Post Acute Withdrawal Syndrome

Post Acute Withdrawal Syndrome – Also known as P.A.W.S.

Post Acute Withdrawal Syndrome is widely considered to be the most significant contributing factor in the relapse of thousands of recovering drug addicts and alcoholics each year.

Post Acute Withdrawal Syndrome is widely considered to be the most significant contributing factor in the relapse of thousands of recovering drug addicts and alcoholics each year. In this lens, learn exactly what this condition is and how to properly recognize and treat it. Doing so could mean the difference between a lifelong recovery and a disastrous relapse. We’ll discuss how addiction forms, how PAWS forms, and what specific symptoms to watch out for.

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What is Post Acute Withdrawal?

Post Acute Withdrawal Syndrome or PAWS is a set of symptoms that begin to set in immediately after an addict or alcoholic has detoxed from drugs or alcohol. Depending on the person and the severity and duration of their drug or alcohol use, PAWS symptoms may be light and short-lived in some cases, and debilitating and long-lasting in other cases.

But in order to understand what PAWS is, why it occurs and how to successfully manage it, you must first gain an understanding of the neurological nature of addiction.

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How Addictions Form

It’s a neurological process

Addiction is most likely a primordial survival response that we have yet to fully understand. However, what we do know is that early humans were programmed to be rewarded for certain behaviors. For instance, eating and sex – both necessary for survival – were both associated with feelings of pleasure. In order to propagate the species and ensure its survival, the early human brain is theorized to have created contextual associations between the environments and circumstances surrounding the pleasurable experience.

By doing so, the brain actually built neurological pathways that would send signals to the central nervous system when those contextual associations were present. What does this mean in simple terms? The brain reinforced survival behavior like eating, sleeping and sex by releasing hormones like dopamine that cause a euphoric, “feel good” sensation.

So in the case where an early human, say, fished by a certain river, had good luck fishing there and ate there often, the brain would create these associations whereby when similar environments and stimuli were introduced, the brain would actually send signals to cause a sense of “craving,” thereby compelling the human to repeat the feel-good survival behavior.

Over time, these associative and dopamine-releasing processes build permanent neurological pathways to service them.

Fast forward thousands of years, and the same situation applies to humans that use drugs. Because the drugs cause a sudden rush of dopamine, the brain considers them to be a “feel good” substance and creates neurological reward pathways to facilitate the propagation of the behavior.

Because the introduction of drugs changes the body’s chemical structure, the central nervous system must make changes to combat and adapt to this, despite the fact that the brain is in essence calling for more drugs constantly. As the body attempts to mitigate the effects of the drugs, tolerance sets in, followed by dependence, and finally followed by outright addiction, where the person cannot function normally from a physical or emotional standpoint without the drugs being in their system.

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How Post Acute Withdrawal Syndrome Works

Understanding PAWS post-detox

In order to break free from the chemical and psychological bonds formed during active addiction, a person must undergo detox. During this 5 day to 2 week period, the body will experience a wide range of symptoms as the drugs leave the system and the central nervous system returns to a normal state. During this time, a recovering addict may experience uncomfortable symptoms as brain receptors and neurological process numbed by drug use suddenly become hyperactive. However, most people are fully recovered from detox within 10 days. After this time, PAWS sets in.

The reason that PAWS continues to be a problem for an unpredictable amount of time after detox is because those neurological processes mentioned earlier in this lense – the processes that service the addictive behavior – are permanent. The contextual associations made during the active addiction phase will continue to operate long after some addicts have cleaned up. This is why staying away from people, places and things associated with former drug use is so critical – especially to those people who are newly clean.

However, there is also an unknown factor of PAWS that can’t be accurately described. This is evidenced by the fact that so many people in recovery experience such wildly different symptoms. These symptoms may be transient, constant, severe or light – it all depends on the person in question.

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The Symptoms of Post Acute Withdrawal Syndrome

Recognizing these can mean the difference between continued recovery and a dangerous relapse
While the symptoms of PAWS are different for each person, they generally consist or varying degrees of the following 6 trouble areas:

  • Thought Processes
  • Memory
  • Emotional Instability
  • Fine and Gross Motor Skills
  • Sleep Issues
  • Stress Coping

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These key areas can be affected individually or simultaneously and will often manifest in some or many of the following specific symptoms:

  • Inability to concentrate
  • Inability to solve simple problems
  • Disorganized thought patterns
  • Difficulty sleeping or staying asleep
  • Sexual dysfunction
  • Mood swings
  • Depression
  • Anxiety
  • Drug or alcohol cravings
  • Self imposed isolation
  • Exhaustion
  • Poor physical coordination (dry drunk)
  • Memory troubles
  • Lack of emotional response or inability to feel emotions
  • Thoughts of suicide

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