Post Acute Withdrawal Syndrome (PAWS) is a unique pairing of symptoms that can make maintaining substance use goals challenging due to persistent and long-lasting symptoms.
Common symptoms of PAWS include low mood, cravings for substances, irritability, anxiety, decreased ability to handle stress, poor sleep, dreams involving substance use, brain fog, and low energy. These symptoms can last up to 2 years, but most often resolve after several months of stopping substances.
PAWS is caused by the brain regulating back to normal after prolonged substance use. Just like a physical injury, our brains need time to heal resulting in bothersome symptoms. Looking deeper, our understanding is that PAWS is caused by dysfunction in parts of the brain called the nucleus accumbens and prefrontal cortex.
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Acute Withdrawal symptoms:
- Occurs for 1-2 weeks after stopping a substance. See below:
- Involves mostly physical symptoms.
- Symptoms are based on the substance used, but common acute withdrawal symptoms include chills, sweating, headache, stomach discomfort, diarrhea, nausea, vomiting, anxiety, and tremors.
- Withdrawal can be life-threatening if severe symptoms are present. These can include seizures, hallucinations, delusions like paranoia, dehydration, suicide.
Post Acute Withdrawal Symptoms:
- Occurs for months, weeks, or up to 2 years. Most often occurs for several months. The exact timeline lacks good research but in practice we often see what is listed below:
- Involves mostly mental or psychologic symptoms. Insomnia and cravings are most frequently seen in patients.
- Symptoms are worse with benzodiazepines and alcohol. Symptoms last the longest with stimulants.
- Common symptoms include low mood, cravings for substances, irritability, anxiety, decreased ability to handle stress, poor sleep, dreams involving substance use, brain fog, and low energy.