When you decide to seek treatment for your addiction to drugs or alcohol, you will find that the first step toward recovery is usually detoxification. The detox process cleanses your body of the substance you have been using so you can start the path toward a healthier body and mind. Since you have been addicted to the drug or alcohol, you will experience withdrawal from the substance in the detox stage. This can lead to post-acute withdrawal syndrome (PAWS). Understanding PAWS can help you through the early recovery stages.
What is PAWS?
Post-acute withdrawal syndrome (PAWS) is something you may encounter in early recovery as your brain and your body start to heal. You can experience PAWS as you get used to being without the drugs or alcohol you were addicted to, physically and emotionally. Sometimes the symptoms are more than uncomfortable and may last for some time after you have detoxed.
The Semel Institute for Neuroscience & Human Behavior at UCLA states that it is “estimated that 90 percent of recovering opioid users experience the syndrome to some degree, as do 75 percent of recovering alcohol and psychotropic abusers.” Symptoms of PAWS most commonly show up after a withdrawal period from alcohol, benzodiazepines, and opioids, as well as other psychoactive substances.
While researchers are still not certain about the precise mechanisms behind PAWS, they believe that the physical changes to the brain that occur during substance abuse and that are responsible for an increased tolerance to the substance are also responsible for the recurring withdrawal symptoms.
Most recreational drugs and alcohol can cause the symptoms of PAWS; however, some drugs are more likely to produce symptoms than others. Marijuana, cocaine, methamphetamines, opiates, and benzodiazepines are among those more likely to cause PAWS symptoms after you begin your early recovery.
PAWS may result from physiological changes that occur in the brain as a result of a substance use disorder. Researchers believe that prolonged substance abuse can reduce the brain’s capacity to deal with stress. During the period of time in which you are using drugs, your brain adapts to accommodate for the changes in your neurotransmitters. These changes can cause increased excitability as your neurotransmitters make the change in your early recovery stage.
PAWS can manifest after withdrawal from almost any abusive substance, but those abusing benzodiazepines seem to be the most at risk. There have been reports of benzodiazepine abusers experiencing symptoms of PAWS for years after final cessation of drug use.
The PAWS Timeline
In early recovery, you will typically begin your treatment with the detox process. After the detox is complete, the second phase of the withdrawal process, PAWS, may begin. Depending on how long and how intense your addiction was, — that is, how frequently, how much, and for how long you used mind- and mood-altering substances — this second phase can last from a few days to years after you stop using drugs or alcohol.
The Semel Institute lists common symptoms of PAWS that tend to fluctuate in severity. These symptoms may actually disappear at some point, only to reoccur later in the recovery period. PAWS symptoms may increase in severity when triggered by stressful situations, especially as you are experiencing the stress and challenges of early recovery:
- Difficulty with cognitive tasks, such as learning, problem solving, or memory recall
- Feelings of anxiety or panic
- Depressed mood
- Obsessive-compulsive behaviors
- Difficulty maintaining social relationships
- Craving originally abused substances
- Apathy or pessimism
- Disturbances in sleep patterns
- Increased sensitivity to stress