Post-acute withdrawal syndrome (PAWS) refers to the lingering drug withdrawal symptoms, such as fatigue, cravings, and anxiety, that occur once the acute withdrawal phase is over.
Although PAWS affects thousands of people in recovery, further exposing them to the risk of relapse, it hasn’t been thoroughly studied yet, which makes managing it even more challenging.
This article will help you learn more about protracted withdrawal symptoms, including how to recognize them and when to seek help.
What Is Post-Acute Withdrawal Syndrome (PAWS)?
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Post-acute withdrawal syndrome (PAWS), also known as protracted withdrawal syndrome (PWS), refers to a set of withdrawal symptoms that persist beyond the acute drug or alcohol withdrawal phase.
While post-acute withdrawal syndrome can develop with any substance that can cause dependence and addiction, it is most commonly associated with:
- Alcohol
- Opioids
- Antidepressants
- Benzodiazepines
Let’s take hydrocodone as an example. If you take it for a prolonged time, you will eventually develop opioid dependence. In other words, it’s only a matter of time before you have to take it to feel normal and prevent uncomfortable opioid withdrawal symptoms.
Once you stop using it, your body will enter the acute phase of hydrocodone withdrawal, characterized by physical and psychological symptoms like muscle aches, anxiety, nausea, cravings, and so on. While these symptoms can be very intense, they usually subside within a week or two, depending on the drug’s formulation, the extent of your opioid use, etc.
However, those suffering from post-acute opioid withdrawal syndrome find themselves struggling with withdrawal symptoms well past this point. Their symptoms may linger for several weeks, months, and even years after drug discontinuation.
Although there’s still limited scientific research on PAWS, there’s no denying that post-acute withdrawal syndrome affects hundreds of thousands of people around the world. It is widely believed that as many as 90% of people recovering from opioid use disorder (OUD) may experience long-term withdrawal symptoms, such as cravings, anxiety, sleep problems, and depression.
Ultimately, PAWS can make opioid recovery even more challenging. To increase your quality of life and the chances of lifelong sobriety, it is crucial to seek professional treatment for post-acute withdrawal syndrome.
What Causes Post-Acute Withdrawal Syndrome?
Post-acute withdrawal syndrome is caused by the changes that occur in the brain chemistry due to prolonged drug use. In some cases—especially with abrupt drug cessation and long duration of drug use and abuse—the brain may need more time to readjust to the absence of drugs and restore normal functioning, leading to PAWS.
For example, taking illicit or prescription opioids for a prolonged time causes the brain to create more opioid receptors and stop producing endorphins, leading to dependence.
Once you stop using them, your nervous system won’t immediately return to normal; it will need some time to recalibrate and start producing endorphins naturally.
The likelihood of developing post-acute withdrawal syndrome and the severity of its symptoms depend on various individual factors, including:
- The type of drug taken
- The frequency, amount, and duration of drug use
- The method of drug discontinuation (for example, quitting opioids “cold turkey” may increase the risk of PAWS)
Some drugs, including opioids, are more likely to lead to post-acute withdrawal syndrome than others. For this reason, managing opioid dependency under medical supervision is crucially important, as it may help reduce the risk of PAWS and other complications.
Common Signs and Symptoms of PAWS
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Some common signs and symptoms of PAWS include:
- Anxiety
- Fatigue
- Irritability
- Mental fog
- Depression
- Mood swings
- Panic attacks
- Impaired memory
- Emotional numbness
- Drug or alcohol cravings
- Decreased concentration
- Increased sensitivity to stress
- Inability to experience joy and pleasure
- Sleep disturbances, such as insomnia, nightmares, etc.
The signs and symptoms of post-acute withdrawal syndrome may also vary based on the substance used. Even though these symptoms are typically psychological, PAWS can also manifest in physical symptoms. For instance, antidepressants can cause brain zaps, whereas alcohol-induced PAWS may lead to nausea and even chronic pain.
If you recognize any of the signs listed above, you’re likely suffering from post-acute withdrawal syndrome.
Seeking professional help is in your best interest, as going through PAWS alone is not only difficult but also dangerous due to the high risk of relapse. It can also trigger or exacerbate any pre-existing mental health issues, such as depression, which can also make you more vulnerable to suicidal ideation.
How Long Does PAWS Last?
How long PAWS lasts varies from one person to the next, depending on the extent of the damage drugs cause to the brain and the brain’s ability to repair itself. In most cases, post-acute withdrawal syndrome lasts 6–24 months, but some people may experience episodes of protracted withdrawal symptoms for several years after quitting the substance.
Some factors that may impact the duration of PAWS include:
- Overall health
- The type of substance used
- The quantity, duration, and frequency of drug use
Partaking in polysubstance use (e.g., mixing Vicodin and alcohol) may also impact the intensity and duration of PAWS, especially if you develop a dependence on both substances or abuse them frequently.
Precisely determining the timeline of post-acute withdrawal syndrome isn’t possible, as each person’s body breaks down and processes drugs differently. Generally, PAWS symptoms tend to become less frequent and intense over time. Nonetheless, the risk of relapse remains significant as long as these symptoms persist.
The Challenges of Managing PAWS
Managing PAWS can be very challenging, and the fact that post-acute withdrawal syndrome is under-researched only makes it more challenging.
Therefore, post-acute withdrawal syndrome remains largely misunderstood, undiagnosed, and untreated. Sometimes, it may even be misdiagnosed as another condition, such as depression or bipolar disorder (BP), one of the most overdiagnosed mental health disorders.
Although there’s no research on the rates of misdiagnosis between PAWS and bipolar disorder, a study done by Ghouse et al. found that only 33%–42.9% of people with a dual diagnosis of substance use disorders (SUDs) and bipolar disorder fully meet the criteria for BP.
Furthermore, the symptoms of PAWS tend to appear, disappear, and reappear without warning. This fluctuating and unpredictable nature of post-acute withdrawal syndrome makes it even more difficult to cope with it and increases the risk of relapse.
Given that abstinence reduces drug tolerance, relapse is extremely dangerous—your usual dose may be enough to cause an overdose. If not treated promptly, a drug overdose can be deadly.
Luckily, it is possible to prevent post-acute withdrawal syndrome by opting for a comprehensive treatment that addresses the root of drug dependence. When it comes to opioid addiction and dependence treatment, ANR is your best option.
How ANR Opioid Dependency Treatment Helps With PAWS
Accelerated Neuro-Regulation (ANR) prevents PAWS altogether, as it essentially undoes the changes in brain chemistry caused by prolonged drug use. It is an ultra-modern opioid dependence treatment that fosters long-lasting recovery by attacking opioid dependence at its core.
As of today, it has supported nearly 25,000 people worldwide in leading a healthy, opioid-free life.
ANR works by re-regulating the endorphin-receptor system to its normal levels, effectively returning the brain to its pre-addiction state. Since patients are sedated during the 4–6 hour procedure, they experience no discomfort associated with opioid withdrawals. Moreover, the hospital stay for ANR patients lasts only 36 hours on average.
Developed by Dr. Andre Waismann, ANR prioritizes patient safety, tailoring the treatment to each patient’s individual needs and medical history. Therefore, it is suitable even for those with co-occurring medical conditions, such as cardiovascular disease.
The ANR team comprises highly experienced and compassionate anesthesiologists, critical care physicians, and other board-certified healthcare professionals. The treatment is conducted in an ICU setting of fully accredited hospitals with state-of-the-art medical equipment, ensuring the highest patient safety standards.
ANR vs. Detoxing From Opioids
While opioid detox treatments simply remove opioids from the system, ANR recognizes that this isn’t nearly enough to sustain lifelong recovery. As the first and only treatment that acknowledges and addresses the neurobiological causes of opioid dependence, ANR has a clearly defined therapeutic goal: to bring the nervous system back to balance.
Therefore, ANR doesn’t merely eliminate opioids, exposing patients to the risk of severe withdrawal symptoms and relapse. It repairs the damage opioid exposure causes to the brain and helps it resume natural endorphin production.
By achieving neuro-equilibrium, ANR allows patients to forget about cravings or reliance on potentially addictive opioid replacement drugs, such as methadone.
Benefits of Managing PAWS With ANR
The key benefit of managing opioid dependence with ANR is that once you complete the treatment, you can return to your normal daily life without the fear of persistent cravings.
Unlike other opioid treatment programs, ANR doesn’t simply treat the symptoms of opioid dependence.
On the contrary, it targets the very root of the problem, reversing opioid-induced chemical changes and restoring normal brain function. As such, it eliminates the risk of ongoing cravings and post-acute withdrawal syndrome, negating the risk of relapse and supporting sustained recovery.
With ANR, you don’t have to suffer from PAWS for years before your brain heals itself. Our revolutionary treatment facilitates and accelerates this process, enabling you to break free from opioid dependence within a matter of days.
For your convenience, ANR Clinic has several centers around the world, all of which are equally dedicated to treating opioid dependence safely, quickly, and effectively.
If you’re ready to take the first step toward living an opioid-free life or want to learn more about the ANR treatment, contact us today for a free, 100% confidential consultation.
Key Takeaways
The bottom line is that the only way to prevent post-acute withdrawal syndrome is to correctly treat dependency by repairing the chemical imbalance resulting from prolonged drug use. Today, ANR is the only opioid dependence treatment that can effectively achieve this.
Before you leave, let’s summarize the key points we discussed today:
- Post-acute withdrawal syndrome is marked by the presence of opioid, benzodiazepine, or other drug withdrawal symptoms that linger past the acute withdrawal phase.
- The longer and more often you’ve been taking drugs, the more likely you are to develop PAWS, as your body will need more time to recover from the drug-induced damage.
- The symptoms of PAWS are usually psychological (e.g., mood fluctuations, sleep disturbances, cravings, and anxiety), but some drugs can also cause protracted physical symptoms.
- Managing post-acute withdrawal syndrome can be very challenging because this condition hasn’t been officially recognized yet, and its symptoms can be unpredictable.
- ANR is a highly effective and safe opioid dependence treatment that prevents the risk of PAWS and relapse by re-balancing the endorphin-receptor system.
Post-Acute Withdrawal Syndrome FAQ
Having PAWS typically feels like an emotional rollercoaster, as this syndrome usually manifests in mood swings, anxiety, and depression. It’s not unusual for people to feel normal one day and experience overwhelming cravings, sudden fatigue, difficulty concentrating, and other debilitating symptoms the next day, making drug recovery even harder.
There are no FDA-approved medications for PAWS. Specifically, post-acute withdrawal syndrome hasn’t been officially recognized yet and can manifest with a variety of symptoms requiring different interventions. However, your doctor may be able to recommend some medications based on the symptoms you experience to help you deal with PAWS and sustain recovery.
Yes, PAWS symptoms often come in waves. It’s common for people with PAWS to experience flare-ups of symptoms followed by periods of relief. Some symptoms may disappear altogether and reappear after a while without any warning. Others, such as cravings, may also be triggered by certain places, people, or situations (e.g., stress).
You should seek professional help for PAWS if your withdrawal symptoms last longer than normal. Post-acute withdrawal syndrome can look different for everyone, so if you suspect you may be struggling with it, it’s best to seek professional help for lingering symptoms to reduce the risk of relapse, overdose, and death.
