People who have been living with addiction may notice that some symptoms stick around longer than others, even when they feel as though they have recovered. In this blog, we explore the symptoms and timelines associated with post-acute withdrawal syndrome, PAWS.
What is post-acute withdrawal syndrome (PAWS)?
PAWS refers to persistent psychological and neurological symptoms that can last for several months, and in some cases longer, after an acute detox. These symptoms typically occur after the withdrawal phase has passed, and can be a result of the brain adjusting to the absence of substances the brain has become dependent on.
Many people expect that their bodies return to their pre-addiction state soon after the substances are removed from their bodies, but this is not always the case. In some cases, people continue to experience symptoms long after detox, well into the recovery phase.
Not everyone experiences PAWS, and the severity can vary widely from person to person.
PAWS is widely recognised in addiction recovery as part of the brain’s healing process following prolonged substance use.
Acquiesce Rehab Centre is here to provide support with addiction, ensuring that clients leave with the tools and techniques needed to continue recovery in their own environment.
Acute withdrawal vs PAWS: What’s the difference?
Many people get confused about the difference between acute withdrawal symptoms and PAWS. Here are the main differences.
Acute withdrawal symptoms
- Occurs immediately after substance use is stopped
- Primarily involves physical symptoms, although some psychological symptoms may also occur
- Typically lasts for a few days or weeks
Post-acute withdrawal syndrome (PAWS)
- Begins after the acute withdrawal symptoms end
- Mostly leads to psychological and neurological symptoms
- Can last weeks or months, or even longer in some cases
Post-acute withdrawal syndrome timeline
PAWS timelines can vary depending on the substance used, duration of use, and individual health factors, but many people experience similar phases of recovery.
Phase 1: Acute withdrawal phase
At this early stage of the recovery journey, it’s common for physical symptoms to peak. Many people experience nausea, sweating and tremors, all of which can be challenging to deal with. Some people may also notice increased cravings and insomnia during the night.
Depending on the substance you are removing from the body, a medical detox may be required. A medical detox provides supervised support, sometimes including a gradual reduction or medication to safely manage withdrawal symptoms.
Removing some substances altogether with no weaning process can be extremely dangerous, as the body is relying on them. Always seek professional support.
Acute withdrawal typically lasts from a few days to a couple of weeks, depending on the substance and individual circumstances.
Phase 2: Early stage of PAWS
At around 2 – 6 weeks, you may begin to notice the signs of PAWS. This can involve a transition from physical to psychological symptoms. Many people experience mood swings, anxiety and a lack of motivation.
All of these symptoms can be challenging to manage and can affect other areas of life, including work, relationships, and more.
Phase 3: Mid PAWS
This stage usually lasts for 1 – 3 months and can see people dealing with intermittent symptoms that come and go. Many people experience brain fog and sleep problems during these stages. They may also experience sudden emotional distress.
Phase 4: Late PAWS symptoms
The latest stage of PAWS can last anywhere between 3 and 12 months, or even longer for some people. It involves gradual stabilisation of symptoms, which is common in recovery. Many people experience increased emotional resilience when they progress through this experience with support.
Common psychological symptoms of PAWS
If you are concerned that you may be experiencing PAWS, these are some common psychological symptoms that you may experience. Symptoms often come in waves rather than remaining constant.
- Brain fog: Difficulty concentrating, experiencing memory issues and slower thinking.
- Anxiety: Generalised anxiety, sudden panic attacks and heightened stress sensitivity.
- Sleep issues: Insomnia, fatigue, nightmares and irregular sleep patterns.
- Mood disturbances: Depression, irritability, low motivation and emotional numbness.
- Cravings: Psychological urges to use substances.
“If you’ve stopped using but still feel low, anxious, or unlike yourself, please know this is part of healing. Sometimes the mind takes longer to catch up, and that’s okay.”
– Tina McCoy, Service Manager at Acquiesce Rehab
What causes PAWS?
PAWS occurs as the brain and body work to rebalance after prolonged substance use. When a person uses drugs and alcohol, their brain chemistry changes in many ways. One of the ways is through disruptions in serotonin and dopamine, which are both required in the brain for a person to feel happier and more rewarded. Some drugs can cause spikes in dopamine, reducing the brain’s ability to regulate dopamine levels naturally, and therefore leading to them often feeling flat and low.
Substance use can also lead to hypersensitivity in the nervous system, which can affect many other parts of the body.
It’s important to note that these are all common aspects of recovery, and experiencing PAWS does not mean that you are failing or doing a bad job.
It takes time for the body to learn how to cope without substances, especially when they have been present for a prolonged period of time.
How to manage PAWS effectively
If you are experiencing PAWS, you can use these coping strategies to support you.
- Ensure a structured routine: Regular meals, sleep, and activities can help stabilise mood and make a person feel more energised.
- Access therapeutic support: Seek counselling, learn CBT techniques or look for group therapy sessions.
- Ensure sleep hygiene: Maintain a consistent bedtime routine, limit caffeine and screens and ensure relaxation within your routine.
- Perform mindfulness: Introduce meditation, yoga or gentle exercise into your routine.
- Ensure a balanced diet: A well-balanced diet can help support brain recovery.
- Plan relapse prevention: Relapse can happen; it’s a good idea to identify triggers, develop coping mechanisms and seek ongoing support.
When to seek help with PAWS
If you are particularly concerned about PAWS, then it’s important to seek professional support. Here are some signs that you may need to seek support.
- Your symptoms feel overwhelming or are getting worse
- You experience sleep deprivation
- You experience severe anxiety
- You believe your risk of relapse is increasing
Seeking support for substance use is something to be proud of. While it can feel scary in the beginning, it is the first step to a happier and healthier life, which is free from addiction.
How can we help with recovery?
Acquiesce Rehab Centre in Bolton can support you with addiction recovery from a range of substances. We work closely with clients on recovery and can organise a medical detox, if necessary, at one of our partner centres.
Our rehab treatments involve personalised, holistic care for every individual. We focus on promoting physical, psychological and spiritual recovery, teaching clients the tools and techniques they need to be free from addiction going forward.
We also support clients with a range of aftercare services, including giving clients a phone number to contact their practitioner, an exclusive member’s area, and weekly Zoom sessions focused on aftercare.
Our members’ area is designed to foster social connection and is for individuals who have experienced Acquiesce’s transformative journey. Read our blog on why aftercare is just as important as rehab.
Dealing with prolonged withdrawal syndrome
While PAWS can be challenging to deal with, it’s important to remember that it is temporary and can be managed effectively. Recovery from substances is a long-term journey, not just a simple detox.
If you are worried about substance use or have symptoms of PAWS, we recommend seeking professional support.
Contact our friendly team today to discuss your situation in confidence and find out how we can support your recovery. As a CQC-rated ‘Outstanding’ service, we are committed to delivering safe, effective, and compassionate care for alcohol addiction.
