What is post-acute withdrawal syndrome? If you don’t know the answer to this question, you’re far from alone. Though many people endure PAWS when trying to end their use of alcohol and certain other substances, awareness of this condition is relatively low. We’d like to change that.
If you or a loved one are struggling with addiction, don’t hesitate to reach out to Live Oak Wellness today.
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What Is Post-Acute Withdrawal Syndrome?
Post-acute withdrawal syndrome (PAWS), involves a series of symptoms that persist for much longer than it usually takes to complete the withdrawal process.
This syndrome, which is sometimes also referred to as protracted withdrawal, is most likely to affect people who are working to recover from addictions to alcohol, opioids, and benzodiazepines.
When a person with an addiction to one of these drugs abruptly stops using the substance, their body will often respond with a variety of unpleasant physical and psychological withdrawal symptoms.
The length of time it takes for a person to complete withdrawal can depend on several factors, including:
- Which drug they had become dependent on
- How long they had been abusing this drug
- The frequency and amount of their substance use
- If they have any co-occurring medical or mental health concerns
- If they try to complete withdrawal on their own or enter a detox program
Even taking these and other potential influences into account, it’s safe to say that withdrawal usually takes five to 14 days. Some people may finish more quickly, and others could take a few more days, but in general most can expect to be done with the process within two weeks.
Unless, of course, they develop PAWS, in which case the acute phase of their withdrawal may be just the beginning of a long struggle.
Common PAWS Symptoms
The information in the previous section is a partial answer to the question, what is post-acute withdrawal syndrome? To fully explain PAWS, we need to discuss the types of symptoms people experience, as well as how long these symptoms might last.
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) contains entries for withdrawal from alcohol and several other substances, but it doesn’t include criteria for PAWS.
This doesn’t mean that post-acute withdrawal symptom doesn’t exist. As many professionals and patients can attest, PAWS is real. But the lack of a PAWS entry in the DSM-5 means that clinicians in the U.S. don’t have a standardized list of symptoms to guide them when diagnosing a person with this condition.
Further complicating the matter is that relatively little research has been conducted on post-acute withdrawal syndrome, an unfortunate reality that has been acknowledged by the authors of more than one PAWS-related study.
Yet even with these limitations, experts have been able to establish some general parameters for what a person can expect if they develop post-acute withdrawal syndrome.
For example, someone who is going through PAWS may experience psychological symptoms such as:
- Drug cravings
- Anxiety
- Panic attacks
- Depression
- Irritability
- Vivid nightmares
- Difficulty concentrating and focusing
- Memory problems
- General “brain fog”
- Low motivation
- Anhedonia (difficulty experiencing joy or pleasure)
PAWS can also involve various forms of physical distress, including:
- Persistent fatigue
- Disrupted sleep
- Diminished sex drive
- Impaired coordination
- Greater sensitivity to pain
A person doesn’t have to develop every one of the symptoms listed above to be diagnosed with PAWS. Also, the severity and duration of PAWS symptoms can vary considerably from one person to the next.
How Long Does Post-Acute Withdrawal Symptom Last?
Post-acute withdrawal syndrome doesn’t follow an easily identifiable timeline. The general consensus is that its symptoms are likely to persist for months or even years.
Here are examples of how two reputable organizations have described the duration of PAWS:
- A 2020 publication on alcohol withdrawal management from the American Society of Addiction Medicine (ASAM) refers to protracted withdrawal as involving “subacute symptoms of irritability, anxiety, and sleep disturbances [that] can persist for weeks.”
- In a guide for military veterans who have struggled with alcoholism, the U.S. Department of Veterans Affairs advises that PAWS symptoms can last for “weeks to years” after a person stops drinking.
It’s important to differentiate between lingering withdrawal symptoms and PAWS. As we noted earlier in this post, the acute phase of withdrawal (when symptoms are at their most intense) usually lasts five to 14 days.
If you’re in a detox program, once the most severe symptoms have subsided, you will probably be discharged so you can transfer into the next phase of your treatment. But reaching the end of detox or acute withdrawal doesn’t mean that you’ll be back at full physical and psychological strength.
Just like when you’re recovering from a cold or the flu, it’s not uncommon to have some residual discomfort after completing withdrawal. So if you’re still feeling sluggish or having cravings 20 days after you ended your substance use, that doesn’t necessarily mean you have PAWS.
However, if you continue to struggle with multiple symptoms, and if those symptoms are severe enough to impair your ability to function, post-acute withdrawal syndrome could be to blame.
Treatment for Post-Acute Withdrawal Syndrome
Treatment for post-acute withdrawal syndrome can involve medication, therapy, education, and peer support. These services can’t cure PAWS, but they may be able to alleviate some aspects of the condition and help people manage their symptoms more effectively.
The list of medications that may be incorporated into PAWS treatment includes antidepressants, anticonvulsants, acamprosate, and gabapentin.
Examples of therapies that may be beneficial include cognitive-behavioral therapy (CBT) and dialectical behavior therapy (DBT):
- CBT helps patients identify maladaptive thought patterns that may be contributing to their distress. Over multiple sessions, patients can learn to develop healthier ways of viewing their challenges and other difficult experiences. This can help them respond to PAWS in a healthy and productive manner.
- DBT focuses on skills development in four areas: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. The first three of these skills can be particularly relevant for someone who has PAWS.
As with addiction treatment itself, there’s no one-size-fits-all approach to caring for someone who has PAWS. What’s most important is working with a provider that will take the time to understand your unique needs and goals, and then develop an individualized plan just for you.
Find Help for Post-Acute Withdrawal Syndrome Today
Live Oaks Wellness offers a full continuum of personalized services for adults in the San Francisco area who have been struggling with addictions to alcohol and other substances. Treatment options at our addiction rehab center in Marin County include detox, residential care, and outpatient programming. Our team can meet you wherever you are in your recovery journey, and provide the focused care that will help you achieve your short- and long-term goals.
To learn more or to schedule a free assessment, please visit our Admissions page or call us today.
