What is Post-Acute Withdrawal Syndrome?

Addiction and alcoholism, over time, eventually cause the addict or alcoholic to experience horrible withdrawal symptoms that cannot be tolerated. These types of withdrawal symptoms are known as acute withdrawal symptoms. Severe withdrawal symptoms are usually physical and can cause a person to suffer sincerely and are generally debilitating.

Acute withdrawal symptoms are the reason that addicts and alcoholics remain on their drug of choice is to avoid the symptoms. Medically supervised detox programs are recommended for a person who is experiencing acute withdrawal symptoms to increase their chances of long-term recovery.

Post Acute Withdrawal Syndrome PAWS

What is PAWS?

Once a person has successfully become clean and sober, it is likely they will experience some level of post-acute withdrawal syndrome in the first months of recovery. Also known as PAWS, this problem occurs after the acute withdrawal symptoms have subsided and can last for several months and even years. The reasons that former drug addicts and alcoholics experience PAWS even after they have entered recovery is because of the damaging effects that substances have on the brain. The people most susceptible to PAWS are people who have been ingesting large amounts of drugs and alcohol for many years. Their brain and neurochemistry need time to repair the damage that long term drug and alcohol use causes.

The areas of the brain that are damaged from drug and alcohol use control how people function as well as cope with life in general. The National Institute on Drug Abuse reports the three specific brain areas that are damaged from substance abuse.

The basal ganglia, which plays an important role in positive forms of motivation, including the pleasurable effects of healthy activities like eating, socializing, and sex, and are also involved in the formation of habits and routines. These areas form a key node of what is sometimes called the brain’s reward circuit the extended amygdala plays a role in stressful feelings like anxiety, irritability, and unease… Over time, a person with substance use disorder uses drugs to get temporary relief from this discomfort, the prefrontal cortex powers the ability to think, plan, solve problems, make decisions, and exert self-control over impulse. (NIDA)

PAWS is different from acute withdrawal symptoms. Acute withdrawal symptoms are mostly physical symptoms, whereas PAWS results in psychological and emotional symptoms. The symptoms of PAWS are similar for drug addicts and alcoholics; the type of substance abused is not as relevant for PAWS symptoms as it is for acute withdrawal symptoms.

PAWS Can Stay with You For a Long Time

According to the National Center for Biotechnology Information on advances in science and health, the symptoms of PAWS can last for months and years but do diminish with time. The symptoms of PAWS include:

Mood swings, anxiety, irritability, variable energy, low enthusiasm, variable concentration and disturbed sleep. Many of the symptoms of post-acute withdrawal syndrome overlap with depression, but post-acute withdrawal syndrome symptoms are expected to gradually improve over time. (NCBI)

PAWS can also lead to obsessive-compulsive behaviors, inability to cope with stress, difficulty maintaining social relationships, cravings for drugs and alcohol, lethargy, irregular sleep patterns, or an inability to fall or remain asleep, and negative self-talk and attitudes about others and life. The symptoms of PAWS can come and go for several years. A recovering addict or alcoholic may have several months with no PAWS symptoms and then suddenly experience difficulty in handling stress or disturbances in their sleep cycles.

For people who are experiencing symptoms of PAWS, it is recommended that they receive psychotherapy that is evidence-based to help them improve their behaviors that cause an increase in anxiety or depression, or that could also lead them to relapse.  Cognitive-behavioral therapy is a type of evidence-based therapy that specifically targets how a person reacts to stress, emotional situations, and anxiety. Other methods of treatment that assist with reducing the effects of PAWS symptoms are group therapy, stress management, and relaxation techniques.

To reduce symptoms of post-acute withdrawal syndrome, it is also recommended that a person be involved in 12 step meetings, exercise, eat healthy foods with moderate sugar intake, avoid caffeine, see a therapist regularly, and develop a strong spiritual life. The 12-step program is especially important to newly recovering addicts and alcoholics as it provides guidance and support from other recovering people who share the same experiences. Getting and working with a sponsor is another key component to learning how to become satisfied in life clean and sober.

Stay Clean & Sober

Fortunately, the symptoms of PAWS do diminish the longer a person remains clean and sober. Recovery is a lifelong commitment, and with time, the stresses and worries that used to cause a person in recovery to feel poorly, stop. Although recovery is not a guarantee that life will always go perfect and trouble-free, it is the solution for how to manage conflict, disappointment, and stress. For successful recovering addicts and alcoholics, peace of mind in recovery is not the absence of conflict but the ability to cope with it and maintain their recovery.