What is Post-Acute Withdrawal Syndrome (PAWS)?

Most people are aware that there is a period of physical withdrawal symptoms when someone stops using highly addictive substances, from alcohol and opioids to cocaine and benzodiazepines. This period is referred to as acute withdrawal. The symptoms of acute withdrawal can include muscle aches, nausea, headache, and increased heart rate. It’s even possible for someone to have serious, potentially deadly health consequences during acute withdrawal, which is why experts recommend medically supervised detox.

What many people may not know is that withdrawal can also include a second phase, known as post-acute withdrawal syndrome, or PAWS. During this period, the brain recalibrates as it works to recover from active addiction. This can lead to ongoing withdrawal symptoms that last longer than acute symptoms.

Myths and Truths About PAWS

Many myths and truths surrounding PAWS can affect an individual’s recovery journey. Some of the most common include:

Myth: PAWS only occurs in severe cases of addiction.

Truth: PAWS can occur in individuals with mild to severe addiction. The severity of PAWS symptoms does not necessarily correspond to the severity of the addiction.

Myth: PAWS only occurs in individuals who have used drugs or alcohol for a long time.

Truth: PAWS can occur in individuals who have used drugs or alcohol for a short or long time. The length of substance use does not necessarily correspond to the likelihood of developing PAWS.

Myth: PAWS symptoms are the same for everyone.

Truth: PAWS symptoms can vary widely from person to person. Common symptoms include anxiety, depression, fatigue, irritability, and insomnia, but some individuals may experience other symptoms such as mood swings, difficulty concentrating, and memory problems.

Myth: PAWS is a sign of weakness.

Truth: PAWS is a real medical condition that occurs as a result of changes in the brain and body caused by substance use. It is not a sign of weakness or a lack of willpower.

Myth: PAWS is untreatable.

Truth: PAWS can be treated with a combination of therapy, medication, and lifestyle changes. Treatment can help individuals manage their symptoms and improve their chances of long-term recovery.

PAWS is a real and complex condition that can affect individuals with all levels of addiction. Understanding the myths and truths about PAWS can help individuals navigate their recovery journey with greater knowledge and confidence. With that said, here’s what you should know about PAWS and how it’s treated.

What Causes PAWS to Happen?

Just as the body needs to physically heal from the effects of addiction, the brain also needs to recover from the impact of drugs and alcohol. During this time, individuals may experience withdrawal symptoms even after they have completed the detoxification process. The onset of these “secondary” symptoms is known as post-acute withdrawal syndrome.

For many experiencing PAWS, the symptoms come and go. Those affected have described the symptoms as coming on like a wave, then cresting and slowing down. Symptoms may be triggered by stress and triggers that remind the person of their substance use, whether that’s a person, a place, or an experience.

Typically, at the beginning of recovery, a person’s PAWS symptoms may be more severe. The further they are in their sobriety, the fewer symptoms they may experience. Medical help may be necessary for those experiencing severe symptoms. Support groups, behavioral therapy, or medications such as Acamprosate are all methods that can help manage the worst of PAWS symptoms.

There is no timeline for how long someone may experience post-acute withdrawal syndrome. Some individuals only experience mild symptoms for a few days or weeks, while others may face more severe issues for years. The timeline for PAWS will depend on the person, their physical health, how long they have been struggling with addiction, and what substance they abused.

Common Symptoms of Post-Acute Withdrawal Syndrome

There are multiple symptoms associated with post-acute withdrawal syndrome. Many of these may hinder an individual’s ability to stick with their recovery. Recognizing that these symptoms are temporary is important. Some of the common symptoms associated with PAWS include:

• Foggy thinking/trouble remembering
• Urges and cravings
• Irritability or hostility
• Sleep disturbances, such as insomnia or vivid dreams
• Fatigue
• Issues with fine motor coordination
• Stress sensitivity
• Anxiety or panic
• Depression
• Lack of initiative
• Lack of interest in sex
• Chronic pain
• Impaired ability to focus
• Mood swings

Certain issues may make PAWS worse, including co-occurring physical or mental health conditions. Factors such as the type of substance the person was abusing, as well as the duration, quantity, and frequency of abuse can impact someone’s experience with PAWS.

Finally, any acute emotional issues that occur during the early portion of a person’s recovery, as well as the support they receive from professionals during that time, can play a part in their symptoms and the severity with which they experience PAWS.

Is Post-Acute Withdrawal Syndrome Common?

While not everyone will experience PAWS after addiction recovery, it is more common than you might think. Some studies estimate that up to 90% of individuals trying to quit drugs or alcohol will experience some form of PAWS. Symptoms can include difficulty concentrating, mood swings, anxiety, and fatigue, among others. Fortunately, PAWS is a temporary condition and symptoms typically improve over time.

How Long Does Post-Acute Withdrawal Syndrome Last?

Post-Acute Withdrawal Syndrome (PAWS) is a condition that often accompanies addiction recovery. It can be incredibly frustrating for those experiencing it, as it can last for months or even years after sobering up. PAWS can cause symptoms such as anxiety, insomnia, depression, and irritability, which can make it harder for people to adjust to their new, sober lives. It’s important to keep in mind, however, that PAWS is a sign that the brain is healing and adjusting to life without drugs or alcohol. With the right support and self-care strategies, those going through PAWS can find relief and continue on their path to lasting recovery.

Is Post-Acute Withdrawal Syndrome Preventable?

It can be difficult to avoid this syndrome as it varies between individuals and their history of addiction. Understanding risk factors prior to detoxing is key to trying to reduce the severity of PAWS. Generally, those with the highest risk of developing PAWS have had long-term addictions to:

• Benzodiazepines
• Alcohol
• Opioids

Sadly, there is no surefire way to avoid it altogether; however, understanding the causes and potential severity of PAWS can help those battling addiction prepare for its effects accordingly. By planning ahead for the difficulties that come along with PAWS, people can put themselves in the most optimal position to overcome this condition.

Strategies for Dealing with Post-Acute Withdrawal Syndrome

Because post-acute withdrawal syndrome can impact individuals on a psychological and emotional level, support from a therapist or counselor plays an important role in managing symptoms. The unpredictable nature of PAWS makes it a challenge for many and very stressful. There are other steps individuals can take to help them deal with and cope with PAWS. These include:

• Practicing self-care. From eating a healthy diet and getting regular exercise to avoiding places or people that may trigger cravings, it is important that anyone experiencing post-acute withdrawal syndrome does all they can to surround themselves with positive and supportive relationships.

• Educating themselves about PAWS. Knowing what symptoms to expect may help individuals cope with PAWS, so they aren’t caught off guard when, and if, they experience those symptoms. This is especially important because of the sporadic nature of PAWS symptoms and the increased risk of relapse they pose.

• Reflecting on their experience. Keeping a journal may be helpful in remembering experiences to determine the series of events that led up to a surge of PAWS symptoms. Writing down experiences can help someone recall how they reacted to certain events and provide them with alternative ways of handling these situations in the future.

• Devising a schedule that works. One of the most common symptoms of PAWS is difficulty concentrating. If that is an issue, individuals can try limiting the amount of time they spend on each task. Allocate 15 minutes to an activity and then schedule a break or switch to something different to help with a lack of focus. If lack of memory is an issue, set up reminders on a phone or write notes to help.

If a person feels caught in a cycle of circular thinking, switch gears by engaging in a different activity that may help distract them from that particular line of thought.

Many experiencing PAWS suffer from insomnia. Establishing a sleep routine, where the person avoids caffeine before bed, goes to bed at the same time every night, and wakes up at the same time each morning can help improve sleep patterns.

• Understand that recovery takes time. Finally, it is important that anyone living with post-acute withdrawal syndrome recognize that treating addiction can’t be rushed. Patience is an essential component of recovery. Some days will be harder than others, but these symptoms are proof that individuals are making progress on their journey to sobriety.

At Bridges of Hope, our treatment philosophy is based on a comprehensive and integrated approach to addressing substance use and mental health disorders. Utilizing therapeutically proven, evidence-based clinical practices, we provide superior client care in Indiana through our all-inclusive treatment services.