The first step in any effective addiction treatment plan is medical detoxification, in which someone is closely monitored by medical professionals as they purge their body of the substances they have become dependent on.
This process involves both physical and mental withdrawal symptoms, which are typically very uncomfortable and potentially dangerous. Though the length and intensity of these symptoms will vary depending on factors such as the substance they were abusing and the severity of the dependency, the symptoms will lessen and eventually end in the span of roughly two to three weeks.
However, this is not always the case. After someone has undergone detox and the acute withdrawal phase has ended, they may enter a second phase that can last for months or even years known as Post-acute-withdrawal syndrome, or PAWS. PAWS serves as an umbrella term for a range of long-term withdrawal symptoms, mainly psychological or mood-related, that persist long after someone has stopped using drugs or alcohol.
Because the mostly mental symptoms of PAWS are harder to measure than physical ones and are largely based on self-reporting by those experiencing them, there is some controversy as to the validity of the disorder. While there has been documented research on persistent and protracted withdrawal from substances such as alcohol and benzodiazepines, PAWS is not currently recognized by the Diagnostic and Statistical Manual of Mental Disorders.
What Are the Signs of Post-Acute-Withdrawal Syndrome?
So how can you know if you are experiencing Post-acute-withdrawal syndrome? While each experience will vary, which is part of what makes PAWS so difficult to pin down and validate, there is a list of symptoms that are most commonly reported across the spectrum of protracted substance withdrawal. If you have stopped using drugs or alcohol for more than several weeks and are experiencing some of these symptoms, you may be suffering from PAWS.
#1 – Unstable and Unpredictable Moods
One of the most frequently noted symptoms of PAWS, and part of why this syndrome is often mistaken for depression, are major and uncontrollable swings in mood. This can happen intermittently in episodes that can last anywhere from a few days to a few weeks before disappearing again. Sometimes, those suffering from PAWS who are experiencing these mood swings can appear to be exhibiting an undiagnosed bipolar disorder.
#2 – Symptoms of Depression
The most affecting of these changes in mood are depressive symptoms, in which individuals experience an extreme and overt melancholy that can feel like an anchor tied around their necks. These symptoms can last only minutes or linger for days, with no apparent trigger behind them. This can be an understandable source of frustration and even cause a relapse.
#3 – Experiencing Anxiety or Panic Attacks
While depression is at one end of the mood-swing scale, anxiety and panic attacks are at the other. While these anxious feelings can be triggered by cravings and a reduced ability to handle stressors, similar to depressive symptoms, there is no outside motivator required to cause anxiety or even something as severe as a panic attack.
#4 – Anhedonia
Anhedonia is a term used to describe a condition in which someone has lost, either partially or entirely, the ability to experience a pleasure. Anhedonia goes much further than just a loss of interest in activities and pursuits someone previously enjoyed and is often described by those experiencing it as the feeling that their ability to enjoy almost anything has been switched off. A typical symptom of withdrawal, those with PAWS are likely to suffer longer and more extreme bouts of Anhedonia, losing interest in not only hobbies or socializing, but also in relationships, sexual activity, and even basic desires like eating.
#5 – Strong Drug Cravings
Even if it is not the most common, perhaps the most expected symptom of PAWS is cravings for the substance that the individual was previously dependent on. While these cravings will eventually fade in strength, they can still sometimes persist for long periods of time after someone has achieved sobriety. Cravings can be extremely problematic, either serving as a trigger for other symptoms of Post-acute-withdrawal syndrome or putting an individual at risk of a relapse.
#6 – Poor Coordination and Clumsiness
Individuals experiencing Post-acute-withdrawal syndrome will often exhibit a general loss of physical coordination, including dizziness, slowed reflexes, poor balance, and issues with hand-eye coordination. Because of this, they will often be seen tripping or bumping into things, dropping things, or spilling food or drinks. Apart from simply being the manifestation of another PAWS symptom, a secondary reason behind this lack of coordination is distraction caused by comorbid feelings of depression and disinterest.
#7 – Difficulty Falling Asleep
Similar to becoming clumsier due to being distracted by feelings of depression, those suffering from PAWS will also usually have a great deal of difficulty getting to sleep at night. This can be due to feelings of anxiety and restlessness, as well as a lack of stimuli to keep them from focusing on the negative psychological symptoms that are characteristic of Post-acute-withdrawal syndrome.
#8 – Sleep Disturbances
Unfortunately, even once someone experiencing PAWS manages to fall asleep, they’re unlikely to stay that way. Individuals will often have their sleep interrupted, either from withdrawal cravings, unusually vivid and unpleasant dreams, or altered sleeping patterns causing them to wake up for no particular reason. Because of these disturbances, people with PAWS will often oscillate between going as long as several days without sleeping to sleeping for days at a time once their exhaustion has caught up with them.
#9 – Inability to Concentrate or Think Clearly
Similar to the loss of coordination, those with PAWS can have difficulty focusing or thinking clearly due to the distraction from cravings or feelings of intense depression. The lack of sleep can also cause them to struggle with concentration, creating a vicious cycle, as their minds’ inability to focus on something other than the negative feelings manifested by PAWS is part of what makes sleep seem so impossible. It becomes quite difficult to concentrate for anyone experiencing Post-acute-withdrawal syndrome.
#10 – Thoughts of Suicide or Suicide Attempts
If the depressive symptoms of the post-acute-withdrawal syndrome have become frequent and severe enough, they can progress to a stage where the individual can begin to have suicidal thoughts or ideations, and may even make an attempt to commit suicide. If this is the case, professional help should be immediately sought to ensure the individual’s safety and help to treat them. Thoughts of or attempts at suicide should always be taken seriously.
#11 – Increased Sensitivity to Stress
As part of a post-acute-withdrawal syndrome, individuals often become extremely vulnerable to stress and situations that might provoke feelings of stress. Like a raw nerve or an exposed wound, even the smallest contact with a stressful situation can be enough to overwhelm them and cause an outburst. These symptoms are only magnified by the presence of mood swings and an increased vulnerability to panic attacks.
#12 – Increased Sensitivity to Pain
In addition to becoming more sensitive to stress and anxiety, individuals experiencing post-acute withdrawal syndrome will also frequently exhibit increased sensitivity to physical pain. While it decreases a person’s capacity to feel joy, PAWS can conversely heighten their capacity for pain, making even the most negligible injuries feel excruciatingly painful.
#13 – Intensified Emotions
While the symptoms of depression and Anhedonia can make those suffering from PAWS feel numb or empty inside, the other extreme is also possible: namely, an intense overflow of emotional feelings. Individuals with Post-acute-withdrawal syndrome will often exhibit the most