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Post-Acute Withdrawal Syndrome Signs and Symptoms

post-acute withdrawal syndrome

When someone is in early recovery from alcohol or other substance use, they may experience these lingering effects of drug and alcohol withdrawal. Withdrawal can occur in two phases: acute withdrawal (commonly known as detox) and Post-Acute Withdrawal Syndrome (PAWS)  Symptoms of withdrawal may be mildly unpleasant or seriously uncomfortable but they put a person at a higher risk of relapse because a person in early recovery may resort to taking the drug or drinking in order to get rid of the withdrawal symptoms.

After a person detoxes from alcohol or other addictive substances, there is usually a short period of physician discomfort that characterizes acute withdrawal. Symptoms that they may experience include muscle aches, nausea, headache or tachycardia (or increased heart rate). Detoxing from alcohol and addictive substances should be done under medical supervision because acute withdrawal can cause more dangerous and life threatening complications. Following this initial detox, a person may experience a second phase of symptoms that involve more of the psychological and mood-related aspects of withdrawal. These symptoms once again puts a person at risk of relapse as they may return to drug or alcohol use to try and stop the uncomfortable withdrawal symptoms.

What is Post Acute Withdrawal Syndrome (PAWS)?

Post-acute withdrawal syndrome (PAWS) is a cluster of withdrawal symptoms that persist after acute withdrawal symptoms have dissipated. This occurs because the brain is trying to recover from the effects of active addiction and reset itself. PAWS occurs most commonly and intensely when a person has abused alcohol, benzodiazepines, heroin or medically prescribed opioid pain medications for an extended amount of time. As such, the withdrawal symptoms of PAWS are often the opposite of the effects of the drugs abused as the brain tries to recalibrate itself to correct the chemical imbalances associated with active drug or alcohol addiction. It is important for a person in early recovery to know that these symptoms are temporary and unlike an underlying mood or anxiety disorder, will happen less often and fade as time passes and the brain has a chance to recalibrate.

Symptoms of Post-Acute Withdrawal Syndrome

Common symptoms of PAWS include:

  • Depression 
  • Mood swings
  • Difficulty with memory
  • Irritability and hostility
  • Overwhelming fatigue
  • Issues with fine motor skills and lack of coordination
  • Anxiety or panic attacks
  • Inability to focus
  • Insomnia or vivid dreams leading to difficulty sleeping
  • Cravings
  • Decreased libido

As aforementioned, it is important to recognize these signs and symptoms and to be aware of this second phase of withdrawal because it can catch people in early recovery off guard and result in relapse if not addressed. Unlike acute withdrawal symptoms, PAWS symptoms can last from 3 months to multiple years, which can be very discouraging to a person in early recovery. In general, people who are older in age, used for years or decades, have existing renal or liver damage may be more susceptible to developing PAWS and to have it last longer. The symptoms of PAWS may not be persistent and consistent and instead may be more cyclical in nature and happen in unexpected waves. While it isn’t possible to prevent PAWS from happening, it is possible to manage the symptoms to help a person feel better physically and emotionally, and to help reduce the risk of relapse. It is also helpful to be aware that PAWS symptoms are often triggered by stress or by situations that remind the person of past usage.

How to Cope With and Manage Symptoms of PAWS

While most symptoms of PAWS can last for a few days at a time, it can take the brain anywhere from 3 months to several years to reset itself after active addiction. Some practice ways to cope and manage with symptoms and PAWS:

  • Find support:
    • Support in the form of professional psychiatric and psychological care will be important to learn and understand symptoms, develop coping strategies and process the difficult emotions associated with PAWS
    • Support in fellowships and other support groups are also important to develop a network of others in recovery who may have experienced similar withdrawal symptoms in the past
    • Talking about PAWS symptoms and experiences 
  • Self care:
    • Often in active addiction people forget to practice basic self care. Early recovery is a time to develop healthy habits: eating well, incorporating exercise, establishing supportive relationships, meditation, journaling

It is important to consult a physician if symptoms become extreme or dangerous and if you have thoughts of suicide or hurting yourself or someone else.

Alcohol Rehab in California

If you or a loved one is struggling with PAWS in addiction recovery or may be in need of substance use disorder treatment, Asana Recovery can help. Contact Asana Recovery or give us a call today at 949-763-3440.Our trained professionals will walk you through the admissions process and make sure all of your questions are answered. The first step is admitting you need help, and is often the hardest. Once you take that first step, there will be a team on your side to help you be successful in your new future.