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  • Kim WD, Psych NP

I Stopped Drinking – Why Do I Still Feel So "Not Right"?

Post-Acute Withdrawal Syndrome (PAWS)

Withdrawal from alcohol or other drugs can involve everything from moderate physical discomfort to life-threatening health conditions. Less well known, but also very common, are the lingering, more lasting effects of withdrawal – also known as Post-Acute Withdrawal Syndrome (PAWS). PAWS can make it hard to live a healthy lifestyle and may seriously challenge sobriety. PAWS symptoms are a result of brain dysfunction while the brain readjusts to being without alcohol and drugs, and your brain chemistry gradually returns to normal.

Who does PAWS affect?

PAWS affects people who have experienced long-term drug or alcohol use. The extent of PAWS symptoms may differ depending on age, gender, length of substance use, and overall state of health. The longer and heavier the drug and alcohol use the more severe and longer lasting the PAWS symptoms.

Acute alcohol detox and withdrawal can last from a few days to a week. PAWS is the stage after acute withdrawal, and symptoms can last from weeks to months. The full post-withdrawal period lasts for about two years. PAWS episodes and symptom flares become farther and farther apart as time goes on, and can feel exhausting. But PAWS symptoms are not a sign of weakness or failure – PAWS is a sign that your brain is recovering.

PAWS Symptoms

PAWS can feel like being on a rollercoaster of symptoms. Recognizing the symptoms of PAWS is the first step to managing them. Successful management of your alcohol or drug withdrawal symptoms will help you feel better physically and emotionally, improve your self-esteem, and reduce your risk of relapse. PAWS symptoms commonly include –

  • Inability to think clearly, make decisions, problem solve

  • Memory problems, inability to learn new things

  • Emotional outbursts, overreactions, or numbness

  • Sleep disturbances, strange dreams, vivid dreams about using

  • Low energy, lack of motivation

  • Physical coordination problems, balance, and reflexes

  • Stress sensitivity

PAWS Strategies

Know the symptoms and have a plan to deal with them. Talk about the symptoms you are experiencing with your support system – program peers, counselor, therapist, health care providers, religious groups, and family.

Find people to talk to who will not criticize or minimize your experiences, and who support your desire to stay clean and sober. It is especially important to –

  • Stay in touch with your support system.

  • Do a reality check. Ask a trusted friend if you are making sense, if you are “on target.”

  • Identify emotional states that trigger your desire to use: anger, boredom, sadness, loneliness. Get more support when they arise.

  • Eat throughout the day. Concentrate on healthy eating, and stay away from highly processed junk foods (salt and sugar can trigger emotional swings).

  • Journal. Start a journal to document your experiences and identify alternative ways of responding next time.

Difficulty thinking clearly

Symptoms

  • Concentration problems

  • Abstract thinking problems

  • Circular thinking

Strategies

  • Limit the amount of time you spend on any one task to no more than 15 minutes.

  • Increase the time only when you are consistently successful.

  • Give yourself permission to be a concrete thinker for this period.

  • Interrupt the circular thinking cycle by doing something very different (talk to a friend, listen to music, work out).

  • Treat yourself with patience and understanding.

Memory problems

Symptoms

  • Short-term memory lapses

Strategies

  • Give yourself permission to not be able to remember things for even 15 minutes.

  • Tell friends about your memory problems, and let them know this may be a PAWS symptom.

Emotional overreaction or numbness

Symptoms

  • Reaction disproportionate to event

  • Emotional numbness if emotionally overloaded

  • Unpredictable mood swings

Strategies

  • Recognize that frequent mood swings are a symptom of PAWS.

  • Discuss your possible overreaction with people with whom you live and work, explaining that overreaction or numbness may be a symptom of PAWS.

  • Ask friends to talk with you about your reaction when it seems to be excessive.

  • Give your friends permission to talk with you about your mood swings and help with reality checks.

Sleep disturbances

Symptoms

  • Nightmares, night terrors

  • Difficulty falling asleep, staying asleep, changes in sleep patterns

  • Vivid dreams about using

Strategies

  • Try to establish a healthy sleep routine.

  • Acknowledge sleep problems as a symptom of PAWS.

  • Trust that "this too shall pass."

  • Use low-impact, non-sedating sleep aids (melatonin, lavender, antihistamines)

Physical coordination and low energy problems

Symptoms

  • Dizziness

  • Balance problems

  • Sluggish reflexes

  • Impaired eye-hand coordination

Strategies

  • Identify when these symptoms occur and what triggered them.

  • Avoid high risk situations when you are experiencing these symptoms (such as operating a motor vehicle).

  • Tell your family and co-workers about your PAWS symptoms so that they don't think you have relapsed.

  • Exercise can help reduce stress and increase your energy.

  • Add in to your daily routine times to meditate, relax, and rest.

Stress sensitivity

Symptoms

  • Difficulty managing stress

  • Overreacting to stress

  • Reacting inappropriately to stress

Strategies

  • PAWS symptoms can increase during times of high stress, which may make managing stress more difficult.

  • Get to know your stress triggers and your stress threshold.

  • Let trusted friends, family members, counselors, and others know about your stress triggers.

  • Be prepared to experience an increase in other PAWS symptoms if you are under high stress.

  • Do all you can to minimize your stress triggers, but be accepting – stress is part of life.

But most of all, understand that you don't have to go through this alone. Reach out, there's help available if you ask.


References

Addictions and Recovery Organization. (2010). Post-Acute Withdrawal (PAWS). Retrieved from http://www.addictionsandrecovery.org.

Carty, B. (2016, September 26). Post-Acute Withdrawal Syndrome (PAWS). Hazelden Betty Ford Foundation. Retrieved from http://www.hazeldenbettyford.org/articles/carty/post-acutewithdrawal-syndrome

Heilig, M., Egli, M., Crabbe, J., Becker,H. (2010). Acute withdrawal, protracted abstinence and negative effect in alcohol. Addictive Biology. Apr;15(2):169-84.

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