13 Signs You’re Suffering from PAWS

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 855-534-3574. 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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Why a Medical Detox Program is Needed Before Rehab

Addiction isn’t a disease that occurs overnight. The prelude to addiction is reckless experimentation with substance abuse. Individuals either become curious about recreational intoxication or begin misusing mind-altering substances while the body becomes increasingly dependent on frequent consumption.

When the body becomes dependent on alcohol or drugs, an individual must imbibe several times throughout the day in order to keep withdrawal symptoms at bay. Withdrawal can range from mildly uncomfortable to debilitating and even life-threatening, which is why addicts continue their substance abuse and oftentimes fear the recovery process.

However, recovery isn’t an overnight process either. When an individual decides to overcome his or her dependency on chemical substances, a process begins. Embarking on the journey of recovery means exploring treatment options, learning about the different types of rehabilitative programming and the treatments that work best for particular needs, determining whether there’s a particular area or region in which one would prefer to recover, whether a facility accepts certain types of health insurance and a number of other considerations.

Moreover, many individuals who suffer from alcohol or drug addiction will need to detox before beginning an actual program. Though not always required, a detox program is an important part of the rehabilitation process and can even be safer than detoxing on your own.

Why is Detoxing at Home Risky?

women with prescription pill addiction

After abusing chemical substances several times a day for years or even decades, addicts’ bodies have become dependent on their substance abuse for even natural functions and processes. In particular, the brain begins relying on an individual’s imbibing alcohol or drugs in order to trigger a production of important neurochemicals, unable to maintain minimum levels without the addict’s substance abuse.

When someone whose body has become chemically dependent ceases his or her substance abuse, the individual promptly begins to experience symptoms of withdrawal. The most common symptoms of withdrawal include sweating, hot flashes and cold chills, trembling and shaking, nausea, diarrhea and/or vomiting, anxiety, depression, agitation, loss of appetite, lethargy, and headaches. In short, mild to moderate withdrawal can produce symptoms that are similar to experiencing a cold or the flu, persisting for approximately a week at peak intensity. However, the detox processes for some substances are worse than others.

In instances where an individual’s addiction is very severe—such as having been in the throes of active addiction for many years—it follows that his or her withdrawal during detoxification will be more severe. In addition to those mentioned above, symptoms of severe withdrawal can include hallucinations, confusion, racing heartbeat, fever, and even seizures. If the individual’s addiction is to alcohol, this can even include a condition known as delirium tremens, a condition that occurs as a result of an alcoholic’s severe withdrawal and which directly affects the individual’s nervous system. Severe withdrawal is not only uncomfortable to the point of being quite painful but can even be a major health risk to the point of threatening one’s life.

What is a Medical Detox Program?

There are many components to the process of overcoming addiction to alcohol and drugs. When one thinks of rehabilitation, one often thinks of psychotherapy and the treatments involved, but an important precursor to the treatment phase is detoxification. Detoxing is the process of ridding or cleansing the body of the harmful substances and other toxins that individuals put into their bodies while in active addiction.

During detox, individuals will experience the onset of withdrawal symptoms and progress through them until the symptoms begin to subside. Although it’s possible to do this at home on one’s own, it’s generally not advised due to the dangers involved in unsupervised detoxification. A medical detox program is a period that precedes addiction treatment and allows those beginning the recovery process to detox in a controlled, supervised setting, benefitting from continuous monitoring and care by physicians and healthcare professionals.

Benefits of Completing a Medical Detox Program Before Addiction Treatment

women in drug and alcohol detox

There are a number of benefits to completing one’s detoxification in a medical detox program rather than attempting to detox at home while unsupervised. By detoxing under medical supervision, individuals’ withdrawal symptoms can be monitored in order to make sure that they don’t become potentially harmful or life-threatening, which ensures their safety during the detox process. Additionally, this continuous supervision affords medical care that individuals wouldn’t receive when detoxing at home.

If an individual’s withdrawal symptoms become severe and uncomfortable along the detox timeline, physicians can administer medicinal treatments in order to help alleviate some of the discomfort of withdrawal and make the process easier. The medications that can be administered during a medical detox program can not only alleviate the physical symptoms, but they can also help to eliminate or reduce the cravings individuals have during withdrawal. With the aid of nutritional supplements and other non-addictive medications, individuals’ bodies are cleansed and returned to a state of physical health and wellness.

Upon completion of a medical detoxification program, individuals will have overcome the physical components of addiction or be only experiencing negligible post-acute symptoms of physical dependency. This allows them to begin the actual treatment phase of recovery while being able to focus on overcoming the psychological aspects of addiction. Medical detox programs are designed to help individuals achieve physical wellness so that they can learn more about addiction, the factors that led to their development of addiction, and learn a number of strategies and skills that will help them to maintain sobriety long-term.

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There are many ways to achieve recovery, but by taking advantage of a medical detox program individuals can significantly increase their chances of success in treatment. If you or someone you love is suffering from addiction and would like to learn more about medical detoxification and other treatment programs, call the Palm Beach Institute at 1-855-534-3574 or contact us online. We have a team of recovery specialists available to help match individuals to the treatments that address their needs, allowing them to return to a state of sobriety, health, and wellness.

Detox Timeline: How Long Does it Take?

Medical detoxification is an essential part of early recovery, in which the symptoms associated with drug use are minimized to the point where the addict becomes stable enough to enter treatment. Detox is an important piece of recovery, but the discomfort that can be associated with the process may cause apprehension.

While pre-existing health issues, mental conditions, and use of other drugs can lengthen the detox timeline, there are general timelines in which people can expect to be in detox. The following are timelines broken down by drug type, as well as what to expect during detox.

Alcohol Detox Timeline


Alcohol detoxification needs to take place in a medically-supervised inpatient setting, due to the rapid onset of withdrawal symptoms. And, the overall detox timeline can last about a week. Withdrawal symptoms usually start 6 to 24 hours after the last drink.

Patients can experience tremors, restlessness, nausea, and impaired judgment. The more severe of these symptoms usually occur within the first 48 hours, so medical monitoring is highly recommended. Continued medical supervision may be needed for a few days afterward, due to the possibility of hallucinations and seizures, which can be deadly.

Drugs such as Dilantin and Clonidine can be used to relieve withdrawal symptoms, especially if the patient has seizures or experiences delirium. Depending on the overall health of the patient, those with even moderate withdrawal symptoms may benefit from medications in the detox process. Other drugs that may be used include Diazepam, Ativan, and Tegretol.

Opiate Detox Timeline

While opiate withdrawal does not pose significant medical dangers, it can be intensely uncomfortable and unpleasant in which medical monitoring is recommended. The opiate detox timeline can last 5 to 10 days, in which patients are closely monitored and throughout the detox process and given the appropriate medication to prevent severe withdrawal symptoms such as diarrhea, vomiting, and agitation. While detoxing from opiates, there is a tapering (a decrease of dosage) of a substance that is related to the original drug of abuse that is now substituted to prevent withdrawal.

Methadone is a commonly-used drug in the detox timeline, but it also has a high potential for abuse and needs to be carefully monitored by medical personnel. Other drugs, such as Suboxone and Naltrexone, are being used more frequently in the detox process due to the lower risk for addiction. However, both of these drugs still need to be administered under close medical supervision.

Benzodiazepine Detox Timeline

Hand of nurse giving patient medication

Like opiate detox, “benzo” detox generally lasts between 5 and 10 days. Medical detox is crucial, due to the severity of withdrawal symptoms and especially the psychological symptoms. Those who are withdrawing from benzos can experience psychological symptoms that can mimic schizophrenia and other forms of psychosis.

Additionally, benzodiazepines, such as Xanax, are commonly used with other drugs, like alcohol. Therefore, it is crucial those with benzodiazepine addiction undergo detoxification immediately.

Currently, there are no drugs that are FDA-approved in the management of benzo withdrawal symptoms. However, drugs such as Flumazenil and Catapres are commonly used to minimize both the physical and psychological withdrawal symptoms. Along with medical detoxification, it is common those who are withdrawing from benzodiazepines can also utilize IV therapy.

Is Detox Needed for Drugs with No Physical Withdrawal Symptoms?

There are some drugs that have little to no physical withdrawal symptoms. Even though the physical symptoms aren’t present, the psychological withdrawals may warrant inpatient drug detoxification. For example, cocaine shows little to no physical symptoms of withdrawal but the psychological cravings and dependence on the drug create intense discomfort. In these cases, cocaine detox is recommended, and can last for a few days but not longer than a week.

Marijuana is another example of a drug with little or no physical withdrawal symptoms, but have pronounced psychological symptoms such as depression and anxiety. For those withdrawing from marijuana, the detox process can last several weeks since THC, the active compound in marijuana, is stored in the body’s fat cells. However, the extent of detox would be the monitoring of psychological symptoms and any co-occurring mental disorders.

The Palm Beach Institute offers a comprehensive treatment approach, including a full range of medically-supervised detox services. If you or a loved one is suffering from addiction, contact us today at 1-855-534-3574.

What Drugs Have the Worst Detoxes?

There are many mind-altering substances to which a person could become addicted, each offering its own risks and dangers. However, it goes without saying that some substances are more addictive and dangerous than others.

Additionally, while the use and misuse of certain substances are more dangerous than others, there’s also the fact that detoxing from certain substances can be particularly risky as well. Therefore, the following will explain the purpose of detoxification and name the drugs that are known for having the most difficult or worst detox processes.

What Exactly is the Purpose of Detox Treatment?

When it comes to addiction, there are two sides to the disease: the physical and the psychological. Before an individual can overcome the psychological aspects of dependency — which is essential in order to achieve long-lasting sobriety — he or she must overcome physical dependency, which is the purpose of detox treatment.

When an individual begins detox treatment, he or she typically resides in a special detox facility while receiving care and being monitored by physicians and other treatment providers.

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The purpose of detoxing in a facility is to ensure that an individual’s detoxification progresses smoothly without endangering the patient’s life; moreover, detoxing under supervision means the patient’s symptoms can be treated with so-called “comfort medications” in order to alleviate some of the severity of withdrawal.

In short, the purpose of detox treatment is to cleanse an individual’s body of toxins and other harmful substances, helping him or her to overcome physical dependency in order to begin receiving treatment for psychological dependency.

Heroin Detox

heroin worst detox

Considered by most to be the most addictive drug there is, heroin is an opioid that’s derived from the opium obtained from a special poppy. The substance bonds with the brain’s opiate receptors, causing a sedative effect while relaxing the individual and alleviating any pain or physical discomfort.

The drug also causes a spike in the levels of certain neurochemicals that activate the reward and pleasure circuits in the brain. When deprived of the drug, individuals who are addicted to heroin undergo intense withdrawals that make it one of the worst detox experiences.

During heroin detox treatment, individuals sometimes receive medications like methadone, Suboxone or Subutex (buprenorphine), clonidine or even mild benzodiazepines to alleviate some of the discomforts of withdrawal.

Unfortunately, many heroin addicts experience post-acute withdrawal symptoms for months or even years after becoming sober. However, detox treatment helps with the most severe symptoms and helps individuals become ready to receive heroin addiction treatments.

Alcohol Detox

Alcohol Worst Detox

One could call alcoholism the original addiction as it allowed us to gain a better understanding of substance abuse and addiction as a whole. Alcohol is a very highly addictive substance that’s difficult for alcoholics to give up. Compared to most other substances, the physical dependency that an alcoholic forms with alcohol is incredibly intense, making alcohol detox potentially dangerous and giving it a top spot among the worst detox experiences.

In fact, alcoholics are typically discouraged from detoxing on their own without some form of professional supervision due to the risk of several life-threatening conditions that are sometimes brought on by an alcoholic’s sudden cessation of alcohol. Specifically, conditions like delirium tremens, alcoholic hallucinosis, alcohol withdrawal syndrome, and a condition known as “wet brain” can occur when individuals detox from alcohol without supervision. In instances of severe alcoholism, many patients will receive medications in order to make them safer during detoxification.
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Benzodiazepine Detox

Benzodiazepine Worst Detox

Similar to alcohol, benzodiazepines are a substance to which individuals can develop incredibly strong physical dependencies. For those who are unfamiliar with them, benzodiazepines are essentially a form of tranquilizers or strong sedatives that are frequently prescribed for the treatment of anxiety, insomnia, epilepsy and similar conditions, social phobias, and prior to surgical procedures to help calm individuals down. Unfortunately, their effects make benzodiazepines a popular type of substance for abuse.

Due to their moderate to intense effects on the central nervous system, habitual use and misuse of benzodiazepines are incredibly dangerous with the drug being notoriously difficult from which to detox. When an individual dependent on benzodiazepines ceases consumption suddenly, he or she is at risk of experiencing severe withdrawal symptoms, which can even include seizures; as such, it’s crucial that those addicted to benzodiazepines detox is in supervised, medical environment.

Crystal Methamphetamine Detox

Crystal Methamphetamine Worst Detox

While there are other drugs — such as heroin — that are equally as addictive, crystal methamphetamine, or crystal meth for short, has one of the worst detoxses for more reasons than as a recreational drug. In terms of its effects, crystal meth is a stimulant with its greatest effects being to the central nervous system. During World War II, the man-made substance was often given to soldiers to help them to stay away during extended or prolonged combat.

Nowadays, crystal meth is made in patch-make, improvised home laboratory using a variety of volatile, dangerous chemicals that often cause explosions. The effects of crystal meth last for many hours with individuals frequently going on “binges” during which they’ll continue to use crystal meth for days on end.

When under the influence of meth, neurochemical levels are exceedingly high, especially with regard to dopamine. However, the high dissipates quickly, causing dopamine levels to plummet.

Additionally, long-term meth use is known to cause brain damage as well as neurotoxicity. Methamphetamine detoxification is considered one of the most difficult detoxes for a number of reasons. Some of the most common symptoms of a methamphetamine detox include depression, inability to feel happiness or pleasure, insomnia and irregular sleep patterns, paranoia, hallucinations, anxiety, physical pain throughout the body, agitation, and intense cravings.

Find a Medical Detox Program at the Palm Beach Institute

There are many treatment and recovery options available to those who are in need. At the Palm Beach Institute, our goal is to match anyone who is suffering from addiction with the programs that best address his or her needs. If you or someone you love would like to begin living a life of health and sobriety, call the Palm Beach Institute at 855-960-5456 for a free consultation and assessment.

Our specialists are available anytime, day or night, to help you or your loved one. No one should have to continue suffering from an addiction to alcohol or drugs.

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