Understanding Post-Acute Withdrawal Syndrome (PAWS)

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Recovery from addiction is a long battle that often comes with unexpected challenges. One of these challenges is post-acute withdrawal syndrome (PAWS), a condition that can affect individuals who are in the early stages of sobriety. The symptoms of PAWS can persist for weeks or months and are believed to be the result of physiologic changes in the brain. 

Let’s look closer at what PAWS is, its symptoms and how to manage it effectively on the path to lasting recovery.

What Is Post-Acute Withdrawal Syndrome (PAWS)?

PAWS is a condition that occurs after the initial acute withdrawal phase from substance abuse. Acute withdrawal refers to the immediate physical symptoms that happen when a person stops using a drug or alcohol, such as nausea, sweating and anxiety. 

PAWS, on the other hand, is a more prolonged and protracted withdrawal phase that can last for weeks or even months after the acute phase has subsided. While PAWS can happen after withdrawal from nearly any abusive substance, it’s most common with benzodiazepines, alcohol and opioids. 

The hardest part about PAWS is that the symptoms can be unpredictable. You may go a month without experiencing any symptoms, and then they reappear out of nowhere. This is why it’s important to follow your aftercare plan, practice self-care and stay closely connected to your support network. 

Common PAWS Symptoms

PAWS can manifest in a variety of ways and can be different for each individual. Some common symptoms of PAWS include:

  • Mood swings. Individuals may experience mood swings, ranging from periods of depression to sudden irritability and anger.
  • Anxiety and panic. Persistent feelings of anxiety, panic attacks and generalized anxiety disorder symptoms can be part of PAWS.
  • Sleep disturbances. Sleep problems like insomnia or vivid nightmares can make it challenging to get restorative sleep. Not getting enough rest can worsen other withdrawal symptoms. 
  • Cognitive impairments. Difficulties with concentration, memory and decision-making are common during PAWS.
  • Physical symptoms. Some individuals may experience lingering physical symptoms like fatigue, headaches and gastrointestinal issues.
  • Cravings. Intense drug or alcohol cravings may persist, making it crucial to have a relapse prevention plan in place.

Causes of PAWS

The exact causes of PAWS are not fully understood, but it is believed to result from several factors. Specifically, long-term substance use can lead to changes in the brain’s chemistry, affecting neurotransmitters responsible for mood and behavior. As the brain regulates itself after addiction, symptoms like fatigue, insomnia and foggy thinking can occur. 

Psychological factors may also be to blame, as the stress, trauma and anxiety associated with substance use can contribute to the development of PAWS. While there is no definite way to prevent PAWS, attending a medical detox program will help you manage your symptoms effectively. 

Managing PAWS and Promoting Recovery

While PAWS can be challenging, there are effective strategies for managing and mitigating its symptoms. If you seek treatment at a drug and alcohol rehab, you will also receive built-in support for PAWS, including talk therapy, medication and support.

Here are some of the best ways to cope with PAWS symptoms:

  • Professional support. Addiction professionals, therapists or support groups that specialize in substance abuse recovery can offer invaluable support. They can teach you how to manage PAWS symptoms effectively. 
  • Healthy lifestyle. Embrace a healthy lifestyle that includes regular exercise, balanced nutrition and sufficient sleep. These factors can significantly influence mood and overall well-being.
  • Medication-assisted treatment (MAT). In some cases, medication-assisted treatment may be recommended to alleviate specific symptoms or cravings. MAT is most effective for treating opioid use and alcohol use disorders. 
  • Mindfulness and stress reduction. Techniques such as mindfulness meditation, yoga and deep breathing exercises can help manage anxiety and stress. Keeping a journal can also be effective, and it will document how far you’ve come. 
  • Patience and self-compassion. Recognize that PAWS is a temporary phase in your recovery journey. Be patient and treat yourself with the same kindness and understanding you would a friend. 

Take the First Step with Detox Rehab in Santa Rosa CA

Post-acute withdrawal syndrome is a challenging but manageable aspect of addiction recovery. By understanding its nature, seeking professional support and adopting healthy coping strategies, individuals can navigate PAWS successfully and continue on the path to lasting sobriety. 

Pura Vida Recovery is an outpatient rehabilitation facility that treats substance use and mental health disorders. We can give you a referral for a local detox center, and then you can start outpatient services with our team. Having this continuum of care allows you to manage any lingering withdrawal symptoms. Contact our admissions team to learn more about starting your journey.