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What Is Post-Acute Withdrawal Syndrome (PAWS)

post acute withdrawal paws

Post-Acute-Withdrawal Syndrome (PAWS) are mental and physical ailments that take place after acute withdrawal is complete, and they can last up to an entire year with on and off cycles of symptoms.

They are caused primarily by the changes to the brain that took place during the time of substance use and what specific symptoms are displayed depends on what the drug was, among other factors. Mood swings and signs of irritability are incredibly frequent.

What is PAWS?

PAWS is not limited to only illicit drug use and can also happen to people who are taking some prescribed pills who are forced to quit cold turkey due to circumstances.

It may not always be possible to avoid PAWS depending on specific circumstances. Still, it is less likely to develop if you are under the care of a medical professional during initial acute withdrawal.

According to the Semel Institute for Neuroscience and Human Behaviour, “it is estimated that 90 percent of recovering opioid users experience the syndrome to some degree as do 75 percent of recovering alcohol and psychotropic abusers.” [1]


Which Substances Can Cause PAWS?

Many different substances can lead to PAWS, including prescribed medications, illegal substances, and alcohol. Almost any drug that has an acute withdrawal period can cause PAWS. Below is a list of the most common:

  • Stimulants
  • Opioids
  • Marijuana
  • Benzodiazepines
  • Antipsychotics
  • Antidepressants
  • Alcohol
  • Methamphetamine
  • Cocaine

What to Expect From PAWS?

The symptoms will not begin until after acute withdrawal is complete. Then they can appear suddenly and continue in cycles that can be quite distressing for the person experiencing it. They can start any time after acute withdrawal, including weeks or even months afterward.

Generally, they last between a few months and a year, but some cases last for several years. Incredibly rare circumstances may take place where a person may suffer from the syndrome off and on for life.

The symptoms will last from several days to several weeks and then will be followed by a period with none until the next flare-up takes place. The stress of these rollercoaster symptoms can drive people to return to taking the substance to get relief. It is essential to work with a medical professional and therapist to get work through the psychological effects.

What Causes PAWS

There are several different processes taking place, which cause PAWS. These include:

The brain is a complex organ with sometimes contradictory or unhelpful responses to situations. PAWS is one of the times in which the human mind creates automatic feedback that it should not.

It is naturally reacting to a loss of the feel-good’ chemical reactions caused by drugs or alcohol.

Your brain will keep trying to chase that positive feeling that came with taking the substance because, in our very recent evolutionary past, this would have been a way to increase the quality of life.

It has been scientifically proven multiple times that when we develop a pattern of behaviour that ends with a positive feeling, then any of the cues along that pattern can cause a conditioned response.

For example, if someone always went out for drinks after getting a perfect score on a test, then the next time they achieve the same success, a very intense urge to drink may take over. This is habit induced conditioning.

Neurotransmitters are affected by substance use, and the longer it was used, the more severe the mental changes will have been.

While most of the neurological damage can be reversed, it is still not entirely clear to researchers if it can ever go back entirely to the same healthy state it started with. PAWS is the result of neurological damage and unhealthy connections.

Risk Factors for PAWS

No one thing causes PAWS, and while some risk factors are known, there is still much research that needs to be done on the subject. Genetics are known to play a role. The number one risk associated with PAWS is drug abuse, and the longer it takes place, the more severe the symptoms.

Below is a list of a few more areas that can provide known risk factors:

  • Duration, intensity, and pattern of substance abuse
  • Physiology
  • Psychological factors
  • Mental or physical illness


Signs & Symptoms of PAWS

These symptoms usually come in cycles of several days to weeks, and they can be mild or severe depending on the substance abuse history of the person. One of the most seen symptoms is mood swings including feeling depressed, overwhelmed, anxious, or irritated. These mood swings can fluctuate wildly and are felt very strongly by the person experiencing them. [2]

In addition to having intense mood swings, there can also be a numbing effect where a complete lack of emotional response can take place. Anhedonia, a loss of interest in things, can also crop up during individual symptom cycles. This can be extreme to the point where the person loses interest in all things, including eating. There may also be a lack of interest in sex and some chronic aches or pains.

Hazy thoughts, inability to focus, and low physical coordination are also signs of PAWS. This can take the form of dizziness and lack of coordination as well as trouble balancing. The cause is neurological, and the overall appearance of someone suffering from this form of PAWS can be that of intoxication even if they have not consumed any drugs or alcohol.

There is a sudden sensitivity to all stress-related issues, which can lead to insomnia and depression. The number one cause of relapse in PAWS is insomnia. When mixed with the intense cravings that can also follow it, resisting the urge to take some of the substance to decrease the discomfort can be very difficult. [3]

How Long Does PAWS Last?

This is highly dependent on the individual, length of time, and severity of their substance abuse. There are also genetic factors that can play a part in determining how long PAWS may last. With such diverse causes, it can be hard to nail down a specific length of how long PAWS will last.

Some people experience it for only a few weeks and then never again while others may suffer for years. Medications and therapy can be used to cope with PAWS so that it does not affect the rest of your life.

how paws is treated

How is PAWS Treated?

Some medications can help, but staying on top of PAWS is more likely to involve therapy. It is primarily mood-related, so being able to talk to someone and having a good support system is vital.

Here are a few other things you can do to counter PAWS:

  • Staying healthy through nutrition and exercise
  • Keeping regular sleep patterns
  • Self-reporting any changes or symptoms to your doctor
  • Educate yourself on treatment options
  • Remain positive and encouraged
  • Join a support group
  • Get help with your impulse control

Avoiding Relapse When Going Through PAWS

The best way to avoid relapse is to understand what to expect from PAWS. Being educated about how it can affect you and treatment options you can lean on to assist through those cycles of symptoms will make the most difference.

There is also an increase in sensitivity to stressful situations, so if you work to maintain a lower stress level in your life through meditation, therapy, and lifestyle changes, then it will be more likely that you will experience long-term success in your sobriety.

The Best Defence Against PAWS

Now that you are aware of all how PAWS can manifest, it is helpful to know what changes you can make in your life to minimize the impact of these symptoms.

1. Mind and Body

Stress-free environments and relaxation techniques will help to lessen the negative symptoms. Mindful meditation is an excellent way to de-stress by means of focused breathing exercises and calming your thoughts. There are many meditation channels on tv, online, and books on tape that can guide you through meditation if you are not sure how to do it on your own at first.

2. Sleep Regulation

The top cause of relapse is the inability to sleep, so staying rested is vital to remaining sober. Having a sleep routine will make it easier to maintain regular sleep patterns. It is also helpful to not nap during the day and to always stick to sleeping at the same time of night, so your body gets used to resting during that time.

3. Healthy Relationships

If you are serious about remaining sober, then you need to cut ties or significantly lessen contact with any friends or family members that still take part in substance abuse. Replacing those relationships with healthy ones will decrease the likelihood of relapse. Having a secure and encouraging support system around you will help when coping with PAWS.

4. Exercise Routine

This can be as simple as a 20-30-minute walk three times a week, or you can begin a new healthy lifestyle that includes gym routines or active hobbies like biking and swimming. Exercise is important because many substance abusers allow their bodies to atrophy, and it is not uncommon to sustain some level of permanent organ damage. The healthier your routines after you become sober, the more likely you will live a long and fulfilled life.

5. Healthy Diet

A healthy diet can help improve mood, decrease stress, and balance out everything from moods to sleep. There is no substitute for a proper diet. It can be useful to speak with a nutritionist and your doctor about what changes you might need to make to your current eating habits to get the best results.

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