What Is Post-Acute Withdrawal Syndrome (PAWS)?

Post-Acute Withdrawal Syndrome (PAWS) is also known as protracted withdrawal. PAWS consists of symptoms that begin weeks or months after you stop using drugs or alcohol. This differs from acute withdrawal because it happens over time instead of immediately experiencing withdrawal symptoms after stopping the use of a substance.

If done correctly, acute withdrawal usually won't last longer than two weeks. However, protracted or post-acute withdrawal symptoms can last weeks or months after they begin.  

Today, we are exploring PAWS and looking into how to manage the symptoms and what can potentially cause it so you know what to look out for.

How Common Is PAWS?

PAWS commonly occurs with substance use disorders (SUD) of alcohol, benzodiazepines, and opioids. About 90% of those recovering from opioid abuse will experience PAWS, and about 50% of people recovering from other addictions will experience them.

How to Recognize PAWS

PAWS — like the withdrawal symptoms you experienced during detox — will vary depending on the substances you used, how long you used them, how much you used them, and what other health conditions you have. During the first stage of detox, symptoms can be more severe. They may even be life-threatening if the detox process is not done correctly.

This second stage of withdrawal symptoms usually tends to have more emotional and psychological symptoms than the first stage. This is also often true for PAWS. Symptoms may include:

• Increased stress levels

• Sleep pattern disturbances 

• Difficulty with memory 

• Irritability

• Anxious feelings without a specific cause 

• Obsessive-compulsive behaviors 

• Substance cravings 

• Inability to maintain social relationships 

• Depression

PAWS for Different Substances

The substance you used can affect the PAWS you experience. This is because each substance affects your brain differently, also depending on how long you struggled with your SUD. PAWS for alcohol, benzodiazepines, opioid, and marijuana addictions are the most common.

Alcohol PAWS

PAWS for alcohol can include anxiety, hostility, irritability, depression, mood changes, fatigue, insomnia, problems concentrating, decreased libido, and some unexplained physical pain.

Benzodiazepine PAWS

PAWS for benzodiazepines can include anxiety and insomnia. These symptoms tend to come and go through continued abstinence from benzos.

Opioid PAWS

PAWS for opioids can include sleep disruptions, anxiety, depression, fatigue, and decreased executive control functions.

Marijuana PAWS

PAWS for marijuana can include sleep issues and strange dreams through continued abstinence from marijuana.

Is PAWS Dangerous?

One of the biggest risks of PAWS is that it can increase your risk of relapse. It is important to have other coping skills you can use to manage the physiological and psychological effects of PAWS.

What Causes PAWS?

When people engage in substance abuse, their bodies undergo many physical changes. These changes can affect their emotions and cognition as well as their general physical health. Withdrawals happen due to the stress the body experiences when it is deprived of a substance it is dependent on.

The reasons that PAWS occurs weeks or months after cessation of substance use are still unknown. One potential cause for PAWS is the effect of the chemical changes in your brain from continued substance use. Once you stop using the substance, your brain needs to re-adjust to be able to function again without having the substance in your system. This causes further changes within your central nervous system. However, further research is needed.

Since PAWS itself is a newer phenomenon and something people are slowly starting to recognize, there is a bit of controversy surrounding it. This is because there is a lack of information about what PAWS is, why it happens, and what are the best ways to treat it. Due to this dearth of information, PAWS is not yet included in the DSM.

How to Manage PAWS

PAWS can be distressing, but it can be managed by many aspects of treatment and recovery. If you experience PAWS and want more time to focus on solidifying your recovery skills, you might consider a longer form of treatment, such as an inpatient program. After residential treatment, you might participate in an after-care program with the treatment center of your choice.

You can do other things to manage PAWS without relapsing. The following tips may help.

• Educate Yourself: Continuing to educate yourself and the ones around you the most. It is important to continue to learn about SUD. This way, you can understand why you’re experiencing these symptoms later on in life. If you’re helping a loved one who is in recovery, it is also important to stay educated on the symptoms they might experience and ways to help them.

• Maintain Healthy Habits: Prioritize healthy habits, including proper sleep, eating healthy meals, moving your body, and regularly visiting healthcare professionals. Maintaining visits with your doctor is important because they can keep you accountable to your goals and assess your needs throughout this process.

• Decrease Your Stress: Addiction and recovery can stress your body due to the many physiological changes involved in both processes. It is also important to note that these symptoms can flare up or increase in severity during stressful situations. Therefore, you can manage PAWS by trying to keep your stress levels low.

• Attend Therapy: Regularly attending therapy can help. This can include group therapy, family therapy, or individual therapy. Cognitive-behavioral therapy (CBT) may be especially helpful for managing the symptoms of PAWS. The main idea of CBT is to help with problem-solving and managing negative thought patterns.

• Appreciate Your Progress: Celebrate every small milestone you can. This is important because it can increase your motivation and help you remain on track for lifelong recovery.

The Edge Treatment Center Will Help You Through Withdrawal … and Into a Lasting Recovery

The Edge Treatment Center partners with trusted, effective detox centers to ensure our clients receive the best possible start to their recovery. We’ll help you navigate withdrawal, PAWS, and any other complication that can arise from addiction treatment.

Drug detox is the critical first step to recovery. With us, we’ll make sure your first step is the best possible. Contact an Edge expert today.