Post-Acute Withdrawal Syndrome (PAWS): Symptoms and Stabilization

When you hear the word “detox,” what comes to mind? Cravings? Pain? Symptoms that resemble the flu? If so, you’re only half right.

What you’re likely imagining is the first stage of detox, commonly known as withdrawal. But the reality is drug and alcohol detox does not end the moment the offending substance is no longer present in a person’s system. In fact, it can take up to two years for neurochemistry to return to normal.

The second stage of detox that takes place after withdrawal, known as post-acute withdrawal syndrome, or PAWS, comes with its own troublesome symptoms and is much less pleasant than its cute acronym would lead you to believe.

The unfortunate reality of PAWS is that the symptoms can be a trigger for relapse. Because this second stage of detox occurs during the period in which the brain chemistry is returning to normal, it can take 20 months or more before it has passed.

The most important thing that those in recovery need to understand is that recovery takes time. If a person goes into detox expecting it to be over within a matter of months, they are far more likely to be unprepared for the journey ahead.

What are the Symptoms of Post-Acute Withdrawal Syndrome?

Below are a list of the symptoms that typically accompany post-acute withdrawal syndrome. It is important that anyone going through this stage of detox makes self care a priority.

While PAWS can be uncomfortable, being able to practice patience, relax, and enjoy the good parts of life will get you through the hard days. Believing in your own ability to overcome detox is what will deliver you to the other side. Trust us, you can do this!

PAWS is marked by the following symptoms:

  • Inability to think clearly
  • Memory problems
  • Emotional overreactions or numbness
  • Sleep disturbances
  • Physical coordination problems
  • Stress sensitivity

Inability to think clearly

The thought disorders that are experienced when PAWS is activated should not be confused with overall intelligence. Think of this symptom as a malfunction that switches on and off, rather than a chronic condition.

“Unclear” thinking can include the inability to concentrate for long periods of time and the impairment of abstract reasoning, meaning it inhibits the ability to identify logical rules and apply them to basic problem solving.

Another common symptom is rigid and repetitive thinking in which the same thoughts circle around until they cannot be put together in an orderly way.

Memory Problems

Imagine being able to understand something when it is first explained to you but then, 20 minutes later, you either can’t make sense of it or have forgotten it completely. This is a common and particularly frustrating symptom that accompanies PAWS.

In addition, long term memory can be affected, and those experiencing PAWS may have a difficult time remembering significant events from their past. Much like how their ability to thinking clearly comes and goes, memory can also come and go.

Something that is easily remembered in one moment may be lost in the next, making it especially difficult to retain new information and learn new skills.

Emotional Overreactions or Numbness

Think of someone in your life who has a tendency to overreact, someone whose response to stress or excitement is consistently more amplified than it should be.

Now, imagine that person’s typical reaction multiplied by ten. This is the emotional overreaction response associated with post-acute withdrawal syndrome.

When experiencing PAWS, even the most trivial matters can lead to intense anger or anxiety, a response that has the potential to overwhelm the nervous system, resulting in an emotional shutdown.

When this occurs, it leaves the person feeling numb and with unpredictable mood swings.

Post-Acute Withdrawal Syndrome Sleep Problems

Sleep Problems

While the majority of PAWS symptoms are temporary, issues related to sleep may be lifelong. This symptom often manifests in unusual or disturbing dreams that may interfere with full, restful sleep, or difficulty falling and/or staying asleep.

These inferences can result in a change in sleep patterns, meaning the person will sleep for unordinary long periods of time or at unusual times of the day. Even though sleep issues are likely to improve with time, some of the unusual patterns may never resolve completely.

Fortunately, this is a symptom that many become accustomed to without severe difficulty.

Physical Coordination Problems

A less common but particularly challenging symptom of PAWS is difficulty with physical coordination, making the person more prone to injury and accidents.

This can result in categorical stumbling or clumsiness that makes a sober person appear to be intoxicated.

This symptom is marked by dizziness, imbalance, poor hand-eye coordination, and slow reflexes.

Stress Sensitivity

For those without PAWS, distinguishing between low-stress and high-stress situations comes naturally. However, not having this ability can easily lead to emotional breakdowns related to compounded stress or intense overreactions that result in inappropriate behavior.

While a person experiencing PAWS may act irrationally to stress in the moment, later on they will often be able to see the situation more clearly. This can lead to confusion and aggravation, as even they won’t understand why they reacted so strongly.

Stress Sensitivity of Post-Acute Withdrawal Syndrome

Stabilization of Post-Acute Withdrawal Syndrome (PAWS)

Because PAWS is a common trigger for relapse, is very important that those in recovery manage any of its symptoms as quickly as possible.

If you are experiencing any symptoms of post-acute withdrawal syndrome, use these five methods of stabilization to care for yourself and continue putting your recovery first:

  1. Verbalization: Having people to talk to who will not criticize or minimize what you are experiencing is crucial. Not only will it provide support, it will also give you the opportunity to bring conscious awareness to your symptoms and help you see your situation realistically.
  2. Ventilation: Learn to express how you are thinking and feeling, regardless of if it seems irrational or unfounded.
  3. Reality Testing: Your perception of what is going on may be very different from reality. It is important to ask those around you if what you are saying and how you are acting is making sense.
  4. Problem Solving and Goal Setting: Be proactive about getting better. Identify steps you can take to continue moving forward and create a plan of what you can do to get there.
  5. Backtracking: Reflect on the symptoms you have experienced. Make note of when they began and reflect on what you can do to turn them off. Recall specific symptomatic episodes, and identify what may have caused them and what helped resolve them. What actions could you take to help prevent future episodes or end them more quickly?
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