Post-Acute Withdrawal Syndrome (PAWS) and Alcohol
If you’ve quit drinking, then you’ve probably seen the topic of post-acute withdrawal syndrome (PAWS) come up.
What is post-acute withdrawal syndrome (PAWS)?
PAWS is a set of symptoms that occur after acute withdrawal has gone away. They are usually mood related and psychological and can last for 6 months to 2 years. These symptoms can put you at risk for relapse because they are uncomfortable and will trigger you to want to drink to cope.
Often, symptoms are triggered by stress or brought on by situations involving people, places or things. These were things we used to drink at before, so they are triggering in recovery.
Symptoms of PAWS
PAWS symptoms come and go in cycles, with each occurrence lasting a few days. It includes things like,
irritability and hostility
depression
anxiety
mood swings
low energy and fatigue
insomnia
disrupted focus
brain fog
low libido
cravings
fatigue
lack of pleasure
What PAWS is not
PAWS is not constant misery.
A common misunderstanding about PAWS is that the symptoms are nearly constant. This can be demotivating if you are in early sobriety and worried that you’re going to feel terrible for years.
If you are experiencing these symptoms frequently, then it may not be PAWS. Often, when someone gets sober an underlying mental health condition is revealed, like depression or anxiety, that was hidden by our drinking. Since PAWS symptoms are mood related, it may feel like this is an explanation for why you are struggling most days, but PAWS is not constant misery. I encourage you to talk to your doctor and work with a therapist if you are struggling with your mood. You don't have to suffer.
Why you might get PAWS after quitting drinking
Just like it didn't take 2 weeks of heavy drinking for your brain to become reliant on alcohol, it doesn't take 2 weeks for your brain to heal. PAWS represents the long term healing process of your brain.
Alcohol damages all areas of the brain, especially the areas responsible for focus and processing emotions. This is why you may experience symptoms like brain fog, crankiness, anxiety and depression after acute withdrawal has ended.
PAWS happens because your brain is learning to correct neurochemical imbalances that occurred from drinking so much. Your brain has to learn to regulate its chemistry without relying on alcohol. This takes time.
How to cope with the symptoms
In my opinion, the best thing you can do if you are struggling with PAWS symptoms is to work with a therapist. I also highly recommend talking to your doctor if feelings of anxiety or depression are becoming unmanageable. A therapist can help you:
understand what to expect
help you maintain patience for recovery and the healing process, so you don't feel "why bother"
provide accountability
help you learn to regulate your emotions
help you learn to cope with stress in healthy ways
help you to identify your triggers
Other options for treatment include:
antidepressants to help cope with mood related symptoms
Naltrexone or other prescription medications to help cope with cravings
Post-acute withdrawal syndrome and relapse
PAWS is a big trigger for relapse because it brings on negative emotions and symptoms that we used to drink to deal with. It can also make you feel like sobriety sucks, why even bother if you don’t feel better.
It’s important to stay patient. If you drink again you are resetting your timeline. You're doing something really hard. You don't have to be insanely productive, go on a diet, or advance your career too. Allow yourself to heal. It takes time.
Try to recognize that you're not going to be a super sober person immediately, and part of sobriety is recognizing that some days just stink and it's okay. Sometimes we're low energy, and that's okay. Sometimes we mess up, and that's okay. As long as you're working on being a little bit better than you were last week, over time you'll get there.
If you’re having some tough days in sobriety then here are some things that can help:
get a meal delivery kit so you don’t have to cook
ask other people in your household to help with responsibilities
allow yourself to rest
when in doubt, go to bed early
join a community so you can get support from other people who get it
get a task app or write things down if you are struggling with brain fog
if you’re having trouble with insomnia then try melatonin or CBD
go to the gym and stay on top of your nutrition
listen to sober podcasts and read quit lit
remember the good times that you’ve had in sobriety so far
This will pass!
FAQS about Post-Acute Withdrawal Syndrome (PAWS) and Alcohol
How long does it take for PAWS to go away?
It depends on the person, their genetics, how severe their acute withdrawal was, etc, but PAWS can last anywhere from 6 months to 2 years. I felt like the 2 year milestone was a huge transition point for me, but please remember, there is a ton of healing that happens in the first year. Sobriety doesn’t mean committing to suffering for years.
How do you know if you have PAWS?
If you are experiencing any of the symptoms above and they are occurring in cycles, not constantly at all times, then it may be PAWS. You can discuss this with your doctor or therapist for more support.
What is the best treatment for PAWS?
Therapy and medication can be very helpful to both manage your symptoms and learn how to identify your triggers. Therapy can help you learn other coping skills besides alcohol or anything else external (food, cannabis, etc).
Sources
Crane, M. Post-Acute Withdrawal Syndrome (PAWS): An In-Depth Guide. American Addiction Centers. 2020
Walker, L. Alcohol Withdrawal Symptoms, Treatment, and Timeline. American Addiction Centers. 2020
Hazelden Betty Ford. What is Post-Acute Withdrawal Syndrome. 2019.
Hilliard, J. What are Central Nervous System Depressants? Addiction Center. 2020
