Dealing with PAWS (Post Acute withdrawal Syndrome)

After you have finished acute withdrawal, you have completed what can be considered the most difficult part of recovery. Withdrawal is unfortunately not over at this time. After this initial stage, there is another stage of withdrawal, known as Post Acute Withdrawal Syndrome (PAWS).

While not being as severe as acute withdrawal, PAWS can be unpleasant, and may cause you to relapse if you are not prepared for it. This article talks you through all the ins and outs of PAWS, and lets you know how you can get through it with your sobriety still in tact.

What is post acute withdrawal syndrome (PAWS)?

Post Acute Withdrawal Syndrome (PAWS) refers to the symptoms that can arise after the acute phase of withdrawal has ended. It is important to note that not everyone will experience PAWS, and if you do, the severity and duration of symptoms varies greatly from person to person.

There is no one-size-fits-all solution to reducing the symptoms of post acute withdrawal syndrome, as each person experiences it differently. However, there are some general things that you can do to help make the symptoms more manageable.

Symptoms of post acute withdrawal syndrome (PAWS)

Whilst the symptoms of PAWS can vary from person to person, there are some common symptoms that you may experience if you suffer from this condition.

Physical symptoms of PAWS

Physical symptoms of PAWS can include fatigue, headaches, muscle aches and pains, and disturbed sleep. You may also experience cravings for drugs or alcohol, as well as feeling nauseous or dizzy.

Emotional symptoms of PAWS

Emotional symptoms of PAWS can include anxiety, depression, mood swings, irritability, and feelings of agitation. You may also find it difficult to concentrate or to remember things.

Behavioural symptoms of PAWS

Behavioural symptoms of PAWS can include isolation, restlessness, and impulsiveness. You may also start engaging in risky behaviours or experiencing problems with your relationships.

How to recover from PAWS faster

Read these tips to become aware how you can get through PAWS symptoms relatively quickly.

Get plenty of rest

Firstly, it is important to get plenty of rest and relaxation. This means making sure that you get a good night’s sleep, and taking time out during the day to rest and recuperate. It can be helpful to set aside some time each day for a nap or to just relax in a quiet space.

If you have a tendency towards overworking, bear this in mind. If you can, ease up on work a little. This is not the time to take on extra projects at work, drum up new clients or start a new business.

Exercise

Secondly, regular exercise can help to release endorphins and improve your overall sense of well-being. If you’re not sure what type of exercise you like, take some time to find out! Try engaging with a bunch of different healthy activities to see what you enjoy the most.

Many people in addiction recovery enjoy exercise as a way of shaking away the cobwebs and getting fitter and healthier. Take it slow and build yourself up. There are many immediate and long-term health benefits to even just taking just a half-hour stroll each day.

Eat a healthy diet

Eating a nutritious diet is also important, as it will help your body to heal and repair itself. Healthy diets are not a one fits all approach. While you should eat a balanced diet, some people work better with more fruits, others work with a high-protein diet etc. Find out what works for you.

If you’re going through PAWS, you should not start dieting. Your body needs plenty of good food so that it can recover from addiction. Eating decent sized meals with plenty of fresh ingredients when you are hungry will speed up your recovery from PAWS.

Talk about how you’re feeling

It can also be helpful to talk about how you’re feeling with someone who understands what you’re going through. This could be a friend, family member, therapist, or counsellor. Talking openly and honestly about your experiences can help to lessen the feelings of isolation and loneliness that can often accompany PAWS.

You can also consider attending recovery meetings. Here you can not only share about your experience, but also hear others talk about their experience, strength and hope.

If you’re struggling with PAWS, it’s important to remember that you are not alone. There are many people who have been through what you’re going through, and who have come out the other side. You can meet many of these people at recovery meetings.

Diary

Keeping a diary may also be beneficial. Writing down your thoughts and feelings can help you to process them in a healthy way, and can also be a useful tool for tracking your progress over time.

Weeks and months in the future, you will be able to look through your diary and appreciate how far you have come. Sometimes it can be difficult to notice progress unless you have a record of where you were.

Medication

For some people, medication can help manage the symptoms of PAWS. If your symptoms are particularly severe, or if you feel like you’re struggling to cope, you might consider taking medication.

However, be aware that some medications that are given for PAWS can be addictive themselves. Subutex, Methadone and Valium may all be prescribed for PAWS, and they may help reduce symptoms, but they all come with nasty withdrawal symptoms if you use them for a long period of time.

Some people actually consider the withdrawal from these drugs to be worse than drugs that they originally had PAWS from. Subutex and Methadone both come with a protracted period of withdrawal, which also means that they have a longer PAWS duration when they are stopped abruptly.

Valium can reduce the anxiety felt from withdrawal, but coming off Valium causes more anxiety. Stopping taking Valium abruptly can also cause death due to seizures.

Follow a recovery programme

In addition to the above self-care measures, many people find that working the 12 steps or the SMART Recovery programme can be helpful in dealing with PAWS. These recovery programmes provide a great framework for recovery, and can help you to make sense of your experiences and to develop a more positive outlook on life.

What causes PAWS?

PAWS is primarily caused by your brain not coping with not being under the influence of substances and attempting to revert back to its previous state. It takes time for the brain to heal and recalibrate to a healthier state.

Stressful situations

Being stressed after you stop using drugs can lead to PAWS, or worsen existing PAWS symptoms. Unfortunately, stress is often high in early recovery, as your number one coping mechanism (substances) has been taken away. There are also aspects of yourself and your past that you need to address and changes that need to be made so that you achieve long term sobriety. Many of these are uncomfortable.

While it can be challenging to avoid demanding situations in early recovery, you can reduce the stress in your life. Set clear boundaries with difficult friends and family members. If they don't understand, be clear about why you are doing this.

Try to pinpoint where the stress is coming from in your life, and take the necessary steps to reduce it.

Multitasking

Doing a million things at once will only make PAWS worse. Do one action at a time. First things first!

Feeling anxious, fearful or angry

These are all emotions that you will encounter in early recovery. Experiencing them without dealing with them will not help PAWS. Learning how you can navigate through these emotions will help you to overcome PAWS. Therapy and a recovery programme can help you to learn how to regulate your emotions.

Social conflicts

Having arguments with friends, family members or a spouse can make you feel disconnected, enrage you and increase your stress levels. All big no-nos for PAWS. No one is expecting you to feel serene in every situation when you’re in early recovery. Do try and reduce conflict, though. Often, simply walking away from the situation may be the best you can do.

Having unrealistic expectations of yourself

Setting high expectations for yourself frequently leads to failure. With this comes feelings of not being enough and dejection. Be easy on yourself. Know that simply doing the right things to stay sober is enough for your recovery at this point. You have already done well just by getting sober.

Who experiences PAWS?

Not everyone who stops taking drugs and alcohol is likely to experience PAWS.

The people who are most likely to experience PAWS are people who:

• Were chronic drug or alcohol users - These people are more likely to experience PAWS because they have been using drugs for a long time and their bodies have become dependent on the drugs. When they suddenly stop taking the drugs, their bodies are not able to function properly and they experience withdrawal symptoms.
• Did not follow an appropriate detox/taper programme - Those who do not follow a taper program are more likely to experience PAWS because they stop taking the drugs suddenly. This can be hard on the body and brain, resulting in additional withdrawal symptoms. This is one of the reasons why it can be useful to attend rehab. The staff there will know how to implement a taper program properly.

How to prevent relapse during PAWS?

There are a number of things that you can do to prevent relapse during PAWS.

The following can help to protect your ongoing recovery whilst going through Post Acute Withdrawal:

• Be aware. It is important to be aware of the symptoms of Post Acute Withdrawal Syndrome and to watch for them in yourself. You can then separate these symptoms from your recovery process
• Develop a support system. You will need a strong support system of friends, family, or fellow recovering addicts who can offer you emotional support.
• Try to stay busy and to find positive outlets for your energy. This includes things like exercise, hobbies, and volunteering.
• Attend recovery support groups. These meetings can provide you with motivation and inspiration and can help you to stay on track.
• Make sure that you have a solid relapse prevention plan in place. This should include things like identifying your triggers, knowing your early warning signs, and having a plan for what to do if you start to experience cravings.

The stages of relapse

Some people believe that relapse only involves the physical act of relapsing, but there is much more to it than this. There are actually three stages of relapse: emotional, mental and physical.

Emotional stage

The emotional stage of relapse is characterized by feelings of hopelessness, despair, and isolation. You may feel like you are a failure, that recovery is impossible, and that there is no way out. You may also withdraw from family and friends, feel like you are a burden or that no one understands you.

Mental stage

The mental stage of relapse is characterized by negative thinking and distorted beliefs about addiction and recovery. You may believe that their situation is hopeless, and that you will never be able to recover. You may also start to obsess about using drugs or alcohol, and may make plans to get and use them.

Physical stage

The physical stage of relapse is characterized by the actual act of using drugs or alcohol. This may be preceded by a period of intense cravings and a strong desire to use. You may rationalise your use, telling yourself that you can control it or that you deserve to use because you have been sober for so long.

Relapse is a process that can be stopped at any stage. The sooner it is recognised, the easier it will be to prevent it from progressing further.

Know that you will get through PAWS

A proverb used frequently in recovery groups is that “this too shall pass”. This saying reminds you of the impermanence of life and tells you that whatever is going on your life will come to an end at some point.

If you are in dire financial straights, are having relationship problems, are sick or are having any other kind of difficulty, you will not have this trouble forever.

The same is true with PAWS. No matter how bad you feel right now, this too shall pass.

If you are struggling with a lack of support you can create your own meeting within our platform and connect with like minded others. Likewise, you can also create a circle of support. Our Wellness hub also offers lots of proven and natural methods of reducing PAWS symptoms. This can prove invaluable when dealing with life on life terms.

References:

• https://www.verywellmind.com/what-is-post-acute-withdrawal-syndrome-22104
• https://www.sciencedirect.com/science/article/abs/pii/S1555415521005523
• https://www.psychologytoday.com/us/blog/some-assembly-required/201505/detoxing-after-detox-the-perils-post-acute-withdrawal