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Post Acute Withdrawal Syndrome

Post Acute Withdrawal Syndrome (PAWS) is an emotional impairments after giving up addiction.
Ashwini Kulkarni Sule Jul 24, 2020
Most people resort to drugs or alcohol for the stimulation that these substances provide. Addicts describe this feeling as a 'kick' or a 'high'. The feeling is so exhilarating, that people start relying on these substances more and more.
As a result, they become so dependent upon these substances, that their bodies refuse to work without the usual dose of the concerned substance.
What addicts don't realize is that these artificially stimulating substances interfere with the neural chemicals and disrupt their normal functioning. Since the person relies heavily upon the artificial stimulator, the function of the neurotransmitters begin to diminish.
When the person finally wakes up to the hazards of drug or alcohol abuse and decides to give up his addiction, he has to fight a number of withdrawal symptoms.

What is Post Acute Withdrawal Syndrome?

The person begins to face physical withdrawal symptoms within hours of quitting his drug or alcohol addiction. These symptoms include shaking, chills, vomiting, etc., and are collectively referred as 'acute symptoms'. These are common alcohol withdrawal symptoms.
However, psychological symptoms develop after 7 to 14 days of abstaining from the substance. Psychological and emotional withdrawal symptoms come under PAWS. These symptoms stay for 3 to 6 months or even a couple of years in some cases.
The severity and duration depend upon the length of time for which the person relied on artificial stimulator. Until the time the neurotransmitters resume their normal functioning, the person has to endure tremendous emotional upheavals. PAWS affects the individual at three levels, which are as follows:


Cognitive processes are greatly hampered by PAWS as the individual is unable to think rationally. Oftentimes, there is undue rigidity in the thinking of the person. There is a lack of coherency in thoughts and they are mostly in scattered form.
The person fails to recognize the connection between two disparate events. Lack of concentration and periods of confusion are also common among people coping with withdrawal from opiates drug addiction.


A person facing PAWS is likely to exhibit either excessive emotional behavior or a complete lack of emotions. Even the most frivolous things are likely to affect such individuals.
This period is particularly stressful for the individual as well as for those around him as he copes with a range of emotions such as anger, guilt, shame, resentment, at the same time.


PAWS for alcohol adversely affects the memory of a person. The person is even unable to recollect events that took place just 30 minutes ago. Events that took place before the drug abuse began can only be remembered in flashes. However, this is a temporary phase and the person soon regains his memory.
PAWS is mostly characterized by irritability, mood swings, anxiety, sleep disorders, low energy levels, etc. The symptoms may appear together or they may not be present for a very long time. Terence T. Gorski studied and developed a relapse model for PAWS. In his study Gorski came up with 37 definite signs of PAWS.

How to Cope with PAWS

Just like alcohol withdrawal syndrome, there is no definite treatment. It depends upon the your will power. Facing PAWS is stressful as you experience shift of emotions every now and then. As the recovery time progresses, frequency of these bouts become less. So, you will have prolonged periods of good mood with high energy and a feeling of well-being.
However, one must consider that phases of bad mood are also likely to be equally intense. One day, you might just wake up with low energy and an irritable mood, which may not improve even at the end of the day. Patience is the only key to getting out of this situation. Maintain a worksheet that will enable you to assess your relapse and recovery.
Post acute withdrawal syndrome can only be conquered with hope, patience, and faith. Stress can only worsen the situation and extend the recovery period. Convince your mind, that this phase will soon go away and then you will be able to enjoy a perfectly normal and healthy life.