Post-Acute Withdrawal Syndrome: What to Expect

Withdrawal is the phenomenon that occurs when you stop drinking or using drugs after your brain and body have built up a reliance on them over many years. Physical symptoms such as chills, nausea, fatigue, stomach cramps, increased heart rate and body aches are among the most common side effects, which can vary in severity and be uncomfortable. Some of the more extreme withdrawal symptoms, like seizures, can even be life-threatening.

Depending on the substance you misused and how long you used it, the initial phase of withdrawal can last anywhere from a few days to a few weeks. Medical supervision will not only shorten the detox timeline, but can also make it far safer and more comfortable, so you can begin to fully focus on the goal of achieving lasting freedom from intoxicating substances. However, some people experience a prolonged withdrawal period called post-acute withdrawal syndrome, or PAWS.

What Is PAWS?

In contrast to the initial symptoms you can expect to experience with withdrawal, which are largely physical, PAWS is mostly mood-related. The onset of PAWS symptoms such as irritability, anxiety, mood swings, fatigue and insomnia can occur unpredictably, and can last for a few days at a time.

PAWS symptoms can occur with any substance of abuse, but are most common for people who used drugs like opioids, stimulants, benzodiazepines, alcohol and marijuana for extended periods. Many people have the following:

• Difficulty concentrating, or clouded thought processes
• Drug cravings
• Trouble falling or staying asleep
• Listlessness
• Anxiety or panic attacks
• Overall lack of motivation

Though PAWS tends to be less intense than the original withdrawal phase, that doesn’t mean it’s not a cause for concern. Any unpleasant or traumatic experience that could leave you more vulnerable to a relapse is something you’ll want to work hard to avoid, especially in the earliest stages of your recovery.

What Causes PAWS?

Medical experts do not know exactly why post-acute withdrawal occurs to some people, but one prevailing theory suggests that it is due to the chemical changes addiction and long-term substance misuse cause in the brain. Over time, you become both psychologically and physically dependent on drugs and alcohol, and the act of quitting can be highly stressful as you try to adapt to life without these substances. When you experience withdrawal, it is because of your brain’s attempt to re-balance itself without the presence of intoxicants, so it makes sense that PAWS would stem from similar causes.

Not only do doctors and psychologists have yet to pinpoint one specific cause for PAWS, but people who experience this condition also do so at different rates, which is one of the reasons the condition can be challenging to understand. Some recovering addicts do not develop PAWS at all, while others have ongoing symptoms that can last several years. Many people who have PAWS find their symptoms ebb and flow as time goes by.

The Lack of a Medical Consensus About PAWS

As common an experience as PAWS is among recovering addicts, it still has not received an official medical diagnosis, which has sparked some intense debate among the addiction treatment community.

Many people view PAWS as an excuse for relapse, while others believe it is yet another reason to encourage people in recovery to seek long-term treatment. Some medical professionals have argued that, instead of classifying PAWS as a separate condition, we need to change our definition of how long the detox and withdrawal timeline lasts. One thing is for certain: PAWS needs further investigation that will help us learn to define, treat and talk about it.

How to Manage PAWS

PAWS symptoms are mostly psychological, so receiving ongoing care from counselors and therapists is vital in minimizing and managing the severity of your experience.

Here are steps you can take to ease your PAWS symptoms:

• Be aware of what to expect in early recovery, and what pitfalls to avoid.
• Practice patience and mindfulness.
• Seek opportunities for self-care, such as napping, bathing or doing yoga.
• Learn natural remedies for insomnia. Develop a healthy pre-bedtime routine that helps you relax and calm your mind.
• If you find you are having trouble concentrating on a task, give yourself permission to take a break.
• Eat a balanced diet, and get at least 30 minutes of physical activity each day.
• Continue attending individual and group therapy.
• Find new hobbies that can help take your mind off how you’re feeling.
• Learn your unique relapse triggers, and have strategies in place for managing them.
• Know that you are not alone. Develop a sober support network of people you can call if you are having a difficult time.
• Have realistic expectations. There are no shortcuts or overnight solutions in recovery, and it’s normal to have setbacks now and then.

What You Need to Recover

While there is no cure for PAWS, you can reduce your risk of experiencing it by undergoing clinically supervised detox, followed by an inpatient rehab program where addiction professionals can help you identify the root causes of your substance abuse disorder, so you can begin the work of managing it for the rest of your life.

Research has established that the longer someone spends in ongoing treatment, the more successful they will be at finding long-term freedom from their addiction. Having a plan in place for continuing care after your discharge from an accredited treatment center will also be a crucial piece of the puzzle for the ongoing management of the chronic disease of addiction.

Beach House’s medical detox program can help provide the foundation for your long-term sobriety. Undergoing the initial detox phase in a comfortable setting will ease the experience of acute and post-acute withdrawal symptoms, while reducing your chances of succumbing to a relapse during this vulnerable phase of recovery.

By continuing to attend therapy and group support meetings, as well as learning to ask for help from your sober support network when you need it, you can learn to manage post-acute withdrawal and continue to pursue your recovery and your goals for living a healthy life.