Post Acute Withdrawal Syndrome (PAWS)

Post-acute withdrawal syndrome (PAWS) is the lingering sign of healing during addiction recovery.

Damage from substance abuse doesn’t happen all at once, and neither does undoing the effects of substance use disorders. Unfortunately, part of recovery can involve some side effects that last longer than the initial withdrawal and subsequent treatment programs. While post-acute withdrawal syndrome symptoms are not life-threatening, they can be stressful enough to contribute to a relapse.

Not everyone will experience PAWS as part of their recovery journey. Still, it is prevalent enough that knowing what to expect and healthy ways to deal with it needs to be common knowledge to help maintain long-term recovery.

What is Post Acute Withdrawal Syndrome?

Post-acute withdrawal syndrome (PAWS), also known as protracted or prolonged withdrawal, is a series of persistent psychological symptoms that occasionally happen for months or years after the initial alcohol or drug withdrawal. People overcoming reliance on highly addictive substances like alcohol, benzodiazepines, cocaine, and opioids are the most at risk of developing PAWS.

Acute withdrawal symptoms occur almost immediately when a person first quits addictive substances. Most acute withdrawal symptoms are physical withdrawal symptoms while the body rids itself of alcohol or drugs and begins healing.

Post-acute withdrawal is like a second wave of healing, but it occurs mentally rather than physically. Alcohol, stimulant, benzodiazepine, and opioid addiction cause chemical changes in the brain and central nervous system (CSN), causing or worsening mental health issues. As the brain and CSN restore natural balance, there are ups and downs responsible for recurring cravings, mood swings, and rebound symptoms, which is the return of preexisting mental health symptoms that certain substances might have suppressed.

Some PAWS symptoms are also triggered by stressful situations and interactions, especially in people who lack coping strategies to deal with stress.

Understanding PAWS

Understanding PAWS is tricky because, unlike physical withdrawal symptoms, it is hard to quantify and observe psychological distress and cravings. Officially, diagnostic manuals and guidelines do not recognize PAWS; however, addiction treatment specialists and mental health professionals acknowledge its existence and work hard to prepare patients in recovery for how to deal with it.

PAWS has various symptoms, some directly related to the addictive substances a person overcame, and some are more general psychological symptoms, making it challenging to establish official criteria for a diagnosis.

The emergence of cravings, mood swings, and symptoms like anxiety, rage, and depression are all common symptoms of PAWS reported during substance abuse recovery. Despite the lack of official recognition, addiction professionals recognize these as post-acute withdrawal symptoms, which can be a driving factor in relapse.

Many people initially turned to alcohol or drugs to self-medicate and mistakenly feel like returning to substance abuse is the only way to alleviate PAWS symptoms. Relapse after a long period of recovery is especially dangerous because people no longer have an increased tolerance to addictive substances, which can result in accidental overdoses.

It cannot be overstated how vital education about post-acute withdrawal syndrome and having a relapse prevention plan is.

Post Acute Withdrawal Symptoms

Post-acute withdrawal symptoms and risk factors will vary for every person based on their physical makeup, co-occurring disorders, the addictive substance they were abusing, and previous withdrawal and detox experiences.

Some of the most common symptoms of post-acute withdrawal syndrome include:

• Mood swings
• Anxiety
• Panic attacks
• Restlessness
• Strong alcohol or drug cravings
• Decreased or complete lack of sex drive
• Fatigue
• Insomnia
• Difficulty focusing
• Feelings of hopelessness
• Unexplained chronic pain

While some of these seem like things people deal with throughout life in general, for people experiencing PAWS, they come on fast and can be extremely overwhelming. Some people in recovery have compared it to being on a rollercoaster with extreme ups and downs.

Long-Term Symptoms

While PAWS is generally a long-term condition, some symptoms last much longer than others or become lifelong occurrences requiring self-care and healthy coping skills to deal with them and prevent relapse.

Long-term symptoms of PAWS include:

• Lack of motivation
• Anhedonia, or inability to feel pleasure
• Memory loss
• Difficulty learning new skills and tasks
• Lack of problem-solving skills
• Intrusive thoughts
• Trouble maintaining long-term relationships
• Lack of interest in hobbies or recreational activities
• Poor impulse control
• Aggressive outbursts
• Extreme or disproportionate reactions to situations
• Depression
• Anxiety disorders
• Suicidal thoughts

Many post-acute withdrawal symptoms, especially long-term ones, can seem random and utterly unrelated to the effects of substance use disorders, which is why treatment programs must educate people about the possibility of PAWS and how to manage it.

How Long Does Post-Acute Withdrawal Syndrome Last?

How long post-acute withdrawal syndrome lasts varies for every person. Because PAWS symptoms are not constant, it can be challenging to establish a timeline.

When PAWS symptoms occur, especially bouts of depression and fatigue, they generally last several days or weeks; as for how long the symptoms will randomly appear, it can be months or years before they stop.

Some people who have overcome alcohol use disorder report that it takes up to three years for their sleep habits to normalize, despite other PAWS symptoms resolving before that.

While it is impossible to predict who will experience PAWS and for how long, there are some things that people can do to decrease the chances of triggering specific symptoms and reduce their impact.

Some PAWS prevention strategies include:

• Undergo supervised medical detox for drug and alcohol withdrawal followed by an evidence-based treatment program
• Seek dual diagnosis and proper treatment for co-occurring disorders
• Avoid triggers from situations, people, and places associated with using drugs or alcohol
• Attend regular 12-step facilitation groups or group therapy for ongoing support
• Practice self-care and positive coping strategies to deal with stress
• Have a relapse prevention plan and support network to rely on when PAWS symptoms occur

One of the many benefits of residential treatment programs is constant access to resources and education that prepare you for the possibility of PAWS while establishing a support network and healthy habits.

Achieve Long-Term Recovery

Choosing to overcome substance abuse is a brave decision. Once you make that choice, White Oak Recovery Center can help you with compassionate, evidence-based treatment.

We offer onsite medical detox to ensure your initial withdrawal process is safe with around-the-clock medical care and support. Through dual diagnosis, we diagnose and address co-occurring disorders that have contributed to substance abuse. Our licensed and experienced team works with you to personalize a treatment plan that will uncover the roots of addiction and empower you to overcome them and face future challenges with grace and confidence.

During your stay in our residential treatment center, we carve out time for rest and recreation and help you build a sense of community and support with the other residents during guided group therapy and activities. We aim to instill every skill you need to achieve a long-term, fulfilling recovery.

At WORC, we plant the seeds that will blossom into a life rooted in recovery. Contact us today; we are eager to answer any questions you have about your treatment options with us.