13 Signs You’re Suffering from PAWS

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The first step in any effective addiction treatment plan is medical detoxification, in which someone is closely monitored by medical professionals as they purge their body of the substances they have become dependent on.

This process involves both physical and mental withdrawal symptoms, which are typically very uncomfortable and potentially dangerous. Though the length and intensity of these symptoms will vary depending on factors such as the substance they were abusing and the severity of the dependency, the symptoms will lessen and eventually end in the span of roughly two to three weeks.

However, this is not always the case. After someone has undergone detox and the acute withdrawal phase has ended, they may enter a second phase that can last for months or even years known as Post-acute-withdrawal syndrome, or PAWS. PAWS serves as an umbrella-term for a range of long-term withdrawal symptoms, mainly psychological or mood-related, that persist long after someone has stopped using drugs or alcohol.

Because the mostly mental symptoms of PAWS are harder to measure than physical ones and are largely based on self-reporting by those experiencing them, there is some controversy as to the validity of the disorder. While there has been documented research on persistent and protracted withdrawal in substances such as alcohol and benzodiazepines, PAWS is not currently recognized by the Diagnostic and Statistical Manual of Mental Disorders.

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What are the Signs of Post-Acute-Withdrawal Syndrome?

So how can you know if you are experiencing Post-acute-withdrawal syndrome? While each experience will vary, which is part of what makes PAWS so difficult to pin down and validate, there is a list of symptoms that are most commonly reported across the spectrum of protracted substance withdrawal. If you have stopped using drugs or alcohol for more than several weeks and are experiencing some of these symptoms, you may be suffering from PAWS.

#1 – Unstable and Unpredictable Moods

One of the most frequently noted symptoms of PAWS, and part of why this syndrome is often mistaken for depression, are major and uncontrollable swings in mood. This can happen intermittently in episodes that can last anywhere from a few days to a few weeks before disappearing again. Sometimes, those suffering from PAWS who are experiencing these mood swings can appear to be exhibiting an undiagnosed bipolar disorder.

#2 – Symptoms of Depression

The most affecting of these changes in mood are depressive symptoms, in which individuals experience an extreme and overt melancholy that can feel like an anchor tied around their necks. These symptoms can last only minutes or linger for days, with no apparent trigger behind them. This can be an understandable source of frustration, and even cause a relapse.

#3 – Experiencing Anxiety or Panic Attacks

While depression is at one end of the mood-swing scale, anxiety and panic attacks are at the other. While these anxious feelings can be triggered by cravings and a reduced ability to handle stressors, similar to the depressive symptoms, there is no outside motivator required to cause anxiety or even something as severe as a panic attack.

#4 – Anhedonia

Anhedonia is a term used to describe a condition in which someone has lost, either partially or entirely, the ability to experience pleasure. Anhedonia goes much further than just a loss of interest in activities and pursuits someone previously enjoyed and is often described by those experiencing it as the feeling that their ability to enjoy almost anything has been switched off. A typical symptom of withdrawal, those with PAWS are likely to suffer longer and more extreme bouts of Anhedonia, losing interest in not only hobbies or socializing, but also in relationships, sexual activity, and even basic desires like eating.

#5 – Strong Drug Cravings

Even if it is not the most common, perhaps the most expected symptom of PAWS are cravings for the substance that the individual was previously dependent on. While these cravings will eventually fade in strength, they can still sometimes persist for long periods of time after someone has achieved sobriety. Cravings can be extremely problematic, either serving as a trigger for other symptoms of Post-acute-withdrawal syndrome or putting an individual at risk of a relapse.

#6 – Poor Coordination and Clumsiness

Individuals experiencing Post-acute-withdrawal syndrome will often exhibit a general loss of physical coordination, including dizziness, slowed reflexes, poor balance, and issues with hand-eye coordination. Because of this, they will often be seen tripping or bumping into things, dropping things, or spilling food or drinks. Apart from simply being the manifestation of another PAWS symptom, a secondary reason behind this lack of coordination is distraction caused by comorbid feelings of depression and disinterest.

#7 – Difficulty Falling Asleep

Similar to becoming clumsier due to being distracted by feelings of depression, those suffering from PAWS will also usually have a great deal of difficulty getting to sleep at night. This can be due to feelings of anxiety and restlessness, as well as a lack of stimuli to keep them from focusing on the negative psychological symptoms that are characteristic of Post-acute-withdrawal syndrome.

#8 – Sleep Disturbances

Unfortunately, even once someone experiencing PAWS manages to fall asleep, they’re unlikely to stay that way. Individuals will often have their sleep interrupted, either from withdrawal cravings, unusually vivid and unpleasant dreams, or altered sleeping patterns causing them to wake up for no particular reason. Because of these disturbances, people with PAWS will often oscillate between going as long as several days without sleeping to sleeping for days at a time once their exhaustion has caught up with them.

#9 – Inability to Concentrate or Think Clearly

Similar to the loss of coordination, those with PAWS can have difficulty focusing or thinking clearly due to the distraction from cravings or feelings of intense depression. The lack of sleep can also cause them to struggle with concentration, creating a vicious cycle, as their minds’ inability to focus on something other than the negative feelings manifested by PAWS is part of what makes sleep seem so impossible. It becomes quite difficult to concentrate for anyone experiencing Post-acute-withdrawal syndrome.

#10 – Thoughts of Suicide or Suicide Attempts

If the depressive symptoms of post-acute-withdrawal syndrome have become frequent and severe enough, they can progress to a stage where the individual can begin to have suicidal thoughts or ideations, and may even make an attempt to commit suicide. If this is the case, professional help should be immediately sought to ensure the individual’s safety and help to treat them. Thoughts of or attempts at suicide should always be taken seriously.

#11 – Increased Sensitivity to Stress

As part of post-acute-withdrawal syndrome, individuals often become extremely vulnerable to stress and situations that might provoke feelings of stress. Like a raw nerve or an exposed wound, even the smallest contact with a stressful situation can be enough to overwhelm them and cause an outburst. These symptoms are only magnified by the presence of mood swings and an increased vulnerability to panic attacks.

#12 – Increased Sensitivity to Pain

In addition to becoming more sensitive to stress and anxiety, individuals experiencing post-acute-withdrawal syndrome will also frequently exhibit increased sensitivity to physical pain. While it decreases a person’s capacity to feel joy, PAWS can conversely heighten their capacity for pain, making even the most negligible injuries feel excruciatingly painful.

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#13 – Intensified Emotions

While the symptoms of depression and Anhedonia can make those suffering from PAWS feel numb or empty inside, the other extreme is also possible: namely, an intense overflow of emotional feelings. Individuals with Post-acute-withdrawal syndrome will often exhibit the most extreme level of any given emotion. This can mean becoming overly excitable when happy or excessively confrontational when angry, which can occur in very close proximity to each other if the individual is also experiencing sudden shifts in mood.

Palm Beach Institute Makes Sobriety Accessible and Attainable

When presented with such a formidable list of symptoms, it’s no wonder that the most common question about Post-acute-withdrawal syndrome is how long it will last. While, unfortunately, there is no definitive answer, for most people, Post-acute-withdrawal syndrome will last somewhere between six months and four years.

However, it’s important to know that if you or a loved one is experiencing the symptoms of PAWS, there is hope. At the Palm Beach Institute, we have many resources available to help individuals struggling with PAWS. If you or someone you love would like a free consultation, call the PBI today at (561) 475-4613. Our specialists can help anyone in need find the treatments and programs they need to beat a deadly substance abuse problem. Call PBI to begin the journey to sobriety as soon as possible.

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Megan Hesse
Content Writer

Megan Hesse is a digital content writer, copywriter, and former teacher, with a Master of Fine Arts from Florida Atlantic University. Her daily goal at Delphi is creating content that's well-researched as well as compelling and engaging.

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  • I have been in recovery from xanax for 2 months a week ago I drank 8oz of beer the day after I felt like I was back in withdrawal..please help did beer set me back?

    1. probably so, xanax works just about the same as alcohol, only on steroids…u gotta fight it through Rawls. I hope all is well.

  • PAWS is basically ur body adjusting. It’s completely normal. I abused opiates for years and I was able to stop by removing myself from the toxic surroundings I was in. My habit was around 20-25 30mg ocycodone Roxocit daily. My withdrawal symptoms would start roughy 12 hours after my last pill. Timing is very important when starting the detox process. What I mean by that is take your last dose at a time where ur withdrawal symptoms will begin in the middle of the night. For example, my symptoms began roughly 10 hours after taking my last pill so I took that last pill around 5-6pm. By doing this, I would wake up involuntary around 4am and I would be wide awake. This meant the first stages of withdrawal symptoms were about to begin. (Yawning, watery eyes, sneezing, etc). As soon as you wake up, take ur Suboxone strip and try to go back to bed immediately but this is easier said than done. I would take .5 mg of xanax and we us usually be back to sleep within 15 mins. While your sleeping you will most likely perspire a lot and go thru a few t shirts which is normal. When you wake back up around 9-10 or even 11ish you will feel completely fine. You shouldn’t be going through any withdrawal symptoms because the suboxone is in your body working. Drinks lots of water. Urinate frequently and always take suboxone on an empty stomach. The more you sleep while on a suboxone, the easier the process is. ALSO, SUBOXONE IS AN AID TO ASSIST YOU AND MAKE THE DETOX PROCESS EASIER. THERE IS NO NEED TO STAY ON SUBOXONE. Physical withdrawal symptoms are gone after the 3rd or 4th day. THERE IS NO NEED TO STAY ON A SUBOXONE REGIMENT. My habit was absurd and I’m lucky I’m still alive. I was heavily addicted to 30mg oxycodone and I never kept a daily ledger but it was safe to say I would ingest anywhere between 20-25 “blues” a day. I detoxed with the help of only two 8mg strips of Suboxone, some xanex for the anxiety, and OG Kush marijuana. I know so many friends who have gotten off opiates but are now addicted to suboxone and it’s bc Dr’s are keeping their patients on these suboxone regiments and IMO its criminal. What aide is going to help you get off off a suboxone addiction?

  • Stone crandall, do people a favor and maybe consider not mentioning suboxone to people who want to get clean. If they take it even a month its harder to get off of. More so than heroin let alone oxycodone. Most people will not just take 2 8mg strips like you did once they try it. I speak from experience. 8 years on suboxone._.It was powerful enough to highjack my heroin addiction and keep my drug seeking brain satisfied. The withdrawals lasted almost 2 months and im going through paws a year later. Suboxone has the potential to highjack a persons brain and fuck it up worse than heroin ever did. 8 years of that stuff constantly in the brain, never sober for a moment. Im suffering big psych and mood probs obviously. Giving people suboxone to combat a persons addiction is like giving jason voorhees a two handed sword to combat his machete murder addiction. And yes potentially suboxone is a MUCH bigger blade to an addict brain. And the problem only grows.

  • 17 years opiate dependent, 7 in abuse, 10, years on a stable dose of 90 mg. of methadone daily with no abuse of ANY substance. ( ican’t explain that part) I had my meds prescribed. I have never been on “clinic” slavery. God bless you who have.
    My CT date is Aug 7th, 2017. I did not even get sick until after 10 days.. I kicked at home and my wife played nurse maid. My pain doctor cut me off because of weed that he knew I smoked.. My wife took me back to his office where he agreed to restart the meds but I refused. I dunno, he said the wrong things…. I saw my out. I am OUT! Out into the PAWS! I made it through CT with vodka and a few benzos. Being a man who has kicked before I was surprised to find that the booze helped provide sleep. I HATE VODKA! It was Nov. 11th of 2017 when I felt good enough to go to a concert. My only other public outtings were to visit a friend just to move or driving my kids here and there.. First week of December now and feeling better. Pain without dope is a bitch but manageable. I have no urges, again, I can not account for this but a theory is brewing, stay tuned.
    Currently my brain is in high gear. I will call it manic but not depressive.. I can consume knowledge at breakneck speed and decipher my conclusions with precise consideration over a wide spectrum.. Clarity at the drop of a dime. I have Valium and/or adderall to stop this but It seems to care for itself.. Weed is cool because it calms without stopping the “THINKING”.! I like this thinking. It is however burdensome to my family. Well, I have to get validation somewhere! So, a friend has just got out of Jail. He is the son of a friend who died at age 27. So he must go to those blasted AA meetings that become our next addiction.. I took him and it seems that I may have something to offer these troubled dolts.
    Our addiction never leaves us and I mean never. I used because my brain questions theses societal norms imposed upon me, (us). I could only pretend for so long before i needed to self sooth. I am a square peg. I do not belong in or with society. I am a tree on the forests edge and I am HAPPY FOR THAT! The train wreck was over ages ago. My last kick had no guilt. No hurt. It was a necessary step to a real freedom that awaits. I am slowing after about 7 days of high octane brain activity. There is no depression. Sans the shackles of methadone I can see hope and opportunity. I should quickly state that marijuana is the only HERB that I use with any regularity. I smoke 3-4 times a week at night while walking my dog. Valium, 10mg, 3-4 tablets a MONTH, 10mg of aderall if i go to a concert and need to be awake to drive home. I have no idea how I can even be in possession of these drugs without abusing them. My wife does not even hide them from me… It may have something to do with a head injury suffered in march of 07. Okay, meeting time! Stay tuned…

  • Derek is exactly right! I became dependant on oxy’s after car accident and 3 major surgeries to my spine, nerve damage, arthritis, joint pain and few other issues I was in pain management for 15 yrs my pill cocktail was 4 to 6 oxy 10’s, klonopin anxiety, cymbalta depression and nerve damage, Lyrica fybro, nuvigil to wake me up and get through day and last an Ambien to put me to sleep. How crazy is this! I depended on a different pill every day to make my body function the way my our bodies are meant to function on there on therefore I realize that meds aren’t helping anymore and my Dr won’t listen to me kept giving same Rx’s until I realized I didn’t know who I was anymore! I was depressed, socially withdrawn even with family, I didn’t leave the house except for Dr appts. I quit taking care of me I lost control of my life and I’ve always been strong and independent and in control of my life and all of a sudden I found myself in the darkest place I didn’t know what to do or how I got there after all I was seeing my Dr and doing what he said I had to to be able to function and have some kind of normal in my life cause I had to live with the pain rest of my life but what the Drs don’t tell you is where those Rx’s he keeps giving will destroy you day by day and you won’t realize until it’s almost too late and some never realize it at all. Dr’s are the reason for most of us yet there’s no one I found to help me except to trade one med for another. I finally told Dr I didn’t want his Rx’s that I was done and since he took part in me getting this low he was going to get me out. So what did he do, sent me to psych Dr that put me on saboxone well I was decieved there to so after 3 months and he wants to write another Rx and I said oh no I went home and quit cold turkey but I nearly died it was worst withdrawals I have ever been through so I got referral to a Dr that has a clinic outpatient recovery and they only Rx saboxone and Subutex. My 1st appt I explained all this he put me on Subutex 16mg a day. It’s suppose to be a short time treatment I was on it almost 2byrs I decided to quit once and for all at home cold turkey cause I knew as long as I was giving them my money they would give me Rx and they don’t want to help you get free it’s a money game. Anyway, I’m on day 60 off subs and first 2 weeks were the hardest but not as bad as coming off saboxone or oxy’s. I think I am going through paws I still don’t have much energy, have headaches almost daily. When will my energy and my motivation to get things done come back? I am so ready to be normal again and my energy level and anxiety are the issues I have daily. Any advice

  • Trust me on this,only stay on subutex or suboxone a very short time.I was on 14 mg subs daily for ten years due to a three year lortab addiction.I had gone through withdrawal 3 times from stopping lortab and all was better after 3 weeks.However stopping subs after 10 years was far more difficult.Withdrawal much more intense,and paws that lasted around 3 years.I stopped subs 2012 and although i feel much,much better i still get days that i don’t feel all that great.I would never go back to that miserable existence on suboxone.Life is much more enjoyable now.

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