Post-Acute Withdrawal Syndrome (PAWS)

When a substance addiction first develops, the addict begins to obsessively seek out the substance and may even gradually increase the dose while trying to get the same high that they did when they first used. Increasing the dose for a high is particularly necessary after the addict has developed tolerance (i.e., the body adjusts to functioning with a specific amount). While this is happening, the addict may also become dependent on the substance (i.e., the body needs the drug or it will not behave normally). Someone who is dependent on a substance will find themselves experiencing withdrawal symptoms if they stop administering the drug with the same frequency that they once did. As the addiction takes a stronger hold, addicts who were once chasing a high suddenly find themselves satisfied with simply keeping the onset of withdrawal at bay.

Withdrawal can be so unpleasant that many addicts will use fear of detox as an excuse for not entering a treatment program. Although doctors can treat symptoms of withdrawal during detox, some individuals may continue to experience certain withdrawal symptoms even after completing a rehab program.

Post Acute Withdrawal Syndrome

Post Acute Withdrawal Syndrome (PAWS) occurs when symptoms related to drug- or alcohol-induced impairments persist after withdrawal. Other names for this disorder include post-withdrawal syndrome and protracted withdrawal syndrome.

Could I have PAWS?

PAWS occurs in different degrees of severity and could theoretically happen to any recovering (substance) addict. However, in its most severe form, PAWS is most likely to affect those whose addiction lasted for an extended period. Infants whose mothers struggled with addiction throughout their pregnancy may also experience PAWS after neonatal abstinence syndrome. Rates of PAWS seem to be high among those who were addicted to crystal meth, heroin, and certain prescription drugs like benzodiazepines and opiates.

PAWS Symptoms

Difficulty sleeping, insomnia
Depression
Anxiety
Panic
Suicidal thoughts
Little interest in formerly pleasurable activities
Cravings for the substance
Problems with memory or concentration
Negative, distorted thinking
Lack of motivation
Moodiness
Obsessive-compulsive behaviors
Poor social interactions
Relationship problems
Feelings of guilt
Low tolerance for stress or pain

PAWS Treatment

Symptoms of PAWS may last only a few months, but, in serious cases, the syndrome can persist for many decades. In the latter case, the patient may experience symptom-free periods or at least times when symptom severity is significantly less. Carbamazepine and trazodone are sometimes prescribed to treat PAWS; if the patient is a recovering alcoholic, acamprosate may be employed. In addition to pharmacological treatments, patients with PAWS may appreciate working with a therapist, particularly if the patient has difficulty resisting cravings.

Help for PAWS Sufferers

If you are in the early stages of recovery, ask your doctors about your likelihood for getting PAWS and what signs would signal an appropriate time to return for additional treatment. If you are months or years past withdrawal and continue to experience any of the symptoms listed above, make an appointment with your psychiatrist in the near future. Although the symptoms may be caused by another problem, all are treatable and should not be ignored.