If you’re in recovery or about to start the process, you might think of withdrawal as a uniquely physical experience. You know addiction has emotional and mental components, but many people think of withdrawal as the sweatiness, nausea, muscle tension and palpitations that come soon after the recovery process begins.
Withdrawal actually comes in two stages. First, you experience the physical symptoms. Every drug and substance is different, and every person is different. That means withdrawal is slightly different for everyone. We call this initial stage “acute withdrawal,” and it is the phase many people think of when withdrawal comes to mind.
The second stage of withdrawal is called post-acute withdrawal syndrome, or PAWS. It’s different than acute withdrawal, but most people still experience some post-acute symptoms during the recovery process.
What is PAWS?
According to AddictionsAndRecovery.org, during the post-acute withdrawal stage, you’ll experience far fewer symptoms. You will, however, experience many more psychological and emotional symptoms. People often refer to this stage as a “rollercoaster of emotions.”
Recovering alcoholic Amy Parrish was interviewed in this article. She had this to say about her PAWS:
“I’m certain I suffer(ed) symptoms of PAWS. My sleep cycles were off, my emotions were all over the place; I would alternate between feeling good, really good, and certain, and then like I couldn’t take all the soul searching one more minute.”
Amy isn’t alone. Though the general public doesn’t know much about PAWS, most people in recovery struggle with it.
PAWS symptoms often include:
- Mood swings
- Anxiety
- Irritability, feeling annoyed very easily
- Tiredness and/or exhaustion
- Variable energy
- Low enthusiasm
- Lack of focus/concentration
- Extreme cravings
- Obsession
- Panic attacks
- Trouble sleeping
Once again, from Addictions and Recovery:
“In the beginning, your symptoms will change minute to minute and hour to hour. Later as you recover further they will disappear for a few weeks or months only to return again. As you continue to recover the good stretches will get longer and longer. But the bad periods of post-acute withdrawal can be just as intense and last just as long.”
PAWS often mimics depression, and there are scientific reasons for that.
Why Does PAWS Happen?
People experience PAWS because substance abuse alters their brain chemistry. As the brain’s chemicals start to level out and return to some approaching normalcy, you just feel “off.” You no longer have drugs or alcohol to alter your brain chemistry, so your brain has a tough time on its path back to a healthy operating state.
Much like depression and anxiety, you experience PAWS because your brain’s chemicals fluctuate in an unnatural way. With PAWS, however, you experience these symptoms because your brain is once again finding its way back to equilibrium.
This article has a good explanation:
“… drugs hijack the brain’s reward circuits, a prime moving part of which is dopamine. In the case of drug abuse and dopamine, the brain not only becomes tolerant, but it also gets primed for an excess of dopamine, meaning the user eventually experiences a simultaneous lack of dopamine with increased signaling for that circuit. In other words, not only does an addict feel bad without the drug, his focus turns solely to it to make him feel good again.”
Most people who have undergone the recovery process know PAWS exists, they just don’t have a name for it. It’s the general feeling of malaise, hopelessness, and being drawn back into old habits.
Your brain can heal itself, but it’s never a quick and easy process.
How Long Does it Last?
According to Addictions and Recovery, PAWS generally lasts for two years. You can go months without feeling any post-acute withdrawal symptoms, but they will come back.
PAWS, much like acute withdrawal, is slightly different for everyone. Your symptoms will depend on which substance you’ve had trouble with, and they’ll also depend on how long you’ve used that substance.
Other than that two year estimate, the best answer is “it depends.” PAWS ends whenever your brain reaches a new state of equilibrium. Some people reach that state more quickly, and some people take a little longer to get there.
No two addictions are exactly the same, and no two brains are exactly the same. But there are some coping mechanisms most people find success with, regardless of how long their symptoms last.
How Can I Cope with PAWS?
Above all else, the best ways to cope with PAWS are preparedness and patience. If you think your symptoms will only last a few months, you’ll be unprepared when they strike again. You have to plan on devoting around two years to power through PAWS and continue along the path to recovery.
How to cope with PAWS:
- Be patient – Know that recovery is a process. Like anything else worth doing, it takes time and hard work. There is no way to rush it or cut any corners. You just have to put your time in, make good choices, and learn everything you can from the experience.
- Avoid triggers – PAWS is very good at leaving you alone for a stretch of time and then hitting you like a ton of bricks. When you wake up irritable and depressed, you’ll be tempted to fall back upon old habits. During these tough times, focus on something positive and avoid your usual triggers. You can be proud of yourself for making good choices at the end of each episode– it’s not easy.
- Self care – Be good to yourself. Each day you make good choices and continue the recovery process, you’ve done an excellent job. Reward yourself with a long walk, a hot bath, or whatever healthy activity you enjoy. What you are doing is enough, and you’re going through a tough process and coming out healthy and alive. Hold yourself accountable, but treat yourself with kindness.
- Relax – When you’re experiencing PAWS, focusing on your symptoms and letting them color your whole world seems natural. The more you focus on your pain, however, the more likely you are to relapse. Try meditation, yoga, or a day at the spa. Allow yourself to relax and go with the flow of life. Fixating on those uncomfortable feelings will only undermine your progress.
Surround yourself with compassionate people who encourage you to make good choices. Other people in the recovery process are good to talk to and confide in, especially your sponsor. Make sure you spend time with people who will hold you accountable and celebrate your success.
Experiencing PAWS is an unfortunate reality for people with a history of substance abuse. Post-acute withdrawal is just a bump on the road to recovery, and it’s something everyone has to deal with. You’re not alone in your struggle, and you can get through if it you prepare and exercise patience.
If you need guidance or someone to talk to, you can always contact us. We’re happy to give you the care you need.
~Paul
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