“Am I Going Crazy?!”

PAWS: Post Acute Withdrawal Syndrome
by Bill Abbott & Suzy W., SMART Recovery Meeting Facilitators

Post-Acute Withdrawal Syndrome (PAWS) is something that perhaps unfortunately, we haven’t discussed much in SMART Recovery®. It is a not yet widely known problematic syndrome (syndrome is a medical term which describes a grouping of varying symptoms) of addiction recovery. The following scenario can illustrate it:

You’ve been through detox and all of the withdrawal symptoms and you are doing pretty well for perhaps a month or two. Suddenly, you start to realize that you’re feeling edgy and antsy. You are experiencing mood swings that range from being on a pink cloud to feeling down in the dumps. You find that you can’t concentrate. You are having trouble sleeping, you’re sleeping too much, or you’re having very vivid dreams. “What’s going on?” you wonder. “Am I going crazy?!”

No, you’re not going crazy. You are suffering from what is known as PAWS (Post-Acute Withdrawal Syndrome). Unfortunately, as noted above, we don’t often hear much about it in the recovery community even though it is an extremely common experience.

We know that recovery progresses in stages. After the initial acute withdrawal, one can enter a second phase of withdrawal symptoms. Weeks to months into recovery, a variety of symptoms can occur such as described above. Here we will discuss PAWS in some detail because understanding it can aid in successful recovery.

In a recent study of a large number of patients it was discovered that between 70% and 90% of people experience symptoms of PAWS. The number affected depended upon what the substance of abuse was: about 70% of former alcohol users and as high as 90% for former opiate users. These numbers are very high!

Mind you, usually the symptoms of PAWS are mild and not too troublesome. However, in some people the symptoms can be extremely bothersome, to the point of people thinking that they are losing it. Intense urges are a big part of PAWS and some consider this to be the number one cause of relapse within the first year.

PAWS can last for varying periods of time and be of varying intensity with the duration usually being measured in months – occasionally over a year. The good news however is that, barring relapse, the symptoms will go away. Like urges, they decrease in frequency and intensity with time.

The list of the various symptoms of PAWS is quite long! It includes 20 symptoms. The following list presents some of the most prominent:

• • Urges and cravings

• • Sleep disturbances – insomnia, hypersomnia (too much sleep) or vivid dreams

• • Mood swings – from depression to euphoria

• • Anhedonia – technical term for the inability to feel pleasure

• • Trouble concentrating

• • Anxiety and even panic

• • Memory problems

• • Irritability or edginess

• Fine motor coordination problems

Symptoms are not always present — they occur intermittently.

Symptoms are made worse by stress or other triggers and may arise at unexpected times and for no apparent reason. They may last for a short period of time or for a long time. Any of the following situations may trigger a temporary return to, or worsening of, the symptoms of post-acute withdrawal syndrome:

• • Stressful and/or frustrating situations

• • Multitasking

• • Feelings of anxiety, fearfulness or anger

• • Social conflicts

• Unrealistic expectations of oneself

There is little in the way of specific therapy for PAWS. That said, if the symptoms are prominent, it is wise to consult one’s physician because certain medications may be helpful. If you’re consulting with your regular physician you might mention that you believe you are experiencing PAWS. Perhaps like you, your physician might not be aware of the syndrome’s existence.

Mindful Awareness Practice is likely to be helpful as well. Also, SMART tools such as urge-surfing are always there for you.

The science in SMART Recovery tells of something called neuroplasticity. In review, neuroplasticity is the phenomenon whereby during the development of a new maladaptive behavior, such as the repeated use of a mind-altering substance, the repeated and habitual use of the substance leads to changes in the brain. Neuroplasticity also aids in the reverse process, which is good news. Once you have become abstinent from the mind-altering substance via your new behaviors, thoughts and feelings, the brain will rewire itself back to, or nearly to, your pre-addicted state. Thus, it is likely that PAWS is due to that very rewiring of the neural circuitry. Remember, neurons that fire together wire together.

Although there’s no easy remedy for getting through PAWS, it is often a great help to know that you’re not going crazy. PAWS is just a temporary set of symptoms, which you can accept, knowing that it is merely evidence that your brain is healing.

PAWS helps you recover!!!

Bill Abbott and Suzy W. are SMART volunteers who, along with other SMART volunteer activities, both facilitate weekly SMART meetings in the Boston area.