Understanding Post-Acute Withdrawal Syndrome (PAWS)

Post-Acute Withdrawal Syndrome (PAWS) Overview

PAWS, also known as protracted withdrawal syndrome, is a collection of symptoms that continue after the initial withdrawal phase.

While the acute withdrawal syndrome occurs in the first few days or weeks of stopping substance use, PAWS can last much longer. This syndrome is most common in people recovering from alcohol withdrawal, opioid dependence, and benzodiazepine addiction.

PAWS is caused by brain chemistry imbalances resulting from long-term substance use. The brain takes time to re-adapt after dependency. Risk factors include:

• Length and intensity of substance use
• Type of drug used (opioids, alcohol, and benzos are high-risk)
• Underlying mental health disorders

PAWS Symptoms

The symptoms of PAWS can vary but often involve emotional, cognitive, and physical symptoms. These symptoms include:

Emotional and Psychological Symptoms

• Mood swings (unpredictable shifts in emotions)
• Anxiety and depression
• Irritability and agitation
• Feeling disconnected or numb

Cognitive Symptoms

• Difficulty concentrating and memory problems
• Confusion and brain fog
• Poor decision-making ability

Physical Symptoms

• Fatigue and low energy levels
• Sleep disturbance (insomnia or vivid dreams)
• Increased sensitivity to stress
• Cravings for alcohol or drugs

These symptoms often fluctuate, with some days feeling manageable and others feeling overwhelming.

How Long Does PAWS Last?

PAWS symptoms can vary significantly in duration, depending on several factors such as the type of substance, the duration and intensity of use, and individual health conditions.

Generally, PAWS symptoms from alcohol and other substances can last from a few days to several months or even years. Most cases tend to resolve within a 6 to 24-month window, but some individuals may experience symptoms for much longer.

The symptoms often fluctuate in intensity and frequency, becoming less common over time as the individual progresses into long-term sobriety.

For alcohol specifically, PAWS symptoms are most severe during the first 4 to 6 months of abstinence and gradually diminish over several years of sustained sobriety.

Overall, the duration and severity of PAWS can be influenced by a variety of factors, including the type of substance used and the individual’s overall health.

How is PAWS Diagnosed?

Diagnosing PAWS can be challenging because its symptoms overlap with other mental health conditions like anxiety and depression. Currently, there is no specific diagnostic test for PAWS. The diagnosis is typically based on a comprehensive assessment of the individual’s medical history, symptoms, and physical examination.

Medical History

A thorough review of substance use history, including the type of substance, duration of use, and intensity of use, is crucial. This helps identify potential risk factors for PAWS.

Symptom Assessment

Healthcare providers assess for symptoms such as anxiety, depression, mood swings, sleep disturbances, cognitive impairments, and cravings. These symptoms often persist beyond the acute withdrawal phase.

Physical Examination

A physical exam may include tests to assess overall health and rule out other conditions that could mimic PAWS symptoms. Common tests include:

• Complete Blood Count (CBC)
• Metabolic Panel
• Liver Function Tests
• Arterial Blood Gas Test
• Urinalysis
• Toxicology Screening

Neurobiological Evaluation

Understanding the neurobiological changes associated with PAWS, such as alterations in neurotransmitter levels and brain regions like the nucleus accumbens and prefrontal cortex, can support the diagnosis. However, these assessments are more research-oriented and not typically part of routine clinical diagnosis.

Psychological Evaluation

Mental health professionals may conduct psychological assessments to evaluate mood, cognitive function, and emotional stability.

Long-Term Effects of Untreated PAWS

Untreated post-acute withdrawal syndrome (PAWS) can have significant long-term effects on an individual’s physical and mental health, as well as their recovery process. Here are some potential long-term consequences:

• Increased Risk of Relapse: People may return to substance use in an attempt to alleviate persistent withdrawal symptoms, which can lead to a cycle of addiction.
• Mental Health Complications: Untreated PAWS can exacerbate underlying mental health conditions such as depression, anxiety, and mood disorders. This can lead to a worsening of symptoms over time and a reduced quality of life.
• Social and Interpersonal Challenges: PAWS symptoms like irritability, aggression, and difficulty maintaining social relationships can strain personal and professional relationships, leading to social isolation.
• Cognitive Impairments: Persistent cognitive issues such as memory problems and difficulty concentrating can impact daily functioning and long-term career prospects.
• Physical Health Issues: While PAWS is primarily psychological, some physical symptoms like chronic pain and gastrointestinal issues can persist if not addressed, contributing to overall health decline.
• Stress Sensitivity: Increased sensitivity to stress can lead to a heightened risk of developing additional mental health issues and complicating existing conditions.
• Reduced Treatment Effectiveness: Untreated co-occurring disorders, such as bipolar disorder, can complicate PAWS treatment and reduce its effectiveness, leading to prolonged recovery times.

Treatment for Post-Acute Withdrawal Syndrome

Treatment for post-acute withdrawal syndrome (PAWS) typically involves a combination of medical interventions, lifestyle changes, and support systems. Here are some strategies used to manage PAWS:

1. Medically Supervised Detox and Medication

While PAWS occurs after the acute withdrawal stage, some individuals may still need medical support. A medically supervised detox can help prevent life-threatening complications during the initial withdrawal phase.

For PAWS, doctors may prescribe medications to ease symptoms, such as antidepressants for depression or sleep aids for sleep disturbance. Additionally, gabapentin is sometimes used for alcohol-related PAWS. Selective serotonin reuptake inhibitors (SSRIs) can help with anxiety, but their effectiveness varies among individuals.

2. Therapy and Counseling

Therapy plays a critical role in managing post-acute withdrawal syndrome (PAWS) by addressing the psychological and emotional challenges associated with recovery.

Therapy, particularly cognitive-behavioral therapy (CBT), helps identify and manage negative thought patterns and behaviors that contribute to emotional instability and relapse risk. It equips patients with healthier coping mechanisms to handle stress, cravings, and mood swings.

Therapists also work with patients to recognize triggers for relapse and develop strategies to avoid or manage these situations to maintain sobriety. Additionally, people suffering with PAWS also experience co-occuring mental health conditions. Therapy provides a structured environment to address these issues simultaneously, improving overall recovery outcomes.

This approach also helps individuals set goals for their personal and professional lives, fostering a sense of purpose that supports long-term recovery.

3. Lifestyle Changes to Cope with PAWS

Adopting a healthy lifestyle can significantly reduce PAWS symptoms.

• Nutrition and Hydration: Maintaining a balanced diet and staying hydrated can support overall health and recovery.
• Exercise and Physical Activity: Regular exercise helps improve mood, reduce anxiety, and enhance sleep quality.
• Sleep Hygiene: Establishing consistent sleep patterns is crucial for managing sleep disturbances common in PAWS.
• Stress Management: Engaging in stress-reduction activities like meditation, yoga, or deep breathing exercises can help manage stress and emotional instability.

4. Support Groups and Community Support

A support group, such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA), provides valuable guidance and encouragement. Connecting with others in recovery reduces feelings of loneliness and reinforces sobriety.

Group members share practical advice and coping strategies that have worked for them, offering diverse perspectives and strategies to manage symptoms. Regular group meetings also encourage accountability and commitment to recovery.

How Can Family and Friends Support Someone Experiencing PAWS?

The support of family and friends is essential for someone dealing with PAWS. Learning about PAWS helps family and friends understand what their loved one is going through and how to provide the right support. Here are other ways loved ones can help:

• Be Patient and Understanding: Mood swings, anxiety, and fatigue can be frustrating, but patience is crucial.
• Encourage Healthy Habits: Promoting good nutrition, exercise, and sleep hygiene can help manage PAWS symptoms.
• Provide Emotional Support: Being a good listener and offering encouragement can make a significant difference in recovery.
• Help Avoid Triggers: Avoiding environments or situations that could lead to relapse is crucial for long-term sobriety.
• Encourage Professional Help: Suggesting therapy, support groups, or addiction centers can provide additional resources for recovery.

Importance of Long-Term Recovery Support

Long-term recovery requires continuous support. Addiction centers and rehab facilities offer extended care programs that help individuals maintain sobriety beyond the initial withdrawal period.

Continuing therapy, attending support groups, and staying engaged in a structured treatment plan all contribute to long-term success. If you or someone you know is struggling with PAWS, seeking help from addiction centers or treatment professionals is the best step toward recovery.

Our addiction treatment facilities in Scottsdale, Arizona offers comprehensive treatment approach for people struggling with PAWS and substance abuse disorders. Professional specialists can help you navigate this phase by providing tailored programs suitable for your needs.