Post-acute-withdrawal syndrome, or PAWS, is when you experience lingering mental health issues after acute withdrawal at the start of recovery. Most people experience PAWS as depression, lack of motivation, inability to feel pleasure, emotional numbness, insomnia, impaired concentration and memory, irritability, and anxiety. Some people develop panic disorders or obsessive-compulsive disorder. There is little scientific evidence for the existence of PAWS and it’s not officially recognized by the American Psychiatric Association, but there is significant anecdotal evidence that it exists. And if you still feel depressed after six months of sobriety, you almost certainly believe it exists. PAWS is thought to be caused by a persistent imbalance in brain chemistry. When you develop a tolerance for a drug and need more to get the same effect, that indicates your brain chemistry has changed. For some drugs, like benzodiazepines and opioids, this can happen in a matter of weeks. The more frequently you have to increase your dose, the more your brain changes. When you quit using the substance, your neurotransmitters are unbalanced and you feel off. It can take a long time for your brain to adequately adjust to the absence of the substance. For example, benzodiazepines tend to have the longest lasting PAWS. Benzodiazepines increase the effectiveness of the inhibitory neurotransmitter GABA, and soon your brain produces less GABA. By the time you decide to quit, your brain may be making very little GABA, which means your nervous system essentially has no breaks. Therefore, people quitting benzodiazepines often experience a prolonged period of agitation, anxiety, and irritability. Different drugs have different PAWS symptoms, but mechanism is basically the same. Unfortunately, there isn’t much you can do for PAWS except wait it out. Depending on what drugs you used and for how long, PAWS might last six months or two years. For most people, it doesn’t last longer than a year, but when you’re feeling depressed, anxious, and unmotivated, a year can feel like a very long time. The best thing to do is stick with your recovery plan, connect with your sober network, talk to your therapist, and try to remember that what you’re feeling is temporary. In some cases, there are medications that may help. Flumazenil, has been found to reduce symptoms of aggression and hostility in people experiencing PAWS as a result of quitting benzodiazepines. Acamprosate, or Campral, has been found to reduce PAWS symptoms in people recovering from alcohol addiction.
If you’re struggling with substance use, Recovery Ways can help. We offer intensive outpatient treatment as well as residential treatment. Recovery Ways is a premier drug and alcohol addiction treatment facility located in Salt Lake City, Utah. Our mission is to provide the most cost-effective, accessible substance abuse treatment to as many people as possible. Request information online or call us today at 1-888-986-7848.
