Post Acute Withdrawal Syndrome

One of the least pleasant aspects of recovery for many alcoholics and addicts is going through withdrawal; many will attempt to avoid it for as long as possible by hoarding as much of the substance as they can acquire (Read Withdrawal and Detox: Get the Facts).  Especially in the case of opiates such as heroin, the potential withdrawal symptoms that a recovering addict may experience are so unpleasant and even dangerous that it is often necessary to first transition users to a less addictive replacement drug before completely discontinuing opiates to increase the likelihood of a successful recovery (Read Living with a Replacement Drug, Why You Shouldn’t Fight Addiction Alone, and Methadone and Suboxone During Pregnancy: Risks and Benefits).  What many people do not realize is that, after the period of detox, which is the most crucial for withdrawal, has been completed, some people may experience Post Acute Withdrawal Syndrome (PAWS).

What is Post Acute Withdrawal Syndrome (PAWS)?

Also sometimes called protracted withdrawal syndrome or post-withdrawal syndrome, PAWS presents as alcohol- or drug-induced impairments that are still present after withdrawal. 

Who experiences PAWS?

Although varying degrees of PAWS can occur to anyone who is going through withdrawal, severe PAWS is most common among individuals who have been addicted to a substance for a significant period of time; it can also occur in babies whose mothers were addicted during pregnancy (Read Addicted Mother, Addicted Baby: Infant Withdrawal after Birth).  There is a high occurrence of PAWS among recovering opiate (heroin, Vicodin, Oxycontin), alcohol, benzodiazepine (Klonopin), and methamphetamine addicts, but it can also occur after withdrawal from other psychotropic drugs.

What are the symptoms of PAWS?

Someone who is suffering from PAWS may experience one or more of the symptoms below:

• Insomnia or sleep problems
• Panic, anxiety, or depression
• Suicidal ideations (Read Suicide and Substance Abuse: Know the Risks)
• Difficulty concentrating or remembering
• Poor coordination
• Apathy toward activities they once enjoyed
• Negative thinking
• Mood swings
• Difficulty interacting with others or problems maintaining relationships
• Cravings (Read Gotta Have It? Control Your Cravings)
• Obsessive-compulsive thoughts or behaviors
• Decreased motivation
• Guilt
• Heightened sensitivity to pain and stress

How long does PAWS last, and how is it treated?

The symptoms can last from a few months to multiple decades; especially with prolonged PAWS, there may be periods of remission when no symptoms are present or symptoms are markedly less severe.  Some medications are available to lessen the severity of PAWS symptoms including trazodone and carbamazepine; acamprosate may be used for PAWS that has resulted from alcoholism. Additionally, patients who are experiencing cravings may benefit from psychotherapy (Read Talk It Out: Is Therapy Right for You?).

What should I do if I think I have PAWS?

If you are entering a rehab to begin detox, ask the physicians at the facility what you can expect after withdrawal from your addictive substance.  If you have already been through rehab, discuss your symptoms with your primary care physician or your psychiatrist (Read Who’s Who in Addiction Medicine).