By Terence T. Gorski
Post-Acute Withdrawal Syndrome (also referred to as PAWS) is a cluster of symptoms that occur in recovering addicts and alcoholics. 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.
Acute withdrawal is comprised of mostly physical symptoms. As the body receives the initial shock of going without substances, the addict may experience a range of physical reactions including shakes, vomiting, chills, muscle soreness and cramps, headaches, diarrhea or constipation, extreme skin sensitivity, sensitivity to light, and more. Once this acute period has passed, however, the addict may begin to experience other more complex and long-lasting symptoms of withdrawal.
According to the recovery manual Staying Sober: A Guide for Relapse Prevention by Terence T. Gorski and Merlene Miller, PAWS is a “a bio-psycho-social syndrome. … It results from the combination of damage to the nervous system caused by alcohol or drugs and the psychosocial stress of coping with life without drugs or alcohol.” Mr. Gorski and Ms. Miller group specific symptoms of PAWS into six types: inability to think clearly, memory problems, emotional overreactions or numbness, sleep disturbances, physical coordination problems, and stress sensitivity.
The first PAWS symptom, the inability to think clearly, is also the most prominent symptom. Addicts who have just completed the acute withdrawal period frequently display an incapacity for simple problem-solving and decision-making. This is largely because recovering individuals at this stage often experience an inability to concentrate, difficulty with abstract concepts, and rigid and/or repetitive thinking patterns.
Memory problems can be especially frustrating for individuals who are trying to recover from addiction. They are in the process of learning new skills and behaviors, but may have trouble immediately remembering what they have learned. It’s important to remember that during the post-acute phase, addicts should take things slowly and avoid undue stress and demands. Stress only seems to worsen memory problems.
The sixth type of symptom listed above – sensitivity to stress – should be noted here. Recovering addicts in the post-acute withdrawal phase are usually very easily overwhelmed. Care should be taken not to overload them with too much information at this point.
Recovering individuals in the post-acute phase also experience exaggerated emotional problems. Many individuals who abuse substance have emotional issues before becoming addicts. While abusing substances, their “emotional compasses” become even more disoriented. As they are withdrawing from the emotional insulation that substance abuse inflicts, they may have difficulty processing emotions. They are more likely to either overreact to situations or to completely shut down and feel nothing.
During the post-acute phase, it is important that emotional demands on the recovering individual be kept to a minimum. This is not the correct time to address grievances, relationship problems, transgressions, or even emotionally charged practical matters like debts.
Individuals in the post-acute phase may continue to experience some physical symptoms of withdrawal. The two most common are sleep disturbances and physical coordination problems. Sleep problems may be due to disturbing dreams (especially in early recovery) and well as an inability to fall or stay asleep. Some of these problems resolve over time, but some individuals report lifelong changes in sleep patterns.
Physical coordination issues are much the same. Depending on the substances abused, physical coordination issues may improve over time, but some may be more permanent. Physical coordination issues may include dizziness, impaired hand-eye coordination, and slower reflexes.
The most important thing to understand about PAWS is that each person must work through it in their own time. Nervous system damage typically requires from six to tenty-four months for recovery. Current research indicates that many people experience symptoms at regular intervals, including 30-day, 60-day, 90-day, 120-day, 180-day, and 1- and 2-year sobriety dates. Research has also shown that some drugs take longer to recover from than others. For instance, individuals recovering from long-term opiate and stimulant abuse may experience PAWS symptoms for up to 10 years following the start of abstinence.
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Read Straight Talk About Addiction by Terence T. (Terry) Gorski