There are two stages of withdrawal, and they each require a different approach. Most are familiar with the acute stage, which occurs immediately and usually lasts a few weeks at most. This is when the person is most likely to experience physical symptoms of withdrawal. However, it is possible to be in the acute stage without physical symptoms, depending on the drug and person.
The second stage of withdrawal is referred to as PAWS. PAWS is an acronym that stands for post-acute withdrawal syndrome. You may also hear PAWS referred to as post-withdrawal, prolonged withdrawal syndrome, protracted withdrawal or protracted abstinence. At this stage, many physical symptoms are likely to subside and emotional and psychological symptoms remain.
PAWS occurs as the brain chemistry begins returning to its pre-substance state. As this happens, brain chemicals fluctuate and this can cause mood and emotional instability.
Symptoms of PAWS typically occur two months or more after the person has stopped the substance they have been abusing. Recovery is an individual thing, but symptoms typically last for several months.
The symptoms people experience in the acute phase are likely to vary greatly, but PAWS symptoms are very similar from person to person. Variances in timing and severity of symptoms may occur based on the type and duration of drug used.
Mood swings and stress
When someone is addicted to a substance, their brain becomes accustomed to a constant flow of something that will ultimately alter their mood. Now that the drug has been removed from the equation, mania or depression can strike at any time while the brain is rebalancing. At this time, the person may find it especially difficult to handle stress.
Any major life change can cause anxiety, and recovery is no exception. Anyone in recovery is susceptible to anxiety during PAWS, but those who were addicted to alcohol and/or benzodiazepines are even more likely to become anxious during this time.
Addictive drugs, and even some prescribed medications, boost neurotransmitters and neuropathways to make the drug user feel good. Once the person stops using, the brain has to get used to producing normal levels of these chemicals on its own. Until then, the person in recovery may have trouble finding anything fun or interesting.
Many drugs and prescription medications have an impact on sleep patterns, so the user’s brain may need time to re-establish healthy patterns. In addition, the recovering addict may be subjected to subconscious desires to go back to their old ways, which manifest themselves in the form of vivid and disturbing dreams that can disturb sleep.
Depression and fatigue
A recovering addict may exhibit symptoms in line with a Major Depressive Disorder or Chronic Fatigue Syndrome, but these symptoms will diminish as the brain readjusts.
As the brain readjusts to working without the aid of a drug, its neurotransmitters will fluctuate before coming back into balance. This causes concentration issues.
Post-Acute Withdrawal Syndrome Treatment
In order to permanently recover from addiction, the rehab process must include a plan for addressing PAWS. Although most addicts experience similar symptoms, the severity and manifestation of symptoms in this stage can vary greatly.
Any treatment plan should take the person’s propensity for any particular symptom into account in treatment. For example, someone with a history of depression before or during their addiction will likely experience this PAWS symptom with a greater intensity than someone else. Their treatment should explore the person’s history with depression, including any potential triggers, so they may be avoided during this stage of recovery. The same holds true for symptoms such as anxiety, mood swings and insomnia.
In addition to a personal approach, an effective treatment plan should also include the following:
- Stress avoidance – Stress can enhance PAWS symptoms, so it’s important for the person in recovery to take it easy and avoid stressful situations.
- Continued therapy – Family and friends should play an important supportive role during this time.
- Introduction of healthy habits – Healthy eating, exercise and meditation are all helpful in this stage of recovery.
- Advanced planning – Think about what could be a trigger and try to create a plan for handling the situation before it occurs.
- Compassion – This is a difficult stage to endure, and it’s important for everyone to go easy on the person in active recovery, including the person herself.
If you or someone you know is struggling to deal with the PAWS stage of recovery, please understand that you are not alone, and there is no shame in asking for help. Reach out to friends and family and talk to someone qualified to help you cope with symptoms as your brain is readjusting to its pre-substance state. Relapse can be very dangerous for your health, so be sure to get help and know that these symptoms are likely to subside before too long.