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Substance Use Blog Series: Post-Acute Withdrawal Syndrome

Today’s substance use blog post is about Post-acute withdrawal syndrome, which is also called PAWS for short. This syndrome refers to a temporary period of time after going through detox where your body is adjusting to its processes without substances. Its symptoms gradually decrease over time, although they may appear with increased intensity for a few days temporarily. PAWS is associated with most substances, including: alcohol, marijuana, cocaine, inhalants, benzos, amphetamines, methamphetamines, nicotine, anabolic steroids, opiates, and hallucinogens. Below are some of the common experiences of PAWS:

  • Difficulty thinking clearly
  • Emotional over-reactivity
  • Sleep disturbances
  • Co-ordination struggles
  • Slow reflexes
  • Difficulties managing stress

The overall time period for this experience is about 2 years, depending on the substance detoxed from, but they fluctuate and are not always present during that time (Addictions and Recovery). These can be confusing symptoms, especially if unexpected or unanticipated. They can also appear after months of feeling strong and positive following detox, which can be a scary and unsettling experience. The following video goes into the symptoms of PAWS in more depth:

It is important to remember that while these symptoms are uncomfortable, they are a normal physiological response to abstaining from addictive chemicals. This process is part of the body’s slow return to balance.

Not everyone goes through this, but it is quite common, and a recent study found that between 70% and 90% experience it, so it is worth knowing about beforehand (SMART Recovery).

If you were to experience this without expecting it or having prior knowledge, it would make sense to develop feelings of shame and guilt, leading to a desire to isolate, which may increase the likelihood of relapse. All these feelings are understandable, but being prepared is the best way to prevent some of the setbacks that can come with this experience. We described relapse prevention plans here, which are another important preventative measure. 

Coping with PAWS

The first step of coping with PAWS is knowing that it is normal and a temporary part of your body and mind’s healing process. Another important step is to develop a solid self-care plan. The topic of self-care comes up a lot, and this is because it’s so important across the board. Self-care is a very personal thing, and tailoring your routine to your own needs, interests and personality is important. Sometimes we can become so focused on certain parts of self-care that we forget about others, so checking in with your habits once in a while can be helpful. We have included this exercise that helps you reflect on where your self-care is currently at. You can go through this exercise to rate your self-care habits and prioritize which you would like to pay more attention to. Periods of PAWS can also be triggered by stress, so finding preventative ways to reduce stress is vital.

Brain derived neurotropic factor (BDNF)

Apart from self-care, there are some activities that trigger what is called the brain derived neurotropic factor (BDNF). This chemical messenger is like a fertilizer that helps our brain grow new neurons. Neurons are necessary for helping new connections form in our brain.

During recovery, our brain is working hard to build new connections. This is because it is finding new ways of experiencing pleasure without relying on substances. This takes time, and doing what we can to increase BDNF in our brain helps the process [1].

Many of the activities that increase BDNF are foundational aspects of physical health, and likely overlap with parts of your self-care plan. Some of these include: 

  • Getting 6 to 9 hours of sleep
  • Eating balanced meals high in protein
  • Physical exercise
  • Sunshine

Some particular foods can help create BDNF, such as fish oils and turmeric. Calming your nervous system with the use of relaxation exercises is also important [1]. In this post we go through the process of grounding which can relax the nervous system, and here is a video that takes you through a specific guided breathing exercise:

We have attached a sheet where you can track these activities every day of the week. This sheet also contains more info about BDNF [1].

Remembering that it is temporary

Everything we have mentioned can biologically help you cope with going through PAWS.

It is also important to continually remember that this process is temporary and you are going through it in service of your recovery. For this reason, being able to remind yourself of the reasons for your recovery and the value it holds to your life is important.

One way of doing this is putting together a hope box. This box includes physical representations of what is motivating your own recovery, and can show you why it’s important to you. This box can be looked at regularly and in times of stress as a physical reminder.

You’ll want to choose items that remind you why you are pursuing recovery. You can also pick objects that represent what you have already learned, and what recovering has added to your life. If you want to reflect on what you have learned so far, we include some journaling prompts in this post. They are in the Action and Maintenance Stage section. 

Some people find it helpful to put their box together with loved ones; others choose to do it alone. What goes into this box is deeply personal, so follow your intuition and be creative. Some ideas include: 

  • Letters, cards, or copied texts from loved ones who support your recovery
  • Photos of meaningful memories experienced during recovery
  • Lyrics to a meaningful song or poetry
  • Religious or spiritual quotes, if you identify with either 
  • Gifts received from loved ones and role models

(Modern Therapy)



[1] Creating BDNF & Growing Neurons (2012). S Owen Counselling


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