You can hang around recovery groups for a long time without hearing people mention PAWS, or Post Acute Withdrawal Syndrome.  That’s too bad, because it is one of the major causes (if not the major cause) of relapse in the first couple of years. Without getting into a lot of detail here, let’s talk about PAWS for a little bit.

Addiction occurs because physical changes take place in our brains when we use drugs.  They cause us not only to crave greater amounts of drugs, but also to need the presence of the drug to keep from getting sick (withdrawal). The symptoms of withdrawal vary, depending on the drug, but they are generally comprised of feelings and physical symptoms that are more-or-less the opposite of those caused by the drugs themselves.

These symptoms begin within a few hours of quitting the drug, and last for several days to about three weeks, depending on the specific drug or drugs that were used. Taken together, they make up acute withdrawal. That’s what we deal with in detox.

Post Acute Withdrawal occurs after the acute phase and can last for up to two years, off and on, in “waves.” Why so long? Well, we exposed our brains to drugs for a long time, and it took quite a while for our brains to become completely used to them. Doesn’t it make sense that it takes our brains quite some time to recover?

The difficulty is that we addicts have taught ourselves that it’s not OK to be uncomfortable. We know just how to deal with unwanted emotions and physical discomfort: we use drugs. The discomfort of PAWS can lead us to make some bad decisions, because much of it occurs in parts of the brain where we can’t just “think” it away. That’s why “Just Say No”…Just Doesn’t Work, and it’s the reason for a lot of relapses.

It’s also the reason that long-term maintenance with Methadone or Suboxone is problematic.  Since the addiction is constantly fed, and since physical recovery never really begins, we still have months of PAWS to deal with when we finally do try to get off the maintenance.  Without proper support, we may find that to be more than we can handle.

PAWS is best dealt with by getting plenty of rest, eating well, watching our intake of sweets, taking a couple of multivitamins a day, exercising, going to meetings, and hanging out with our supports. It doesn’t have to be the end of our sobriety, especially if we know it’s coming and are prepared to accept it and get through to the other side.

If you’re interested, you’ll find more information about Post Acute Withdrawal Syndrome here.

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