What Is Post-Acute Withdrawal Syndrome (PAWS)?

Recovery from drug addiction or alcohol addiction is no easy thing. Fortunately, it isn’t something you have to do on your own.

Help is available at every stage of the journey, and if you experience complications down the road, your treatment team can offer solutions and help you manage your symptoms, including post-acute withdrawal syndrome (PAWS).

Acute Drug Or Alcohol Withdrawal Vs. PAWS

Drug or alcohol withdrawal is an early and often challenging stage of recovery that happens after you stop taking a substance that you are dependent on. This throws off your body’s internal chemical balance for a period of time, often producing uncomfortable withdrawal symptoms that could include anything from headaches and grouchiness to extreme drug cravings, convulsions, fever, vomiting, sleep disturbances, and even seizures or hallucinations.

Fortunately, even moderate to severe withdrawal symptoms (which affect 2-7% of people admitted to the hospital for heavy alcohol use, according to the American Society of Addiction Medicine) usually last for less than a week, with symptoms peaking early and then fading as the body adjusts. And, with close medical support and supervision, withdrawal is generally safe and much more comfortable. It is also necessary in order for other recovery services to begin.

In contrast, post-acute withdrawal syndrome is a secondary condition that tends to develop weeks or even months after acute withdrawal has finished and is thought to relate to the effects of drug and alcohol addiction on the mind, rather than any physical effects. While PAWS is widely accepted by treatment providers as a possible complication of addiction recovery, it is not included as an accepted diagnosis in the DSM-5 at this time.

PAWS Symptoms

PAWS symptoms are mostly mental and emotional, rather than physical. Unfortunately, however, both acute withdrawal and PAWS have the potential to contribute to relapse, especially if a person isn’t working with a treatment provider when they occur.

Symptoms of PAWS are known to include:

• long-lasting feelings of discouragement, depression, anxiety, or panic
• problems feeling pleasure from healthy sources (anhedonia)
• mood swings and emotional reactivity
• fatigue, aches, and pains
• sleep disturbances
• increased sensitivity to pain or stress
• problems with concentration and short-term memory
• reduced libido
• renewed drug or alcohol cravings

In one study cited by SAMHSA, 29% of clients who entered treatment experienced suicidal thoughts in the three months that followed, and other high-risk symptoms like delirium, delusions, paranoia, and hallucinations have also been reported.

Risk Factors For Post-Acute Withdrawal Syndrome

Most people in recovery from drug or alcohol addiction experience some of the symptoms linked with PAWS at some point in the weeks and months following detoxification. Fortunately, these symptoms are usually mild and don’t last long.

However, because PAWS is linked to disrupted brain functioning, it is more likely to occur, and occur severely, when a person has been misusing a substance or multiple substances heavily or consistently over a long period of time. Opioid addiction recovery, alcohol addiction recovery, and benzodiazepine addiction recovery are also more strongly linked to PAWS than other substance recoveries.

PAWS may also be triggered or intensified by other stressful or painful circumstances in a person’s life like personal losses, injuries, or changes in employment.

PAWS Treatment Options

There is no way to prevent PAWS symptoms from happening or to anticipate them beforehand. However, treatment professionals can help you understand these symptoms and develop strategies to manage them in healthy ways.

Some recommended self-treatment practices include:

• practicing self-care (healthy diet, exercise, and sleep)
• spending time in nature
• reaching out to friends, loved ones, and peers for support
• writing down your symptoms as they occur
• spending time in mindfulness or meditation
• setting reminders on your phone
• embracing patience and a positive outlook

The nerve pain medication gabapentin is also sometimes prescribed off-label to treat PAWS, along with pregabalin, carbamazepine, and oxcarbazepine, especially when the person is struggling with a lack of pleasure, difficulty sleeping, and restlessness.

If you experience any symptoms of psychosis or other severe mental health issues, including suicidal thoughts, reach out to your doctor or a mental health professional as soon as possible.

PAWS Treatment Outlook

PAWS is a natural part of the healing process. While it can be different for each person who experiences it, it is always a temporary condition and it will resolve on its own in time.

In most cases, PAWS symptoms will tend to come and go occasionally for anywhere from six months to two years after a person has finished detoxification. These flare-ups usually only last for a few days at a time before fading.

Addiction Treatment At Bedrock Recovery Center

Post-acute withdrawal syndrome can be a difficult part of the recovery process, but you can get through it. And the more time passes, the easier it will get.

If you are just beginning to think about drug or alcohol addiction treatment, or you have tried treatment in the past but run into some setbacks, please consider contacting Bedrock Recovery Center today. Located in Canton, MA, our treatment center offers comprehensive detox and residential treatment services for all forms of drug and alcohol abuse and addiction, as well as residential dual diagnosis and mental health treatment services.

To learn more or explore your own personalized recovery program, please contact us today.