Long Term Withdrawals – PAWS

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What is Post-Acute Withdrawal Syndrome (PAWS)?

This too shall pass.

Post Acute Withdrawal Syndrome refers to symptoms the recovering person will experience as their body heals itself and returns to a normal chemical balance. PAWS is the result of physical withdrawals gradually recurring at lessening strengths during the first year of recovery. The result is that the recovering  person experiences periodic “aftershocks” of the acute withdrawals that they went through during the first month of sobriety.

The first stage of withdrawing from a substance is acute withdrawal, where symptoms can be so severe that newly sober person should be medically supervised. Alcohol and benzodiazepines are very dangerous substances to withdraw from; withdrawal from these substances can kill the patient who attempts to stop using without medical supervision.

Depending on the substance, acute withdrawals are accompanied by extreme discomfort and symptoms such as:

• Shakes
• Cramps/pain
• Nausea
• Vomiting
• Hallucinations
• Insomnia
• Elevated blood pressure
• Incontinence

Withdrawals Continue After the Acute Stage (PAWS)

Once a patient has made it through acute withdrawal, lasting anywhere from a few days to a few weeks, the discomfort is not over. It takes months for the body to expel the substance completely and achieve a normal balance. The cravings the person experiences during this phase are the post acute withdrawals.

The key to dealing with PAWS is to expect it and plan for it. If a newly sober person is unaware of these physical and emotional changes taking place, he or she could conclude that they will never feel good again without their drug of choice. But once somebody knows that it’s all related to chemical changes as the body returns to normal, that person can walk through the discomfort without despair. It is also important in recovery to have an action plan in the case that relapse starts seeming attractive.  Immediately, the person should call their sponsor, and alert their addiction support system.

What are the Symptoms of PAWS?

Symptoms depend on substance(s) used and length of use. Some common symptoms of PAWS include

• Acute cravings
• Mood swings
• Sleep disorders
• Anger
• Sexual dysfunction
• Depression
• Anxiety or panic
• Inability to concentrate

While the above list is formidable, most people do not experience all the symptoms on the list (or all of them at once). Also, the human body is strong and resilient; with continued abstinence, the recovering person can be confident that his or her body and mind are repairing the damage. The above problems will come and go, and the symptoms will decrease in strength and duration as the body continues to repair itself and heal.

How Can a Recovering Person Help Their Body and Mind to Heal Faster?

Healing is a slow process, but there are things the recovering addict can do to help. It’s good to remember to be very kind to your body, mind and spirit. Get plenty of rest, eat well, and exercise. If your body craves something sweet go ahead and eat sugar in moderation. Substances like alcohol are loaded with sugar and you can satisfy this craving and feel better without putting yourself in danger of relapse.

If you need to seek professional help for dual diagnosis issues – be sure to do so. A medical doctor could potentially prescribe the right medication to control a chemical imbalance that is unrelated to substance abuse.

Form friendships with others in recovery and with people who are trying to live healthy. Take every opportunity to have fun. Laughter is a great healer, and especially when things are frustrating, it helps to laugh at oneself; this is possible with the knowledge that things are going to get better.

Above all, do not go back to using. Experiencing the symptoms of PAWS is an opportunity to practice walking through pain without picking up a substance to change the negative feelings.

One feeling you can cultivate to combat despair and the temptation to use is gratitude. It is really hard to ingest a harmful poison when you’re full of gratitude. It’s possible to be grateful for each experience, even pain. Allowing oneself to experience pain without doing something to change the feeling engenders strength and growth.

How Long Will PAWS Last?

There’s no one-size-fits-all answer to this question. You can expect to feel progressively better the longer you abstain from your substance(s), but there can be days that you’re feeling depressed or anxious for no apparent reason. Just remember that this is normal and that it will end.

Contact NorthStar Transitions if You Have Questions about PAWS

Our program has specifically been created with ‘long term’ clinical support in mind. Our mission is to walk the recovering person through their entire first year of sobriety with the support system that gives them every chance to maintain wellness in their recovery.  Contact us at 303-558-6400 if you or a loved one is needing support achieving a fulfilling life of recovery.


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