Addiction A-Z

Post acute withdrawal syndrome (PAWS)

It is a given that adjustment to life without substances is difficult. There are many social, emotional and behavioral issues involved in early recovery and a significant portion of these difficulties in early sobriety are biological. Substance abuse and addiction disrupt normal brain functioning even after withdrawal and detoxification. Post Acute Withdrawal Syndrome (PAWS) occurs in the time between abstinence and neurological stabilization. It is an adjustment period during which the brain attempts to stabilize without substances.

Some of the symptoms of PAWS are:

  • memory problems
  • sleep disturbance
  • coordination problems
  • confusion
  • racing thoughts
  • poor problem-solving
  • increased vulnerability to stress
  • difficulty managing emotions
  • an inability to function appropriately in relationships, on the job and other activities of daily living
  • lack of interest in activities
  • lack of pleasure
  • cravings
  • obsessive thoughts
  • compulsive behavior
  • increased sensitivity to pain

PAWS symptoms varies in severity from person to person. The condition is often complicated by the amount of stress experienced in early recovery as life changes are made and the consequences of substance use are experienced. Additionally, the severity of PAWS depends upon the severity of damage to brain functioning done during active substance use. Usually, with proper treatment, such damage can be reversed; however, some recovering people will have continuing problems. For most, however, symptoms usually occur within the first six months of abstinence and then subside.

Many people in early recovery will only have symptoms of PAWS in the first 90 days of abstinence. Ironically, symptoms seem to peak and coincide with the landmarks of sobriety traditionally celebrated in 12 Step groups in 30 day cycles (30, 60, 90, 180, 360 days). Some will even experience these cycling symptoms over the first two years of abstinence. PAWS symptoms greatly increase the risk of relapse.

Treatment for Post Acute Withdrawal Syndrome can involve the use of medications such as acamprosate and suboxone. Antidepressants are also frequently used. Other treatment recommendations cover a wide range such as:

  • counseling
  • assertiveness training
  • meditation
  • journaling
  • goal-setting
  • support groups
  • exercises to improve coordination
  • exercises to improve memory
  • nutrition
  • vitamins and supplements
  • stress management

Most people who experience Post Acute Withdrawal Syndrome can expect that symptoms will significantly improve in the first six months of sobriety and will disappear within a year. Maintaining good self-care, using a recovery support system, counseling, coping techniques and possibly medication can make this difficult road to stabilization manageable and successful.

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