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Post-Acute Withdrawal Syndrome (PAWS): When Recovery Throws You a Loop

handsome man with tattoo on arm looking frustrated - PAWSMost people know that someone with a substance abuse disorder will experience withdrawal symptoms if they stop using their drug of choice. If the person isn’t able to get access to more drugs or alcohol, the symptoms will generally start within hours. Post-acute withdrawal syndrome (PAWS) is different from the type of acute withdrawal symptoms that someone who is living in an active cycle of addiction will experience. As the name implies, PAWS appears later on in the recovery process and lasts longer than withdrawal symptoms associated with detoxification (detox).

What is Detoxification?

Detox is the process where the body is freed from the influence of chemicals. It is the first stage in addiction treatment; however, someone who only completes detox cannot say that they have been through a drug and alcohol treatment program.

A detox program conducted by an addiction treatment facility will generally include an evaluation to assess the client’s physical and mental health, to confirm the presence of drugs or alcohol, and to discover whether there are any medical issues that may affect the detox. The evaluation also includes developing an appropriate strategy for proceeding with the detoxification process.

Most of the detox process involves stabilizing the client and helping them adjust to being drug-free. This is accomplished using counseling services and medical options to treat symptoms, if required. During a medically-supervised detox, clients are kept physically and emotionally comfortable so that they can start working on their treatment goals free from their substance dependency.

Addiction as a Chronic Illness

In a perfect world, a person who seeks help for a drug or alcohol abuse issue would first go to detox, then complete a treatment program, and then move forward into recovery without any incidents. There wouldn’t be any slips, backslides, or relapses.

Unfortunately, addiction is a chronic illness, and the reality for people living with chronic illnesses is that their condition varies from day to day. It’s not uncommon for someone living with a chronic illness to experience variations in symptoms and mood at different times.

At times, a person in recovery may find that they are doing well. They are managing recovery, maintaining their sobriety, and maybe starting to feel as though they’ve left addiction behind for good. They may start to relax and stop being as vigilant as they were in the first few days and weeks of their recovery. If they aren’t prepared for it, Post-acute withdrawal syndrome (PAWS) may come as a surprise and be challenging to cope with.

What is Post-acute Withdrawal Syndrome (PAWS)?

Post-acute withdrawal syndrome (PAWS) is a set of symptoms that occur after the initial withdrawal symptoms from drugs or alcohol have stopped. PAWS can continue for days or weeks after a person with a substance abuse issue has stopped using drugs or alcohol. Its symptoms most commonly occur among those who have gone through withdrawal from opioids (heroin, OxyContin, Percocet, Vicodin, Percodan, Demerol, etc.), benzodiazepines (Xanax, Klonopin, Ativan, Valium, etc.) and alcohol. People in recovery from other types of drugs can also experience symptoms of PAWS.

Symptoms of PAWS

The signs and symptoms of PAWS vary in severity. They may disappear and then reappear later on. Some of the most common symptoms are:

  • Anxiety or panic
  • Feeling down or depressed
  • Irritability
  • Problems with cognitive tasks (problem-solving, learning, memory recall)

Less common symptoms may include:

  • Apathy or pessimism
  • Cravings for drugs or alcohol (whichever is the original drug of choice)
  • Difficulties with social relationships
  • Increased sensitivity to stress
  • Obsessive-compulsive behaviors
  • Sleep disturbances

These types of symptoms may increase in intensity in response to sensitive situations. A person in recovery may also experience “flare-ups” when things are going well and there isn’t a clear trigger indicating why the symptoms have increased.

Risk Factors for PAWS

Since addiction is a brain disease, researchers think that PAWS is an aftereffect of the brain being exposed to addictive substances. When a person is using drugs or alcohol regularly, the brain chemistry changes to account for the different levels of available neurotransmitters. Once a person stops using their drug of choice, then it takes time for the brain’s neurotransmitters to adjust to a different level of “normal.”

PAWS can occur after withdrawal from any addictive substance. Someone who has stopped using benzodiazepines may be at higher risk for symptoms than people in recovery from other types of drugs. Some former benzodiazepine users report experiencing PAWS symptoms for years.

Treatment Options for PAWS

One of the best ways to deal with PAWS is to make clients in drug and alcohol treatment programs aware that they may experience withdrawal symptoms long after their initial withdrawal has been completed. This information helps to normalize the process and lets clients develop a strategy for handling it.

For some people, medications can help to manage their symptoms. Most people find that seeing a counselor (individually, as part of a group, or both) is very positive in providing support and getting tips to deal with PAWS.

Find Help for Addiction from Great Oaks Recovery

Great Oaks Recovery Center offers client-focused programs that are individualized to suit the needs of each person we work with. We understand that the decision to stop drinking or using drugs is a big one. Our experienced team (which includes licensed counselors, medical doctors, nurses, nursing assistants, and social workers) works together to give each client a complete diagnosis, as well as personalized treatment and an aftercare program. We provide specialized treatment groups, such as ones focusing on chronic relapse and how addiction affects the brain, for clients who can benefit from them.

Contact us today to learn more about our programs or to ask questions.

If you or someone you love is in need of alcohol or drug treatment, contact our Houston drug and alcohol rehab center, anytime at (877) 977-3268. We are here to help.

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