Treatment for Post-Acute Withdrawal Syndrome

The treatment of Post Acute Withdrawal Syndrome (PAWS) is a key component to permanent recovery from drug addiction or alcoholism. The drug rehab process must put significant emphasis on recognizing and addressing these symptoms through quality education and individualized support. PAWS symptoms vary greatly both in how they manifest themselves and in the degree of severity. Identifying an addict’s strengths and weaknesses within themselves and in their lifestyle can help to develop a long term personalized plan for treating Post Acute Withdrawal Syndrome.

Understanding PAWS

Post Acute Withdrawal Syndrome (also known as post-withdrawal syndrome or protracted withdrawal syndrome) consists of persistent symptoms occurring after withdrawal from alcohol, opiates, benzodiazepines and other substances. Symptoms are varied but one common link often makes them easily identifiable – recovering addicts associate the use of drugs or alcohol as a means of relief from PAWS symptoms. These cravings or intense desires are often felt by recovering addicts or alcoholics for weeks, months and even years into recovery.

“PAWS symptoms usually begin to occur between seven and 14 days after the acute period of withdrawal, and usually peak between three and six months after the start of abstinence.” (1)

Symptoms will present as cognitive, physical or emotional issues. Sufferers and onlookers alike can’t always recognize them as residual effects of the withdrawal process. However, some symptoms are easily recognized as conditioned responses, such as seeing a person, place or thing that the addict associates with drug or alcohol use and feeling a compulsion to use.

The following list includes the most common PAWS symptoms. This list is by no means all-inclusive and individuals may have different experiences or exhibit some or all of these symptoms. PAWS symptoms can last for years in severe cases and it is reported that many symptoms will come and go over time, sometimes returning unexpectedly.

  • Inability to think clearly – difficulty with basic problem solving and decision-making
  • Impaired concentration – racing thoughts distracting the individual and often negatively impacting their employment
  • Emotional sensitivity or numbness – over reacting to emotional stimulus our lacking an appropriate emotional response
  • Anger – issues with anger management may either develop or intensify
  • Depression – clinical depression may either develop or intensify
  • Memory problems – the new skills recovering addicts are learning to change their lifestyle and habits are even more challenging to retain
  • Sleep disorders – temporary or life-long changes in sleep patterns from increased tiredness to insomnia
  • Increased sensitivity to pain – some types of addictions numb physical pain so once the substance is removed, many report an increased sensitivity to pain
  • Anxiety – developing or increasing in severity – even to the degree of panic attacks
  • Sensitivity to stress – one of the most common symptoms impacting the severity of other symptoms

Developing A Treatment Plan

“People who relapse can often die from accidents, overdose, suicide or medical problems. For example, if you have a damaged liver, your liver will return automatically -and not gradually- to the level of damage it was at when you were drinking.” (2)

Because the medical risks associated with relapse are so severe, a comprehensive treatment plan involves the anticipation of PAWS symptoms and analyzes each person’s propensity for them.

Someone who has suffered from anxiety problems before and/or during their addiction must be prepared for the likelihood this issue will intensify. This also requires identifying an individual’s triggers that cause some symptoms to manifest in the first place. This empowering knowledge can enable them to avoid triggers completely, experience a trigger mentally-prepared or otherwise control their environment to minimize PAWS symptoms.

When utilizing the services of a drug and alcohol addiction treatment facility, PAWS treatment begins immediately under the guidance of trained professionals. Inpatient and outpatient treatment centers provide group and individual counseling to aid each recovering addict identify their strengths and weaknesses and tailor a personalized treatment plan.

Once leaving the safety and security associated with a treatment facility, the continuation of counseling greatly increases chances of long-term success.

“Don’t try to go it alone. Whatever treatment approach you choose, having a solid support system is essential. The more positive influences you have in your life, the better your chances for recovery. Recovering from drug addiction isn’t easy, but with people you can turn to for encouragement, guidance, and a listening ear, it’s a little less tough.” (3)

Close friends and family are encouraged to participate in counseling so they can understand the full scope of PAWS symptoms and become a part of their loved one’s support system. In a best-case scenario, work supervisors and co-workers would also be a part of the support system because they are also likely to see and be affected by the recovering addict’s PAWS symptoms. Counselors will give addicts the language and encouragement to be forthright about their journey, asking for support, understanding and patience that they might not otherwise receive.

PAWS symptoms often display themselves in ways that appear irrational and exaggerated, causing frustration for both the recovering addict and those around them. Developing self-compassion can be as challenging as giving compassion to others whose behaviors are hurtful or challenging. Addicts and their support system cannot practice compassion for themselves or others during the recovery process without a clear understanding of PAWS symptoms.

Identifying specific symptoms and triggers is just the beginning. It is what you choose to do with that knowledge that is important. Incorporating the following strategies helps reduce PAWS symptoms:

  • Avoid Unnecessary Stress and Demands – Stress significantly impacts all other Post Acute Withdrawal Syndrome symptoms. Emphasizing this one strategy may mean the difference between a lasting recovery and relapse.
  • Continue Therapy – Friends and family are an integral part of the support system, but having a counselor or therapist continues to help beyond the initial process of quitting. Counselors help reveal layers of emotion to find the root cause or issue that must be addressed when PAWS symptoms wreak havoc, and provide an objective perspective when relationships with other parts of the support team become strained.
  • Adopt Healthy Habits – Replacing an old, unhealthy habit like drug and alcohol addiction with a new, healthy habit will help distract the mind from cravings. Some common examples include:
  1. Take up exercise: jogging – boxing – swimming – joining a club.
  2. Enroll in classes: returning to school stimulates the mind and body by reducing “down time” while exercising your mind
  3. Make new friends: put yourself out there. Make new friends that are not associated with your old lifestyle.
  • Practice Compassion – Quitting is extremely difficult – staying clean even more so. Develop compassion for yourself when PAWS symptoms surface, and show compassion for those your behaviors affect.
  • Plan Ahead – Keep looking forward to anticipate triggers and stressors that could impede your recovery. People, places and things are all examples of possible triggers. The stress associated with trying to navigate all these triggers can be an even more overwhelming trigger in and of itself. When planning an outing that is stressful or you anticipate having triggers, talk to those going with you in advance. Let them know your concerns so they can help.
    Ask for Help – Let the people you feel most comfortable confiding in know you would like them to be on your call list and ask if they will be comfortable helping in those moments. This is an important part of building a strong recovery support system.

Finally, if you find yourself in the midst of a relapse, don’t let pride get in the way – all you have to do is pick up the phone.

“The steps to a relapse are actually changes in attitudes, feelings and behaviors that gradually lead to the final step, picking up a drink or a drug… If it happens, it is important that you get back up, dust yourself off and get back on the path to recovery.” (4)

Help is available 24/7 from our professional drug addiction treatment specialists. If you’ve relapsed or fear you may be in danger of relapsing, pick up the phone right now. Your life could literally depend on it.

(1) Emily Battaglia – Post Acute Withdrawal Syndrome: What You Need To Know – Drug and Alcohol Addiction Recovery Magazine – January 1, 2009
Accessed 11/17/11

(2) Save Our Selves (SOS) – Relapse Prevention
Accessed 11/24/11

(3) Authors: Melinda Smith, M.A., Jeanne Segal, Ph.D., and Lawrence Robinson – Overcoming Drug Addiction: Drug Abuse Treatment, Recovery, and Help – – May 2011.
Accessed 11/24/11

(4) Buddy T – Warning Signs of an Alcohol or Drug Relapse: Recognizing the Steps Leading to a Relapse – About.Com Alcoholism – June 12, 2009
Accessed 11/24/11

The Price of Not Getting Help
When contemplating the costs of addiction treatment for yourself, child, or loved one, consider the costs, or consequences, of “things as they are now.” What would happen if the substance abuse or addiction continued? Contact Recovery First, and we will help you or your loved one get the treatment needed to stop the dangerous, progressive effects of addiction.