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What Is PAWS?

Post-acute withdrawal symptoms (PAWS) are the result of a withdrawal from a substance use disorder. After detoxification, PAWS symptoms occur as the brain restructures its neural pathway system, chemistry, and neurocircuitry.

During detox, the body and mind experience severely uncomfortable withdrawal symptoms, but PAWS symptoms occur later on down the road. Sometimes, these symptoms can suddenly appear out of nowhere a month after detox and can be a risk factor for relapse. 

Definition of Post-Acute Withdrawal Symptoms

PAWS symptoms, while similar to the unpleasant and uncomfortable withdrawal symptoms (acute withdrawal) present during detox from alcohol, drugs, or other substances, manifest in a second round of withdrawal symptoms known as post-acute withdrawal symptoms. The initial withdrawal symptoms heal the body, and post-acute withdrawal symptoms heal or recalibrate the brain. PAWS symptoms encompass the emotional and psychological factors of withdrawal from substances. The experience of an additional withdrawal period takes many people by surprise. 

Knowing that PAWS symptoms are temporary and will eventually dissipate is vital. This syndrome typically occurs with alcohol, opioid, heroin, or benzodiazepine addictions. Research indicates these symptoms have triggers like stress, environment, people, places, or actions that are reminders of substance use. PAWS symptoms are said to be similar to a roller coaster ride of ups and downs but vary for each type of substance. 

The following substances show the subsequent PAWS symptoms:

  • Alcohol use disorder: Anxiety, hostility, irritability, depression, moodiness, fatigue, insomnia, difficulty focusing and thinking, decreased sex drive, and physical pain with no known origin
  • Benzodiazepine use disorder: Anxiety, insomnia, and restlessness ebb and flow over time
  • Marijuana use disorder: Sleep difficulties, strange dreams
  • Opioid use disorder: Sleep disruption, anxiety, depression, fatigue, depression, irritability and decrease in executive control functions
  • Cocaine use disorder: Difficulty with impulse control

Symptoms of PAWS

Without any warnings or educational opportunities during treatment, PAWS symptoms can result in a relapse in hopes of relief. Treatment centers must educate their patients soon after detox to prepare them to cope with additional withdrawal symptoms that could occur in the future. The emphasis must include the fact that these other withdrawal symptoms are temporary. Reaching out for help as soon as possible offers the best outcome. 

In addition, the following post-acute withdrawal symptoms can also occur:

  • Brain fog, inability to focus, memory issues
  • Urges and craving for a substance for relief
  • Hostility, irritability, mood swings
  • Sleep disturbances, insomnia, vivid, strange dreams
  • Depression, anxiety, or panic
  • Feeling unable to move forward, having no initiative

PAWS Timeline

While post-acute withdrawal symptoms are not a classified mental health diagnosis, PAWS symptoms correlate individually, like addiction. Substance use disorders revolve around addiction, but substances, individual health factors, age, weight, medical condition, and mental health status are all personal. These factors affect acute withdrawal symptoms in detox, but there is not a singular timeline because of so many variances. Therefore, the PAWS timeline is different for each person in recovery. 

Typically PAWS symptoms occur and only remain for a few days to a week. Substance use disorders affect the brain’s chemistry so drastically that recalibration may take 6 months to 2 years. Once the brain begins to produce endorphins and dopamine at normal levels naturally, the chance of PAWS symptoms recurring is slight. Consequently, there is no one size fits all timeline for total healing, but reaching out for help must be a part of every relapse prevention plan. 

Recognizing post-acute withdrawal symptoms for what they are can help to manage this challenging time. It is vital to realize the brain is still healing from a substance use disorder, although it appears you are sober and have left the SUD in the past. Managing PAWS symptoms is achievable and initiates new levels of self-awareness. The first and most vital concept to grasp from this is there are resources available to avoid relapse.

The following actions will help to manage PAWS symptoms:

  • Contact a mental health professional or your treatment center immediately for aftercare programs; a healthcare provider may prescribe medications to help with severe symptoms.
  • Reinforce a daily schedule to practice good self-care habits, eat healthy, exercise, avoid trigger situations, and reach out to supportive relationships.
  • Visit a support group, sponsor, therapist, or family to talk about the symptoms, emotions, and feelings the situation induces. 
  • Journal the experience. Writing is therapeutic and recording the precipitating events and reactions; if PAWS occurs again, further reflection can occur. 
  • Put limitations on the timing of specific tasks if frustration or lack of focus occurs, preventing additional stress. 
  • If memory suffers, write reminders on sticky notes.
  • If insomnia occurs, reduce caffeine intake. 
  • Stay calm and be realistic about why PAWS happens. 

Detox Can Help

For some, PAWS symptoms will initiate a relapse. Relapse is part of recovery, and treatment is available through detox. If relapse does occur, seek help through a treatment professional, healthcare provider, or mental health professional. After participating in detox, an aftercare program may reinforce sober initiatives. 

When relapse occurs, the brain must do a hard reset again. Staying on track with a sober lifestyle can be manageable by instituting the following guidelines into a recovery plan. 

  • PAWS education for a complete understanding and how to prepare and cope if they occur
  • Celebrate small accomplishments
  • Keep appointments with therapists, healthcare providers, and group meetings.
  • Establish good sleep habits.
  • Stay active, exercise, and participate in fulfilling hobbies or events.
  • Be patient with recovery.
  • Take any prescribed medications responsibly. 

Find Help Managing PAWS Symptoms

For those searching for help with PAWS symptoms to avoid relapse or if regression is present from experiencing PAWS, Tennessee Valley Recovery is an optimal resource to contact for detox. The treatment and admissions staff know how essential detox can be if relapse occurs due to PAWS.

Contact Tennessee Valley Recovery to begin the assessment and intake process today. Receive compassionate understanding from our staff members to relieve any stress and frustration from relapse.