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Managing Post-Acute Withdrawal Syndrome (PAWS)

By Mandy Hazel,
Centerstone Counselor and Case Manager

Most people are aware of the physical symptoms that can occur while detoxing from substance use. But after the initial physical symptoms subside, many other symptoms can persist.

The brain and body are trying to heal from the damage caused through substance use. This can lead to a lot of mixed signals in the body that can last from a couple of weeks to a couple of years. This time of mixed signals is called Post-Acute Withdrawal Syndrome or PAWS.

PAWS simply defined is:

Post: After the original physical detoxification

Acute: Severe or Intense and short

Withdrawal: Process of ceasing to take an addictive drug/substance

Syndrome: A group of symptoms

What are some of these symptoms of PAWS?

  • Inability to think clearly
  • Memory problems
  • Physical coordination problems
  • Sensitivity to stress
  • Sleep disturbances (Insomnia/fatigue)
  • Anhedonia (Inability to experience pleasure)
  • Mood swings
  • Emotional over-reactivity or numbness

Why does understanding PAWS matter?

People who are ready to enter into recovery want to stop using substances and they want to feel better. Many people, however, are not aware that feeling better isn’t going to happen immediately.

After the physical symptoms disappear, people enter what could be considered a “honeymoon” phase or “pink clouding.” This is a time that seems very exciting and hopeful. They are feeling good. They may have even convinced themselves that they don’t have a problem.

But that honeymoon is often short lived, and people quickly hit “The Wall.” The wall is just like it sounds, and people often run right into it. It’s hard and comes seemingly out of nowhere. This may be the beginning of PAWS.

Post-Acute Withdrawal Syndrome can be very scary for the person experiencing it. PAWS can also be scary for the loved ones who have watched the recovering person feeling so much better.

Many loved ones fear that a relapse has already happened because of the behavior changes, even though it’s likely that it has not happened. And the person experiencing PAWS fears relapse is right around the corner if they cannot manage the symptoms. Unfortunately, they may be right.

What can you do if you are experiencing PAWS?

    • See symptoms listed above.
    • Have people you can talk to about what you are experiencing.
    • Have someone who can give you a reality check about what you are experiencing.
    • Seek counseling.
    • Set goals for yourself.
    • Continue your education if you need or want to.
    • Try to eat a healthy balanced diet.
    • Exercise.
    • Make relaxation, meditation and/or journaling a part of your day.
    • Get in touch with your spirituality.
    • Make a schedule to keep you organized and on task.

If you or a loved one is experiencing PAWS, remember that it does not last forever. Continue to focus on the big picture, reminding yourself that your brain will find a new normal and that it will take time and work to manage the symptoms of PAWS.

If you find that you need some extra support during this time, call Centerstone (1- 877-467-3123) or your local substance use treatment facility to get started in outpatient counseling.

Mandy Hazel, BS CADC has been a counselor and case manager at Centerstone’s Fellowship House Campus since July 2014. Mandy works with patients in the outpatient, detox, residential and family programs and has also served as a preventionist.

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