Understanding Post-Acute Withdrawal Syndrome (PAWS)

When you hear "PAWS," you might picture adorable animal feet, but in this context, it stands for something quite different. Post-acute withdrawal syndrome (PAWS) refers to the lingering psychological symptoms that can persist for months after an addictive substance has left your system. Let's explore what PAWS involves and what recovery looks like, based on scientific insights.

What Is PAWS?

First, it's important to distinguish between acute withdrawal and post-acute withdrawal syndrome.

Defining Withdrawal

Long-term use of substances like alcohol alters your brain and body. Addiction hijacks the brain's reward system, which relies on dopamine to encourage behaviors that feel good. While this system evolved to promote survival—like seeking tasty food or companionship—it's vulnerable to instant gratifications such as drugs, gambling, or excessive shopping.

These activities flood the brain with dopamine, and over time, your body adapts to this new normal. When the dopamine supply suddenly stops, withdrawal symptoms emerge, including:

• Nausea and digestive issues
• Increased heart rate and sweating due to an overstimulated autonomic nervous system
• Disrupted sleep patterns
• Mood changes from depleted neurotransmitters
• Heightened anxiety as dopamine drops and dynorphin rises
• Intense cravings for the substance
• In severe alcohol withdrawal, seizures or delirium tremens, which can be life-threatening

How Is PAWS Different?

Acute withdrawal symptoms typically begin within 24 hours of stopping substance use, peak within days, and fade within a week. PAWS, however, can appear later and last for months, even after the substance is completely out of your system. It's not limited to alcohol; research links PAWS to various substances, including:

• Alcohol
• Opioids (e.g., heroin, prescription painkillers)
• Benzodiazepines
• Stimulants (e.g., amphetamines)
• Marijuana
• Nicotine
• Caffeine
• Antidepressants
• Antipsychotics

PAWS Symptoms and Causes

While PAWS isn't as medically dangerous as acute withdrawal, its mix of physical, mental, and emotional symptoms can be deeply distressing. Common symptoms include:

• Mood fluctuations: Rapid shifts between happiness, sadness, and irritability due to neurotransmitter imbalances.
• Anhedonia: Difficulty finding joy in previously enjoyable activities, often worst in the first 30 days of abstinence, linked to dopamine depletion.
• Stress sensitivity: Lower tolerance for stress, leading to overreactions to minor triggers.
• Sleep disturbances and fatigue: Persistent tiredness and irregular sleep, even with adequate rest.
• Difficulty concentrating: Cognitive challenges that improve as the brain recalibrates.
• Anxiety and depression: Increased mental health symptoms as the brain adjusts without chemical support.
• Cravings: Ongoing psychological desire for the substance, which can last for months or years.

What Causes PAWS?

The exact cause isn't fully understood, but it's clear that the brain needs time to recover from the disruption caused by substance misuse. Genetic and environmental factors may also play a role.

Does the Brain Recover?

Yes! PAWS is not permanent. Most people return to their normal state within about a year, with alcohol-related PAWS typically lasting 4-6 months, according to recent studies.

Can PAWS Be Avoided?

To reduce the risk of PAWS, approach initial withdrawal carefully. Detox facilities offer supervised, gradual withdrawal, which is gentler on the brain and body. For alcohol, medical detox often uses benzodiazepines to ease symptoms and taper off safely.

How Is PAWS Treated?

Treatment for PAWS is personalized, as there's no one-size-fits-all protocol. Support and symptom management are key. Helpful strategies include:

• Understand your symptoms: Recognizing that anhedonia and mood swings are temporary can provide comfort and perspective.
• Quitemate the process: View PAWS as part of your healing journey, embracing growth and self-compassion.
• Practice mindfulness: Techniques like deep breathing, meditation, or yoga can rebalance brain chemistry and reduce cravings.
• Nourish your body: Prioritize nutrition, hydration, and sleep. Include brain-healthy foods like salmon and avocados.
• Stay active: Exercise boosts neurotransmitters, releases endorphins, and lowers stress. Find activities you enjoy, whether through online videos or classes.
• Talk to professionals: Therapy, such as cognitive behavioral therapy (CBT), can help address thought patterns and emotional challenges.
• Build a support team: Lean on friends, family, and recovery communities. The Quitemate forums, for example, offer 24/7 peer support.
• Boost dopamine naturally: Engage in social connections and creative activities to stimulate dopamine production.
• Embrace new opportunities: Focus on the positive aspects of life without substances, exploring new interests and relationships.

Life After PAWS

PAWS is a temporary phase. Each day brings you closer to recovery and a more fulfilling life. Stay hopeful and curious about the future—you're on a path to renewed well-being and meaning.