Post Acute Withdrawal Syndrome: 6 Signs of PAWS You Need To Know

Are you wondering why you’ve stopped using drugs or alcohol, only to find you still don’t feel great?

Has it been 3, 6, or 9 months since you stopped using, and you still don’t feel like you are back to yourself?

In this post, I hope to clarify for you what you might be experiencing – Post Acute Withdrawal Syndrome (PAWS).  Knowing the symptoms you are experiencing and their origin can be the next step for you in making changes to enhance your recovery and quality of life. 

Many people experience PAWS symptoms in early recovery.

PAWS can look different for everyone, depending on the types of substances that were used during active addiction, and the length of time the substances were used.

Although there are differences, many people in early recovery experience some combination of the following six symptoms. If you look over this list of symptoms and have an “aha” moment, you are not alone!

Many people don’t know why they feel the way they feel in early recovery. My hope is that the following information will help you to develop increased understanding of what your body and brain are going through in early recovery.  

1.     Stress Sensitivity

Have you found yourself overreacting to minor stressful situations? A small problem that should produce a minimal amount of stress instead producing an overwhelming amount of stress for you?  This is an example of your brain and body adjusting to the “normalness” of life without substances. An example could be feeling heightened stress at work or school, with tasks that normally do not feel quite as stressful like an additional assignment.

2.     Sleep disturbance

People experiencing PAWS may have trouble falling asleep, trouble staying asleep, or even waking up throughout the night and having difficulty getting back to sleep. Again, this is the brain’s way of adjusting to “normal” restful sleep without any substances to help.

3.     Difficulty thinking clearly

This could be having a hard time making decisions, even minor ones like what to eat for dinner. This could also look like difficulty concentrating at school or at work, or even just feeling as if you are in a fog.

4.     Difficulty managing emotions

Usually people fall into 2 categories with this – emotional overreactions or emotional numbness. Some clients have shared they have even experienced both, at different time periods.

5.     Physical coordination

People experiencing PAWS might have difficulty with balance, fine motor skills, or even hand-eye coordination. Some people have described feeling incredibly clumsy, even though they have never been that way before.

6.     Memory

PAWS tends to affect short term memory. A great example is learning something new and not being able to retain the information, such as learning a new concept in therapy. Another example might be not remembering the few things you need to pick up at the store, even though your spouse just told you an hour before.

If you are in early recovery and experiencing these symptoms, there is a good chance you are experiencing PAWS.

For many clients, knowing this information AND knowing what to do with it can be part of the key to their recovery. Knowing that you have stress sensitivity and learning how to manage it and the emotional reactions that go along with it could be the difference between staying clean versus a relapse.

Early recovery is also a time period when brain chemicals are trying to find their way back to balanced, so it is an especially susceptible time for relapse.

Knowing these symptoms and the tools to cope with them will only help to solidify your recovery!

4 Tips for Getting Back on Track after a Relapse

Suffering from an addiction can be devastating.  Even once in recovery, the constant fear of relapse can make the addiction seem all the more terrifying -- to both the substance abuser and their loved ones.

The experience of relapse is common among individuals in recovery from addiction. It happens to those who have been sober for only a few days, as well as to people who have been in recovery for years, maybe even decades.

Is relapse inevitable? No, not always, but it seems more common than not.  The National Institute on Drug Abuse (NIDA) estimates relapse rates to be between 40-60%. It surprises many people to hear that this percentage range is similar to the rates of relapse for other chronic illnesses, like diabetes, asthma, or high blood pressure!

The good news is that even if there has been a relapse (often referred to as a “slip” or “lapse” early on), the addict can choose to get back on the track of recovery at any point in time.  

Some of what I have learned about the recovery process comes from keeping up-to-date on scientific research. But invaluable knowledge also comes from my professional experience, and seeing how real people have successfully overcome their addictive behaviors.

Below are four tried-and-true ways of getting back on the path to recovery:

1.  Tell someone.

The simple act of confiding in a person who’s supportive of you is worth its weight in gold. It’s amazing what can happen, once we speak the truth out loud. First of all, taking this single step can really lighten the load. Once we have shared about our substance use with someone else, we have also shared the burden, and no longer have to shoulder that weight on our own.

Opening up to someone we trust can provide us with non-judgmental support, encouragement, or even advice on what to do or where to go.  This confidant might be able to help with the logistics that seem overwhelming, such as helping you get to a meeting, or calling your therapist to schedule an emergency appointment.

We might even have the benefit of the other person’s experience, perhaps sharing what helped them during similar circumstances, or even a time they relapsed.

2.  Make a game plan.

Once you have chosen to get back on track with recovery, and have told someone else what is going on, you should come up with a game plan. This might include getting the substances out of the house, scheduling an appointment with your therapist, finding a local 12-step meeting, or coming up with a schedule to stay busy.

Many people who struggle with alcohol or drug abuse find that free time and boredom can be huge triggers for them. This is the number one reason to create a schedule – planning down to the very minute where you are going to be, who you will be with, and what you will be doing to minimize your free time. It’s like the saying: “Those who fail to plan, plan to fail.”

3.  Don’t beat yourself up.

Okay, so you’ve relapsed.  You are most likely going to start beating yourself up about it: “I can’t believe I let this happen…I was doing so well….I just threw it all down the drain.” The danger in this line of thinking is that it has great potential to pull you even further back into your addiction, instead of getting you back on the road to recovery. 

Negative thinking can also increase feelings of guilt and shame, which are often emotional triggers for relapse, or remaining in the relapse. I’m not saying that you can’t take some time to process what has happened. It’s natural and common to feel bad about it. Lots of people feel guilt, shame, or remorse.

What I am saying is not to let those thoughts and feelings dictate what happens next. Learn from what happened, and move forward.

4.  Do a relapse analysis.

Relapse is not an event, but a process. Odds are, the relapse episode did not begin when you took the drug or drink. Often, things happen before you use that indicate the beginning of the relapse.

Once you identify your behavior patterns, this can help you recognize and interrupt the relapse next time around.  Usually the best way to do the analysis is by looking for possible triggers that occurred in the days/weeks leading up to the relapse. 

Take note of events that may have happened at work, in your personal life, in treatment, differences in your behavior patterns, any relapse thoughts you can identify, or any changes in health status. Also be sure to look at your feelings associated with any events that occurred, and how that could have increased your chances of relapse.

Just because a relapse has happened doesn’t mean you can’t get back on track. Using these four tips can be extremely helpful in moving forward with your recovery. 

5 Common Challenges in Early Recovery from Addiction

Setting off down the path of recovery from substance use or addiction can be anywhere from challenging to downright terrifying.

I’ve heard some clients describe feeling paralyzed with fear, not even knowing how to go about their day, because they literally have no idea how to live their life without using alcohol or drugs - almost as if they are having to learn how to walk again. However, knowing is half the battle, right?

Here is some of what I have learned from former clients, about their most difficult challenges, during this phase of early recovery from addiction:

 1.    Friends and Associates Who Use

Many clients, just beginning their addiction treatment process, have shared that being around current addicts was their #1 trigger to relapse. We’ve all heard that misery loves company, and lots of us have actually found this to be true.  

People in recovery also quickly find out who their true friends are: the ones supporting them in overcoming addiction -- NOT the ones offering them a beer, or inviting them to places where they know the likelihood of substance use is high.

Separating yourself from negative influences, and surrounding yourself with people who have similar goals and support you, is going to increase your probability of success in early recovery.

 2.    High Sensitivity to Stress

One of the most commonly reported symptoms of Post-Acute Withdrawal Syndrome (PAWS) in early recovery is stress sensitivity, which can sometimes look like anger and irritability. Your body and brain are readjusting to life without chemicals.

The feel-good chemicals in your brain, such as dopamine, are at an all-time low and the natural highs (things like being around family, eating your favorite food, watching a funny movie) just aren’t doing it for you. This can be incredibly challenging, because you know just what you need to feel better quick – drugs or alcohol!

The good news is: Your brain will eventually adjust, the mood swings and stress sensitivity will die down, and the natural highs will start working again. In the meantime, being aware that this is just part of the process, can be a huge help.

3.    Substances in the Home

Being around substances during early recovery from addiction can be a major trigger. If you want to increase your chances of staying clean, the best idea is stay away from all substances --even if it’s a substance that has never been a “drug of choice” for you.  There may be a certain type of beer you’ve never cared for in the refrigerator, but chances are, you know it will do in a pinch.

Without going into too much detail, I’ll just say that our brain works in fascinating ways, and reactions can be triggering without our conscious-selves even being aware.  I’m talking within milliseconds here, our brains can recognize a potential high, and we won’t even consciously notice.

Add that to being extremely sensitive to stress, having mood swings seemingly out of nowhere, and difficulty finding pleasure due to dopamine depletion in our brain…hopefully you are starting to imagine the potential consequences.

This is why we don’t see (or encourage) alcoholics to drink non-alcoholic beer. Sooner or later, it triggers those places in our brain to want the real thing. The best plan of action is to keep any and all substances, and related paraphernalia, out of the house. Your family and/or roommates should understand. If not, it might even be worth looking for another place to live.

4.    Boredom and Loneliness

 Remember at the start of this post, I mentioned a former client who shared with me that he wasn’t sure how to go about living his life during recovery? This was because he had spent most of his free time doing things related to using, before he entered into sobriety.

Once he was in recovery, he needed to find other things to occupy his time, and QUICK. Sitting around with nothing to do was not going to work for him, and as it turns out, that doesn’t really work for anyone who is fresh in recovery. 

During times of boredom and loneliness, our brains tend to start thinking about what we used to do when we were bored (before recovery), and who we used to hang out with (before recovery).  We remember those unnatural highs (the substance-inducing kind), and without anyone or anything around to slap us back into reality… well, you know where this story leads.

That’s why allowing ourselves to become bored and lonely in early recovery is not an option, and why sometimes planning our days out, even down to every 15-minute interval, is what we have to do.

5.    Special Occasions

 Early recovery from addiction can be extremely difficult. It can also be really awesome too. Sometimes this is referred to as the “honeymoon phase” or being on the “pink cloud.”

This can be a risky time though. Because this can also be a time when we are proud of ourselves, we might want to reward ourselves for doing so well.  Especially on a special occasion, like a holiday or at a party….with a drink.

In early recovery, special occasions are best approached with planning ahead. And hey….if you are doing well and are proud of yourself, you should reward yourself!  Just find a different way to do so – have a nice meal, treat yourself to a massage, etc.

So there you have it! Five of the most common challenges in early recovery from addiction. Once we know our biggest triggers, we can then set in motion how to either avoid them, or cope with them. And if we don’t know, we can always find someone who supports us and get their assistance. 

Reach out for help today, and regain control of your life. Set yourself free from addiction.