Resources & Education

December 23rd, 2014

Understanding the second stage of withdrawal: PAWS

Young unhappy woman in depressionPrescription opioid withdrawal can occur in two stages affecting the individual both mentally and physically.

The first stage can last a few weeks and includes physical withdrawal symptoms such as difficulty swallowing, shallow breathing, large pupils, nausea, itching and flushed skin, constipation and more.

The second stage of withdrawal is also known as Post-Acute Withdrawal Syndrome (PAWS) and affects the mental and emotional aspects of a recovering user. Common symptoms include the following:

  • Mood swings
  • Depression
  • Anxiety
  • Irritability
  • Tiredness
  • High to low energy
  • Low enthusiasm/no motivation
  • Lack of concentration/memory problems
  • Poor sleep pattern

PAWS episodes can last for two years of sobriety, with attacks lasting several days and feeling like a roller coaster of emotions, causing the user to fluctuate in feeling minute to minute and hour to hour. There is no definite trigger and as recovery progresses there is a possibility of prolonging the time between attacks with the eventual hope that they end as quickly as they begin.

Post-acute withdrawal shows that the brain is recovering, but the intensity and frequency can be very stressful. However, it’s recommended to be patient, since the process of recovery is never ending and drug addiction is no different. Preparing the mind for potential physical symptoms of withdrawal can make the episodes pass easier. If you’re expecting to feel poorly, recovery can only move in a positive direction as the attacks lessen over time.

Ways to manage a PAWS attack can include:

  • Talk about what’s happening when it’s happening to a supporter/support group.
  • Have someone validate how you’re feeling and explain that what you’re feeling is very real.
  • Set a goal to improve your situation.
  • Decide how to make changes and take action.
  • Think about past attacks and what has changed/gotten better.
  • Identify your own stress triggers to prevent and manage future attacks.

PAWS can be a trigger for relapse.

Not preparing for the episodes can lead to an overwhelming feeling of failure and despair and push recoveries back into addiction’s welcoming arms. Taking the time to take care of yourself, reward yourself for your efforts and learn how to cope with negative emotions and make better decisions in the future.

There are some treatment options including mood stabilizers and behavioral therapy. Your doctor or counselor can help you determine which course of action is best for you.

Small but important steps on the road to recovery

There are some things that can be easily controlled while also greatly improving the recovery process. The following things are incredibly simple to manage, but can make a complete difference in the quality of the recovery:

  • Journaling, writing out or drawing your feelings, emotions and concerns.
  • Maintaining a healthy diet and proper nutrition.
  • Maintaining a schedule for daily activities.
  • Exercising daily to improve health and increase endorphin release.
  • Staying relaxed and practicing stress reduction techniques such as breathing exercises.
  • Meditation and nurturing your spirituality.
  • Finding peace, balance and time for contemplation.

Symptoms of PAWS occur in 90% of long-term opioid users and 75% of alcohol and methamphetamine users.

Though it has not been officially recognized by the Diagnostic and Statistical Manual of Mental Disorders, PAWS has been reported in many recovery communities, and as more studies are conducted to support its existence, its status as a professionally-recognized disorder may change.

If you or someone you know is struggling with addiction or going through withdrawal, we can help. If you are in the Western New York area, please call Horizon Health Services at (716) 831-1800.

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