On Addiction:Post Acute Withdrawal Syndrome (PAWS)
Welcome to the second of our multi-part series on understanding addiction. The purpose is to take a dive into some well know and not-so-well-known parts of addictions recovery so that you can be successful in your recovery goals. We are honored to continue sharing this space with Chrissy LaCivita, LCSW, LCDC-intern. Chrissy is an experienced addiction therapist who is passionate about addiction recovery in all stages of the recovery process, and she is the newest member of our counseling team, here at Salyer Counseling Group.
As we have mentioned, early recovery can be full of emotions ranging from excitement to fear, and everywhere in between. Those who have been there, know just how true this is! In this series are a few pointers for when you first get sober that are not instinctively known and are taught in treatment centers around the globe. Today we will take a deeper dive into Post Acute Withdrawal Syndrome (PAWS) :
PAWS
No not the little feet at the bottom of a cute puppy. Post-Acute Withdrawal Syndrome or PAWS is the experience of certain withdrawal symptoms that occur after (post) detoxing chemically (acute) from substances. Withdrawal symptoms are different depending on what substance is being abused but in general, withdrawal symptoms are the opposite of effects of the substance; alcohol withdrawal includes anxiety and inability to sleep while amphetamine withdrawal includes extreme fatigue and excessive hunger. Withdrawal symptoms include physical, emotional, and mental symptoms. PAWS tend to be emotional or mental symptoms of withdrawal. Some examples include anxiety, depression, fatigue, restlessness, irritability, foggy thinking, and sleep disturbances, though the list is larger.
Detoxing from a substance is hard and to hear that you may have to go through those feelings again is a bit daunting but be assured the severity and intensity of PAWS vary from person to person and substance to substance. A good rule of thumb is if your detox/withdrawal wasn't too bad, PAWS won't be either.
TIMING
The trickiest part of PAWS however is the timing. PAWS comes in waves during different times in one's recovery journey. From my experience working in substance abuse over the past 6 years, I have noticed a pattern that I believe Dr. Bob and Bill W had an idea of when thinking about chips for AA. Typical episodes of PAWS occur around the 2-3 weeks mark, monthly marks, and the first- and second-year marks. Most AA meetings give out chips in this order: 24 hours, 30 days, 60 days, 90 days, 6 months, 9 months, and then every year. Some groups vary but oddly these chip days align significantly with those who experience PAWS. So when you are supposed to be happy to get your 30 day chip at your home group and you feel like crap, it may be PAWS and not that you hate AA now. (1)
As mentioned, the first round of PAWS occurs between 14 and 21 days after our last use, which may sound familiar to many people, especially those who struggle with binge-type use. You know, not the everyday drinker who can’t make it through the day without a beer, but the random user who swears they only snort coke on occasion, but it happens like every couple of weeks and then they are on a binder for a few days… Surprisingly enough around the 2-3 week mark, we get angsty, irritable, sad, lonely, and cocaine would really bring you up out of this mood (or so we tell ourselves). Though not 100% of the time, most individuals who struggle with binge-type use are relapsing around the time of PAWS, unbeknownst to them. Even daily users have a higher likelihood of relapse during times of PAWS because the internal triggers to use are on steroids compared to other times in recovery. When we are emotionally vulnerable from our own brains, let alone the world outside of us, it makes sense why people tend to relapse around these markers.
Having said that, PAWS is no excuse to continue using, even though the addict part of our brain may tell us so. As time progresses instances between bouts of PAWS become further and further apart and their duration gets shorter and shorter. To start, most PAWS lasts for a few days, anywhere from 3-7. If we are prepared for this to happen and make a plan of action to prevent ourselves from using, it results in a bad week, which all humans have at one point or another, versus relapsing and having a bad life.
Like I noted in the cravings segment, these feelings can last up to about 2 years. And just like cravings, they get easier to deal with as time goes on. What is important is to be aware of the signs of PAWS for you and have a game plan to cope because the longer we go without using, the shorter the bouts of PAWS will be, the less intense the cravings will be, and the saner we will be. When we hit that 2-year mark, our emotional pain feels less like PAWS and more like PMS so you might not even know which is which! This goes for you too boys, you know just minus the menses and mostly the attitude of PMS.
Written by Christina LaCivita, LCSW, LCDC-intern
Still wanting to know more about addiction and understand the symptoms and challenges of sobriety? stay with us as we unpack more elements of addiction recovery over the next few weeks.
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