Understanding Post-Acute Withdrawal Syndrome PAWS and Why it Makes Sobriety Difficult
Most symptoms last for a few days at a time, although this is dependent on the type of alcohol or drug addiction, and the amount and frequency of substance use (every person’s withdrawal pattern is a little different). Typically, the brain recalibration process takes anywhere from six months to two years before the brain once again naturally produces endorphins and dopamine. This chronic stress response continues during post-acute withdrawal, receding and effectively resetting only gradually over time.
It’s a major reason why so many people relapse in the early stages of recovery. After the acute phase of withdrawal, a person may still need professional medical care, as PAWS symptoms can be severe and affect the quality of life. PAWS symptoms can be uncomfortable and distressing, and they can be risk factors for relapse. Having a strong self-care routine, working with medical professionals, and having support from people who understand can help.
The human nervous system consists of two main parts, the central nervous system (CNS) and the peripheral nervous system (PNS). The PNS consists mainly of nerves that connect the CNS to the rest of the body so that information can be sent back and forth between them. The autonomic nervous system (ANS) is part of the peripheral nervous system.
Nov Post-Acute Withdrawal Syndrome (PAWS): What to Expect After Detox
It refers to a group of symptoms that linger after the initial stage of withdrawal or that develop later on in recovery. It is not certain that post-acute withdrawal syndrome is restricted only to certain classes of drugs. It is unsurprising, therefore, that long-term effects are commonly reported when patients stop taking their antidepressant medications. This article reviews research on post-acute alcohol withdrawal syndrome (PAWS) management.
- In contrast, PAWS and protracted withdrawal involves a wider range of psychological and emotional symptoms that tend to fluctuate in severity.
- Originally coined by the creators of Alcoholics Anonymous, dry drunk syndrome can have a negative impact on the process of giving up drinking both physically and mentally.
- It has since become largely uncommon in medical literature, though the term remains online, despite not having much authoritative information behind it.
- Memory problems are also common, with both short-term and long-term memory affected.
- Alcohol is a sedative drug and works, in part, by activating gamma-aminobutyric acid (GABA) receptors in the brain.
What Factors Influence the Severity of PAWS Symptoms?
Setting realistic recovery goals and focusing on long-term abstinence can provide motivation and a sense of purpose. Recognizing the risk factors that may trigger cravings or other PAWS symptoms can also aid in planning preventative strategies. PAWS symptoms can include a range of psychological and physical issues that affect individuals during their early recovery. Understanding what to expect during this period can help those in recovery prepare and seek the necessary support. While dry drunk syndrome is most common among people who quit alcohol without the support of addiction professionals, anyone can become a dry drunk, especially during the emotionally charged first year of sobriety. The development and severity of PAWS depends on many factors like genetics, mental health and the degree of past substance abuse.
A diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats can help restore brain chemistry and improve overall physical health. Engaging in self-care activities helps individuals better cope with the challenges presented by PAWS, such as mood swings, sleep disturbances, and cognitive difficulties. By prioritizing self-care, those in recovery can build resilience, reduce stress, and create a strong foundation for long-term recovery success. According to the National Institute on Drug Abuse (NIDA), the relapse rate for substance use disorders is estimated to be between 40-60%. However, by educating individuals about PAWS and providing them with comprehensive support and treatment, it is possible to reduce this rate and improve long-term recovery outcomes. For some, the symptoms may last for a few weeks, while others may struggle with PAWS for several months or even years.
What Causes Post-Acute Withdrawal Syndrome?
In early abstinence, the brain’s stores of endorphins and dopamine are severely depleted. Dopamine, the neurotransmitter that floods the brain during drug use to produce titanic highs, is also involved in the regulation of mood, and a certain amount is necessary in order to maintain a “normal” mood. It can take between four weeks and six months for the brain to naturally manufacture enough endorphins and dopamine to replenish its inventory of these vital chemicals. When that person cuts out alcohol, there is a period when their brain hasn’t yet received the message and still overproduces the stimulating chemicals. With alcohol out of the equation, though, these chemicals cause withdrawal symptoms.
You can control the symptoms with professional oversight and medical intervention at a treatment center. Working with a substance use specialist can provide methods and medications to combat PAWS symptoms. PAWS is a set of impairments that happen immediately after you experience withdrawal from alcohol or other substances. As it tries to reach equilibrium, it causes brain chemicals to fluctuate until they’re stable. Pregabalin has shown efficacy for treating uncomplicated AWS and related negative affective symptoms in a 2-week open-label study (Di Nicola et al., 2010) and a 2-week multicenter trial versus tiapride and lorazepam (Martinotti et al., 2010b).
The severity of experienced symptoms will vary throughout the duration of PAWS. Support makes all the difference in overcoming post-acute withdrawal syndrome and cravings. Our program for relapse prevention program in Boston can help those who are facing PAWs, relapse, or other challenges. Practicing mindfulness, engaging in regular physical activity, and exploring hobbies can improve psychological functioning and decrease the risk of substance misuse.
Although there is some evidence for targeted pharmaco-therapy for treating specific PAWS symptoms, there are few recent, robust, placebo-controlled trials, and the level of evidence is low. Consequently, one strategy for improving PAWS research is to recognize it formally. We hope that the present review’s findings—by synthesizing literature across approximately four decades of research—may create a stronger argument for formalizing PAWS as a diagnostic entity. We restricted eligibility to human adult populations (ages ≥ 18 years), examining any pharmacological (e.g., medications) or Drug addiction substance use disorder Symptoms and causes nonpharmacological (e.g., psychotherapy) interventions for the treatment of PAWS.
Also, the number of endorphins—the natural chemicals that activate opiate receptors—is decreased in chronic opioid drug users as the body compensates for overstimulation of this system. These adaptations by the nervous system reduce opiate signaling to the brain and have been linked to increased pain sensitivity and mood disturbances in individuals addicted to opiates. Similar to alcohol’s mechanism of action, benzodiazepines (BZDs)—such as diazepam (Valium) and alprazolam (Xanax)—are GABA receptor activators, and their chronic use also causes the brain to adapt by switching to a hyperexcitable state. Withdrawal symptoms are common with this class of drugs, even in patients who take them strictly as directed and under a doctor’s supervision.
