Post Acute Withdrawal Syndrome

PAWS. It sounds nice as an acronym, but it is actually a very debilitating syndrome which many recovering addicts face. Imagine you’ve completed a rehab program in Thailand only 2 months ago. You’re feeling good and are learning how to live a sober life. Suddenly one day, you’re not feeling the same.  You just feel off. You wake up from a night of little sleep and feel even worse. You struggle to be in the same social situation which was fine two days before. Your new job is stressful and your memory is lacking. Even the simplest things are now difficult. This is not something you’ve encountered before and now you’re panicking. You have entered the second stage of withdrawal known as Post Acute Withdrawal Syndrome or PAWS.

Around 90% of people recovering from an opiate addiction (heroin and prescription meds) will go through post acute withdrawal. Another 75% of people recovering from alcohol, amphetamines or benzodiazepines will experience this. However, the symptoms and duration will vary from person to person. For some, PAWS is very controllable and lasts a short time. Others will experience such unpleasant symptoms that they become at risk of a relapse. In fact, PAWS is one of the most underestimated reasons for a relapse back into an addiction.

Two Stages of Withdrawal

In the case of addiction withdrawal, there are two stages: acute and post acute. Acute is the initial withdrawal a person will go through immediately after they ceased using their substance of choice. In general, the acute stage lasts for 3-20 days.

The second stage is known as the post acute stage or PAWS. Even after the persons’ body has adjusted to sobriety, the brain is still in recovery mode. At some point it may attempt to go back to the state it was in when the individual was using. Called post acute withdrawal syndrome this can occur within the first few months of recovery and last for up to two years.

Symptoms of PAWS

Post acute withdrawal syndrome can fluctuate in severity. They can be present for a period of time, then disappear and reappear at another time. Some symptoms of PAWS include:

  • Inability to think clearly or remember things
  • Difficulty in concentrating
  • Impaired abstract/ logical reasoning
  • Repetitive thinking
  • Emotional fluctuations or instability
  • Feeling apathetic
  • Inability to sleep or get REM sleep
  • Physical coordination issues
  • Dizziness, balance problems, blurred vision

Primary Impacts PAWS has on a Person

There are three primary areas in which PAWS impacts a person’s life, these are:

Cognitive: The person may have constant racing thoughts which begin to distract them from everything else going on in life. They can be scattered, random and make no sense. As a result, concentration and attention span is greatly hindered leading to a state of confusion and despair.

Emotional: PAWS can cause a person to feel little to no emotion about anything or the exact opposite in that they feel an excess amount of nearly uncontrollable emotions. The smallest things can seem like the biggest problems. This can lead to a social withdrawal and isolation to avoid being judged. Likewise, feeling “numb” or apathetic can lead to the inability to bond with friends and family during the initial recovery process. Without being able to control these emotions, the risk of relapsing is high.

Short and Long Term Memory: This is usually the most common symptom newly sober people will experience. They may find remembering things that they learned 30 minutes before are quickly forgotten. Skills, tools or routines which they have practiced over and over again suddenly are not assimilated as quickly and efficiently. Understanding even the most basic information can seem like a challenge in itself. The person may even find that different things they learned or experienced in their childhood are now broken or spotty.

Physical and Psychological Conditions Which Could Trigger PAWS

While a majority of addicts will experience PAWS, there are things which can trigger it more quickly or exacerbate the symptoms. These can include:

  • Combined use of alcohol and drugs of all types
  • Regular use of alcohol or drugs during adolescents or abusive use for a period of more than 15 years
  • History of head trauma (from accidents, falling, etc.)
  • Personal or family history of metabolic disease like diabetes
  • Personal history of malnutrition (common in addictions)
  • Personal history of psychological trauma (i.e. sexual or physical abuse)
  • Mental illness or personality disorder
  • High stress or anxiety

All of the above can affect anyone who is in the early recovery stages of an addiction. By being able to recognize PAWS, the person and their loved ones can prepare, plan and be supportive throughout the post acute stage. It’s important to understand the severity of PAWS will decrease overtime and that it is stress sensitive. This means that the more stress a person subjects themselves to, the worse the symptoms of PAWS could be and the longer they may last. In addition to lowering stress, reducing caffeine and sugars, eating lots of fruits and vegetables, exercising on a regular basis and sleeping 8-10 hours a night will make a big difference. Mediation, yoga, breathing exercises and massage can also be beneficial to alleviate or eliminate post acute withdrawal. Finally, talking to a therapist, counsellor or group meeting leader can be hugely beneficial and provide a person with valuable advice and support.

If you are ready to go to rehab to safely withdrawal from an addiction to drugs or alcohol while learning healthy ways to deal with PAWS, contact Siam Rehab, we can help.