What Is PAWS? PAWS refers to any symptoms that persist after acute withdrawal has resolved. It can feel like a “rollercoaster” of symptoms, which come and go unexpectedly. Each episode of PAWS can last for a few days, and these can continue cyclically for a year. These symptoms can occur with any intoxicating substance, although post-acute withdrawal syndrome most often occurs among people discontinuing the following drugs:
Alcohol: Though people have struggled to end alcohol addiction for much longer, the symptoms of PAWS were first defined for alcohol use disorder in the 1990s. Suddenly stopping alcohol consumption is dangerous, since it can cause delirium tremens (including seizures and psychosis) and can also increase the likelihood of PAWS (e.g., long-term cravings, exhaustion, and feeling ill).
Antidepressants: While few people abuse these drugs recreationally since they do not cause a rapid intoxication, stopping them suddenly can dramatically change the levels of serotonin and other neurotransmitters in the brain. Since people who struggle with depression are prescribed antidepressants, acute withdrawal will feel like intense depression; unfortunately, this experience could continue for months.
Antipsychotics: These drugs bind to dopamine receptors to decrease hallucinations and delirium. When they are discontinued, especially without a taper, the person could experience withdrawal symptoms like mood swings for months.
Benzodiazepines: Although these medicines help people with anxiety and panic disorders, they are very easy for the brain to develop a dependence on. Most prescriptions do not cover more than two weeks of regular use because they can be addictive. Withdrawal symptoms mimic panic disorders, making it harder to stop taking them. PAWS symptoms, like insomnia, fatigue, and cravings, can last for months after the physical dependence has ended.
Marijuana: Many people become reliant on marijuana to relax and feel normal; when they stop taking the drug, they can feel stressed, depressed, and paranoid. One of the most common withdrawal symptoms is insomnia, and without medical help, this could persist and become PAWS.
Opioids: Whether prescription opioids or illicit versions like heroin, these drugs can lead to post-acute withdrawal syndrome if they are not tapered off properly. People who experience the full intensity of acute withdrawal are more likely to develop PAWS, which includes cravings, exhaustion, and cognitive impairment that does not go away for a long time.
Stimulants: Drugs from Ritalin to cocaine can cause post-acute withdrawal syndrome if withdrawal is not managed appropriately. Although a person taking stimulants may experience negative side effects like paranoia, twitching and tremors, and aggression, the opposite symptoms – extreme fatigue, deep depression, and physical weakness – can be harder to manage psychologically.
As acute withdrawal symptoms fade, PAWS may be an issue for people in recovery. These symptoms, too, will vary in characteristic and degree based upon a number of factors. In general, however, many clients in recovery report experiencing some or many of the following post-acute withdrawal symptoms:
Irritability and hostility
Depression
Anxiety
Mood swings
Low energy and fatigue
Sleep disruption, including insomnia
Limited ability to focus or think clearly
Lack of libido
Inexplicable chronic pain
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