Understanding Post Acute Withdrawal Syndrome

First reported as a biopsychosocial syndrome in 1986, post-acute withdrawal syndrome (PAWS) is also referred to as persistent post-withdrawal syndrome and protracted withdrawal syndrome. Although studies involving individuals with PAWS are scarce, the opioid epidemic and rising rates of alcohol abuse disorder have renewed clinical interest in this condition.

Symptoms of PAWS typically emerge within four to six weeks after medical detoxification and abstinence. The onset of PAWS may vary, depending on the type of substance abused and the length of addiction. Heroin, fentanyl, and prescription opioid addicts seem to suffer more severe symptoms of PAWS while people abusing stimulants or alcohol tend to experience less severe PAWS symptoms.

What Causes PAWS?

Doctors think that post-acute withdrawal syndrome is caused by damage to the central nervous system, specifically the brain and certain chemicals in the brain. Currently, researchers haven’t found out why some recovering addicts develop PAWS and others don’t but suspect these factors are involved:

  • Psychological stress from coping with life with drugs or alcohol
  • Nutritional deficiencies that were not addressed during and after detoxification
  • Contending with the stigma of being an addict in recovery
  • Undiagnosed and untreated mental health issues
  • Remaining in an environment that triggers the urge to relapse

Doctors are also learning that the duration of PAWS symptoms ranges from six months to two years. In severe cases of addiction, symptoms may be irreversible if brain damage is extensive. Some recent research indicates that people who develop and recover from PAWS have successfully “recalibrated” their brain to produce normal amounts of dopamine, a neurotransmitter implicated in the addiction process.

Signs of Post-acute Withdrawal Syndrome

Emotional and psychological disturbances signal the onset of PAWS that include but are not limited to:

  • Moodiness
  • Problems with remembering and focusing
  • Panic attacks/anxiety
  • Depression
  • Irritability
  • Sensitivity to emotional stress
  • Difficulty making decisions
  • Lack of motivation

Physical symptoms of PAWS include:

  • Headaches/migraines
  • Chronic body pain
  • Fatigue
  • Insomnia
  • Gastrointestinal issues (cramps, diarrhea/constipation, nausea, acid indigestion)
  • Trouble coordinating fine motor movements

The most severe symptoms of PAWS involve psychotic behavior (delusions, hearing voices) and suicidal ideation. What makes PAWS so unusual is the sudden disappearance of symptoms for days, followed by an equally abrupt reappearance of symptoms. Stress and triggers that provoke cravings are thought to provoke signs of PAWS. Constantly dealing with stressful situations, trying to do too much at once, and having unrealistic expectations about themselves are common themes among recovering addicts who develop PAWS.

Is There a Treatment for PAWS?

Acamprosate or trazodone may help relieve PAWS in people recovering from alcoholism. No medication is indicated for treating PAWS in recovering drug addicts. Instead, addiction specialists recommend cognitive behavioral therapy (CBT), adopting a healthy lifestyle, cultivating a support network, and avoiding anything that may trigger cravings for individuals with PAWS.

Post-acute withdrawal syndrome is a leading cause of relapse in recovering substance abusers. If you or someone you know is trying to stay sober but is having difficulty due to possible symptoms of PAWS, please call Baystreet Recovery Center for immediate help: Contact Us Today.