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.
{ 16 comments… read them below or add one }
Please print articles in black and maybe a bit larger. My son who is the one with PAWS has seeing problems and cannot read your articles without magnification. He does have special reading glasses provided by the KY Dept of the blind, but still needs magnification to read most things. This would be most helpful.
Thanks,
Betty
Thank you for your suggestion. A number of articles are actually podcasts. Clicking the yellow and blue icon under the title will allow you to hear the article spoken.
As a work around, at the end of every article is a ‘print’ icon. This will isolate the article from the site and allow you to either print it as is, or copy and paste it into Word, where you can increase the font and then print it.
Thank you very much for reading and participating in my site.
Bill Urell
I wanted to comment on your statement that methadone or buprenorphine can be used to treat PAWS in opiate addicts. This is hopefully not an accepted course of treatment. I am currently suffering severe PAWS after a very slow Methadone titration, and havent used illicit opiates for years. Until I was educated about PAWS, I just felt like all the years of stress and poor decision making had taken their toll on my mental clarity. When I was told about PAWS, and further researched it, I found that the descriptions matched exactly what I was experiencing.
Donnie,
My personal view sides with yours in not using those drugs over the long run. I am a bit old school, abstinence is abstinence. However, as stated, there is an opposing view that benefit may be gained by the use of maintainance drugs. Do a search on scholarly articles on “methadone, buprenorphine, PAWS” and you will see a number of studies, albeit with mixed results.
Bill Urell
Hi, I just recently came out of PAWS after going through a year of hell by myself with no understanding of what was going to happen to me, and not until 6 months into it did I find out I had PAWS. I was on methadone for 6 1/2 years. By the time I found out, I had already gone so far without knowing what was wrong that it did not help my mental state to know. I was so sick I could barely take care of myself for at least 10 months, and I live alone. I don’t know how I made it. Could my case just have been very severe or could it have been because I didn’t have an understanding of what was going on?
I was wandering if there is any group meeting regularly. I would prefer female’s group rather than mix. any idea how to find one?
There should be settings on your internet browser (Internet Explorer or Mozilla Firefox) to make the print bigger. Try clicking “View” at the very top of your screen on the tool bar then clock “Text Size”. Also, I use my CONTROL key plus my middle mouse wheel to increase or decrease text size. Hope that helps.
I have been on low doses (under 10mg) of methadone for years simply because I couldnt go any lower. I switched to bupeprenorphine.
It is a fact that Methadone is one of the worst and hardest drugs to get off of. It takes forever.
Please educate yourself on the differences between Methadone and Bupeprenorphine. Anyone who wants to get off opiates for good should avoid methadone.
Buprenorphine differs in that it is a “partial agonist” (it doesn’t block all of your brain’s opioid receptors) and it better allows your brain to start making its own opioids. It is also much easier to get off of than methadone.
Now this is a very important issue when it comes to withdrawal syndrome.If the things are not dealt with all care it can be fatal too.The extreme dependence should never be abruptly snapped, I think medical assistance will surely be a better option.Is it that nicotine dependence can be handled without medical help.Which are the delicate ones?
Fentora is a form of fentanyl that is used to treat cancer pain. Recently Cephalon Inc., the pharmaceutical company that produces the drug, requested approval to use fentora for non- cancer pain.
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johnyymathew
kentucky drug rehab
Post-acute withdrawal symptoms are not the same in everyone. They vary in how severe they are, how often they occur, and how long they last. Some people experience certain symptoms; some people have other symptoms; some people have none at all.
Over a period of time PAW may get better, it may get worse it may stay the same, or it may come and go. If it gets better with time we call it regenerative. If it gets worse we call it degenerative. If it stays the same we call it stable. And if it comes and goes we call it intermittent.
The WORST thing you can do is use METHADONE or BUPRENORPHINE for PAWS because they have a LONGER HALF LIFE and will cause their own PAWS which is even WORSE than HEROIN ………..they are only good for a 7 day detox from HEROIN……but usually HEROIN ADDICTION doesnt cause much of a PAUSE…….the opiates known for causing a that a PAWS are METHADONE and BUPRENORPHINE
I’d have to agree with James. I’m going on a year off of buprepnorphine, and I’m experiencing what seems to be mild PAWS. Sometimes it’s hard to differentiate because I’ve always had moderate/severe ADD, but the one thing that was always constant until aprox. 6 months into my bup treatment (32mgs) was, was my ambition. During that time I quit college, and returned home, with a almost a total lack of ambition. Ambition goes hand in hand with your dreams, and takes no dicipline to maintain. It’s part of your nature, or it isn’t. It’s something that should come to you naturally. Motivation to make your amibitons reality is where the effort comes into play. While my ability to self-modivate has returned to it’s normal mediocre level, my ambitions/hopes/dreams remain absent. It’s not a miserable existence, but it’s definently a grey one. I’m waiting for this purgatory to end, and I know it will some day. It is a long long, process from a treatment, that was for me, detremental. It was an atrocious waste of money, and time. I’m for limiting buprenorphine’s application in opiate dependency treatment to: 21 day detox, or long-term maintenece. I don’t think buprenorphine of being any more, or less evil than methadone. My withdrawal lasted for over a month, and good portion of the next one. If you would like to use suboxone to get off opiates, first know that for some patients, regardless of how low a dose you tapper to (even 1/2 mg or 500mcg) You are still going to have physical withdrawal, and it will be longer and more drawn out that quitting cold turkey, and maybe have to deal with PAWS. The points I truely advocate about buprenorphine, is it’s ability to maintain cravings. In the year I was on it, not once did I even ponder relapse (unlike methadone, it does this void of anything more than caffeine like euphoria). Furthermore, I’ve found it much easier to remain abstinent a year after treatment. I like to attritute that to the 9th level of hell buprenorphine put me through after quitting it more than anything. It was almost as if my brain after such a prolonged dependence on bup, freaked out, and stopped releasing nearly all key neurotransmitters into synaptic gaps, and unlike quitting oxy, it seem to not even know where to start the damage control, making the process excrutiating, and long. In other words, The W/D felt different, but just as miserable, and drawn out 4 times as long. There’s something funky about the stuff
I was on subutex and suboxone for about a year and a half. Ive been off it now for nearly a month. The withdrawals are horrible. Ive been in the emergency room three times because i could not hold food or water in my stomach. In the beginning I was throwing up and dry heaving every two minutes for days. Finally i started taking roxicodone 15 mg to counteract the suboxone withdrawals. I would take like half a pill every 4 or five hours. You still fee like shit and it lasts forever. Now ive stopped takin the opiate about 8 days ago. Im still going through the PAWS, it really sucks but i am determined to get through it. I can only eat a little bit of food and i have lost a lot of weight. Im really tired and going to work is dreadful. Im going to start taking vitamins because i know that my body has been depleted of them. My advice is do not get on this medication. Doctors never warned me about the withdrawals associated with this drug, Ivee been through opiate withdrawals before and its like a walk in the park compared to this because they don’t last nearly as long, at least that has been my experience. I found that the easiest thing to do is taper yourself off of the opiate instead, Roxy’s in my case. I just hope this shit doesnt last to much longer because I have a kid on the way and I dont want to use opiates anymore. I would like to read anyone whos having a similar experience. Bert 25 Florida
When my aunt went through withdrawals she actually acted like she was drunk. Then a year after being clean, she did a detox and once again it made her act like she was drunk again. The more she detoxed, the more normal she became. She also noticed that the more the toxins were out of her system, the less she desired alcohol.
My 19 y.o. son, who was on Buprenorphine for 2 years got PAWS when he stopped it on May 5, 2011. He got psycotic during the night & took a rifle to his head. He would have been 20 y.o. in July. He had stated the day before, “This drug is harder getting off of than heroin.” After reading the package insert (drug information sheet), I do not see any Warnings about this. PLEASE – if there are any other victim’s families/ friends/loved ones who have lost their loved one because of this drug, please email me. Thanks – Irene