Post Acute Withdrawal Syndrome Threat to Recovery

Post Acute Withdrawal Syndrome is considered by many to be the biggest threat to the recovery of an addict or alcoholic. Unfortunately, education and awareness concerning this serious condition is lacking in the public health sector, and many drug rehab centers do not educate their clients about what to expect with PAWS and how to properly manage its symptoms. These symptoms can be severe yet seemingly unexplainable to the addict. Many will turn to drugs or alcohol again as a result and the cycle of addiction will remain unbroken. However, by educating addicts and alcoholics about what post acute withdrawal syndrome is, how to recognize it and ways to properly manage it, more people will achieve lasting recovery and fewer relapses will devastate the lives of addicts and their families.

Post acute withdrawal syndrome occurs immediately after Acute Withdrawal Syndrome. Acute withdrawal refers to the physiological process of detoxing from drugs or alcohol. This process generally lasts from 5 days to 2 weeks, depending upon the severity of the substance abuse problem in question. Once this stage is completed, most recovering addicts are then placed in programs such as inpatient treatment or a day/night treatment program. This is when the symptoms of PAWS will generally begin.

However, not every addict or alcohol will experience post acute withdrawal syndrome. According to the entry on the subject in Wikipedia;

“Symptoms occur in over 90% of people withdrawing from a long-term opioid (such as of persons recovering from long-term use of alcohol, methamphetamine, or benzodiazepines and to a lesser degree other psychotropic drugs.” (1)

But despite the fact that 25% or more of addicts will not experience PAWS symptoms, many of these will still go on to relapse. This leads some to speculate that in these individuals post acute withdrawal symptoms may simply go unrecognized, or they may be obscured by denial on the part of the addict. Less studied addictions – such as addiction to cough medications, bath salts or inhalants probably skews PAWS and relapse rates.

Whatever the case may be, PAWS is as individual a condition as addiction is. In a report by the Substance Abuse and Mental Health Services Administration, an advisory board wrote:

“Some clients experience no symptoms after the acute withdrawal stage, whereas others have lingering symptoms. Still others experience an initial clearing of symptoms for the first month or two of abstinence and then develop unpleasant symptoms again. The intensity of symptoms also differs among clients.” (2)

Recognizing the symptoms of PAWS is critical in order to prevent significant distress and eventual relapse. PAWS can cause serious mental, emotional and physical problems that for some people can seem insurmountable. These symptoms come at a time when the addict is likely trying to reintegrate with their communities and places of employment. PAWS symptoms can completely disrupt this process by causing the recovering addict or alcoholic to experience:

  • Psychosocial dysfunction
  • Anhedonia
  • Depression
  • Impaired interpersonal skills
  • Obsessive-compulsive behavior
  • Feelings of guilt
  • Autonomic disturbances
  • Pessimistic thought
  • Impaired concentration
  • Lack of initiative
  • Craving
  • Inability to think clearly
  • Memory problems
  • Emotional overreactions or numbness
  • Sleep disturbances
  • Physical coordination problems
  • Stress sensitivity
  • Increased sensitivity to pain (3)

In fact, some of these symptoms can actually make it seem like the person suffering through them is instead exhibiting signs of drug use or alcoholism. According to some the term “dry drunk” is likely derived from the drunken or drugged physical and behavioral characteristics exhibited by some people who have only recently begun abstaining from drugs or alcohol.

Fortunately, PAWS symptoms can be used as an accurate predictor of relapse likelihood. Terry Gorski, one of the most prominent addiction researchers and experts in the world, developed a simple questionnaire that can help determine if a relapse is imminent. This includes questions like:

“I feel trapped and stuck, like there is no way out.”
“I am doing things to stay sober.”
“I engage in wistful thinking.”

The recovering alcoholic or addict is asked to evaluate the level of truth, if any, for each of these and 25 other questions/statements. Answers are assigned a point value; with the higher the total point value the more likely that a relapse has already or probably will occur. (4)

This predictor is an excellent example of how awareness of post acute withdrawal symptoms can help to prevent a relapse. By educating recovering alcoholics and addicts about the symptoms of PAWS, steps can be taken to mitigate or alleviate these effects. This involves a lifelong process of self reflection, self-awareness and working a constant daily recovery plan with an eye for PAWS management. According to Prison Talk, a prison information and family support community, a number of things can be done to manage post acute withdrawal:

  • Verbalize – talk about your problems
  • Ventilate – express your feelings even if they seem irrational
  • Reality Test – ask someone you trust if you are making sense
  • Goal Setting – having something to work toward is important
  • Education – learning about addiction and recovery is a constant process
  • Avoidance Behaviors – stay away from people and places associated with using
  • Proper Nutrition – Eating and hydrating properly is critical to warding off PAWS
  • Exercise – Exercise is important for both the body and the mind to guard against post acute withdrawal
  • Relaxation – time off from work and other stressors is imperative to refresh the mind and body
  • Spirituality – spirituality is the cornerstone of any successful recovery program (5)

If you or someone you care about is experiencing PAWS symptoms, it’s important to reach out for help as soon as possible. And if a relapse has already occurred, treatment is available to aid in getting clean again immediately. Call the number at the top of your screen now for a free, confidential consultation about getting your life back on track.

Recovery First, one of American Addiction Centers’ detox centers in Florida, is ready to help you overcome addiction and find long-term recovery. Call us today at to learn more about addiction treatment near you.

(1) Wikipedia Post Acute Withdrawal Syndrome

(2) Substance Abuse and Mental Health Services Administration Protracted Withdrawal July 2010 Vol 9 Issue 1
Substance Abuse Treatment Advisory US Department of Health and Human Services
Accessed 09/12/2011

(3) Paxil Progress.ORG PAWS (Post Acute Withdrawal Syndrome)
Accessed 09/12/2011

(4) TGorski.COM The AWARE Questionnaire
Accessed 09/12/2011

(5) Prison Talk PAWS Post Acute Withdrawal Syndrome
Accessed 09/12/2011

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