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Post-Acute Withdrawal Syndrome (PAWS)- A Safe Treatment Guide

Post-acute withdrawal syndrome (PAWS), also called protracted withdrawal, may afflict some people in recovery.

Regular withdrawal can last a few days or weeks, but PAWS causes symptoms to reappear months or years after the fact. PAWS can be incredibly discouraging for people in recovery.

Withdrawal

Battling drug and alcohol misuse takes a lot of courage and support. Most people need medical assistance for the first part of their journey, which often includes detox from a substance that was formerly abused.

Symptoms of drug withdrawal occurs as a result of quitting an addictive substance.

Your genes, history of drug use, and the drugs used have an influence on how withdrawal manifests itself and how long it will last. Drugs like heroin and benzodiazepines have particularly intense periods of withdrawal. 

A General Overview of PAWS

Psychology Today says detox is a key first step toward recovery, but it does not curb addiction on its own or prevent a person from feeling withdrawal in the future. There are two primary stages to withdrawal once a person decides to stop using.

  • Acute withdrawal is immediate detoxification and should involve a doctor’s help. The drug is processed from the body, so the person is no longer under its influence
  • Post-acute withdrawal syndrome (PAWS) can last for weeks, months, and even years, depending on the person’s genes, the drugs used, and how long they were used.

PAWS can surprise people in recovery because they often believe that getting sober only involved an initial detox period. Withdrawal symptoms triggered by PAWS occur even after a person’s brain, and body are now free from the substance.

PAWS has been misunderstood for years because some in the medical community doubted its existence. The condition is not yet considered an official health concern because its parameters have not been set in the Diagnostic and Statistical Manual of Mental Disorders.

The medical community has still not made up its mind about whether or not PAWS exists, but many health experts feel that parameters for PAWS should be set. Detractors say PAWS is another justification for intentional relapse.

Reports increasingly define what PAWS consist of. Additional research shows some drugs are more likely to cause PAWS than others.

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Common Symptoms

PAWS symptoms are diverse, and gender, size, and drug use can all affect withdrawal. For now, PAWS has been found to last about two years after a person has quit and abstained from a drug, but there is no guarantee that symptoms will stop even after this point.

Symptoms common to post-acute withdrawal syndrome include the following:

  • Decreased desire for sex
  • Confusion
  • Fatigue
  • Moodiness
  • Difficulty sleeping
  • Aggression or irritability
  • Chronic pain

Various drugs can cause PAWS, but people who have used opioids are more likely to report one or more symptoms of PAWS.

Drugs Linked to PAWS

The list of drugs linked to PAWS is diverse, but the list of drugs below consists of the main culprits.

 

Better known as crystal meth, physical withdrawal lasts an estimated two weeks. The first 24 hours are found to be the most difficult. Psychological withdrawal takes much longer and has reportedly taken months.
A person’s physical and mental condition influences their withdrawal experience. People who experience PAWS during meth withdrawal may become anxious, feel fatigue, and start craving the drug. Inhibition stemming from meth use can last for years even with completely abstaining from the drug.

 

Most people who try cocaine do not feel they can become addicted, but those who have may experience additional difficulties during detox. Cocaine causes withdrawal because of its rebound effect. Using it causes a person to feel alert, but its crash can be very intense.
Withdrawal is a way for the body to get back to normal after cocaine has changed its balance. Former cocaine users report feelings of withdrawal that last for weeks or even months after their last dose.

Most people who try cocaine do not feel they can become addicted, but those who have may experience additional difficulties during detox. Cocaine causes withdrawal because of its rebound effect. Using it causes a person to feel alert, but its crash can be very intense.
Withdrawal is a way for the body to get back to normal after cocaine has changed its balance. Former cocaine users report feelings of withdrawal that last for weeks or even months after their last dose.

Teens are more likely to become addicted to marijuana, and they may not know that it causes withdrawal, as reported by the National Institute on Drug Abuse for Teens. People who experience PAWS after quitting marijuana generally report insomnia and lack of energy.

A 2015 study published by the Australian Prescriber reports that withdrawal from benzodiazepines is hard to predict because each form of the medication has different effects. Tapering use helps people decrease their withdrawal symptoms, but it does not stop them.
Benzodiazepines are often used for anxiety or panic disorders. PAWS symptoms, as well as initial anxieties, make recovery difficult for those recovering from this misuse.
Using benzodiazepines for a few weeks causes physical dependence. Using them for an extended period of time can result in a longer withdrawal timeline.

Prescription opioids often provide necessary relief for people with severe or chronic pain. MedlinePlus mentions that withdrawal is especially difficult for people who want to quit or decrease their dose.
These drugs cause tolerance (a need for higher doses to remain effective) and dependence (a need to use these drugs to function). Quitting use of opioids often requires help because stopping opioid use cold turkey is dangerous.
Commonly reported symptoms of PAWS after months of abstaining from opioids are anxiety, lessened ability to control impulses, and depression.

Alcohol and PAWS

Studies are being conducted on alcohol, but a 2010 paper on Addiction Biology reports that abstaining from alcohol for three to six weeks can cause a person to feel cravings that make it harder for a person to stay sober.

So far, it is known that if you try to quit alcohol, you will have a hard time feeling pleasure and joy from activities that once made you happy. These feelings should subside in the weeks to come.

A February 2014 article by writer Jeanene Swanson, published on The Fix, discussed PAWS and alcohol misuse. Swanson stated that many people who used to struggle with addiction relapsed because they felt extremely uncomfortable as their bodies were adjusting to life without drugs or alcohol.

Those in recovery from alcohol addiction could be experiencing PAWS symptoms similar to those felt by people who are in the process of quitting benzodiazepines. This is because alcohol and benzodiazepines are both depressants that have similar effects on the brain.

Home detoxing from alcohol and benzodiazepines carry the possibility of seizures and death. This is why medical detox at an accredited addiction treatment center is essential.

Treating It Safely

Drug detox should always involve a doctor’s supervision. Though some people may end up detoxing at home if their use was not severe, some people may be able to use certain medications to make their withdrawal process more comfortable.

Acute withdrawal (the first stage of quitting a substance) may take place at:

  • Home with the help of family and friends
  • A treatment center that is equipped to help with detox
  • A hospital if your doctor determines that withdrawal will be very uncomfortable or even life-threatening

Doctors may be able to help those who have abused opioids by using medication that can keep them stable and prevent relapse. These medications are:

  • Buprenorphine, to lessen withdrawal symptoms and reduce cravings for opioids
  • Methadone, which is known to assist with the discomfort of detox. Some people may need it for years so they can fully recover. Doctors taper the dose over time until the person can fully live without it. It can also decrease cravings for opioids.
  • Clonidine, which can assist with anxiety, vomiting, nausea, and cramps

Health care providers can also treat you with medication that restores your ability to sleep or assists with vomiting and withdrawal-induced diarrhea. They may also suggest an over-the-counter medication that can help you.

There are additional methods to aid with recovery and help former drug users stay sober.

  • Inpatient treatment at a center
  • Hospitalization
  • Counseling
  • Assistance from self-help groups

MedlinePlus also recommends screening patients for mental health issues and depression during the process of recovery.

A diagnosis could help patients deal with issues that may have caused them to turn to drugs in the first place. Therapy for these issues may help them build confidence to stay strong even if they experience PAWS.

The Fix discourages people in recovery from going through withdrawal on their own.

Strategies to Cope With PAWS

Dealing with PAWS is a long-term commitment. There are a few strategies to help you adjust.

  • Learn how to deal with stress. Misusing substances numbs you to the problems around you, but they are part of life. Stress management strategies can help you improve your outlook and self-esteem. Controlling your reactions will help you in recovery.
  • Identify your triggers and talk about them with your therapist or sponsor.
  • Develop healthy habits. Regular exercise, a nutritious diet, and relaxation techniques can set you up for success.

These strategies will not solve every problem or symptom you experience during regular withdrawal or with PAWS, but they can go a long way in helping you recover and reclaim your life.  

Sources

(November 2018) Why Post-Acute Withdrawal Syndrome (PAWS) Can Be a Barrier to Recovery. Verywell Mind. Retrieved February 2019 from https://www.verywellmind.com/what-is-post-acute-withdrawal-syndrome-22104

(October 2018) Is PAWS Real or Just Another Relapse Excuse? Verywell Mind. Retrieved February 2019 from https://www.verywellmind.com/is-paws-real-or-another-relapse-excuse-4109902

(May 2015) Detoxing after Detox: The Perils of Post-Acute Withdrawal. Psychology Today. Retrieved February 2019 from https://www.psychologytoday.com/us/blog/some-assembly-required/201505/detoxing-after-detox-the-perils-post-acute-withdrawal

(February 2014) How to Isolate and Treat Protracted Withdrawal Symptoms. The Fix. Retrieved February 2019 from https://www.thefix.com/content/paws

(April 2010) Acute withdrawal, protracted abstinence and negative affect in alcoholism: Are they linked? Addiction Biology. Retrieved February 2019 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3268458/

(July 2010) Substance Abuse Treatment Advisory. Substance Abuse and Mental Health Services Administration. Retrieved February 2019 from https://store.samhsa.gov/system/files/sma10-4554.pdf

(July 2018) How Long Should You Expect Withdrawal Symptoms to Last? Verywell Mind. Retrieved February 2019 from https://www.verywellmind.com/what-is-withdrawal-how-long-does-it-last-63036

(February 2019) What to Expect From Meth Withdrawal. Verywell Mind. Retrieved February 2019 from https://www.verywellmind.com/what-to-expect-from-meth-withdrawal-22358

(November 2018) What to Expect from Cocaine Withdrawal. Verywell Mind. Retrieved February 2019 from https://www.verywellmind.com/what-to-expect-from-cocaine-withdrawal-21990

(April 2015) Marijuana Withdrawal is Real. National Institute on Drug Abuse for Teens. Retrieved February 2019 from https://teens.drugabuse.gov/blog/post/marijuana-withdrawal-real

(October 2015) Management of benzodiazepine misuse and dependence. Australian Prescriber. Retrieved February 2019 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4657308/

(May 2018) Opiate and opioid withdrawal. MedlinePlus. Retrieved February 2019 from https://medlineplus.gov/ency/article/000949.htm

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