Post Acute Withdrawal Syndrome (PAWS) is a set of impairments that occur immediately after withdrawal from alcohol or other substances. The condition lasts from six to eighteen months after the last use and is marked by a fluctuating but incrementally improving course. It has importance to the recovering addict’s ability to benefit from recovery, treatment, function effectively on the job, interact with family and friends, and regain emotional health.
Post Acute Withdrawal Syndrome (PAWS) has three major areas of impact upon the individual:
Cognitive: PAWS creates many difficulties with cognitive processes. Racing or recycling thoughts are often noted and found to be highly distracting by the individual. Thoughts may be scattered and even a lack of coherence at times may be present. Others may notice a certain rigidity of thinking and lack of required flexibility. In connection with this, abstract and conceptual thought may be negatively impacted. Cause and effect reasoning suffers as well in the early stages of recovery. Themes and threads connecting disparate events may not be recognized as easily. Concentration and attention span may be impaired. Confusion may be present. Prioritization by the individual will likely be a difficulty for six to twelve months.
Emotional: PAWS tends to create in individuals either a dearth or excess of emotion. The individual may be hyper reactive emotionally. Even small events of little consequence may loom large in his/her mind and create strong and overly valent (not being able to bond thoughts together) reactions. This may lead others to suspect a relapse or create social withdrawal. Shame emotions may be noted. Conversely, The individual may notice a numbing of emotions. The inability to feel impairs proper emotional bonding with friends and family during the early recovery process. It also impairs the recovery process itself as the individual struggles with trying to feel the resentments, anger, guilt, shame and other emotions common in recovery.
Memory: Memory is frequently the most noted PAWS problem. Recently learned information (within the last 30 minutes) may be quickly forgotten. New skills or routines may be learned and then not assimilated as before the drinking began. Information may be retained for a short time (days/weeks) and then lost, requiring the individual to learn it anew. As recovery requires inspection of the past, the individual may discover that developmental and childhood memories are totally absent or only remembered in a spotty fashion.
All of the above PAWS issues can obviously affect the early recovering person. The recognition of this syndrome by the recovering person as well as by friends, family and colleagues is important. The individual will note that the severity of PAWS decreases as time progresses and that PAWS is stress sensitive. Lowering of stress is helpful. Healthy habits such as limiting caffeine, getting 8-10 hours of sleep, eating three balanced meals and exercising three-four times weekly usually prove beneficial. Meditation, or relaxation exercises can be invaluable once properly learned. Obviously AA involvement with a sensitive and experienced sponsor is key to navigating through PAWS.
Most individuals find the first six months to be the most PAWS impacted with decreasing severity over the next six-month period. By the end of one year, most persons have returned to their respective levels of functioning.