Post-Acute Withdrawal Syndrome (PAWS):

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What is Post Acute Withdrawal Syndrome?

When a substance-dependent person decides to stop using a drug or loses access to it they experience withdrawal syndrome, which has two phases. The first is the physical symptoms of acute withdrawal (or detox). The second phase, post acute withdrawal syndrome (PAWS), is a collection of psychological and mood-related symptoms that occur as the brain recovers from the effects of active addiction.

PAWS Symptoms:

  • Depression.
  • Mood Swings.
  • Hostility and irritability
  • Trouble sleeping.
  • Lack of coordination.
  • Exhaustion.
  • Less interest in sex.
  • Inability to feel pleasure (anhedonia).
  • Anxiety or panic.
  • More sensitive to stress.
  • Trouble concentrating.
  • Problems with memory.

PAWS and Relapse

One of the more dangerous aspects of PAWS is that many people don’t know about it. There is a common belief that after detox, when all the drugs are out of your system, normal life will resume. This is not the case. Those who experience the re-occurring and prolonged discomfort of PAWS without understanding it can become demoralized, depressed, anxious, and prone to relapse.

How Long Does Post Acute Withdrawal Syndrome Last?:

The symptoms of PAWS can last 3 months or 2 years. It depends on the type of substance abused, the length of time it was abused, and the health of the person.

In general, PAWS lasts longer for someone who:

1. Spent several years using drugs.
2. Used drugs by snorting or injecting them.
3. Is older.
4. Has kidney or liver problems.

What Does PAWS Feel Like?

Early in recovery, the symptoms of PAWS will arrive in unexpected waves. You may wake up one morning feeling tired, run down, and extremely irritable for no reason. Or find yourself suddenly at a loss of balance and coordination. They can appear and disappear by the day or even the hour.

Later in recovery, the symptoms become more cyclical in nature. They last for several days at a time before disappearing again for several weeks or months. As more time passes, symptoms will happen less often and fade more quickly.

The Cause of PAWS:

In pre-addiction, when someone completes a task related to their survival (eating, sleeping, procreating, physical activity) the limbic system creates dopamine, a neurotransmitter that leads to feeling happy, satisfied, or even euphoric. It’s the brain’s way of motivating us to do what we need to survive — it feels good.

During active addiction, drugs and alcohol flood the brain with massive amounts of dopamine every time the person uses. Since the brain is an organ capable of learning it makes two conclusions.

  • Only things that relate to survival create this much dopamine. Therefore, this stuff that keeps creating so much must also be related to survival.
  • There is so much dopamine all the time now. I don’t need to make more on my own anymore.

In recovery, when those drugs are withdrawn it creates a huge dopamine shortage.

As a result, during PAWS people will struggle with things that require dopamine.

post acute withdrawal syndrome, dopamine pathways
Functions that require dopamine.

For instance, dopamine helps maintain a “normal mood” baseline. Without this balancing agent, people experience drastic mood swings. The high end of the spectrum is anger or anxiety while the low end is dysphoria, depression, anhedonia.

Dealing with Post Acute Withdrawal Syndrome:

PAWS happens while the brain heals post-addiction. It’s an uncomfortable process that must run its course, but there are many ways to speed up the recovery.

Consult a physician if symptoms become extreme or dangerous. For instance, suicidal thoughts.

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