Help and Support for Post-Acute Withdrawal Syndrome (PAWS)

How to Cope When Withdrawal Symptoms Linger

These symptoms are normal...you're not alone
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Post-acute withdrawal syndrome, or PAWS, is the condition of continuing to experience drug withdrawal symptoms – for weeks, months, or years -- even though you’ve completed a drug addiction treatment program and are no longer “using.”

--Other names for post-acute withdrawal syndrome include post-withdrawal syndrome, prolonged withdrawal syndrome, and protracted withdrawal syndrome.

Which Drug Addictions May Lead to This Condition?

Post-acute withdrawal syndrome typically begins after someone has withdrawn from alcohol, a benzodiazepine tranquilizer, or a narcotic drug (opioid), such as heroin.

About 90 percent of people who were addicted to opioids experience some degree of post acute withdrawal syndrome, which occurs in about 75% of recovered alcoholics. However, it may also occur after withdrawal from other addictive drugs.

People recovering from abusing benzodiazepines seem to experience post-acute withdrawal syndrome most often and for the longest periods of time, often for years.

What Causes Post-Acute Withdrawal Syndrome?

The exact cause or causes are not yet known, but they’re continuing to be investigated. Many scientists currently believe that the physical changes addiction causes in the brain, particularly the changes related to increasing a person’s tolerance to the drug, continue to cause withdrawal symptoms even after his or her recovery is complete.

Scientists are also investigating the ability of a drug user’s brain to deal with stress, which may decrease during long-term drug abuse as well as during withdrawal.

This may increase the recovered user’s chances of experiencing recurring withdrawal symptoms.

What Are the Symptoms?

In general, the symptoms of post-acute withdrawal syndrome are similar to the symptoms of anxiety and mood disorders. They may range from mild to severe in a single individual; they may also go away entirely for a period of time and then reappear.

Some of the most common symptoms of post-acute withdrawal syndrome include:

  • Problems with thinking (cognitive) tasks, such as problem-solving, learning, or memory recall
  • Irritability
  • Anxiety or panic
  • Depression

Less often, a person may experience:

  • Obsessive-compulsive behaviors
  • Problems with social relationships
  • Cravings for the addictive drug they used
  • Pessimism or lack of interest (apathy)
  • Sleep disturbances
  • Increased sensitivity to stress
     

Stress can make any of these symptoms of post-acute withdrawal syndrome worse, but this can also happen without any apparent cause.

What Treatment Is Available?

A medication often used to help alcoholics recover, acamprosate, can sometimes be effective in managing symptoms of post-acute withdrawal syndrome. Treatment may need to be prolonged, depending on how long the symptoms last, and may also include other medications and counseling using behavioral therapy methods.

Tips for Coping With Post-Acute Withdrawal Syndrome

If you're struggling with post-acute withdrawal syndrome, the following may help:

  • Some of the methods you used for getting through acute withdrawal may also help in this situation. Give them a try.
  • Talk honestly about your symptoms and feelings with an understanding (non-using) friend or therapist.
  • Learn about your addiction. Understanding more about what happened can help you gain greater perspective on your current problem.
  • Explore spirituality. Most people have a spiritual side they may or may not know much about. You may find that your spirituality provides meaningful comfort during this difficult time.
  • Work toward moderation and balance in every area of your life,

Meeting the Challenge

People who go through the painful and difficult experiences of drug addiction, detoxification, and withdrawal treatment likely feel justified in thinking that they’ve been through enough in achieving their recovery goal. Yet post-acute withdrawal syndrome may lie ahead. Yes, it’s a challenge to deal with ​a recurrence of symptoms, but they can be managed with the combination of effective medication and supportive therapy.

Sources:

“Post acute withdrawal syndrome (PAWS).” University of California Dual Diagnosis Program (2016). 

Gorski T, Miller M. "Staying Sober – A Guide For Relapse Prevention." Independence Press (1986).

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