What is Post Acute Withdrawal Syndrome?

man with post acute withdrawal syndrome sitting at a table in front of his phone while holding his head
man with post acute withdrawal syndrome sitting at a table in front of his phone while holding his head

Drug addiction can be a hard thing to live with, and it can lead to countless negative side effects. While it can cause havoc in the life of the person battling the addiction, it can also quickly devastate the lives of those around them as well. For those who have chosen to get help, the first part of recovery, the acute withdrawal stage, can be incredibly challenging and can feature many uncomfortable or even painful side effects. Following that is the post-acute withdrawal stage, which can have an entirely different set of withdrawal symptoms. 

Understanding Withdrawal

When someone living with alcohol use disorder or substance use disorder, commonly called “drug addiction,” seeks professional addiction help, they will go through two stages of withdrawal. These are known as the acute withdrawal stage and the post-acute withdrawal stage and will each have its own challenges and withdrawal symptoms. Below is a breakdown of what each one consists of. 

Stage 1 is the acute withdrawal stage and will consist of the most severe physical withdrawal symptoms as well as numerous psychological or mental symptoms. These symptoms will often be uncomfortable and even painful at times, depending on the type of alcohol or drug addiction the individual is detoxing from. This stage will generally begin 24-48 hours after the last drink or dose of the substance and will last up to two weeks, depending on the user and their individual addiction profile. 

Stage 2 is called the post-acute withdrawal stage and will begin once the physical withdrawal symptoms from stage 1 have begun to subside. It can last for months in some cases, and while the individual may no longer be physically uncomfortable, they will often be challenged with several psychological side effects. This stage and these effects are what make up the majority of the recovery timeline.

What is Post-Acute-Withdrawal Syndrome?

Post-acute withdrawal syndrome is the second phase of recovery that someone recovering from substance use disorder will experience, following the initial detox stage involving most of the physically uncomfortable detox symptoms. It is the response of the body and mind to being recalibrated. This recalibration occurs when the active addiction cycle is broken, and the body and brain break their dependence on the addictive substance. 

Unlike the acute stage, the withdrawal symptoms of PAWS are largely psychological and emotional in nature. The strength and duration of PAWS are highly dependent on the addiction profile of the individual going through recovery. This means that for some users, the post-acute stage can be over in a few weeks, while for others, it may take many months to fully overcome the post-acute withdrawal symptom. 

Why Does Post Acute Withdrawal Syndrome Occur?

Drug addiction creates a significant imbalance in neurotransmitter chemicals and many of the compounds associated with pleasure and reward in the brain. When this addiction is broken, the brain and body need to cope with the loss of a substance that they have grown dependent on, which causes them to go into withdrawals. While PAWS is present to some extent in nearly all addiction recovery, it is most common for those recovering from alcohol and opioid addiction.

Is There a Way to Avoid PAWS?

While there are ways to shorten the acute withdrawal timeline, such as medical detox, there is no current method for avoiding the post-acute withdrawal syndrome. In some cases, the PAWS stage may be relatively minor, but this will be entirely dependent on the user and their addiction profile. In fact, PAWS may be one of the few things to be present in nearly any addiction treatment. Research shows that up to 90% of those recovering from opioid addictions and 75% of those recovering from alcohol use disorder will experience PAWS. Additionally, 15% of individuals that have abused benzodiazepines will experience long-term PAWS.

What Are Some Signs and Symptoms of PAWS?

There are many symptoms that are associated with post-acute withdrawal syndrome, and it’s important to be able to recognize these symptoms. This is particularly important for those already in recovery so that they know it’s completely normal and expected, as well as understanding that they will eventually pass. The most common symptoms include:

  • Brain fog
  • Difficulty concentrating or maintaining focus
  • Increased irritability or even hostility
  • Disruption to the sleep cycle, including restlessness or insomnia
  • Fatigue or low energy
  • Feelings of anxiety or panic
  • Depression
  • Mood swings or other emotional instability

How Long Do PAWS Symptoms Usually Last?

PAWS isn’t constant, and most individuals only experience symptoms for a few days at a time, depending on their recovery and addiction profile. In most cases, PAWS symptoms will begin to significantly reduce around six months, but in some cases can resurface for a year or two.

How is PAWS Treated?

PAWS isn’t treated so much as it’s coped with by those in recovery. It’s important to remember that it’s a normal part of the detox and withdrawal process, and the best thing to do to make getting through it easier is to learn some coping techniques that can help. Here are some of the most commonly effective coping tips:

  • Cut yourself some slack, recovery is challenging, and healing isn’t linear.
  • Stay current on your mental health appointments, and be honest in therapy sessions, whether they’re individual or group.
  • To help limit the loss of concentration, manage your task-oriented time in 15-minute chunks.
  • If intrusive, circular thought patterns begin, distract yourself by changing your setting and going for a walk, meeting up with a friend, or simply putting on some music.
  • For those dealing with insomnia, limit caffeine and make a bedtime routine that cuts out digital devices and high-energy activity preceding bedtime.

Getting Treatment for PAWS

If you or a loved one are living with drug addiction or alcohol use disorder, the best thing you can do to make the first step on the road to recovery is to talk to an addiction expert since studies show that up to 80% of addicts in recovery relapse during PAWS. 

Contact the Agape professionals today to discuss your treatment needs privately and create a treatment plan tailored to those specific needs. By completing detox and withdrawals in a safe, clean, and comfortable environment, the strongest foundation for recovery can be created.

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