What is Post Acute Withdrawal Syndrome?

Post Acute Withdrawal Syndrome is a debilitating condition that affects drug addicts and alcoholics in recovery. In fact, the symptoms of PAWS are widely considered to be the leading cause of relapse - especially in people who have been clean for several months or more. Understanding this condition is a critical part of mitigating the dangerous public health concern that is drug addiction and alcoholism.

Post acute withdrawal isn't a topic of particular interest in the addiction sciences at the moment; however, the condition has already developed a number of different names. These include the common acronym of PAWS, as well as Protracted Withdrawal, Post Withdrawal, Post-Acute Withdrawal and others.

What is PAWS?

PAWS symptoms generally set in after an addict or alcoholic has ceased using and gone through the physiological process of withdrawal and AWS or Acute Withdrawal Syndrome. AWS lasts anywhere from several days after the last use of drugs or alcohol, and can continue for up to 3 weeks in some rare cases. In general acute withdrawal symptoms subside after 7-10 days, after which time post acute withdrawal sets in.

Theory

Humans have an evolutionary trait that at one time ensured our survival, while today often backfires in the form of various addictions. This trait consists of a reward system whereby the brain releases "feel good" chemicals when a person does something that can ensure their survival; eating, sex, finding warm shelter, etc. As these chemicals are released the brain creates contextual reference points that serve to reinforce the "survival" behavior via a literal compulsion in the person to seek out those contextual associations.

Unfortunately, using drugs and/or alcohol mimics this process, leading to addiction when the user is compelled to recreate those events or feelings again and again. These behavioral processes are neurological in nature and are permanent. This means that even after a person has stopped using, neurological pathways in the brain continue to exist that constantly seek to recreate the "good feelings."

Post acute withdrawal essentially refers to the symptoms and behavioral changes and compulsions related to these neurological pathways. In lay terms, the user is still going through withdrawal, but the symptoms are no longer considered to be "acute."

Symptoms

Protracted Withdrawal symptoms are different for everyone. They can include: headaches, nausea, exhaustion, restlessness, night sweats, difficulty formulating and expressing thoughts, feelings of inadequacy and isolation, depression, mania, anger and rage, insomnia, suicidal thoughts, poor physical coordination (sometimes referred to as Dry Drunk), inability to solve simple problems, short and long term memory loss, and many other types of symptoms.

Some people may only experience one or two of these symptoms, while others may experience many of them. This is partly dependent on attitude, physical fitness, mental acuity and a number of other factors.

Duration

Some people in recovery indicate that they've never had any signs of PAWS, while others state that they've had symptoms for years at a time. In general, the more severe a person's drug use, the longer the duration of active drug addiction and the higher the frequency of relapse, the more likely it is that symptoms of post withdrawal will continue for months or even years, and the more likely it is that those symptoms will remain consistent.

However, some people who only used drugs for short periods of time or those whose substance abuse problems were not considered severe may still experience pronounced and lengthy periods of protracted withdrawal symptoms. Conversely, some people who used heavily experience only light issues related to PAWS.
Overall, post acute withdrawal syndrome is a highly individual condition, but the primary unifying symptom is always the same: an acute, powerful and compelling urge to use drugs or drink alcohol again. This is because in essence those neurological pathways mentioned earlier are doing their job by causing the recovering addict to be compelled to reactivate, feed and thereby keep those pathways "alive."

Barriers to Public Acceptance

Many Americans are resistant to the concept of addiction as a disease, although most of the healthcare industry treats it as such on the surface. This type of attitude extends to PAWS in the sense that if addiction isn't a true disease, then a secondary condition as a result of addiction probably doesn't warrant that much attention. It is precisely this type of thinking that has led to the relative obscurity of PAWS despite its obvious effect on people in recovery.

Treatment

Treatment for post-acute withdrawal has two primary objectives: to prevent symptoms before they occur, and to treat them individually when they do. For emotional symptoms of the condition this can include treatments like biofeedback therapy, individual counseling, group or family counseling and in some cases medication. For physical symptoms over the counter medications are a typical response, however, few people understand the critical role of diet and exercise in PAWS symptom management.

If post acute withdrawal syndrome has caused a person to relapse in an effort to seek relief from their symptoms, then treatment will need to focus on cessation and detox, followed by a longer term plan for recovery, depending on the severity and duration of the relapse event.

As more people accept the disease model of addiction, it's likely that there will be a corresponding change in the way we as a society address post acute withdrawal and relapse. The most effective way is through education such as this article, and through the funding of much needed clinical research projects.