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Alcohol And Post-Acute Withdrawal Syndrome(PAWS)

Isaac Alexis, M.D., AAMA, AMP-BC

Medically reviewed by

Isaac Alexis, M.D., AAMA, AMP-BC

June 20, 2019

Overcoming alcohol addiction is a process that takes time. Many people think that after the initial detoxification, they are done with the withdrawal process. Unfortunately, post-acute withdrawal syndrome (PAWS) causes many people to experience symptoms like anxiety, cravings, and mood swings for months after they stop drinking.

Alcohol is the most commonly abused drug in the United States, and nearly 16 million Americans battle alcohol addiction. Some of those who struggle with alcohol use disorders may seek treatment and detox in a medically supervised program. But what about withdrawal symptoms that linger for weeks after detox?

Post-acute withdrawal syndrome (PAWS) is a group of symptoms that occur after the withdrawal or detoxification phase of alcohol. The symptoms of PAWS can be extremely uncomfortable, and usually, affect a person’s mental health. Post-acute withdrawal symptoms may feel like they come out of nowhere. Feelings of aggression, fatigue, and stress may start and stop abruptly.

It can be helpful for people who are recovering from alcohol addiction to familiarize themselves with the reality of PAWS. Being aware of the symptoms of post-acute withdrawal syndrome can help people navigate this phase of recovery.

What Is Post-Acute Withdrawal Syndrome (PAWS)?

Heavy alcohol use has lasting effects on a person’s mind and body. Once a person stops drinking, it takes time for their brain and other organs to adjust to the absence of alcohol.

Many people are familiar with the physical symptoms of alcohol withdrawal, but PAWS typically has more of an impact on a person’s mental well-being.

Symptoms of PAWS may include:

  • irritability
  • aggression
  • anxiety
  • mood swings
  • cravings for alcohol
  • inability to feel pleasure
  • shortened attention span
  • trouble falling or staying asleep
  • depression
  • difficulty making decisions
  • impulsivity
  • low energy
  • financial problems
  • body aches
  • exhaustion

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What Causes Post-Acute Withdrawal Syndrome (PAWS)?

Chronic alcohol exposure causes neurotransmitters in the brain, especially GABA, to change. Once a person stops drinking alcohol, the brain goes through an adjustment phase that can lead to the physical and psychological side effects of PAWS.

When a person uses alcohol long-term, their body depends on that substance for everyday functions like digestion and sleep. As this occurs, the toxins from alcohol can also be simultaneously damaging the systems of the body.

Up to 50 percent of people who stop drinking experience acute withdrawal symptoms that affect the daily functions of the body. Once the acute withdrawal phase has passed, the symptoms people experience are largely psychological.

Many people report mental discomfort and feeling a rollercoaster of changing emotions. Much of this is due to the hormonal changes that occur once a person stops drinking.

How Long Does Post-Acute Withdrawal Syndrome (PAWS) Last?

Researchers have found that alcohol withdrawal symptoms can last weeks or months after the initial detoxification phase. The physically threatening symptoms of withdrawal (such as hallucinations or seizures) tend to stop within a week of alcohol cessation. However, psychological distress and mood disturbances can continue for months.

Knowing how to treat PAWS is a vital part of recovering from an alcohol use disorder. If a person doesn’t expect these symptoms or understand that they are normal, they may feel something is wrong with them. These feelings can lead to a relapse (a return to the drug).

More than half of people who quit drinking experience withdrawal symptoms. This suggests that post-acute withdrawal symptoms are also likely to occur in a majority of the population.

Risk Factors For Post-Acute Withdrawal Syndrome (PAWS)

When a person considers abstaining from alcohol, they may wonder what their chances are of developing PAWS. Since this syndrome is not universally recognized by the medical community, there have not been many studies on the risk factors for PAWS. This makes it difficult to predict who is most at risk for this syndrome.

That said, there are some general factors that could increase a person’s chance of developing post-acute withdrawal syndrome symptoms.

Possible risk factors for PAWS could include:

  • history of substance abuse
  • polysubstance use
  • age at which a person began drinking
  • amount of alcohol ingested daily
  • how often a person drinks alcohol
  • genetic factors
  • overall physical and mental health

How To Get Through Post-Acute Withdrawal Syndrome (PAWS)

While PAWS does not affect everyone who has detoxed from alcohol, it is a common problem. Fortunately, there are several ways to prepare yourself for the symptoms.

Experts suggest the following ways to equip yourself for managing PAWS:

  • Educate yourself on the realities of post-acute withdrawal symptoms
  • Speak with your doctor or healthcare provider about how to manage symptoms
  • Consider joining a 12-step group like Alcoholics Anonymous for support
  • Celebrate small accomplishments along the way (either privately or in a support group)
  • Stay active and try to move your body as much as possible throughout the day
  • Exercise your memory and cognition with routines or to-do lists
  • Be patient with yourself during the journey of recovery

There is no right way to deal with alcohol addiction and PAWS. However, it can be overwhelming to experience these symptoms alone. If you or someone you love is suffering from alcohol withdrawal symptoms, seeking professional help can be an important part of the recovery process.

Post-Acute Withdrawal Syndrome (PAWS) Treatment

The symptoms of PAWS can be difficult to endure on one’s own. After a person detoxes from alcohol, they may want to consider entering an inpatient rehab center for further support. Addiction treatment centers are equipped to help those dealing with the exact kind of symptoms that PAWS causes. Additionally, research shows that those who participate in formal addiction treatment after detox tends to have better recovery outcomes.

At an inpatient rehab center, clients engage in recovery therapies and different types of counseling. Therapeutic groups and recreational activities may be part of the daily structure. This supportive atmosphere can be a game-changer for those who are beginning to experience the symptoms of post-acute withdrawal syndrome.

Trained, compassionate staff are available to help guide people through the symptoms of PAWS. 24-hour supervision is provided, in order to ensure the safety and comfort of patients. Integrated therapy with peers and family can also help to support those who are newly sober.

For people who struggle with the ongoing mental health symptoms of PAWS, physicians may prescribe medication-assisted treatment (MAT). These medications soothe symptoms like anxiety and mood swings. Some forms of MAT have even been shown to reduce cravings and prevent relapse.

PAWS is a normal part of recovering from alcohol addiction. Try to remember that the symptoms are a temporary phase of the recovery process.

To learn more about alcohol and post-acute withdrawal syndrome (PAWS), reach out to one of our treatment specialists today.

National Institutes of Health: National Institute on Alcohol Abuse and Alcoholism - Alcohol's Effects on the Body

National Institutes of Health: National Institute on Alcohol Abuse and Alcoholism - Alcohol Facts and Statistics

Substance Abuse and Mental Health Services Administration - Protracted Withdrawal

U.S. National Library of Medicine, National Institutes of Health - IDENTIFICATION AND MANAGEMENT OF ALCOHOL WITHDRAWAL SYNDROME

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