Post-Acute Withdrawal Syndrome (PAWS)

The lingering effects of alcohol or drug withdrawal and how you can manage them

It is widely understood that withdrawal from alcohol or other drugs can involve everything from physical discomfort to life-threatening conditions. What are less known but very common are the lingering effects of withdrawal, called “post-acute withdrawal syndrome” (PAWS), which can seriously challenge sobriety.

These symptoms are a result of brain dysfunction caused by the brain readjusting to being without alcohol and drugs. Recovery from PAWS usually takes somewhere between six and 24 months. Understanding these symptoms allows you to manage them, which helps you feel better physically and emotionally, improves self-esteem, and reduces the risk of relapse.

Common PAWS Symptoms

PAWS symptoms can include:

• Inability to think clearly
• Memory problems
• Emotional overreactions or numbness
• Sleep disturbances
• Physical coordination problems
• Stress sensitivity

Managing Difficulty Thinking Clearly

Symptoms:

• Concentration problems
• Abstract thinking problems
• Circular thinking

Suggestions:

• Limit the amount of time you spend on any one task to no more than 15 minutes.
• Increase the time only when you are consistently successful.
• Give yourself permission to be a concrete thinker.

Managing Emotional Overreactions or Numbness

Symptoms:

• Feeling more intensely than a situation warrants
• Feeling “numb,” unable to feel much of anything
• Frequent mood swings

Suggestions:

• Acknowledge that your emotions may be “turned up” or “turned down” because of PAWS.
• Check out your reactions with trusted friends to see if they are disproportionate.
• Negotiate with friends to provide reality checks for mood swings.

Managing Sleep Disturbances

Symptoms:

• Nightmares or night terrors
• Difficulty falling asleep or staying asleep
• Changes in sleep patterns

Suggestions:

• Acknowledge sleep problems as a symptom of PAWS.
• Trust that “this too shall pass”.

Managing Physical Coordination Problems

Symptoms:

• Dizziness and balance problems
• Sluggish reflexes
• Impaired eye-hand coordination

Suggestions:

• Identify the circumstances and triggers for these symptoms.
• Avoid high-risk situations (e.g., operating a motor vehicle) when experiencing these symptoms.
• Inform family and co-workers so they do not mistake symptoms for a relapse.

Managing Stress Sensitivity

Symptoms:

• Difficulty managing stress
• Increased severity of all other PAWS symptoms during times of high stress

Suggestions:

• Get to know your stress triggers and your stress threshold.
• Minimize stress triggers as much as possible.
• Keep trusted friends, family, counselors, and your sponsor informed.
• Be prepared for an increase in other PAWS symptoms if you are under high stress.