PAWS Strikes Again: Coping with Post-Acute Withdrawal Symptoms

What is PAWS?

PAWS, or post-acute withdrawal syndrome, is a set of symptoms that can persist for weeks or months after initially overcoming acute withdrawal from drugs or alcohol. Also known as prolonged withdrawal, PAWS refers to the long-lasting symptoms that can occur after the initial intense withdrawal phase.

Unlike acute withdrawal, which begins just hours after the last drug use and involves severe physical and psychological symptoms, PAWS is more subtle and can begin 7-10 days after stopping substance use. PAWS can come and go in waves, where symptoms flare up for a period of time and then seem to get better before worsening again.

The effects of PAWS can last for weeks, months or even years after overcoming the acute withdrawal phase. This lingering group of symptoms is a sign that the brain is still healing and trying to adapt to functioning without being altered by drugs or alcohol.

What Causes PAWS?

PAWS is caused by changes to brain chemistry from prolonged substance abuse. When someone regularly abuses drugs or alcohol, their brain chemistry is thrown off balance as it tries to compensate for the frequent presence of the substance. Over time, the brain alters the production of various neurotransmitters and receptors in an attempt to establish a new equilibrium.

Once the substance is removed and the person gets sober, the brain is still calibrated to operate under the influence. It takes time for the brain’s chemistry to recalibrate and reach a new balance. During this transition period, the person may experience cognitive, emotional, and physical symptoms. These post-acute withdrawal symptoms indicate the brain is going through a healing process to recover from dependence on the substance.

PAWS sets in after the acute withdrawal phase, from a few months to 2 years into abstinence, as the brain works to revert back to its pre-addiction functionality. Since chronic substance abuse causes substantial changes to neurotransmitters like dopamine, serotonin, GABA, and cortisol, it requires an extended period of natural readjustment in the absence of the substance to fully heal.

How Long Does PAWS Last?

The duration of PAWS can vary significantly depending on the severity of the addiction and individual factors. Generally speaking, PAWS symptoms can persist for weeks, months or even years after stopping drug or alcohol use.

For those recovering from mild substance use disorders, PAWS may only cause intermittent symptoms for a few weeks or months. However, people recovering from moderate to severe addiction are more likely to experience PAWS persisting for 6 months to 2 years.

In the most extreme cases of long-term, heavy addiction, some people report experiencing waves of PAWS symptoms for 3-4 years after getting sober. Even 5 or 10 years into recovery, PAWS can occasionally resurface during periods of stress or trauma.

The lengthy and unpredictable course of PAWS is why having patience with the recovery process is so crucial. Understanding that ups and downs are normal can help recovering addicts stick to their sobriety and avoid relapsing when PAWS symptoms flare up. Ongoing support, healthy lifestyle choices and positive coping strategies are essential tools for managing the ebb and flow of PAWS over the months or years it takes to fully stabilize.

Common Symptoms

Many people experience a range of symptoms during PAWS that can persist for weeks or months after initial withdrawal. The most common symptoms include:

• Anxiety and depression – Feelings of anxiety, sadness, or hopelessness are very common during PAWS. Mood swings between excitement and depression are also frequent. These emotional symptoms are due to neurotransmitter imbalances as the brain adjusts to functioning without drugs or alcohol.
• Fatigue – Lack of energy and constant feelings of tiredness are hallmark symptoms of PAWS. Fatigue can stem from poor sleep, chronic stress, hormonal changes, and the body diverting energy toward healing. Mentally and physically taxing daily activities may seem impossible.
• Insomnia – Difficulty falling asleep and staying asleep are common during acute withdrawal and PAWS. Disruptions to sleep cycles and inconsistent sleep-wake patterns frequently occur as neurotransmitter signaling recalibrates. Insomnia can exacerbate other symptoms like fatigue and mood disturbances.
• Concentration problems – Many people with PAWS experience difficulty concentrating, cloudy thinking, distractibility, and poor short-term memory. Mental tasks like reading, conversation, and work projects seem challenging. Concentration problems result from structural and functional brain changes during recovery.
• Cravings – Drug or alcohol cravings frequently arise during PAWS, even after months of sobriety. These cravings are strong urges or desires to use due to memories associated with the reward of intoxication. Cravings may never fully disappear, but become easier to manage over a long recovery process.

PAWS vs. Relapse

Post-acute withdrawal syndrome (PAWS) is often confused with relapse as both can involve the return of withdrawal symptoms long after drug use has stopped. However, there are key differences:

• Relapse means a person returns to actively using drugs or alcohol again after a period of sobriety. With PAWS, the person remains sober but experiences intermittent withdrawal symptoms.
• PAWS symptoms tend to come in waves, with windows of feeling normal in between. Relapse is characterized by continuous substance use.
• The symptoms of PAWS like depression, anxiety, sleep disturbances, and cravings are similar to acute withdrawal, but milder. Relapse brings a more rapid onset of severe withdrawal symptoms.
• While PAWS can begin within the first few months after quitting drugs or alcohol, relapse can happen at any time, even after years of sobriety.
• Relapse indicates the person is no longer able to control substance use. With PAWS, it is the body’s lingering addiction response, not active drug use.
• Relapse often requires restarting addiction treatment or detox. PAWS is managed through maintaining sobriety, self-care strategies, and sometimes medications.

The takeaway is that PAWS does not mean someone has relapsed or failed at recovery. While difficult, PAWS symptoms are expected and manageable. Relapse means breaking sobriety and resorting to substance misuse. Being able to distinguish between the two is important for recovery.

Treatment

Treatment for PAWS focuses on lifestyle changes rather than medication. Since PAWS is a consequence of long-term substance abuse and addiction, there are no medications that specifically target its symptoms. However, some medications may help manage certain symptoms like depression and anxiety.

The main treatments for PAWS include counseling, support groups, nutrition, exercise, and making positive lifestyle changes.

Counseling and Support Groups

Seeking professional counseling and joining support groups can help individuals with PAWS. Counseling provides coping strategies for PAWS symptoms and helps people address any underlying issues that may have contributed to addiction. Support groups connect people going through similar struggles. They provide understanding, encouragement, and peer advice.

Nutrition

Eating a healthy diet is essential for recovering from substance abuse. Proper nutrition repairs organ damage, restores brain chemistry, and improves mood. Complex carbohydrates, lean protein, fruits, vegetables, and healthy fats help stabilize blood sugar levels. Avoiding sugar, caffeine, and other stimulants can lessen anxiety and mood swings. Staying hydrated is also important.

Exercise

Exercise boosts feel-good endorphins and neurotransmitters in the brain. It relieves stress, improves sleep, and enhances overall wellbeing. Getting regular physical activity such as walking, yoga, or light strength training can reduce PAWS symptoms like fatigue, depression, and brain fog. However, overdoing exercise can be counterproductive. Start slowly and pace yourself.

Lifestyle Changes

Making positive lifestyle changes is key to overcoming PAWS. Establishing a consistent daily routine, practicing relaxation techniques like meditation, pursuing new hobbies, and connecting with sober friends build a strong foundation for recovery. Avoiding triggers, high-risk situations, and sources of stress also helps minimize PAWS symptoms. With time, healthy habits make the brain and body more resilient.

Coping Strategies for PAWS

Dealing with PAWS can be challenging, but there are many effective coping strategies to help manage symptoms and avoid relapse.

Exercise

Regular exercise is strongly recommended as it releases endorphins which boost mood and reduce stress and anxiety. Start slowly and build up endurance with activities like walking, swimming, cycling, or yoga. Avoid overexertion.

Meditation

Meditation and mindfulness practices help calm the mind and body. Try sitting quietly, focusing on deep breathing, listening to relaxation audio, or using meditation apps. Even 5-10 minutes daily can make a difference.

Journaling

Writing thoughts and feelings in a journal can provide an emotional outlet and help process PAWS symptoms. Note triggers, changes, and patterns over time. Journaling can reveal progress and give a sense of control.

Patience

It takes time for the brain to heal and regain equilibrium after substance dependence. Be patient with yourself and understand that PAWS is temporary, even though it may not feel that way sometimes. Take it one day at a time.

Self-Care

Make self-care a priority, including proper sleep, nutrition, hydration, rest, social connection, and activities that bring joy and comfort. Say no to obligations that cause excessive stress. Listen to your needs.

Support System

Don’t go it alone. Surround yourself with positive people who listen and care but don’t judge. Consider joining a PAWS support group to share with others going through the same difficulties. Therapists can also help manage symptoms. You have more strength with support.

Prevention

The best way to prevent PAWS is to avoid substance abuse in the first place. However, for those already struggling with addiction, there are steps that can be taken to reduce the likelihood and severity of PAWS:

• Gradually reduce drug use – Quitting drugs “cold turkey” often leads to more severe withdrawal symptoms. Working with a medical professional to slowly taper drug use over time can make detoxification more manageable. This helps avoid shocking the brain and body.
• Seek professional help for addiction – Entering a medically-supervised detoxification program can alleviate withdrawal symptoms and cravings. This makes it easier to stay sober. Ongoing support like counseling, therapy and 12-step programs help prevent relapse after rehab. Getting addiction treatment can reduce the risk of experiencing protracted withdrawal.
• Consider medication – Drugs like methadone, buprenorphine and naltrexone can curb cravings and support recovery. Medication-assisted treatment provides biological assistance for staying substance-free. This can smooth out brain and body recovery.
• Make lifestyle changes – Adopting healthy routines aids the post-acute withdrawal process. Sufficient sleep, a balanced diet, exercise, and stress reduction techniques help the brain heal faster. Building a strong support system also boosts recovery.

Getting professional treatment, making gradual lifestyle adjustments, using medication as needed, and avoiding relapse are the best ways to prevent extended withdrawal symptoms. With the right help, it is possible to recover from substance abuse and avoid PAWS.

Prognosis

The good news is that PAWS will eventually subside. However, PAWS symptoms may persist and come and go for a year or more after stopping substance use. Some sources estimate PAWS can last up to two years.

The duration and severity of PAWS depends on many factors like:

• The substance that was abused
• How long the substance was abused
• Quantity of the substance abused
• Individual biology and psychology

While PAWS can be extremely difficult to deal with, it’s important to remember that it does get better with time as the brain heals and rebalances. With continued sobriety, proper self-care, and support, PAWS will run its course and dissipate. Though symptoms may resurface during times of stress, they will continue to decrease in severity and frequency.

Full recovery takes patience and perseverance. But understanding that PAWS is temporary can provide motivation to stick with sobriety until the post-acute withdrawal phase passes completely.

Supporting Someone with PAWS

When a loved one is struggling with PAWS, it’s important to be patient and provide support. Here are some tips:

• Offer encouragement and empathy – Recognize that PAWS can be extremely difficult and frustrating to deal with. Avoid judgment and criticism. Instead, offer kind words, a listening ear, and emotional support. Validate their feelings and reinforce that what they’re going through is normal.
• Help establish healthy routines – Having structure and positive habits can help recovery tremendously. Encourage activities like exercise, proper nutrition, meditation, journaling or attending support groups. Doing things together promotes bonding and accountability.
• Suggest counseling – A professional counselor can help your loved one develop coping strategies for PAWS symptoms. Cognitive behavioral therapy in particular is effective. Having an objective third party to talk to can also be very beneficial.
• Educate yourself – Learn about PAWS so you can better understand what your loved one is going through and how to help. Information empowers both of you.
• Avoid enabling – It’s important not to enable any unhealthy behaviors. However, be compassionate and focus on positive progress vs. perfection. Relapse is common with PAWS.
• Take care of yourself – Make sure you also maintain self-care. Supporting someone with PAWS can be draining. Reach out to others for support when needed.

The key is providing unconditional love and positivity. With time, care and professional help, PAWS can be overcome.