What Is Post-Acute Withdrawal Syndrome (PAWS)?

Post-Acute Withdrawal Syndrome (PAWS) can be a challenging part of recovery for those overcoming addiction. After the initial withdrawal symptoms fade, PAWS can appear, causing emotional and physical symptoms that linger for weeks or even months. Understanding PAWS is essential for anyone in recovery, as it helps explain why the journey might still feel difficult even after the worst of withdrawal is over. This guide will break down what PAWS is, why it happens, and how to manage it, so you can stay on track with your recovery.

What is PAWS?

Post-Acute Withdrawal Syndrome (PAWS) is a set of lingering symptoms that can appear after the initial phase of withdrawal from drugs or alcohol. Unlike the intense physical symptoms experienced during the acute withdrawal stage, PAWS is characterized mainly by psychological and emotional challenges that can last for months or even years after stopping substance use.

Why Does Post-Acute Withdrawal Syndrome Occur?

Post-Acute Withdrawal Syndrome (PAWS) occurs because long-term substance use changes the brain’s chemistry. When someone uses drugs or alcohol regularly, their brain becomes dependent on these substances to function normally. These substances alter the levels of chemicals in the brain that control mood, stress, and pleasure.

When the person stops using the substance, the brain struggles to readjust to its natural state. This struggle creates an imbalance, which leads to the symptoms of PAWS. The brain needs time to heal and return to its normal functioning, but this process can take months or even years.

How Long Does PAWS Last?

PAWS can last anywhere from a few months to over a year. The duration varies based on the substance used, the length and severity of the addiction, and individual factors like age and overall health. Some people may experience symptoms that diminish within a few weeks, while others might continue to feel the effects for 12 to 24 months or more. Recovery is different for everyone, so the timeline for PAWS can be unpredictable​.

Acute Withdrawal Stage

The acute withdrawal stage occurs right after a person stops using a substance like drugs or alcohol. During this time, the body reacts to the absence of the substance. This stage usually lasts for a few days to a couple of weeks, depending on the substance involved.

Symptoms during this stage are often intense and include both physical and psychological effects. Common physical symptoms include nausea, sweating, shaking, and rapid heart rate. Psychological symptoms might include anxiety, depression, and strong cravings for the substance.

The acute withdrawal stage is challenging because the body has become used to the substance, and now it has to function without it. This period is crucial for detoxification, as it marks the beginning of the body’s adjustment to life without the substance.

Common Post-Acute Withdrawal Symptoms

Approximately 75% to 90% of people who undergo withdrawal from substances like alcohol, opioids, or benzodiazepines experience Post-Acute Withdrawal Syndrome. This is why it’s important to recognize common symptoms, including:

• Mood Swings: Frequent and unpredictable changes in mood, often shifting from anxiety to depression.
• Anxiety: Persistent feelings of worry or panic, sometimes severe enough to interfere with daily life.
• Depression: Deep feelings of sadness or hopelessness that may come and go.
• Sleep Disturbances: Trouble falling asleep, staying asleep, or experiencing vivid and unsettling dreams.
• Fatigue: Chronic tiredness that makes it difficult to carry out daily activities.
• Cognitive Impairment: Difficulty concentrating, remembering things, or thinking clearly.
• Drug Cravings: Intense urges to use the substance again, even after the acute withdrawal phase has passed.
• Irritability: A low tolerance for frustration, leading to frequent feelings of annoyance or anger.
• Anhedonia: Inability to feel pleasure from activities that were once enjoyable.
• Difficulty Managing Stress: A reduced ability to cope with everyday stressors, often leading to feelings of being overwhelmed.
• Physical Coordination Problems: Issues with balance, coordination, or fine motor skills, making simple tasks more challenging.
• Increased Sensitivity to Pain: Some people may notice a heightened sensitivity to pain, even in the absence of injury or illness.

Can Post-Acute Withdrawal Syndrome be Avoided?

Avoiding Post-Acute Withdrawal Syndrome entirely is challenging, as it largely depends on individual factors and the substance involved. However, there are steps that can reduce the likelihood or severity of PAWS:

• Gradual Tapering: Slowly reducing the dosage of the substance, especially with medications like benzodiazepines, can help the brain adjust more gradually, potentially lowering the risk of PAWS.
• Proper Medical Supervision: Detoxing under the care of healthcare professionals can ensure that withdrawal is managed safely and that any emerging symptoms are addressed promptly. This can reduce the risk of severe PAWS​.
• Comprehensive Treatment Plans: Engaging in a well-rounded recovery program that includes therapy, support groups, and possibly medication can help manage withdrawal symptoms and support long-term recovery, which might decrease the chances of developing PAWS​.
• Healthy Lifestyle Choices: Maintaining a balanced diet, regular exercise, and good sleep hygiene can support the body’s healing process and may help in mitigating some symptoms of PAWS​.

PAWS Symptoms by Substance

Each substance impacts the brain differently, which is why the symptoms of PAWS can vary so much depending on what the individual used. Let’s take a look at some of the commonly abused substances and their effects.

Alcohol

Post-Acute Withdrawal Syndrome (PAWS) from alcohol is marked by symptoms like anxiety, mood swings, fatigue, and sleep disturbances. These symptoms occur because long-term alcohol use alters the brain’s neurotransmitter levels, which leads to a difficult adjustment period once alcohol is removed. Individuals may also experience depression, irritability, and a strong desire to drink again. The symptoms can persist for months, so outpatient services in alcohol rehab centers in Pennsylvania can be really valuable help during this time.

Antidepressants

For those withdrawing from antidepressants, PAWS can include symptoms like persistent anxiety, depression, and a lack of interest in activities once found enjoyable (anhedonia). These symptoms occur as the brain struggles to rebalance the neurotransmitters that were regulated by the medication. Other common symptoms include mood instability, sleep problems, and a general sense of discomfort or unease.

Benzodiazepines

PAWS related to benzodiazepines, such as diazepam or alprazolam, often involves prolonged anxiety, mood swings, sleep disturbances, and cognitive difficulties. Benzodiazepines enhance the effects of GABA, a neurotransmitter that calms the nervous system, so withdrawal can lead to a heightened state of anxiety and stress. Other symptoms might include tremors, physical discomfort, and an increased risk of panic attacks. During a benzo detox, individuals often face the challenge of these persistent PAWS symptoms, which can make the detox process more difficult. A carefully managed detox, often under medical supervision, can reduce the severity of these symptoms.

For those recovering from Xanax addiction, the PAWS symptoms can be particularly intense. Xanax, a commonly prescribed benzodiazepine, is known for its strong impact on the brain’s chemistry, making withdrawal and the subsequent PAWS phase especially challenging.

Cocaine

Cocaine withdrawal often results in severe psychological symptoms during PAWS. Common issues include depression, fatigue, sleep disturbances, and strong cravings for the drug. The stimulant effect of cocaine on dopamine levels in the brain means that withdrawal can leave individuals feeling emotionally flat or unable to experience pleasure. These symptoms can persist for months and often fluctuate in intensity. Professional cocaine rehab is necessary to prevent relapse during this time.

Methamphetamine

PAWS from methamphetamine use can be particularly intense. Symptoms often include severe depression, anxiety, fatigue, and cognitive deficits such as memory problems and difficulty concentrating. Methamphetamine significantly alters the brain’s dopamine system, leading to prolonged recovery periods. Individuals may also experience irritability, mood swings, and strong cravings.

Opioids

Opioid PAWS symptoms are both physical and psychological. They often include mood swings, persistent cravings, sleep disturbances, and physical discomfort. Opioids like heroin, morphine, and prescription painkillers act on the brain’s opioid receptors, so withdrawal can lead to prolonged discomfort and a significant risk of relapse. These symptoms may linger for months or even years, with periods of symptom intensification triggered by stress or other environmental factors.

During methadone withdrawal, individuals may experience similar PAWS effects, with symptoms that can be particularly intense and long-lasting. Methadone, often used in opioid replacement therapy, can have a protracted withdrawal period, leading to an extended experience of PAWS symptoms that require careful management.

For those going through heroin withdrawal, the PAWS phase can be especially challenging. Heroin’s powerful impact on the brain’s reward system means that the psychological and physical symptoms can persist well into recovery, necessitating ongoing support and treatment.

Marijuana

PAWS from marijuana can bring challenges like mood swings, irritability, anxiety, and difficulty concentrating. Sleep disturbances, such as vivid dreams or insomnia, are also common. Long-term marijuana use affects the brain’s endocannabinoid system, which can lead to these symptoms.

Individuals may experience a lack of motivation and anhedonia, making everyday tasks feel more difficult. Strong cravings and a desire to use again, particularly in stressful situations, can persist for weeks or months. Seeking professional help through marijuana rehab in Pennsylvania can provide the support needed during this period.

Coping With PAWS

Coping with Post-Acute Withdrawal Syndrome (PAWS) requires a combination of strategies that address both the psychological and physical symptoms. Here are some effective ways to manage PAWS:

• Outpatient Rehab: Enrolling in an outpatient rehab program can provide structured support while allowing you to maintain your daily life. Outpatient treatment programs in PA offer therapy, counseling, and medical supervision, helping you to navigate the challenges of PAWS with professional guidance. Outpatient rehab is especially beneficial because it offers flexibility and access to resources that can prevent relapse and manage symptoms effectively​.
• Therapy and Counseling: Regular therapy sessions, such as cognitive-behavioral therapy (CBT), can help you develop coping strategies for the emotional and mental symptoms of PAWS. Therapy can also address any underlying mental health issues that might be exacerbating your symptoms​.
• Healthy Lifestyle Choices: Maintaining a balanced diet, exercising regularly, and ensuring you get enough sleep can significantly improve your ability to cope with PAWS. These lifestyle changes can help your body and mind recover more quickly and reduce the severity of symptoms like fatigue and mood swings​.
• Support Groups: Joining a support group, such as those offered by Alcoholics Anonymous (AA) or Narcotics Anonymous (NA), provides a sense of community and shared experience. Support groups can be invaluable for emotional support and accountability during the recovery process​.
• Stress Management: Learning to manage stress is crucial, as stress can trigger or worsen PAWS symptoms. Techniques like mindfulness, meditation, and deep breathing exercises can help reduce stress levels.

How Can you Support a Loved One Experiencing PAWS?

Supporting a loved one experiencing PAWS requires patience, understanding, and ongoing encouragement. It’s important to recognize that PAWS can cause unpredictable mood swings, anxiety, and other emotional and physical challenges. Being there for your loved one means offering a listening ear without judgment and encouraging them to talk about what they’re going through.

Providing a stable and calm environment can make a big difference. Help them stick to a routine that includes healthy meals, regular exercise, and enough sleep, as these factors can greatly impact their recovery. Encourage them to attend therapy sessions or support groups, as professional help is crucial in managing PAWS symptoms. Understanding that recovery is a long process is key. Avoid putting pressure on them to “get better” quickly, and instead, celebrate the small victories they achieve along the way.

Get help for Post-Acute Withdrawal Syndrome at Little Creek Recovery

Post-Acute Withdrawal Syndrome (PAWS) is a challenging part of the recovery journey, affecting both the mind and body long after the initial withdrawal phase. Understanding PAWS is essential for managing its symptoms and staying committed to sobriety. With the right support, including therapy, healthy lifestyle choices, and a strong network of loved ones, those experiencing PAWS can navigate this difficult period and move toward a healthier future. If you or a loved one is struggling with PAWS, our rehab center in Pennsylvania is here to help.