Post Acute Withdrawal Syndrome (PAWS)

by Simon Olstein, MD, SACS, RYT; Medical Director, Scottsdale Treatment, Inc.; Board Certified in Addiction Medicine; American Society of Addiction Medicine

Post Acute Withdrawal Syndrome (PAWS) is a group of symptoms that results from the combination of damage to the nervous system caused by alcohol or drugs and the stress of coping with life without alcohol or drugs. The severity of the symptoms of PAWS depends on two things: the amount of brain dysfunction caused by the addiction and the amount of stress experienced in recovery. The symptoms can begin one to two weeks into sobriety and usually grow to peak intensity over the next three to six months. The damage is usually reversible, meaning the majority of symptoms will go away with time if proper treatment is received. But the adjustment doesn’t occur rapidly. Recovery from the nervous system damage usually requires six to twenty-four months with the assistance of a healthy recovery program.

There are six kinds of symptoms that make up PAWS although not everybody experiences every one of them all the time. These symptoms are: inability to think clearly (including difficulty with concentration), memory problems (especially with short-term memory), emotional overreaction or numbness (including unexplained mood swings), sleep disturbances (including unusual or disturbing dreams), physical coordination problems (occasionally making someone appear drunk even though they haven’t been drinking), and problems in managing stress.

Issues relating to stress play a particularly important role in recovery. Recovery itself is a very stressful process because of all the changes one needs to make. Increased stress causes worsening of PAWS symptoms and the severity of PAWS increases stress which makes it more difficult to deal with the stress. One thus creates a classic vicious circle. Much of a successful recovery program revolves around the recognition of and management of stress. That’s where individual counseling and group therapy and self-help groups can lend a hand. It’s in these settings that you can learn new techniques and abilities such as relaxation exercises and coping skills to help you manage stress and PAWS symptoms when they occur.