Stress Sensitivity and PAWS

If you or someone in your family have finally committed to professional treatment for a substance use disorder, you probably want to breathe a sigh of relief in expectation that the suffering will soon end. Getting professional help and detox is a vital first step, but after physical cleansing comes long-term planning: goals, support groups, stress management, relapse prevention. And, often, coping with lingering health issues. Among the most common of these is post-acute withdrawal syndrome (PAWS).

PAWS: Symptoms Aren’t Always Over When Detox Is

If you follow health news, you’ve heard of “long-haul COVID,” where a COVID-19 patient recovers from the virus but is left with months of chronic fatigue, depression, or other symptoms that continue to impede normal functioning. Years before the novel coronavirus was discovered, addiction medicine professionals were familiar with PAWS, which has similar long-haul effects.

As many as 90 percent of people recovering from opioid addiction, and 75 percent of those recovering from addiction to benzodiazepines or alcohol, experience some level of post-acute withdrawal syndrome as brain neurotransmitters adjust to the new normal. Typical symptoms include:

• Brain fog: unusual difficulty concentrating, remembering, or taking initiative
• Frequent fatigue
• Sleep problems
• Mood swings
• Panic attacks or bouts of depression
• Cravings to return to drug use
• Stress sensitivity

Stress Sensitivity as a PAWS Symptom

Every life transition, negative or positive, brings natural stress: post-detox adjustment is no exception. And since most people with addiction disorder have long depended on drugs for stress relief, they face a two-front battle: the stress itself, and temptation to take the easy way out by relapsing into old habits. When someone has PAWS, trying to function under physical or mental impairment adds a third battlefront. Small wonder that increased stress sensitivity is frequently associated with post-acute withdrawal.  

You probably have a stress sensitivity problem if:

• You get furious over everyday frustrations
• You hold unreasonable grudges
• You physically tense up during ordinary activities
• You have unexplained aches and pains when life feels hectic
• You’re dissatisfied with the results you get from standard stress-management techniques

People who have anxiety disorders co-occurring with addiction disorder are particularly vulnerable.

Stress Reduction Tips

Where stress sensitivity is a problem and especially where other PAWS symptoms are present, minimizing overall life stress is vital.

• Learn relaxation practices such as deep breathing, meditative prayer, or yoga.
• Take a brisk daily walk to burn off frustration and reduce depression.
• Plan your daily schedule to reinforce your goals and passions.
• Take on new (or return to old) commitments very slowly. Building resilience is more important than resuming former activity levels.
• Establish clear boundaries in your life: hours you can and can’t work or socialize, quiet spaces to retreat to.
• Do something creative: paint or journal your feelings, plant a garden, assemble a jigsaw puzzle.
• Make fresh fruit, vegetables, whole grains, and lean proteins the backbone of your diet. Too many sweets will make your blood sugar—and your mood—swing violently up and down.
• Skip the coffee, or take it decaf without sugar. If you “need” extra caffeine to function, you’re pushing yourself too hard to begin with.
• Get a full night’s sleep, and take rest breaks throughout the day.
• Practice healthy assertiveness.
• Be as kind to yourself as you would be to a good friend.
• Count your blessings several times a day.

Note that many of these practices involve building new habits, which can take several months and carries its own transition stress. For maximum effectiveness (and stick-to-itiveness), focus on just one or two new habits at a time. Expect, and commit to, at least two months of consistent practice rather than taking a “quick results or I give up” attitude. And stay active in a support network: you’ll need the accountability and encouragement.

Don’t give up. Even PAWS and the related stress sensitivity will pass, and everything will eventually prove worth the effort.

Let Us Help with Your Long Haul

At Beach House, we know that with or without PAWS issues, primary addiction treatment is only the first step to long-term recovery. Our professionals will help you create a treatment plan that includes ongoing support, goal setting, and stress management. Contact us to request a confidential consultation at no charge.