When an individual enters treatment for a substance use disorder, the first order of business is to undergo the detox and withdrawal phase of recovery. Generally, the detox process can take between 5-14 days to complete. That timeline depends largely on the duration and severity of the SUD, as well as the specific substance involved.

Post-acute withdrawal syndrome (PAWS) refers to a cluster of physical and psychological symptoms that may linger for weeks or months after the acute withdrawal phase has ended. Understanding PAWS can help you to better prepare for this possibility. Continue reading to learn about PAWS and how best to manage the residual symptoms.

What are the symptoms and causes of post-acute withdrawal syndrome?

During the acute withdrawal phase of detox, the symptoms may vary depending on the substance involved. While there are some differences specific to each substance, the symptoms tend to follow a few common themes. For individuals who experience PAWS, the symptoms may include:

  • Inability to think clearly.
  • Memory problems.
  • Emotional overreaction or numbness.
  • Sleep disturbances.
  • Stress sensitivity.
  • Poor coordination.
  • Symptoms of depression.
  • Symptoms of anxiety.

Clinicians believe that PAWS stems from the effects on the brain caused by the prolonged use of psychoactive substances. The following effects may occur when discontinuing the substance use, possibly triggering PAWS:

  • Brain Chemistry Changes: Substance use causes alterations in brain pathways and brain chemistry. The reward system is hijacked, which affects levels of serotonin, dopamine, glutamate, and GABA. When discontinuing substance use, the brain undergoes a period of instability as it attempts to recalibrate and adjust to the absence of the substance.
  • Pronounced Stress Response: During active substance use, the substance impacts both the peripheral and central nervous systems. The substance also activates the autonomic nervous system, which triggers the fight or flight response. PAWS can cause a chronic stress response that makes it difficult for the individual to manage even normal levels of stress.
  • Physiological Changes: Substance use can have a powerful effect on various bodily functions over time. When discontinuing the substance, the body attempts to rebalance hormone levels and digestive functions. This may result in gastrointestinal symptoms that linger for weeks after detox.
  • Lifestyle Adjustment Issues: After achieving sobriety, some individuals may struggle to adjust to a new sober lifestyle. They may experience symptoms of depression, anxiety and cravings as a result of the significant life changes they have recently made.

It’s important to remember that PAWS is not a permanent condition, and will eventually pass.

Tips for dealing with withdrawal

It’s essential for the individual entering treatment to know of the possibility of experiencing PAWS following detox and withdrawal. By being prepared and having realistic expectations, PAWS is much less likely to derail the recovery process.

Some tips for getting through PAWS include:

  • Continuing with outpatient therapy.
  • Considering medication for managing symptoms of depression or anxiety.
  • Participating in a local 12-step community for added social support.
  • Getting regular exercise.
  • Maintaining a regular sleep pattern.
  • Being aware of H.A.L.T. and other relapse triggers.
  • Sticking to a nutritious diet and limiting sweets and processed foods.
  • Practicing self-care, such as managing stress through mindfulness and yoga.
  • Considering Medication Supported Recovery to help control cravings.
  • Joining a PAWS support group.

Early recovery is notoriously difficult, and dealing with PAWS is one of the reasons why. By engaging in continuing care efforts following treatment, you can secure your recovery and manage any lingering withdrawal symptoms better.

Ashley Addiction Treatment, formerly Father Martin’s Ashley, is a nationally recognized nonprofit leader in integrated, evidence-based treatment for substance use disorders. Our programs are accredited by The Joint Commission, and result in frequent publications of ongoing research into effective treatment methodologies. We offer holistic care that encompasses the mind, body and spirit through inpatient and outpatient treatment, provide drug detox, relapse prevention plans, family wellness programs and a variety of other services tailored to each patient’s unique needs. Our driving principle — “everything for recovery” — reinforces our mission to transform and save lives through the science of medicine, the art of therapy and the compassion of spirituality, and is complemented by our philosophy of healing with respect and dignity. For information about our comprehensive programs, please call (866) 313-6307