Post-Acute Withdrawal Syndrome: Causes, Symptoms, and Treatment

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For most people, recovery from drug or alcohol addiction begins after completing a detox program. Individuals have gone through their withdrawals with the help of medications and therapies and are ready to begin the remainder of their treatment. However, some individuals may have a harder time, even after completing detox. In fact, a study of people recovering from benzodiazepine addiction found that about 10-25% of these individuals suffered from withdrawal symptoms lasting for many months. This phenomenon is now known as post-acute withdrawal syndrome (PAWS) and is extremely frustrating for recovering addicts or alcoholics.

By definition, post-acute withdrawal syndrome (PAWS) is a collection of serious physical and emotional withdrawal symptoms that continue to occur after the normal withdrawal timeline. Individuals who suffer from PAWS are at a higher risk for relapse due to their desire to self-medicate their lingering symptoms of withdrawal. However, relapse can be avoided for individuals suffering from post-acute withdrawal syndrome. In fact, addiction treatment centers often take this condition into consideration when treating patients, teaching them natural ways to cope as well as prescribing safe medications to lessen their symptoms.

What is Withdrawal and Acute Withdrawal?

Drug or alcohol withdrawal is a direct result of the toxic effects these substances have on an individual’s brain and body. Similarly, acute withdrawal describes the symptoms that occur when a substance-dependent individual abruptly quits taking that substance. Illicit drugs, prescription drugs, and alcohol all cause withdrawal and acute withdrawal. Typically, acute withdrawal, or the symptoms of withdrawal, last anywhere from a few days to a couple of weeks.

During the initial days and first weeks of withdrawal, individuals commonly experience acute withdrawal symptoms. These symptoms range anywhere from being mildly unpleasant, to seriously uncomfortable and completely debilitating. Additionally, acute withdrawal symptoms vary from person to person, depending on the substance of abuse as well as the individual’s medical history. Typically, acute withdrawal symptoms are only present during the early stages of recovery, subsiding after completing a drug or alcohol detoxification.

Post-Acute Withdrawal Syndrome

Post-acute withdrawal syndrome (PAWS) is a second phase of withdrawal symptoms that occur after the brain recalibrates from substance abuse. Not to be confused with typical drug or alcohol withdrawal, PAWS persists after acute symptoms of withdrawal typically end. These symptoms often come and go unexpectedly, with a higher presence of emotional and psychological symptoms than acute withdrawal. The development of this syndrome depends on the duration and intensity of addiction, what substance was being abused, and an individual’s personal medical history. Additionally, these factors play into the starting point and length of post-acute withdrawal symptoms. In other words, PAWS can occur anywhere from a few weeks into recovery, to a few weeks or even a year after abstinence. Unfortunately, PAWS is one of the leading causes of relapse for individuals with under a year of sobriety.

Post-acute withdrawal syndrome can occur due to the abuse of any intoxicating substance, but this condition most commonly occurs from discontinuing the use of:

  • Antidepressants
  • Antipsychotics
  • Alcohol
  • Stimulants
  • Benzodiazepines
  • Opioids

Common Symptoms of Post-Acute Withdrawal Syndrome

In order to receive proper medical attention, it is important to be able to identify the symptoms of post-acute withdrawal syndrome. Many of the unpleasant or uncomfortable sensations experienced during early recovery from substance abuse could be symptoms of PAWS.

The common symptoms of post-acute withdrawal syndrome include:

  • Anxiety
  • Impaired ability to focus
  • Lack of libido
  • Inexplicable chronic pain
  • Mood swings
  • Irritability and hostility
  • Depression
  • Low energy and fatigue
  • Urges and cravings
  • Sleep disturbances—insomnia or vivid dreams
  • Issues with fine motor coordination
  • Stress sensitivity

Post-acute withdrawal syndrome is characterized by severe symptoms of distress. For example, someone suffering from PAWS as a result of opiate abuse may experience flu-like symptoms such as nausea and muscle cramping.

On the other hand, individuals recovering from alcohol addiction who develop PAWS may experience tremors and/or seizures. Needless to say, due to the unpredictable nature of the symptoms of post-acute withdrawal syndrome, medical supervision and intervention are vital.

How to Cope With PAWS

Due to the severity of the risk of relapsing after experiencing post-acute withdrawal symptoms, a comprehensive treatment plan is essential for one’s success. Drug and alcohol treatment centers anticipate PAWS by analyzing each patient’s propensity for developing this condition. As a result, patients are able to properly manage the symptoms of PAWS while focusing on their addiction or alcoholism recovery. By attending a drug or alcohol treatment center, individuals who may develop this syndrome have a higher chance of success in recovery and commonly maintain lifelong sobriety.

In addition to attending a professional drug or alcohol treatment center, having positive influences can help an individual to cope with a post-acute withdrawal syndrome. For example, having a support system made up of close friends or loved ones can help an individual to stay sober despite their temporary but uncomfortable symptoms.

Additionally, family members and close friends may be able to spot the signs of PAWS before the individual can. As a result, family members and close friends can become active in an individual’s recovery by helping them receive treatment for PAWS or even attending group therapy sessions with them. When loved ones participate in an individual’s addiction or alcoholism therapy sessions, all parties become informed and better equipped to deal with the symptoms of PAWS.

Similar to the support of loved ones, the following strategies can help to reduce PAWS symptoms:

  • Avoid stress and demands that are unnecessary and harmful to recovery
  • Continue therapy. Friends and family play an important role, but counselors help reveal the root cause of addiction and provide an objective perspective
  • Engage in healthy habits and friendships. Focusing on building new friendships and avoiding those “friends” that are still using reduces temptation and negative influence
  • Practice compassion for yourself when PAWS symptoms surface and be compassionate for those people your behaviors affect.
  • Plan ahead. When entering a potentially stressful situation, anticipate possible triggers, and identify tools to deal with these triggers.
  • Ask for help. Ensure people in your support network are prepared for you to lean on them for support.
  • Finally, if you’re at the point of relapse, don’t let pride get in the way, utilize all options you have in your support network and find treatment as soon as possible.

Get Started on the Road to Recovery Today

If you or a loved one are addicted to drugs or alcohol, it may be time to attend a professional detox program. At CWC Recovery, we take issues such as post-acute withdrawal syndrome into consideration from the beginning of treatment. As a result, patients are better able to focus on the benefits of recovery, rather than the uncomfortable stages of withdrawal. If you would like to begin a new way of life, contact CWC Recovery for more information on our holistic, comprehensive, and individualized treatment plans.

Medically Reviewed: September 25, 2019

Dr Ashley

Medical Reviewer

Chief Editor

About

All of the information on this page has been reviewed and verified by a certified addiction professional.

Dr Ashley Murray obtained her MBBCh Cum Laude in 2016. She currently practices in the public domain in South Africa. She has an interest in medical writing and has a keen interest in evidence-based medicine.


All of the information on this page has been reviewed and verified by a certified addiction professional.

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