Post-Acute Withdrawal Syndrome and Alcohol: A Guide To Understanding PAWS
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Post-Acute Withdrawal Syndrome and Alcohol: A Guide To Understanding PAWS

“Recovery is real, it works and it’s happening every day.”  – Laurie Dhue

Sobriety has many moving parts and is a complex process. One thing that can get in the way of moving forward in the recovery of an alcohol use disorder is a phenomenon known as post-acute withdrawal syndrome (PAWS) – also known as “dry drunk syndrome.”  

PAWS refers to withdrawal symptoms you may have after the acute withdrawal or detox phase of recovery from alcohol or drugs. While acute withdrawal symptoms generally resolve in a few weeks, PAWS symptoms can last for as long as two years (Substance Abuse and Mental Health Services Administration). In the case of recovering from an alcohol use disorder, PAWS is when an individual continues to behave as if he or she is still addicted to alcohol, even though they have been sober for some time. They haven’t made the behavioral or emotional changes necessary to move forward in their sobriety. They may also look like they are intoxicated or exhibit physical symptoms similar to withdrawal even though he or she has been entirely abstinent. If not appropriately managed, PAWS can trigger a relapse or even lead to suicide. 

What are the symptoms of PAWS?

It’s essential to understand and recognize the symptoms of PAWS syndrome, and not mistake them for something else. There is a myriad of symptoms associated with post-acute withdrawal syndrome and this is not an exhaustive list. However, some of the more commonly found ones are:

  • Physical symptoms can include slow reflexes, dizziness, tremors, and issues with balance and coordination. Unexplained pain and physical complaints as well as memory lapses.
  • Little to no tolerance for stress, even everyday stressors.
  • Engaging in impulsive and risky acts, with little or no regard for how his or her behavior may cause harm. 
  • Stopped drinking, but still turns to other substances to cope with stress.
  • Becoming nostalgic about or romanticizing alcohol. 
  • Consistently living in negativity, feelings of self-pity and deep feelings of helplessness. Believing they failed to “recover” and that rehab programs are a waste of time.
  • Stop doing activities/hobbies once enjoyed or lost the will to rebuild their lives.
  • Cognitive impairment such as mood swings and difficulty concentrating. 
  • Little to no recognition that things need to change. The person refuses to accept that he or she is in long-term recovery and needs to do the behavioral, emotional, and physical work it takes to change his or her life.

What causes PAWS?

PAWS is a multi-layered syndrome, with no one-specific cause. However, PAWS is usually brought on by actual physiological changes that occur in the brain after it readjusts to being without alcohol. During active addiction, the brain goes through significant chemical changes. After detox, the brain needs time to heal, reset and begin its natural production of chemicals. These changes can lead to behavioral and emotional shifts that can cause a person to give up on their sobriety and/or behave as though they are still drinking. If an individual stops intensive counseling and does not learn alternative healthy coping mechanisms, he/she will not be able to deal with stress or negative emotions successfully and will naturally fall back into their old patterns. Without these mechanisms in place, some people resist completing all the steps of their rehab program; they feel they “don’t need it.” Without these much-needed support systems, guidance, and recovery tools in place, individuals will not be able to identify and alter unhealthy behavioral responses – allowing discouragement, frustration, and depression to set in. If not treated early, the symptoms of PAWS can spiral out of control and lead to relapse, even death.

How can you avoid PAWS?

PAWS can be avoided by treating the behavioral and emotional issues of an alcohol use disorder at the source. Professional rehabilitation treatment, following the steps, group support, and counseling are the keys to a full and lasting recovery. Don’t be afraid to discuss any of the above symptoms with your family, sponsor, counselor, or anyone who will not question or minimize your experiences. If you understand what the symptoms of PAWS are, you are in a position to manage them. Successful treatment of the syndrome will help you feel better physically and emotionally, improve your self-esteem, and reduce your risk of relapse.

Alcohol Use Disorder, PAWS, and Treatment

Whether you or a loved one has PAWS, understand it is treatable. The syndrome does not mean you’ve lost your chance at sobriety. You can get back on the right track and recommit to recovery through the right support and treatment. If you or a loved one is battling addiction or a substance use disorder, get help today—contact Daylight Recovery Services at 1-833-2DAYLIGHT. There is no cure for addiction, but recovery is possible. 

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