A Primer on Post-Acute Withdrawal Syndrome

There are two stages of withdrawal that every addict in recovery will have to go through before they can truly move beyond their dependency on drugs or alcohol. First comes the acute stage, which will begin as soon as an addict stops using and will continue for several weeks after that. During this period of time, the physical cravings that the addict experiences will be intense and persistent, as the body has not yet adjusted to the loss of the drug it had relied on for so long. In this stage of withdrawal, the desire for chemical relief from the pain may be so overwhelming that addicts will feel like they are dying, and most former substance abusers will tell people later that this stage of their recovery was the hardest thing they ever had to go through in their lives. But unfortunately, this is not the end of the story. Addicts must pay a high price for their long history of usage, and it will actually take up to two full years before their neurochemistry finally returns to something resembling a normal state. After the acute stage of withdrawal ends, the post-acute stage begins, and the raft of troubling symptoms that those in recovery will experience during this nearly 20 month plus period of time have been labeled Post-Acute Withdrawal Syndrome, or PAWS for short.

Defining PAWS

While the physical cravings associated with chemical addiction will start to abate after the first few weeks, drug and alcohol abuse cause more than just a simple physical dependency. It is during the post-acute stage of addiction that emotional and psychological symptoms of withdrawal begin to emerge and become dominant, taking recovering addicts on a roller coaster ride through a full range of thoughts, feelings, and reactions. While individual experience varies, some of the most commonly reported manifestations of PAWS include:

  • Attacks of anxiety
  • Irritability
  • Sudden mood swings
  • Fatigue
  • Lack of motivation
  • Insomnia
  • Inability to concentrate
  • Obsessive thoughts
  • Fluctuating energy levels
  • Memory loss
  • Difficulty in solving problems and thinking clearly
  • Depression

These states and conditions will come and go throughout the duration of the post-acute stage, and they generally strike without warning. In the early days of PAWS, emotional and psychological turmoil is the norm, as the ups and downs come and go so quickly that recovering addicts will feel like their lives are careening out of control. Recovering addicts will experience alternating periods of dysfunction and near-normality throughout the post-acute stage, with the only change being that as time passes the duration of the good times will begin to increase. This is the result of the brain slowly re-organizing and re-balancing itself, and even though the negative effects associated with PAWS will remain a part of the equation for quite some time addicts should take heart in knowing that eventually those comforting feelings of normalcy and stability will transition into a full-time state of being. The symptoms of PAWS are the equivalent of a ghost that haunts the soul of the recovering addict, reminding him or her over and over again of the damage they did to themselves by abusing chemical intoxicants for so long. Thankfully, over time the relentless voices of those persistent spirits will begin to fade away, until there is nothing left of them but a barely audible whisper. But if they expect to reach that final destination of sobriety, the suffering associated with PAWS is a toll that all passengers who have taken the ride of substance abuse will have to pay.

Learning to Cope with PAWS

Despite the intensity of the cravings in the acute stage, many addicts are able to resist them, only to relapse later during the post-acute stage. This is because substance abusers are often well-prepared for the strong physical symptoms that accompany abstinence, but they are not ready at all for the scary and unfamiliar emotions they are suddenly forced to deal with after the onset of PAWS. That is why knowledge is the most important defense an addict can have against PAWS; as long as they know what to expect, they will not be taken by surprise when the various manifestations of the post-substance abuse blues descend upon them. When dealing with bouts of PAWS, recovering addicts should remain calm and relaxed, realizing that this too shall pass and that all of their inner turbulence is just a natural and unavoidable consequence of getting clean and sober. The best strategy for coping with the negative emotions and loss of focus and motivation associated with PAWS is to scale things down and to simplify. Outside of work, days and nights should be filled with small activities that bring pleasure, such as playing sports or games, exercising, reading, taking nature walks, journal writing, pursuing favorite hobbies, and so on. Generally anything that does not involve too much time or effort is acceptable; however, it is not a good idea to while away the hours by surfing idly on the internet or by vegging out in front of the television, since passive, unfocused pursuits like these can actually reinforce a negative mindset and end up making a person feel worse rather than better. Activities that require real effort and concentration in manageable doses, which is what recovering addicts dealing with the symptoms of PAWS should be looking for. Another thing that has worked for many is a change in diet that replaces the typical junk food and processed fare with plentiful helpings of fruits and vegetables, whole grains, beans and lentils, brown rice, lean meats, etc. Healthy foods are the building blocks of a healthy body, and there is every reason to believe that improving the nutritional quality of the things we consume can help a damaged brain restore itself to proper working order much more quickly. Avoiding substances like caffeine and refined sugar is also important to recovering addicts, since these products cause spikes in energy levels followed by crashes, which recreates the effects of drugs and alcohol in a milder form and could ultimately trigger dangerous new cravings for something stronger. More than anything, recovering addicts taking the long march through the post-acute stage of withdrawal need the support of their counselors and their peers. Appointments with therapists should be made regularly and kept, support group meetings should be attended religiously, and no one who goes to either should be reluctant to share a single detail about what they have been feeling and experiencing with PAWS. The kind of advice, encouragement, and understanding that recovering addicts will receive from support groups and in counseling sessions during this time will be invaluable, and the odds of surviving this difficult and taxing stage of recovery will be improved exponentially for those who are smart enough to take advantage of these priceless resources.

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