Author: James Anderson

Post-Acute Withdrawal Syndrome: Symptoms, Treatment

It can also lessen the risk of relapse because of medical support and supervision. Stopping alcohol use cold turkey or attempting to recover from drug addiction is not recommended. Because of the severity of the symptoms, people often feel the need to drink or use drugs to make them go away.

We used a standardized tool to extract information about authors, study objectives, sample characteristics, inclusion/exclusion criteria, study design, and outcome variables in Covidence, which we transferred to a Microsoft Excel spreadsheet (Veritas Health Innovation, 2019). We restricted eligibility to human adult populations (ages ≥18), examining any descriptive component of PAWS. In addition, we restricted eligibility to English-language articles or those with an available English-language translation. We considered randomized controlled trials and nonrandomized intervention studies (e.g., pre-post studies). We excluded commentaries, reviews, editorials, and case reports; we did not restrict the study’s data or location. We also excluded treatment studies, as these were the focus of a parallel review.

How to Manage Symptoms of Post-Acute Withdrawal Syndrome

Doctors may diagnose PAWS based on a person’s medical history and the findings of a physical examination. Keep reading to learn more about PAWS, the causes and risk factors, and how to cope in recovery. PAWS is a hypothesized syndrome, not a scientifically proven entity.

It is unsurprising, therefore, that long-term effects are commonly reported when patients stop taking their antidepressant medications. After the acute withdrawal stage, some uncomfortable symptoms may linger. Although PAWS can be challenging, there are ways to manage the symptoms and successfully avoid using the substance again. The symptoms of protracted withdrawal can come and go over time depending on triggers.

1. Those who have used psychoactive substances for longer, more often, and at higher doses are more likely to experience post-acute withdrawal symptoms, and the symptoms will be more intense than they are for those whose drug use was lighter.
2. All authors contributed to this study’s design, the interpretation of the data, subsequent manuscript drafts (and revisions), and final approval for submission.
3. PAWS is a dangerous withdrawal period with a high potential to cause relapse.
4. The authors acknowledge the University of Calgary Health Sciences Librarians for their support in developing our search strategy.
5. It is the second withdrawal stage, often called post-acute withdrawal symptoms (PAWS).
6. Genetics and physiological factors are likely to play a role, however, since post-acute withdrawal syndrome can manifest differently in two individuals who have used the same substance in the same manner.

In a review of protracted withdrawal by Satel and colleagues (1993), the authors concluded that symptoms extending beyond the period of acute withdrawal from alcohol—as well as opioids, for that matter—have been relatively consistently described but not conclusively demonstrated. Further, the authors mentioned that the concept of protracted withdrawal was ambiguous, confounding interpretations of the literature, and precluded derivation of a unified vision of the term, which would be necessary for adding the diagnosis to the DSM (Satel et al., 1993). Ultimately, Satel and colleagues found insufficient empirical evidence for the existence of PAWS to justify its inclusion in the DSM (Satel et al., 1993). In the 1980s, De Soto and colleagues furthered the concept of PAWS described earlier by Wellman (1954), Segal et al. (1970), and Kissin (1979) in noting that PAWS partially reverses with sustained alcohol abstinence (De Soto et al., 1985). They observed several characteristic mood and anxiety symptoms—such as depressed mood, interpersonal sensitivity, obsessive–compulsive symptoms, and guilt—during the first 3 to 4 months following acute withdrawal (De Soto et al., 1985). Fortunately, in a sample of persons who had been abstinent for nearly 10 years, most PAWS symptoms gradually diminished, with near normalization 4 months after detoxification (De Soto et al., 1985).

What Causes Post-Acute Withdrawal Syndrome?

The emotional and mental distress caused by PAWS can be tough to handle, but if you’re aware of the causes and prepare yourself for the symptoms, you’ll be well-equipped to face them head on. It typically lasts for several months or years, depending on the severity of addiction. You can control the symptoms with professional oversight and medical intervention at a treatment center. Working with a substance use specialist can provide methods and medications to combat PAWS symptoms. The severe effects of PAWS exacerbate the cravings you’ll be going through throughout the recovery process. This can make it difficult for you to participate in counseling and therapy sessions productively.

This manifests in a series of psychological withdrawal symptoms that can be stressful to deal with. The condition is described as ongoing withdrawal symptoms, typically mood-related. This study aims to review the neurobiology and symptomatology of post-acute alcohol withdrawal syndrome (PAWS). It refers to a group of symptoms that linger after the initial stage of withdrawal or that develop later on in recovery. If you or a loved one is in need of help managing PAWS in addiction recovery, or seeking treatment for co-occurring mental health or substance use disorders, there is help and there is hope for you at the Hazelden Betty Ford Foundation. Stimulant drugs—such as cocaine and amphetamine—provide some of the clearest evidence that post-acute withdrawal syndrome is a true medical condition and not simply an extension of acute withdrawal.

How to Manage Post-Acute Withdrawal Syndrome

Still, there is a need for a further study exploring the interrelatedness—or lack thereof—between symptoms considered to be part of PAWS. The release of cortisol, the endogenous stress hormone, is regulated by corticotrophin-release factor (CRF), whose levels increase during alcohol withdrawal (Heilig & Koob, 2007). Accordingly, individuals experiencing acute and protracted AWS have higher reported basal serum cortisol levels (Heilig & Koob, 2007). However, CRF-like peptides also appear to maintain a negative-affective state, suggesting that they have a specific role in mediating the underlying PAWS stress response (Bruijnzeel & Gold, 2005).

Following medically supervised detox from alcohol, opiates, marijuana, cocaine, benzodiazepines or other highly addictive substances, most people experience a short phase of physical discomfort, otherwise known as acute withdrawal. Symptoms often include muscle ache, nausea, headache and increased heart rate. Acute withdrawal can produce more dangerous health consequences—even life-threatening complications—if detox isn’t done in a supervised setting. But there’s more to drug and alcohol withdrawal than physical symptoms of discomfort.

Studies examining symptoms now attributed to post-acute withdrawal syndrome have been published in medical journals since the 1990s. These are some of the most common manifestations of post-acute withdrawal syndrome, but this is not a comprehensive list. One unifying theme among these symptoms is that they all impair various facets of an individual’s emotional state. Another common aspect of the symptoms is that they are intermittent and may come and go over days and weeks, and they generally do not impact a person to the same extent over the entire course of their withdrawal. Most symptoms last for a few days at a time, although this is dependent on the type of alcohol or drug addiction, and the amount and frequency of substance use (every person’s withdrawal pattern is a little different).