Post-Acute Withdrawal Syndrome (PAWS): What You Need to Know About the Cunning, Baffling, and Powerful

As someone who’s lived through withdrawals and detox countless times and from a number of different substances, I can attest that it’s no walk in the park. Typically, it’s about three days of Hell followed by a gradual return to reality and something slightly resembling normalcy.

The common misconception, though, is that withdrawal symptoms begin and end right there. A few days of Hell and a return to normalcy and that’s the end of that. What many don’t realize–especially addicts who are new to recovery detoxing on their own and the family and loved ones around them–is that detox is only the beginning for many.

For people who began using at a young age and/or those who have used for a long time, the real danger comes after acute withdrawal symptoms have subsided. Enter post-acute withdrawal syndrome.

What is Post-Acute Withdrawal Syndrome (PAWS)?

PAWS is a particular part of the recovery process that begins after acute withdrawal symptoms end, and can last for weeks, months, even up to a year or more, depending on the individual’s history and substance(s) of choice. PAWS, or post-acute withdrawal syndrome, describes “any symptoms that persist after acute withdrawal syndrome as resolved” (1).is These symptoms can vary from person to person, and from substance to substance. It can be rather unpredictable as symptoms often don’t present right away and can be irregular, striking at random times and without warning, and even retreating just as mysteriously.

The good news, I suppose, is that PAWS symptoms are rarely physical. The nausea, cramping, unbearable pain–those common symptoms of acute withdrawal syndrome are over. Rather, post-acute withdrawal syndrome is “largely psychological and mood-related” (1).

What are the Symptoms of PAWS?

some of the most common symptoms of PAWS
some of the most common symptoms of post-acute withdrawal syndrome

The symptoms of post-acute withdrawal syndrome can mimic a wide range of psychological conditions and disorders, ranging from depressing and anxiety to problems with cognitive thinking and learning, sleep disturbances, and impulse control. While there is no exhaustive list of symptoms, I’ve done my best to compile a list of the most common, severe, and disruptive symptoms than can occur. These symptoms may include:

  • irritability and hostility
  • depression
  • anxiety
  • mood swings
  • low enegery
  • fatigue
  • insomnia and other sleep disturbances
  • “brain fog”
  • trouble focusing
  • lack of libido
  • chronic pain
  • memory problems
  • cravings
  • increased sensitivity to stress
  • lack of initiative of motivation
  • lack of enthusiasm
  • poor impulse control
  • apathy
  • problems with learning and problem solving
  • obsessive-compulsive behaviors
  • difficulties maintaining social relationships
  • pessimism (1, 2, 3, 4)

These symptoms will vary from person to person, may vary from day to day, and may change over time. One may experience all of these symptoms, or none of them; but being aware of them at all times can potentially save us from relapse.

Why is PAWS So Dangerous?

As I said, the symptoms of post-acute withdrawal syndrome are varied an unpredictable. At least with typical detox symptoms, you know what you’re getting, you know how to prepare, and you know when it will end. But symptoms of PAWS can strike out of nowhere, with or without cause, and leave us vulnerable.

Many of the symptoms mimic other lifelong psychological and mood disorders which can make it more difficult to treat, not knowing whether our symptoms are attributed to PAWS or an underlying condition.

Additionally, there seems to be a lack of knowledge and proper education on the condition in many treatment and recovery programs. Friends and family members can mistake our mood swings and other behaviors associated with PAWS as symptoms of using, and this coupled with the symptoms themselves can leave us feeling like there’s something wrong with us, or that things will never get better.

But this isn’t the case.

There is Treatment

Treatment for post-acute withdrawal syndrome can include various kinds of therapy and medication. Harm reduction medications such as methadone, buprenorphine, and Vivitrol stave off PAWS symptoms, while psychiatric medications such as antidepressants, non-narcotic anxiety medications, sleeping pills, and more can help treat the symptoms themselves as well as any potential co-occurring mood disorders.

For many, though, the best treatment of post-acute withdrawal syndrome is a combination of education, therapy, and time.

Conclusion

Post-acute withdrawal syndrome is a bitch. I’ll be the first to say it. And I went through a cycle of detox, PAWS flares, and relapse for years before I realized that the symptoms I was experiencing were a normal part of recovery. Until then I thought there was something wrong with me and that I would never get better, so I might as well keep using. I know it’s a cop-out. And a bad one. But that’s how the addict brain works, isn’t it?

We have to know what we’re up against. We have a disease of the mind that’s cunning, baffling, and powerful. We have a disease of the mind that uses our own brains against us. We have to be prepared.

When we educate ourselves, and seek the treatment and support we need, we take back control of our lives. We take up arms against our addiction and we learn to fight back. Education and support are the most powerful weapons against addiction that we can find.

Sources

(1) American Addiction Centers, “Post-Acute Withdrawal Syndrome: And In-Depth Guide”

(2) Hazeldon Betty Ford, ” What Is Post-Acute Withdrawal Syndrome”

(3) Addiction Center, “Post-Acute Withdrawal Syndrome”

(4) Semel Institute for Neuroscience and Human Behavior, “Post-Acute Withdrawal Syndrome”

Resources for Addiction, Recovery and Mental Illness:

Recovery Bees, “20 Tips for Staying Sober”

Recovery Bees, “10+ Tips for Opioid Withdrawal Relief”

SAMHSA National Hotline: Website, Call (1-800-662-HELP (4357))

Recovery Bees Support Forum & Social Network (Women Only)

Recovery Bees Private Facebook Support Group (Women Only)

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