Understanding PAWS (Post-Acute Withdrawal Syndrome)
February 14th, 2018 | By Allaire Kirk
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.
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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 based on 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: Like 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 based on 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.