7/16/2020
PAWS
Post Acute
Withdrawal
Syndrome
Pres ented and Edited by
Carolyn J Clontz , MS
Licens ed Marriage & Family Therapis t As sociate
Licens ed Chemical Dependency Couns elor Intern
• Addiction – psychological and physical inability to stop
consuming a drug, chemical, activity, or substance even though
it is causing psychological or physical harm
• Addiction NOT JUST dependence on substances like
marijuana or alcohol
• Inability to stop participating in activities like gambling,
eating, or working
Addiction
• Chronic disease – never goes away
• When a person experiences addiction:
• they cannot control how they use a substance or partake
in an activity
• they become dependent on it to cope with daily life
• Addiction can take over and reduce self-control
• Already there
• First interaction may be voluntary
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• What things did you experience during
your using days?
• Cravings, lows, highs, want v. need
Withdrawal
vs. Post Acute
Withdrawal
• What happens when you stop using—
especially during the first one or two
weeks?
• This is typically the Acute Withdrawal
time.
 A syndrome that alcohol and
drug addicts experience in
early recovery
What is PAWS?
 A bio-psycho-social syndrome
which results from the
combination of damage to the
nervous system caused by
drugs and the psychosocial
stress of coping with life
without drugs
 Addiction is not just a disease
of using/drinking but a disease
of early sobriety
 The presence of brain
dysfunction has been
documented in 75-95% of the
recovering alcoholics/addicts
Th e B rain is i mpacted long
af t er thi s first few days after
y o u stop using.
• If people don’t understand these
symptoms, that can increase the
chance of relapse.
• But the more you know about
them, the better you can learn to
deal with them.
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Two Things
to
Remember
• 1. The damage to the
brain is usually
reversible—things will
get better—there is no
need to fear.
• 2. With a good recovery
program and not using
alcohol or other
substance, your brain
can get back in balance.
• Neuroplasticity
Why?
These symptoms result from the body’s
struggle to heal the damage done by drugs and
alcohol.
Symptoms
Inability to think
clearly
Memory problems
Emotional
overreactions or
numbness
Coordination problems
Oversensitivity to
stress
Sleep disturbances
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Onset: symptoms start 7 to 14 days
after quitting
Onset, Duration,
and Severity
Duration: symptoms of PAW grow
to peak intensity over three to six
months after abstinence begins.
Severity: depends on the degree of
brain dysfunction caused by the
addiction and the amount of
psychosocial stress experienced in
recovery
Resilience is key!!
Onset, Duration, and
Severity
 Nervous system damage usually required from six to 24
months with a healthy recovery program
 Often those 30, 60, 90, 4 & 6 month, and 1 & 2-year sobriety
dates seem to be "triggering" times for PAW symptoms
 Often PAW symptoms appear to come and go without
apparent reason or pattern
 May last up to 10 years
 Recovery from the damage caused by the addiction
requires abstinence.
 The damage itself interferes with the ability to
abstain.
 Use of alcohol or other drugs can temporarily
reverse the symptoms of the damage. If loved ones
drink or use, they will think clearly, have normal
feelings and emotions, even feel healthy for a little
while.
 Unfortunately, the disease will eventually trigger a
loss of control that will again destroy these
functions.
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Not So Fun
Fact….
Heroin addicts who have
been clean and sober for
many years will experience
opioid withdrawal
symptoms such as nausea,
diarrhea and stomach
cramps after being shown
films of a person preparing
heroin for injection!
Have a hard time
concentrating &
paying attention.
Thinking
Problems
Having rigid,
repetitive thinking.
Difficulty dealing
with non-concrete
(abstract) concepts
or ideas.
Short term memory:
• Hear something and
understand it, and 20
minutes later you can’t
remember it.
Memory
Problems
Long term memory:
• Sometimes, under stress,
can’t remember important
events from the past. They
aren’t gone, just forgotten
for the moment.
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Emotional Problems
1
Over-reaction to
situations-everything
becomes a “big deal.”
2
When the stress gets
too great, tend to “shut
down”—become
emotionally numb.
Sleep Problems
• Unusual or disturbing dreams.
• Hard to fall asleep.
• Difficulty staying asleep.
• Restless sleep; don’t feel rested
when you awake.
• Changes in sleeping/awake cycles.
Trouble with balance
Dizziness
Physical
Coordination
Problems
Poor eye/hand coordination
Clumsiness
Accident Prone
Slow reflexes
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Difficulty dealing with Stress
Can’t recognize stress
at low levels.
Over-react when stress
is recognized.
May do things
inappropriate for the
situation.
Other PAW symptoms
become worse under
stress.
• You may feel—
• Embarrassed
• Filled with Shame
• Feel inadequate or “less
than others”
No wonder I
have a hard time
getting along
• OK, Show me how to
deal with this…..
What To Do
The first is to understand that
PAW is a normal part of recovery
Learn & use coping
strategies for
unavoidable stressful
situations
This
too
shall
pass
Avoid stressful
situations as much as
possible
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• Good nutrition
• Exercise
Strategies
• Relaxation
• Stabilization
• Education
• Stress Reduction
Stabilization
Get regular feedback from
those you trust:
• Therapy group
• Professional
counselor/doctor
• Self-help group
• Sponsor
Verbalize: Need to talk
about what your
experiencing.
• Talk to people who are
not going to accuse,
criticize, or minimize.
• Become self aware of
symptoms.
• Need reality checks.
Recovery Tools
Problem Solving and Goal Setting:
• Identify and Clarify the Problem
• Identify options and best
possible outcome
• Get feedback if needed
• Act and review outcome
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Recovery Tools
Backtracking: If something isn’t going well, stop and look
at when things got off track.
What could be done differently?
Were there any PAW symptoms?
How can you get back on track?
Education
Learn about addictive
disease recovery and
PAW symptoms
Understanding helps
relieve anxiety, guilt,
and confusion about
what you are
experiencing
Learn to handle things
one at a time to avoid
feeling overwhelmed
• Taking a walk
• Daydreaming
• Laughing
• Playing
• Music
Stress
Reduction
• Reading
• Singing
• Taking a hot bath
• Soaking your feet
• Massage
• Relaxation tools
• Deep Breathing
• Tense/Relax muscles
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Nutrition
• Poor nutrition leads to poor health which
leads to stress
• Establish new eating habits and stick with
them
• 3 meals/2 snacks a day
• Beware hypoglycemia small glucose loads
• Adequate protein and carbohydrates
It relaxes,
calms, and
reduces
tension.
EXERCISE
Relaxation
Rediscover
enjoyable activities
that help reduce
stress
Reading, sports,
meditation, spending
time with friends and
family, hobbies and
other activities
greatly reduce stress
Pick an activity that
is enjoyable and do it
often
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Spirituality as a key to
healthy recovery:
• One of the ways to deal
with early recovery is to
have an active
relationship with a power
greater than yourself.
Spirituality
• Meditation: Practice listening to your
Higher Power
• Prayer—conversation with your Higher
Power
Spirituality
• Turning it over
• Letting Go
• Journaling—keeping a personal record of
thoughts, feelings, ideas
• Spiritual Fellowship - friendship based on
shared spirituality
SIMPLICITY
GROWING SPIRITUALLY ONE STEP
AT A TIME
Personal Inventory:
In the morning to plan the day
In the evening to review the day
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Summary
• Post acute withdrawal is a bio-psycho-social syndrome that
affects people in early recovery
• Understanding the symptoms and using strategies to cope
with stress can greatly reduce the severity of symptoms
• This too shall pass
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