For most people entering rehab, the usual detoxification period—during which the body and brain expel the substance of abuse—lasts about one week, give or take.  Even though detox and withdrawal is a dreaded but necessary step in recovery, most individuals are able to wrap their brains around accepting one week of misery.  In reality, many recovering addicts will be prone to protracted withdrawal symptoms called post acute withdrawal syndrome (PAWS), symptoms that linger for up to six months following the initial medical detox.

The severity of the PAWS is dependent on the history and type of the substance, with opiate and prescription opioid addiction producing the longest lasting symptoms.  PAWS can last anywhere from a couple of weeks to several months, depending on how long the addiction lasted and the level of consumption.  PAWS can become a threat to recovery because it leaves individuals prone to depression while they are trying to adjust to life without the substance.  Post-acute withdrawal syndrome treatment provides ongoing relief for individuals as they struggle through these difficult residual withdrawal symptoms.

About Post Acute Withdrawal Syndrome

The cluster of symptoms, both physical and psychological, that linger after the initial acute detox has been completed is referred to as post acute withdrawal syndrome (PAWS).  PAWS will typically emerge in individuals who have a long addiction history because many of their bodily systems have been significantly impacted over that period of time.  The body needs time to recalibrate after the substance has been removed, causing the prolonged period of withdrawal symptoms.

PAWS poses a threat to sustained recovery because the misery caused by the symptoms can become so unbearable that the individual may return to using again just to find relief.  This is why the longer the person can remain in a treatment program the better his or her chances are for a successful recovery.  In an extended treatment program, such as six months, the brain and body will have made the adjustment while the individual receives post-acute withdrawal syndrome treatment throughout the period.

Causes of PAWS

 There are several factors that can cause PAWS, but they all revolve around the changes to brain structures during addiction, and the resulting stress response.  Causes of PAWS may include:

• Brain chemistry changes. During active addiction, significant changes occur in the brain anatomy and chemistry.   The brain’s normal functioning was undermined for a prolonged period, turning the reward system upside down.  Being flooded with dopamine following drug use causes the brain to stop producing its own supply of dopamine and endorphins.  This leaves the individual with an inability to experience joy in the early months of recovery as the brain recalibrates and heals.
• Physiological changes. Other bodily functions are also impacted by the constant influx of drugs or alcohol.  Following initial detox, the body attempts to re-regulate digestion functions or hormone levels.  After detox, the individual may experience ongoing digestive issues, such as nausea, stomach cramps, or diarrhea for a few weeks.
• Stress response. Both the central nervous system and the peripheral nervous system are impacted during active addiction.  Activation of the sympathetic division of the autonomic nervous system (part of the peripheral nervous system) is extremely heightened during addiction, which triggers the fight or flight response.  PAWS can produce a chronic stress response, making it difficult for the individual in early recovery to manage even normal amounts of stress.
• Habit changes. Getting clean and sober requires making changes in daily habits that were tied in with addiction.  In recovery, it is sometimes difficult to overcome the loss of the habit or activity and symptoms of depression, anxiety, and cravings can result.

Symptoms of Post Acute Withdrawal Syndrome

The symptoms of PAWS will vary depending on the drug of abuse.  Each drug has a cluster of PAWS symptoms that will challenge the individual during the first year of recovery.  The good news is that it is a temporary condition and, with support, the individual will eventually see the symptoms subside.  Here are some general symptoms of PAWS, with each drug having symptoms that are unique to that substance:

• Depression
• Anxiety
• Loss in interest in sex
• Aggression or hostility
• Irritable
• Insomnia
• Mood swings
• Panic or fear
• Memory problems
• Extreme sensitivity to stress
• Cravings
• Dizziness
• Emotional numbness
• Feely uncoordinated
• Problems with concentration

Post Acute Withdrawal Syndrome Treatment

Addiction treatment programs should make it a point to educate clients about the dangers of PAWS to recovery.  By forewarning them about the discomfort of the symptoms and the risk they present to recovery while they are still in rehab they will have much more realistic expectations and will be on the offense.  Arming clients with this important information, and emphasizing to them that the symptoms will indeed end in about six months, can allow them to approach recovery in truth.  Not warning clients about PAWS sets them up for disappointment, unnecessary suffering, and a heightened risk of relapse.

Post acute withdrawal syndrome treatment involves ongoing psychotherapy, either in an extended rehab program or through outpatient counseling services.  This emotional support is key in giving clients a sounding board, someone with whom they can discuss what they are going through—someone who can support them through it. 

Medication for depression or anxiety may be of some use in more extreme cases, as not everyone can just gut it out.  Joining a support group or network can also provide peer-based support with others who have gone through PAWS and made it to the others side.

In the early months of recovery it is important to heal the body and the mind.  Getting regular exercise and eating nutritiously will help restore overall health and improve mood.  In addition, some individuals may benefit from naltrexone to help reduce cravings.  And always remember, this too shall pass.

Solutions 4 Recovery Provides Post Acute Withdrawal Syndrome Treatment

Solutions 4 Recovery is a premier addiction and dual diagnosis treatment program located in Southern California.  At Solutions 4 Recovery, our team is well aware of PAWS and how it can upend recovery by causing individuals to relapse.  Ongoing treatment and support of these uncomfortable symptoms are provided during the program and continuing care efforts.  You will not be left to manage this difficult set of symptoms alone—your recovery is too important.  For more information about all our addiction treatment services, please contact Solutions 4 Recovery today at (888) 417-1874.