13 Signs You Have Post-acute-withdrawal syndrome
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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.

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.

#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 1-855-960-5456. 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.

4 Responses to “13 Signs You’re Suffering from PAWS”

  1. 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?

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

  2. Stone Crandall

    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?

  3. Derek zoolander

    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.


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