What is Post Acute Withdrawal Syndrome?

Most individuals struggling with addiction, as well as their loved ones, are familiar with the concept of withdrawal. Typically occurring during a detox, withdrawal symptoms can be unpleasant but typically last for just a week or two. Less known, however, is the potential for a syndrome known as post-acute withdrawal syndrome, or PAWS. This withdrawal syndrome can be longer but awareness is key in targeting and treating it properly.

Understanding PAWS

Post acute withdrawal syndrome is a condition where the cessation of addictive substances brings on additional withdrawal syndromes. It follows the more commonly known period of acute withdrawal, which occurs in the days immediately following the beginning of a detox from addictive substances.

PAWS is one of the ways that the body reacts to no longer having a substance that it was chemically dependent on. PAWS goes by a number of other names, including prolonged withdrawal syndrome, protracted withdrawal and post-withdrawal syndrome.

PAWS typically won’t appear until several weeks into the recovery process. Patients may complete a detox, see the end of their acute withdrawal symptoms and begin to feel confident about maintaining sobriety for a lifetime. Unfortunately, the appearance of PAWS can be frustrating and feel like a setback. That’s why it is so important to understand what PAWS is and how it can be treated.

Symptoms of Post Acute Withdrawal

Post acute withdrawal can manifest itself in a number of ways. While there are some physical symptoms, most of the symptoms associated with PAWS will be psychological in nature.

The most obvious sign of PAWS is depression. This is notable because after the initial withdrawal period, many patients in recovery begin to feel much better and far more positive about their future. When PAWS approaches, however, depression can sink in.

Depression is far from the only psychological symptom of PAWS. It is also common for those struggling with PAWS to experience anxiety, mood swings, panic attacks, thoughts of suicide, irritability and even hostility. They also may suffer from mental confusion, the inability to focus and trouble falling asleep or having energy during the day.

One of the most noteworthy physical symptoms of post acute withdrawal is unexplained and sudden chronic pain. This pain typically won’t be acute, but it will be uncomfortable and make it challenging for patients to stay active. Other physical symptoms might include a lack of libido among both men and women.

It is also key to remember that an increase in cravings can accompany PAWS. When patients are aware of this risk, they will understand that the cravings are a temporary condition. They will eventually pass, as will PAWS, and patients can enjoy feelings of positivity and confidence once again.

Patients Most Likely to Struggle With PAWS

PAWS has the potential to impact anyone who is overcoming an addiction to drugs, alcohol or prescription medication. While it doesn’t impact everyone, no one is exempt from the possibility of this particular challenge. There are, however, some issues that can exacerbate PAWS or make it more likely that patients will struggle with the syndrome.

A lack of support can be a tremendous factor in the development of PAWS. If patients grow accustomed to 24/7 support in rehab centers, for instance, it can be overwhelming to transition to independent living. Therefore, it is critical that patients have support during and after treatment. This can be in the form of group meetings, family support or ongoing behavioral therapy.

It is also possible that the existence of mental health conditions can exacerbate PAWS. Patients who already struggle with panic attacks, depression and anxiety, for example, will be prone to the development of similar post acute withdrawal symptoms. Dual diagnosis treatment during rehab can help to target these conditions before PAWS has the opportunity to develop.

Finally, PAWS can also be brought on by the emotions, events and challenges of everyday life. Patients might feel great following rehab, but depressed at their difficulty re-entering the workforce afterwards. Divorce, relationship problems and deaths in the family can also increase the likelihood of PAWS and increase the intensity of the syndrome among some patients.

Addictions More Commonly Associated With PAWS

Post acute withdrawal may also be more commonly associated with addictions to specific substances. PAWS can also manifest itself slightly differently depending on the drug or substance in question.

Those in recovery for marijuana addiction may notice sleep disruption or intense dreams when experiencing PAWS. Those in recovery for a cocaine addiction, in contrast, are more likely to struggle with impulse control.

Opiates are the drug most commonly linked to the development of post acute withdrawal. Anxiety, depression and inadequate sleep are just a few of the typical symptoms that can crop up when patients experience PAWS.

Post acute withdrawal syndrome is also more likely among those individuals who struggled with severe addictions. This could mean an addiction that lasted for several years, or it could mean an addiction where consumption increased rapidly before treatment.

Treatment for Post Acute Withdrawal

Treatment for PAWS is multifaceted, and it also depends heavily on the individual and their addiction, mental health and support system. One of the most integral elements of treatment, however, will always be education. Understanding what PAWS is and how it appears can help patients know that they are not alone and that it will pass.

Treatment for PAWS should be ongoing, because the symptoms can potentially last for several months or even as long as two years. However, they are rarely constant. Instead, they may appear for two days and then disappear for days or weeks at a time. For that reason, treatment may be required daily or weekly to help combat any risk of relapse. Weekly group counseling, 12-step meetings or therapy sessions can be helpful in treating post acute withdrawal.

PAWS is not as widely discussed as acute withdrawal, but it is just as important that patients are aware of what it is and how it can impact recovery. With education and treatment, patients can overcome PAWS just like they overcame addiction.