PAWS (No! Not that kind!)

Do not pray for an easy life. Pray for the strength to endure a difficult one. – Bruce Lee

Post-Acute Withdrawal Syndrome (PAWS) is generally understood as the second phase of detox when the brain is recalibrating after active addiction. It is a complex syndrome with no one specific cause.

PAWS symptoms are typically more psychological and emotional in nature though there can be physical aspects as well. Some clients have reported experiencing aches and pains, nausea, cramping, headaches, or other physical symptoms.

When I work with clients, we talk often about the “recovery rollercoaster”. Starting with a low point (acute detox), some (but not all) may experience a “high” called the “pink cloud”. The “pink cloud” is where everything seems easy and the thought of returning to use seems absurd or impossible. As life goes on and the brain continues to detox and rewire, clients often experience Post-Acute Withdrawal symptoms (a low). PAWS generally shows up around 3-6 months after acute withdrawal (though it can be much sooner/later for some) and is temporary. However, PAWS is a high-risk factor for returning to use. You cannot avoid PAWS, but you can manage symptoms.

To minimize the risk of returning to use, it's important to understand that many of the unpleasant or uncomfortable symptoms you experience in recovery could be symptoms of PAWS. Here are some of the most common symptoms:

Foggy thinking/trouble remembering

Urges and cravings

Irritability or hostility, rage, overwhelm

Feelings of grief

Sleep disturbances—insomnia or vivid dreams

Fatigue

Issues with fine motor coordination

Stress sensitivity

Anxiety or panic

Depression

Lack of initiative

Impaired ability to focus

Mood swings

Fluctuations in energy

Symptoms may last for a few days at a time before resolving. They may return within days or weeks – everyone’s patterns are a bit different. The brain can take anywhere from 6 months to 2 years (sometimes up to 10yrs in the case of opioids) to recalibrate – so be patient with yourself!

Some tips for managing PAWS:

Let your support team know! Enlist the help of professionals if necessary!

Recall- what helped during the acute withdrawal phase?

Stick to your sleep/wake routines to the best of your ability, limit caffeine and tobacco

Exercise and nutrition

Biochemical Repair

Identify your triggers so you are not surprised the next time you are activated

If you are having a hard time focusing, set a timer for 10-20mins and focus on one task at a time. When the timer ends, move on to the next task or give yourself a break!

Write things down if you are having a hard time remembering things

Throw a wrench in the circular/ruminating thoughts! Call a friend, practice STOP THOUGHT, listen to music, go for a run!

Manage your expectations! This is temporary – it will NOT be like this forever. Please be patient and kind when it comes to your self-talk. Your brain is healing!

MINIMIZE & AVOID:

Stressful and/or frustrating situations

Multitasking

Feelings of anxiety, fearfulness, or anger

Social conflicts

Unrealistic expectations of oneself

Ultimately, we cannot control who experiences PAWS nor can we “cure” it. We can manage symptoms and remain patient – knowing it will pass. Most individuals start to feel better and experience an elevation in mood and cognitions around 6-12 months.

If you think you may be experiencing PAWS, please know that you are NOT alone. Tell someone! Ask for help. Seek support.

Please continue to let me know how I can support you on your healing journey! M