Post Acute Withdrawal Symptoms – Recovered 505

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A Primer on Post-Acute Withdrawal Syndrome


Sleep problems, irritability, emotional outburst, these are common when we first come into AA

Your initial thoughts?


Post Acute Withdrawal Symptoms or PAWS.

When we stop using drugs and alcohol, some of us suffer as our body adjusts.  These physical manifestations of this adjustment are known as PAWS, Post Acute Withdrawal Symptoms.

So let’s start at the beginning and define some terms.

OK, Cristie, PAWS what is it, what is your understanding.

What is it?  What is the Definition?


What were some of your symptoms?

How long did they last?

Did you know that you were suffering from withdrawal?

Are they still ongoing?

Did they taper off?

Do they come back? If so when?


What are the symptoms? How long do they last?

Some symptoms may include:

Difficulty with Clear Thinking –  such as trouble with problem-solving, reasoning, processing thoughts, and concentrating.

Difficulty with Managing Stress – such as trouble coping with stress or even recognizing it.

Difficulty with Managing Emotions – such as feeling extreme emotions, overreacting, depression, feeling numb, or under-reacting.– such as insomnia, sleep apnea, sleeping too much, or not being able to keep a regular sleep cycle.

Difficulty with Physical Coordination – such as trouble with balancing, fine motor skills, hand-eye coordination, and reflexes.

Difficulty with Memory – such as short-term or long-term memory loss.


for me, I had

my acute symptoms were:



could not sleep

I knew these things were happening because of withdrawal

But my post acute included:


difficulty focusing


dry skin, my face peeled

my eyes changed, need bifocal glasses

I didn’t understand that these things were happening as a result of alcohol withdrawal

I just thought that I was a miserable guy and that my life sucked


We have some call on hold, Cristie, you want to take a call?



Now let’s look at the science, what is physically going on?

What is the cause?

What is the Neuroscience?

Corey to fill in here?

Primarily, these drugs hijack the brain’s reward circuits, a prime moving part of which is dopamine. In the case of drug abuse and dopamine, the brain not only becomes tolerant, but it also gets primed for an excess of dopamine, meaning the user eventually experiences a simultaneous lack of dopamine with increased signaling for that circuit. In other words, not only does an addict feel bad without the drug, his focus turns solely to it to make him feel good again.


However, dopamine’s not the only culprit. Building upon decades of research, key brain structures have been implicated in addiction—the nucleus accumbens and the amygdala—as well as several key neurotransmitters, including dopamine, but also opioid peptides, serotonin, GABA, and glutamate. Scientists at the Medical University of South Carolina and others are beginning to look beyond neuronal misfiring in reward and pleasure regions—these explain how drugs take hold of the brain, but they don’t explain why addiction is so hard to beat. New research on glutamate finds that drug addiction can be viewed as impaired reversal learning, and this can be attributed to disrupted glutamate signaling.


Like to take another call?



Here at the Recovered Podcast, we are all about solutions. Now that we have defined the problem and that problem looked like for us. Let’s talk about how we are working on the solution. What has been our experience.


How did you cope?

Did you pursue treatment? What types? What types are available?

Did you use any medicines in rehab or outpatient?

What would you say to the new person?


First of all, I got treatment

I saw a psychiatrist and starting working on some stuff

I also saw a therapist who is in recovery

I was prescribed some meds, which I took according to instructions

I simplified my life.  I focused on meetings, work and family life, everything else was on hold for about a year

Big decisions such as whether we would get divorced or sell the house was put on hold for one year.

I started to look for a hobby, which lead me to podcasting

I studied recovery

Prayer – serenity prayer over and over

I started smoking



Despite the intensity of the cravings in the acute stage, many addicts are able to resist them, only to relapse later during the post-acute stage. This is because substance abusers are often well-prepared for the strong physical symptoms that accompany abstinence, but they are not ready at all for the scary and unfamiliar emotions they are suddenly forced to deal with after the onset of PAWS. That is why knowledge is the most important defense an addict can have against PAWS; as long as they know what to expect, they will not be taken by surprise when the various manifestations of the post-substance abuse blues descend upon them. When dealing with bouts of PAWS, recovering addicts should remain calm and relaxed, realizing that this too shall pass and that all of their inner turbulence is just a natural and unavoidable consequence of getting clean and sober.


The best strategy for coping with the negative emotions and loss of focus and motivation associated with PAWS is to scale things down and to simplify. Outside of work, days and nights should be filled with small activities that bring pleasure, such as playing sports or games, exercising, reading, taking nature walks, journal writing, pursuing favorite hobbies, and so on. Generally anything that does not involve too much time or effort is acceptable; however, it is not a good idea to while away the hours by surfing idly on the internet or by vegging out in front of the television, since passive, unfocused pursuits like these can actually reinforce a negative mindset and end up making a person feel worse rather than better. Activities that require real effort and concentration in manageable doses, which is what recovering addicts dealing with the symptoms of PAWS should be looking for.


Another thing that has worked for many is a change in diet that replaces the typical junk food and processed fare with plentiful helpings of fruits and vegetables, whole grains, beans and lentils, brown rice, lean meats, etc. Healthy foods are the building blocks of a healthy body, and there is every reason to believe that improving the nutritional quality of the things we consume can help a damaged brain restore itself to proper working order much more quickly. Avoiding substances like caffeine and refined sugar is also important to recovering addicts, since these products cause spikes in energy levels followed by crashes, which recreates the effects of drugs and alcohol in a milder form and could ultimately trigger dangerous new cravings for something stronger.


More than anything, recovering addicts taking the long march through the post-acute stage of withdrawal need the support of their counselors and their peers. Appointments with therapists should be made regularly and kept, support group meetings should be attended religiously, and no one who goes to either should be reluctant to share a single detail about what they have been feeling and experiencing with PAWS. The kind of advice, encouragement, and understanding that recovering addicts will receive from support groups and in counseling sessions during this time will be invaluable, and the odds of surviving this difficult and taxing stage of recovery will be improved exponentially for those who are smart enough to take advantage of these priceless resources.


Check out this episode!


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