Medically Reviewed By: Benjamin Caleb Williams RN, BA, CEN
Written By: Phillippe Greenough
Article Updated: 01/24/2021
Number of References: 8 Sources
Post-acute withdrawal syndrome, also known as PAWS, is a very challenging condition that follows acute withdrawal and is a necessary part of the withdrawal process for many recovering addicts and alcoholics. This guide features in-depth information on the causes, symptoms, and available treatments for post-acute withdrawal syndrome.
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PAWS is an acronym that stands for post-acute withdrawal syndrome. It describes the symptoms felt after the acute withdrawal process. While acute withdrawal is typically the most painful period of detox, PAWS symptoms can last weeks, months, or even years. It’s typically associated with heavy drug or alcohol abuse, but its severity all depends on a person’s addiction, genetics, and someone’s overall mental health.
While the initial withdrawal exhibits mostly physical symptoms, PAWS manifests itself as strictly psychological symptoms. Though no physical symptoms are felt, psychological symptoms can be just as difficult. PAWS can make recovery difficult, and can even lead a person back to drugs or alcohol.
PAWS is a long-lasting condition in which the brain is trying to restore function to neurotransmitter pathways that were disrupted through chronic drug or alcohol use. Neurotransmitters are chemicals used to send signals in the brain, and the “rewiring” that occurs after chronic drug or alcohol use can lead to a variety of mental health issues such as depression, anxiety, and psychosis. The brain is capable of restoring balance, but this process takes time; sometimes many months or even years. The subjective experience during this recovery process can be mentally uncomfortable while the brain is working to heal itself.
The exact symptoms of post-acute withdrawal syndrome will vary in intensity, sometimes greatly, between people. That being said, the imbalances produced through chronic, heavy drug or alcohol use have some very similar results in many people. While these may vary in intensity and duration, the most common symptoms of PAWS include:
This experience of PAWS is typically characterized by a highly aroused mental state, combined with a very bleak outlook on the present and future. Someone may be so overcome with anxiety that they are scared to be around other people, or even to go outside. At the same time, they may be extremely depressed and lonely. This leads to a very dangerous mental space of wanting to do something to calm their anxiety, but being too depressed and scared to reach out to others for help.
Almost every habit-forming substance is capable of producing PAWS, the only difference is in the specific symptoms and possibly their intensity. PAWS is technically a psychological condition resulting from suddenly losing such a powerful, albeit unhealthy coping mechanism. That being said, some substances are known for particularly intense symptoms and issues, and these are often most closely associated with a post-acute withdrawal syndrome.
Some of the substances which most often produce PAWS issues include:
There are a variety of effective treatments for PAWS and they are most effective when used in combination. A multifaceted approach including medication, therapy, social support, and exercise can be extremely effective at making it through PAWS while reducing the intensity of the symptoms.
Medications can be extremely useful in helping someone deal with the symptoms of PAWS. The medications which are most frequently used are ones that are non-habit forming, as someone experiencing post-acute withdrawal syndrome has already demonstrated a substance abuse problem in the form of heavy, chronic drug or alcohol use. These medications are not a solution, but they can give someone the mental stability to begin to build a solid foundation in recovery.
Some of the most commonly used medications for PAWS include medication classes such as:
While medications will help reduce the symptoms, there are a variety of therapies that may help the underlying psychological causes of these symptoms. Throughout addiction, many addicts or alcoholics will isolate and avoid dealing with feelings in healthy ways, keeping emotions strictly to themselves. Learning new, more productive ways to handle these inner issues will go a long way towards achieving some relief during PAWS. Some of the commonly used therapies in this regard include:
Post-acute withdrawal syndrome is different for everyone, and certain treatments may be more beneficial than others. It’s up to each individual going through this to reach out for help, and to try some different approaches until they find what best suits their unique needs. PAWS is unpleasant, to be sure, but it will get better if someone can stay sober. This will require help but it is possible, and there is life after addiction if someone is willing to reach out.
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