Post acute withdrawal syndrome is a group of symptoms that arise as a drug addict or alcoholic attempts abstinence from their chosen mood altering chemicals. These withdrawal symptoms which can include sleeplessness, unclear thinking and stress, generally appear 7 to 14 days into abstinence during the stabilization phase. This impairment is recognized as PAWS or Post Acute Withdrawal Syndrome and can last 6 to 18 months after the addicts’ last use.

While in active addiction, the addict/alcoholic experiences a disruption to normal brain activity which impairs clear thinking and how emotions are expressed. Additionally, short-term memory loss, lack of coordination, sleep disturbances and stress, are all part of PAWS. They can make the recovery process a long and difficult process. As a result of continued abuse of drugs and/or alcohol, the brain needs to make an adjustment in order to ‘right itself’. It takes time as some neurotransmitters return to normalcy, and we acclimate to a life without mood altering chemicals.

Essentially there are 3 major ways that Post Acute Withdrawal Syndrome can impact a recovering person.

They are:

1. Cognitively - racing or recycling thoughts coupled with impaired concentration and attention span.
2. Emotionally – either an absenceof or an excess of emotions, with a tendency towards over or hyper reaction.
3. Memory – short-term (30 minutes) memory loss is often the most noted problem.

These issues usually affect a person early in recovery. Therefore, it is imperative that family, friends and colleagues recognize the presence of these symptoms. Another factor that greatly affects the addict is stress. As a result, the recovering individual needs to understand that the lowering of stress is vital. Specific lifestyle changes need to occur. Healthy habits such as limiting caffeine, getting 8-10 hours of sleep, eating three balanced meals per day and exercising 3 or more times weekly will reap great benefits.

Additionally, meditation and/or other relaxation exercises are often recommended by healthcare professionals and implemented by Drug and Alcohol Treatment Centers as part of their scheduled programs.

Lastly, involvement in Alcoholics Anonymous, which means regular meeting attendance and an ongoing relationship with an AA Sponsor, is critical for several proven reasons:

1. The building of a sober support system outside the circle of family and friends
2. The introduction of the 12 Steps of Recovery as set down in the AA ‘Big Book’.
3. A relationship with AA Sponsor is one of the cornerstones of AA and a key component of the recovery process
4. Like minded people with similar experiences are uniquely qualified for support
5. Active AA participation will reduce the severity of PAWS.
The implementation of the above should go a long way towards restoring the recovering alcoholic/addict to good health.

There is also another school of thought and treatment for opiate dependent PAWS sufferers which was somewhat controversial at one time but has gained general acceptance in the recovering community.

Because Post Acute Withdrawal Syndrome can last for years, if not a lifetime, the best treatment for opiate dependents can often be a maintenance program issuing drugs such as methadone or buprenorphine. This course of action is meant to restore the brain’s chemistry to a more natural state thereby alleviating the common PAWS symptoms of craving, irregular sleep patterns, lethargia and mood swings and post acute withdrawal syndrome.

Opiate detox and withdrawal happens when you suddenly stop, or dramatically reduce, the amount of opiates after heavy and extended use (usually a month or more). When the drugs are stopped, your body needs time to recoup, and withdrawal symptoms occur. Withdrawal from opiates can occur whenever any serious use is discontinued or reduced.

Opiates are a class of drugs that include include heroin, codeine, morphine, Oxycontin, oxycodone, Dilaudid, methadone, and several others. Over 8% of the general population is believed to abuse opiates over the course of their lifetimes, including using illegal drugs like heroin and prescribed pain pills and medications such as Oxycontin. Opiods can cause physical chemical dependence. This means that someone relies on the drug to prevent withdrawal symptoms. Sometimes it is the fear of and withdrawal that is a major contributor to prolonged use. Eventually, larger amounts of the drug become necessary to produce the same effect.

The length of time it can take to become physically dependent can vary with each person. Withdrawal from opioids can be uncomfortable and painful, but not life-threatening. That does not mean that there are not side effects. Opiate detox withdrawal can have some serious side effects. People using opiates often experience drowsiness, vomiting, nausea, muscle soreness, constipation, and dry mouth. With more frequent use, opiate treatment can lead to tolerance, where the body adapts to large opioid levels. This phenomenon is common to most addictive substances, such as heroine or caffeine.

Tolerance extends to the physiological effects of opioids, so that drug users become used to headaches, nausea, and drowsiness. Addicts going through opiate detox and withdrawing from opiates should be assessed for depression and other mental illnesses. Appropriate treatment of such disorders can reduce the risk of relapse. Antidepressant medications should NOT be withheld under the assumption that the depression is only related to withdrawal, and not a pre-existing condition.

Opiate detox and withdrawal though uncomfortable is a needed step on the road to being inaddiction recovery.

Poast Acute Withdrawal Syndrome, Paws, Part 2

In part one of the article on post acute withdrawal syndrome we discussed the various stages of withdrawal. This article concerns itself with the actual symptoms and problems of PAWS.

Hear some symptoms of how PAWS affects the thinking process:

• Having a hard time learning and remembering new information.
• Both short-term and long-term memory can be affected.
• Inability to handle stress or uncertain situations.
• Fuzziness of thinking, an inability to think clearly or logically.
• Difficulty with solving problems and abstract reasoning.
• Difficulty concentrating for any length of time or blanking out.
• All or nothing, black or white thinking.
• Having a difficult time prioritizing goals and putting them into action.

There are some emotional symptoms of PAWS also:

An inability to sleep soundly.

• Having nightmares or dreams about using alcohol or drugs.
• Emotional symptoms are increase due to lack of sleep.
• A frequent occurrence of radical mood swings.
• Difficulty to relate to others.
• Disproportionate emotions for a situation, for example flying into a rage over a small incident.
• Having inappropriate emotions.

In the Big Book of Alcoholics Anonymous the description that they used was feeling restless, irritable and discontent.” The length of time these symptoms can occur is usually thought to be up to three to six months into recovery. However, depending on the severity of the substance use and length of time of its use, Post Acute Withdrawal Syndrome may last up to two years in extreme and rare cases.

Part 1

Post acute withdrawal syndrome, also known as PAWS, was brought to the forefront in relapse prevention by Terence Gorski. His foundation Cenaps is the standard for relapse prevention research.

In discussing stages of withdrawal for addictive chemicals we usually think terms in of two stages. The first stage is the acute, intense and immediate withdrawal that occurs directly after stopping use. The second stage is the long-term effects or withdrawal symptoms that occur after initial withdrawal symptoms.

The severity of the post acute withdrawal symptoms usually depends on two factors. The first is the amount and degree of brain dysfunction or disruption that has been caused by the length of use, and type of chemicals used, and any injuries that occurred associated with the use. The second thing that can affect post acute withdrawal symptoms are the stress factors experienced early in the recovery process and the severity of the psychological and social stressors that may occur.

In part 2, we will discuss post acute withdrawal syndrome symptoms, problems, and duration.