Post Acute Withdrawal Syndrome

Post-acute withdrawal syndrome (PAWS) is a set of continuous symptoms and distresses that occur after withdrawal from substances like alcohol, psychoactive drugs, and others. For instance, if you, or someone you know, are dependent on or addicted to alcohol and drugs, you will experience a wide range of impairments, including physical and psychological distress, when you stop taking the substances. In some cases, these conditions occur only during the early stages of discontinuation. In other cases, the condition continues for much longer. Pregnant women who are dependent on substances are likely to give birth to an infant who will also experience post-acute withdrawal syndrome.

Drug and substance abuse, including to alcohol and prescription drugs, such as antidepressants, opiates and benzodiazepines, can bring about symptoms which closely resemble mental illness. If you abuse substances, you are likely to experience these symptoms, either in an intoxicated state or when you are trying to stop. In some cases, these symptoms can continue long after detoxification. You can also experience withdrawal symptoms long after you have stopped using. Some of the drugs most notable for causing prolonged withdrawal effects are benzodiazepines. Even when you consume moderately, it can increase the level of depression and anxiety you feel, especially when used alongside benzodiazepines. These are two of the most common depression symptoms associated with drug and alcohol abstinence.

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The Signs and Symptoms of Post-Acute Withdrawal Syndrome

Unlike acute withdrawal, you can experience symptoms of post-acute withdrawal syndrome within two months, or more, of quitting. These symptoms are principally psychological in nature and may affect your mood, sleeping pattern, and response to stress. Although PAWS generally lasts for a few months, there are wide amplitudes in the timeline: sometimes it can last for a year, sometimes for a couple of weeks. This problem has long been studied by researchers and, depending on the

substance involved, it is characterised by physical and psychological symptoms. Knowing them can help you recognise a problem in your loved ones.

  • Psychosocial dysfunction
  • Depression and anxiety
  • Obsessive-compulsive disorder
  • Guilt
  • Cognitive failure such as loss of memory and the inability to think clearly
  • Emotional disconnect
  • Insomnia or sleep disorder
  • Panic
  • Increased sensitivity to pain
  • Psychosocial disorder

These conditions are made worse by external stress and may occur at any time and with little to no warning.

When you stop taking benzodiazepines, you may experience symptoms that are similar to anxiety disorder or panic attacks. Problems with cognitive function can continue for several months, or even years, after withdrawal from benzodiazepines. Because this drug has a longer and more severe withdrawal period, it is advisable to discontinue gradually and only under medical supervision.

Substances Associated with PAWS

There are substances commonly associated with post-acute withdrawal syndrome following abstinence. However, because there are few studies done on the subject, the list of substances below is not conclusive. You may be experiencing symptoms of PAWS without knowing because the drug you stopped taking is not listed here. This is why it is important that you get professional help when quitting.

Some of the substances associated with PAWS are:

  • Alcohol
  • Benzodiazepines
  • Antidepressants
  • Opioids
  • Psychostimulants
  • Marijuana
  • Cocaine
  • Methamphetamines

The exact length of time it will take for withdrawal depends on the particular substance, or combination of substances taken, how long it was used for, the manner in which it was consumed, and a combination of other physical and medical factors, including physiological and psychological makeup. Using multiple substances at once is also known as polydrug use – it can worsen the PAWS symptoms.

What Causes PAWS?

The exact cause of post-acute withdrawal syndrome is not known, but scientists believe that it is caused by the physical and chemical changes that happen in the brain when addiction is present, particularly the changes that occur as a result of the brain’s tolerance to the drug.

Specific substances can cause physical brain changes which can increase with the level of intake. When you consistently abstain from drugs, your brain attempts to adjust to its new condition, and this may bring about the symptoms of PAWS.

Other external factors such as stress, social and environmental conditions, as well as genetics, play a role in the severity and length of the symptoms during withdrawal.

More than 90% of opioid addicts experience some degree of PAWS, and this same syndrome occurs in about 75% of alcoholics who stop drinking. PAWS may also occur after withdrawal from a variety of other addictive substances.

The Challenges of Post-acute Withdrawal Syndrome

If you are suffering from post-acute withdrawal syndrome, relapse is a significant concern.

When you are addicted to drugs and other substances, your brain rewires itself to adapt to the changes in lifestyle. When you stop taking these substances and seek treatment, you are likely to suffer from some form of chemical imbalance. This situation will make it difficult for you to feel comfortable, think clearly, sleep well, or manage stress properly. All these problems, coupled with the anxiety of life after recovery, can create the perfect opportunity for a relapse. But it is not a final verdict, because there are treatments and therapies which will teach you how to cope.

Additionally, post-acute withdrawal syndrome is not universally recognised in the medical community. This means there is very little research done on it. This limited research makes it impossible for patients to receive adequate help for the symptoms that accompany abstinence. However, despite this shortcoming, there are several centres in the UK where you can get the professional help you need to manage post-acute withdrawal syndrome.

Treating Post-acute Withdrawal Syndrome

There is no one single method for treating post-acute withdrawal syndrome. However, since this condition is both psychological and physical, you will need professional help from a qualified therapist, a recovery group, and with the support of friends and family members.

Starting the long journey to recovery after getting clean, and staying sober, requires a lot of help and guidance. However, there are a lot of things you can do to make the process easier and to reduce the effects of the symptoms. For instance, focusing on your progress, and avoiding negative thoughts, can give you the strength to get to where you need to go. Additionally, getting involved, and staying active, with friends can help you reduce the depression and anxiety that accompanies the symptoms of PAWS. When you maintain relationships with people who are supportive of your recovery and take part in activities that you enjoy, you will be able to greatly minimise the psychological effects of withdrawal.

It is important to remember that detoxification and treatment are not a magic fix for addiction. After quitting, your brain needs time to heal, and also has to relearn how to function in the absence of drugs or alcohol, and this can take some time.

With patience and the right kind of help, you will be able to effectively manage post-acute withdrawal syndrome, and move successfully into recovery.

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