If there’s one thing I wish I knew when I was first getting sober, and when my son was getting clean and sober, it’s the information I’m about to share with you about post-acute withdrawal syndrome, also commonly referred to as PAWS. It would have saved me, and our family, so much needless confusion and suffering. Once I started working with individuals and family members, I began to realize that I was not the only one who was totally unaware of this critical phase of recovery. It wasn’t until I went back to school to get my PhD, and started my relapse prevention certification, that I began to learn about post-acute withdrawal, and just how important it is for the entire family to be aware of what to expect.
Most people are familiar with the acute withdrawal phase. Acute withdrawal is the physical response that occurs when the individual stops consuming the drug (alcohol or otherwise). It generally lasts between 4 to 10 days, depending on the quantity, duration and type of drug use. It’s the uncomfortable, and often dangerous, physical withdrawal symptoms that occur in response to the discontinuation of use. Many individuals, especially those who are physically addicted to alcohol, are at great risk of experiencing a life-threatening seizure during this stage. Any individual physically addicted to alcohol or other drugs should be medically monitored during this phase. Most individuals will require professional detoxification at a medical facility (detox) prior to entering residential rehabilitation.
Post-Acute Withdrawal (PAWS) is the phase that occurs after the acute phase. It generally kicks in about 14 days after acute withdrawal. It occurs in response to changes in brain chemistry, as the brain gradually returns to normal functioning. As the brain improves, the level of brain chemicals fluctuates as they approach the new equilibrium, causing the post-acute withdrawal symptoms. The most common symptoms of PAWS are mood swings, anxiety, low enthusiasm, cravings, disturbed sleep, insomnia, anhedonia, irritability, variable energy and enthusiasm, cognitive issues, memory loss, stress sensitivity, tiredness, and depression. When you’re aware of what to expect, it will make it much easier to move through the experience.
In the beginning, PAWS will feel like a roller-coaster, the symptoms will change minute to minute and hour to hour. Later in the process, the symptoms will disappear for weeks or months, only to return again. As you continue to recover, the stretches will get longer and longer. However, it’s important to be aware, the bad periods of post-acute withdrawal will be just as intense and last just as long. Generally, each episode won’t last longer than 2 or 3 days, depending on the type of drug use, quantity and duration of use. The disconcerting part is that there’s no obvious trigger for most episodes. The individual will wake up one day, after a period of feeling better, and find themselves back to feeling irritable and depressed again. This is why it’s so important for individuals and their family members to be aware of PAWS.
There’s good news and bad news about post-acute withdrawal. The good news is that the symptoms generally only last a couple of days and will lift as quickly as they started. After a while you’ll develop more confidence that you’ll be able to get through the symptoms, because each episode is time limited. The bad news, or what many perceive as the bad news, is that PAWS can last up to 2 years. Over time, the good stretches will get longer and longer. But this is where many people are at greater risk for relapse, because if you think post-acute withdrawal will only last for a few months, then you’ll get caught off-guard and you could make it worse. This is another one of those facts about recovery that most people don’t realize or want to accept. The reality of just how much time it truly takes to fully recover. With that said, keep in mind that yet another positive aspect of PAWS is the fact that every time your loved one goes through PAWS it means their brain is healing. This is definitely good news and something to embrace.
As the family member, knowing what to expect during the PAWS stage will help you be more supportive, compassionate and understanding toward your loved one, rather than responding from a place of confusion, suspicion or anger. For example, when my son was going through PAWS he struggled with significant insomnia. There would be nights when I would hear him up at all hours. This was a behavior that I also associated with his drug use and I was often fearful that he had relapsed. My own experience with insomnia kept me from acting on my fears and making unwarranted accusations. Yet, there were other symptoms that also mimicked his behavior when he was in active addiction, and it was a real challenge not to become suspicious and accusatory. Had I known about post-acute withdrawal back then, I would’ve experienced far less anxiety.
Here are 10 tips on how to survive post-acute withdrawal:
1. Be patient.
You can't hurry recovery. But you can get through it one day at a time. If you resent PAWS, you and your loved-one will become exhausted. And when you're exhausted you will risk acting out in unhealthy ways. Post-acute withdrawal symptoms are a sign that your loved-one’s brain is recovering. Therefore, don't resent them.
2. Go with the flow.
You're loved one will have lots of good days over the next two years. Enjoy them. They'll also have lots of bad days. On those days, don't try to do too much. Take care of yourself, focus on your own recovery, and you'll get through it.
3. Practice self-care.
Give yourself lots of little breaks over the next two years. Tell yourself "what I am doing is enough." Be good to yourself. Sometimes you'll feel overwhelmed. Understand this and don't over book your life. Give yourself permission to focus on your own recovery.
4. Post-acute withdrawal can be a trigger for relapse.
Your loved one will go for weeks, even months, without any withdrawal symptoms, and then one day they’ll wake up and PAWS will hit like a ton of bricks. They'll have slept badly. They'll be in a bad mood. Their energy will be low. And if you’re not prepared for it, then you have the potential to make it worse. Practice cultivating compassion.
5. Learn to relax.
When you're tense you tend to dwell on your loved-one’s symptoms and make them worse. When you're relaxed it's easier to not get caught up in them. You aren't as triggered by their symptoms which means you’re more likely to stay on track with your own recovery.
6. Practice meditation.
Learning to take back control of your thoughts, feelings and behavior is a big part of successful recovery. With some good direction, you can begin to calm your mind. Short periods of consistent meditation are more beneficial than longer sporadic meditation practice. Meditation is one of the most underrated and under-utilized aspects of successful recovery. It will do more to help you and your loved-one move through PAWS than nearly anything else.
7. Structured Daily Schedule and Consistent Sleep Habits
Insomnia and sleep disturbances are common symptoms of PAWS and one that you and your loved one can combat with a structured daily schedule and a consistent sleep schedule. Strive to maintain a structured routine, and get up and go to bed around the same time every day.
Exercise helps the body heal faster and may shorten the amount of time spent experiencing PAWS. Even something as simple as a 20-minute walk can do wonders for your mood.
9. Healthy Diet
What we eat impacts how we feel. Many people love caffeine, whether you’re in recovery or not. But it’s a good idea to keep caffeine to a minimum. Also, energy drinks can trigger parts of the brain that crave drugs. Too much sugar can also make post-acute withdrawal symptoms worse.
10. Recovery Friendships and Support
Recovery friendships add a layer of accountability to your program and provide people with whom you can confide in during times of need. Lean on these people when PAWS cycles start. Talk to them if your loved-one’s PAWS are affecting you. Ask for direction and support. They’ve been through it themselves.