Post Acute Withdrawal Syndrome (PAWS)

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Earlier in our blog series we discussed the nuances of early recovery and the phenomenon “anhedonia”, that renders former substance abusers unable to feel any forms of pleasure without their drug of choice (see here).  Now, we would like to discuss what happens further into recovery and for up to several years.  There are two distinct phases of drug or alcohol withdrawal:  the acute stage that lasts for a few weeks and may carry a multitude of physical symptoms (depending on the drug of choice) and general anhedonia or apathy.  The second stage, Post Acute Withdrawal Syndrome (PAWS) is marked by pronounced emotional and psychological symptoms.  This is when the brain is recalibrating in order to find equilibrium, a state it has not known since before chemical dependence.   

Symptoms of PAWS include but are not limited to the following:

  • Mood disturbances
  • Anxiety and irritability
  • Low enthusiasm (no “lust for life”)
  • Concentration issues
  • Sleep problems (insomnia or somnolence)

The signs and symptoms of PAWS can be quite unpredictable, and this deters many from sustaining long-term sobriety.  These vague yet distressing symptoms can pop up at any time—even if the person has been seemingly free of them for weeks on end.  However, as time in sobriety increases, the episodes will become less frequent and more manageable.  It is important for recoverees to be aware of PAWS and the obstacles that it brings, otherwise they may lose hope regarding their recovery and personal journey.  If we remain armored with knowledge, we will be able to overcome any PAWS aftermath as it comes and acknowledge that it is simply a facet of recovery, not a reason to throw in the towel.   

Another important thing to note is that PAWS symptoms have no obvious trigger, again adding to the unpredictability factor.  As people delve deeper into recovery, they will become more aware of their own danger signs and be able to decipher their best course of action.  Knowing that the feelings will pass and only last for a limited time frame will give hope and persistence in action.   

Typically, PAWS lasts for about two years, but we know that the whole time is not littered with misery and awful days; it is also full of hope, optimism, and joy.  A paradigm shift is necessary when considering PAWS.  Your brain is recovering from years of over-saturation and abuse—it is only natural that it would take some time for it to get back up to snuff.   We like to view the symptoms as a positive sign that the brain is engaged in your most precious goal: RECOVERY.  Remember, self-care is paramount in the PAWS battle.  Don’t overload your schedule or become over-committed to the point that it jeopardizes your continued sobriety.  If you make it to the PAWS stage that means you have overcome the most important stages of recovery: admitting that your life is unmanageable and beginning to take steps to a new life.  A relapse, small or large, will largely undo any progress that you have achieved in rebalancing brain chemistry.  It does not spell the end of the road but puts you back on the treadmill of early recovery followed by PAWS.  Abstinence despite the discomfort will ensure success on the road to sobriety.  We believe in you!