy them. You'll also have lots of bad days. On those days, don't try to do too much. Take care of yourself, focus on your recovery, and you'll get through this.
Practice self-care. Give yourself lots of little breaks over the next two years. Tell yourself «what I am doing is enough.» Be good to yourself. That is what most addicts can't do, and that's what you must learn in recovery. Recovery is the opposite of addiction.
Sometimes you'll have little energy or enthusiasm for anything. Understand this and don't over book your life. Give yourself permission to focus on your recovery.
Post-acute withdrawal can be a trigger for relapse. You'll go for weeks without any withdrawal symptoms, and then one day you'll wake up and your withdrawal will hit you a ton of bricks. You'll have slept badly. You'll be in a bad mood.
Your energy will be low. And if you're not prepared for it, if you think that post-acute withdrawal only lasts for a few months, or if you think that you'll be different and it won't be as bad for you, then you'll get caught off guard.
But if you know what to expect you can do this.
Being able to relax will help you through post-acute withdrawal. When you're tense you tend to dwell on your symptoms and make them worse. When you're relaxed it's easier to not get caught up in them. You aren't as triggered by your symptoms which means you're less ly to relapse.
Remember, every relapse, no matter how small undoes the gains your brain has made during recovery. Without abstinence everything will fall apart. With abstinence everything is possible.
Recovery and Relapse Prevention Strategies
For more techniques on how to get through withdrawal and post-acute withdrawal, learn more about recovery skills and relapse prevention strategies in the following pages. You can recover from addiction.