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Post-Acute Withdrawal Symptoms (PAWS)

Sobriety-Based Symptoms (PAWS):

  1. Inability to think clearly
  2. Memory problems
  3. Emotional overreactions or numbness
  4. Sleep disturbances
  5. Physical coordination problems
  6. Stress sensitivity


Inability to Think Clearly

There are several thought disorders experienced by a recovering person when PAW is activated. Intelligence is not affected. It is as if the brain is malfunctioning sometimes. Sometimes it works all right. Sometimes is does not.

One of the most common symptoms is the inability to concentrate for more than a few minutes. Impairment of abstract reasoning is another common symptom of post-acute withdrawal. An abstraction is a nonconcrete idea or concept, something that you cannot hold in your hand, take a picture of, or put in a box. Concentration is more of a problem when abstract concepts are involved.

Another common symptom is rigid and repetitive thinking. The same thoughts may go around and around in your head and you are unable to break through this circular thinking in order to put thoughts together in an orderly way.


Memory Problems

Short-term memory problems are very common in the recovering person. You may hear something and
understand it, but within 20 minutes you forget it. Someone will give an instruction and you know exactly
what to do. But you may walk away, and that memory becomes clouded or may disappear completely.

Sometimes during stressful periods it may also be difficult to remember significant events from the past.
These memories are not gone; the person may be able to remember them easily at other times. The person realizes that he or she knows but just cannot recall it while experiencing the stress.

Because of memory problems in recovery, it may be difficult to learn new skills and information. You learn
skills by acquiring knowledge and building upon what you have already learned. Memory problems make it
difficult to build upon what you have already learned.


Emotional Overreaction or Numbness

Persons with emotional problems in sobriety tend to overreact. When things happen that require two units of emotional reaction, they react with ten. It is like holding the “times” key down on a calculator. You may find yourself becoming angry over what may later seem a trivial matter. You may feel more anxious or excited than you have reason to be. When this overreaction puts more stress on the nervous systems than it can handle, there is an emotional shutdown. If this happens to you, you become emotionally numb, unable to feel anything. And even when you know you should feel something, you do not. You may swing from one mood to another without knowing why.


Sleep Problems

Most recovering people experience sleep problems. Some of them are temporary; some are lifelong. The most common in early recovery is unusual or disturbing dreams. These dreams may interfere with your ability to get the sleep you need. But they become less frequent and less severe as the length of abstinence increases.

Even if you do not experience unusual dreams, you may have difficulty falling asleep or staying asleep. You
may experience changes in your sleep patterns; sleeping for long periods at a time or sleeping at different
times of the day. Some of these patterns may never return to “normal,” but most people are able to adjust to them without severe difficulty.


Physical Coordination Problems

A very serious PAW problem – though perhaps not as common as the others – is difficulty with physical
coordination. Common symptoms are dizziness, trouble with balance, problems with coordination between hand and eye, and slow reflexes. These result in clumsiness and accident proneness. This is how the term “dry drunk” came into being. When alcoholics appeared drunk because of stumbling and clumsiness, but had not been drinking, they were said to be “dry drunk.” They had the appearance of being intoxicated without drinking. The term “dry drunk” has been expanded over time to include the other symptoms listed here.


Stress Sensitivity

Difficulty in managing stress is the most confusing and aggravating part of post-acute withdrawal. Recovering people are often unable to distinguish between low-stress situations and high-stress situations. They may not recognize low levels of stress, and then overreact when they become aware of the stress they are experiencing. They may feel stressful in situations that ordinarily would not bother them, and in addition, when they react they overreact. They may do things that are completely inappropriate for the situation. So much so that later on they may wonder why they reacted so strongly.


Stabilization of PAWS (1-2-3-4-5)

If you are experiencing post acute withdrawal symptoms, it is important to bring them under control as soon as possible. Here are some suggestions that may help you be aware of what is going on and help you to interrupt the symptoms before they get out of control.


1. Verbalization: Start talking to people who are not going to accuse, criticize, or minimize. You need to talk about what you are experiencing. It will help you look at your situation more realistically. It will help you bring internal symptoms to your conscious awareness. And it will give you support when you need others to rely upon.

2. Ventilation: Express as much as you can about what you are thinking and feeling even if it seems irrational and unfounded.

3. Reality Testing: Ask someone if you are making sense. Not just what you are saying but your behavior. Your perception of what is going on may be very different from reality.

4. Problem Solving and Goal Setting: What are you going to do right now about what is going on? You can
choose to take action that can change things.

5. Backtracking: Think back over what has been happening. Can you identify how the episode started? What could have turned it off sooner? Think of other times that you were experiencing symptoms of PAW. What turned it on? What turned it off? Were there other options that might have worked better or sooner?

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