Post-Acute Withdrawal Syndrome is not a term many people are familiar with, although most know about the symptoms.
When you hear the word “detox,” what comes to mind? Cravings? Pain? Symptoms that resemble the flu? If so, you’re only half right.
What you’re likely imagining is the first stage of detox, commonly known as “withdrawal.” But the reality is drug and alcohol detox does not end the moment the offending substance is no longer present in a person’s system. In fact, it can take up to two years for the brain’s neurochemistry to return to normal.
The second stage of detox that takes place after withdrawal is known as Post-Acute Withdrawal Syndrome, or PAWS, and comes with its own troublesome symptoms. PAWS symptoms are much less pleasant than its cute acronym would lead you to believe.
The unfortunate reality of PAWS Syndrome is that the symptoms can be a trigger for relapse. Because this second stage of detox occurs during the period in which the brain chemistry is returning to normal, it can take 20 months or more before it has passed.
Often times, people going through withdrawal from benzodiazepines will notice the longest period of symptoms that could last for a year or more, whereas PAWS alcohol symptoms are less persistent, and are marked by bouts of depression or anxiety. In severe cases, patients may experience delirium tremens.
The most important thing that those in recovery need to understand is that recovery takes time. If a person goes into detox expecting it to be over within a matter of months, they are far more likely to be unprepared for the journey ahead.
What are the Symptoms of Post-Acute Withdrawal Syndrome?
Below is a partial list of Post-Acute Withdrawal Syndrome symptoms that typically accompany this phase of recovery. It is essential that anyone going through this stage of detox makes self care a priority in their journey.
While PAWS symptoms can be uncomfortable, being able to practice patience, relax, and enjoy the good parts of life will get you through the hard days. Believing in your own ability to overcome detox is what will deliver you to the other side. Trust us, you can do this!
PAWS Symptoms are Marked by Many of the Following 6 Signs:
- Inability to think clearly
- Memory problems
- Emotional overreactions or numbness
- Sleep disturbances
- Physical coordination problems
- Stress sensitivity
1. Inability to Think Clearly
The thought disorders that are experienced when PAWS is activated should not be confused with overall intelligence. Think of this symptom as a malfunction that switches on and off, rather than a chronic condition.
“Unclear thinking” can include the inability to concentrate for long periods of time and the impairment of abstract reasoning, meaning it inhibits the ability to identify logical rules and apply them to basic problem solving.
Another common symptom is rigid and repetitive thinking in which the same thoughts circle around until they cannot be put together in an orderly way.
2. Memory Problems
Imagine being able to understand something when it is first explained to you but then, 20 minutes later, you either can’t make sense of it or have forgotten it completely. This is a common and particularly frustrating symptom that accompanies PAWS.
In addition, long term memory can be affected, and those experiencing Post-Acute Withdrawal Syndrome may have a difficult time remembering significant events from their past. Much like how their ability to thinking clearly comes and goes, memory can also come and go in the same manner.
Something that is easily remembered in one moment may be lost in the next, making it especially difficult to retain new information and learn new skills.
3. Emotional Overreactions or Numbness
Think of someone in your life who has a tendency to overreact – someone whose response to stress or excitement is consistently more amplified than it should be.
Now, imagine that person’s typical reaction multiplied by ten. This is the emotional overreaction response associated with post-acute withdrawal syndrome.
When experiencing PAWS, even the most trivial matters can lead to intense anger or anxiety, a response that has the potential to overwhelm the nervous system, resulting in an emotional shutdown.
When this occurs, it leaves the person feeling numb and with unpredictable mood swings.
4. Sleep Problems
While the majority of PAWS symptoms are temporary, issues related to sleep may be lifelong. This symptom often manifests in unusual or disturbing dreams that may interfere with full, restful sleep, or difficulty falling asleep or staying asleep for the entire night.
These inferences can result in a change in sleep patterns, meaning the person will sleep for unordinary long periods of time, or at unusual times of the day. Even though sleep issues are likely to improve with time, some of the unusual patterns may never be resolved completely.
Fortunately, this is a symptom that many become accustomed to without severe difficulty.
5. Physical Coordination Problems
A less common but particularly challenging symptom of PAWS is difficulty with physical coordination, making the person more prone to injury and accidents.
This can result in categorical stumbling or clumsiness that makes a sober person appear to be intoxicated.
This symptom is marked by dizziness, imbalance, poor hand-eye coordination, and slow reflexes.
6. Stress Sensitivity
For those without PAWS, distinguishing between low-stress and high-stress situations comes naturally. However, not having this ability can easily lead to emotional breakdowns related to compounded stress or intense overreactions that result in inappropriate behavior.
While a person experiencing PAWS may act irrationally to stress in the moment, later on they will often be able to see the situation more clearly. This can lead to confusion and aggravation, as even they won’t understand why they reacted so strongly.
Additional Post-Acute Withdrawal Symptoms
The six symptoms listed above are the most common ones that people experience during the post-acute withdrawal stage, but each person is different and so is each type of addiction.
Here are other issues that may manifest from PAWS:
- Depression
- Cravings for drugs or alcohol
- Pain or a heightened sensitivity to pain
- Obsessive or compulsive thoughts, similar to OCD
- Difficulty relating to other people
- Feelings of guilt, remorse, or shame
- Lack of drive or ambition
- Cynical thoughts
Many of these may come and go over time, so it’s fundamental to recognize these are only symptoms of withdrawal and usually won’t last for long. This makes it necessary to find ways to overcome, or learn how to stabilize them.
Stabilization of Post-Acute Withdrawal Syndrome Symptoms (PAWS)
Because PAWS is a common trigger for relapse, it is very important that those in recovery manage any of its symptoms as quickly as possible.
For people in recovery who are experiencing any of the signs of post-acute withdrawal syndrome, it’s sometimes necessary to stabilize the symptoms for proper self care and to continue putting recovery first without worrying about relapse.
5 Ways to Stabilize Post-Acute Withdrawal Syndrome Symptoms
1. Verbalization
Verbalizing your thoughts and feelings can be difficult at first, but it can be an indispensable part of recovery.
Having people to talk to who will not criticize or minimize what you are experiencing is crucial. Not only will it provide support, it will also give you the opportunity to bring conscious awareness to your symptoms and help you see your situation realistically.
2. Ventilation
Learn to express how you are thinking and feeling, regardless of whether it seems irrational or unfounded. We all need to vent at some point but make it productive. Once you let it out, be done with it and move on without looking back.
3. Reality Testing
Your perception of what is going on may be very different from reality. It is meaningful to ask those around you if what you are saying and how you are acting is making sense.
This circles back to verbalization and points to why it’s critical to have a good support system of people you can count on to be honest and objective without being critical of your situation.
4. Problem Solving and Goal Setting
Be proactive about getting better. Identify steps you can take to continue moving forward and create a plan of what you can do to get there.
Having goals will ensure that you are staying on track and it makes it easier to measure your progress. If you stray from the goals you set or fall back, recognize this and make changes to resume the coarse. This is why problem solving is grouped with goal setting.
5. Backtracking
Reflect on the symptoms you have experienced. Make note of when they began and reflect on what you can do to turn them off. Recall specific symptomatic episodes, and identify what may have caused them and what helped resolve them. What actions could you take to help prevent future episodes or end them more quickly?
What is the Treatment for PAWS?
To minimize the symptoms of post-acute withdrawal syndrome, it’s critical to begin recovery at a medically-supervised detox facility that is staffed by trained professionals to monitor all symptoms and keep the patient comfortable.
A Medication Assisted Treatment Program can be beneficial for overcoming many of the withdrawal symptoms and reducing cravings during detox, and after it is finished.
After detox has been completed, transitioning to a residential addiction treatment program will offer the most effective way of recovering and staying on track to lessen the chances of relapse.
An inpatient program will also offer therapies and tools to alleviate many of the psychological symptoms of withdrawal.
Regular exercise, a healthy diet, and proper, restful sleep each night are excellent ways to improve mood and counteract the negative side effects of post-acute withdrawal.
Cognitive Behavioral Therapy is recommended as a way to understand and mitigate the signs of negative thinking that can accompany PAWS.
As mentioned earlier, recovery takes time. Having a good support system in place, especially in the early stages, is crucial for a successful recovery.
