Understanding Post-Acute Withdrawal Syndrome (PAWS): What You Need to Know

When someone goes through the process of detoxing from drugs or alcohol, the immediate withdrawal symptoms are usually the first things that come to mind. These can include nausea, sweating, shaking, anxiety, and irritability, among others. But what happens after the acute withdrawal phase? For many individuals recovering from addiction, the answer is Post-Acute Withdrawal Syndrome (PAWS). This can be a confusing and frustrating phase of recovery, but understanding it is key to navigating this challenging time.

What is Post-Acute Withdrawal Syndrome (PAWS)?

Post-Acute Withdrawal Syndrome refers to a set of symptoms that persist long after the initial detox phase. While acute withdrawal typically lasts for a few days to weeks, PAWS can stretch for months or even years after someone has stopped using substances. The symptoms of PAWS are not as physically intense as those during acute withdrawal but can be just as disruptive to a person’s life.

PAWS is thought to result from changes in the brain caused by substance use. Many addictive substances affect the brain's chemistry and disrupt its normal functioning, and it can take time for the brain to restore balance. This means that while the person may no longer be using drugs or alcohol, their brain may still be adjusting to its new chemical state, which can lead to ongoing symptoms.

Symptoms of PAWS

The symptoms of PAWS can vary from person to person and may fluctuate over time. However, some of the most common symptoms include:

1. Emotional Instability: People may experience intense mood swings, anxiety, depression, or irritability. They might find it hard to regulate their emotions.

2. Sleep Disturbances: Insomnia, restless sleep, or vivid dreams can be common during PAWS. Sleep problems can be exacerbated by stress or anxiety.

3. Fatigue: Even though individuals might sleep more, they can still feel constantly tired or drained of energy.

4. Cognitive Impairments: Individuals may have trouble with memory, concentration, and decision-making. This is often referred to as "brain fog."

5. Cravings: The desire to use substances again can still be strong during this phase. These cravings can be triggered by stress or certain situations.

6. Anxiety and Panic Attacks: Anxiety is often more pronounced in PAWS, and some people may experience panic attacks.

7. Physical Discomfort: Although the intense physical withdrawal symptoms have passed, some individuals may still experience headaches, muscle pain, or digestive issues.

How Long Does PAWS Last?

The duration of PAWS varies widely among individuals and depends on several factors, such as the type of substance used, the length of time the person was using it, their overall physical health, and the presence of any co-occurring mental health conditions. For some, PAWS might last only a few months, while for others, it can persist for over a year.

It’s important to note that PAWS tends to improve over time, but recovery is often a gradual process. While the symptoms might seem overwhelming at times, they typically become less intense as the brain heals and adjusts.

What Causes PAWS?

PAWS is primarily caused by the brain's adaptation to substance use. When someone uses drugs or alcohol, the brain’s neurotransmitters, which regulate mood, stress, and pleasure, are altered. The brain becomes reliant on the substance to function, leading to a reduction in its natural production of certain chemicals, such as dopamine.

When the substance is removed, the brain can take time to return to a balanced state. During this time, individuals may experience the symptoms of PAWS as their brain chemistry and function slowly normalize.

Managing PAWS: Tips for Coping

While dealing with PAWS can be difficult, there are ways to manage the symptoms and improve the recovery experience. Here are some tips:

1. Stay Connected to Support: Whether it’s through a support group, therapy, or trusted friends and family, staying connected can provide both emotional support and practical coping strategies.

2. Exercise Regularly: Physical activity can boost mood, reduce anxiety, and help regulate sleep patterns. Even a short daily walk can make a big difference.

3. Practice Mindfulness and Stress Reduction: Techniques such as meditation, yoga, and deep breathing exercises can help reduce the impact of anxiety and emotional instability.

4. Get Enough Sleep: Sleep hygiene is crucial for healing. Create a consistent bedtime routine and avoid stimulants such as caffeine in the evening.

5. Be Patient with Yourself: Recovery from addiction is a long-term process, and healing takes time. Try not to be too hard on yourself if progress feels slow.

6. Consider Therapy: Cognitive-behavioral therapy (CBT) or other forms of therapy can help individuals develop coping skills for managing the emotional and cognitive aspects of PAWS.

7. Celebrate Small Wins: Recovery is a journey. Recognizing and celebrating small victories can help boost morale and maintain motivation.

When to Seek Professional Help

While PAWS is a normal part of recovery, there are times when professional help is needed. If you or someone you love is struggling with severe symptoms such as intense depression, suicidal thoughts, or overwhelming cravings, it’s important to reach out to a healthcare professional or addiction specialist.

Additionally, if symptoms persist for longer than expected or interfere with daily life, medical intervention can be helpful to ensure that any underlying conditions (such as co-occurring mental health disorders) are addressed.

Conclusion

Post-Acute Withdrawal Syndrome is an often-overlooked part of the recovery process, but it’s crucial to understand and address it for lasting success. While it can be a challenging phase, it is temporary, and with the right strategies and support, individuals can navigate through it and continue on the path to full recovery.

If you or someone you know is dealing with PAWS, remember that healing takes time, and each day brings you closer to a healthier, more balanced life.

Stephen Rought, LCSW Can Help You

I can help you understand the importance of mental health maintenance and getting back on track. Whether through individual therapy or couples counseling, I am here to help your emotional well-being.

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