Monday, January 18, 2010

PAWS - It's not your kitty's foot

Post Acute Withdrawal Syndrome is the period of time after acute withdrawal from alcohol or drugs. Acute withdrawal occurs within 3-10 days while post acute withdrawal can last anywhere from 3 months to 2 years and some forms may even cause permanent, if intermittent, symptoms.

Terrence Gorski was the first to coin the term and identity the syndrome. Mr. Gorski is a pioneer in the field of addiction and especially relapse prevention. Studies now show that it takes a minimum of one year for the brain to heal from addiction and often much longer.

The symptoms of post acute withdrawal can include any or all of the following:

Inability to think clearly which includes an inability to concentrate, an inability to solve problems and rigid, repetitive thinking.

Memory problems.

Emotional overreaction or numbness.

Sleep disturbances.

Difficulty in managing stress and day-to-day life circumstances.



The major challenge for a person newly recovering is discovering how many of these symptoms will go away with continued abstinence and how many may be due to co-occurring disorders such as anxiety and depression.

The amount of stress encountered in early sobriety directly affects how severe a person’s symptoms will be. That’s why it’s so important in the first couple of years of sobriety to keep stress levels at a minimum and do everything we can to take good care of ourselves – mentally and physically. This is also why it’s advised to stay away from certain people, places and things in early recovery and why it helps so much to be around people who understand addiction and recovery from it.

When I got sober in 1988, PAWS was not known about, but I certainly suffered from it and would’ve been helped at the time by a better understanding of what was happening with me. For the first two years of my sobriety I had all of the above symptoms and most of the time felt like I was going nuts. At two years, I finally sought help for what had become debilitating depression and anxiety and was placed on medication that, along with continued abstinence, brought a lot of relief.

I’ve come to believe that my history of chronic relapse has been in great part due to untreated PAWS and I’m grateful for the work that Mr. Gorski has done in this field.

Now that we know what it is, how do we deal with it? Not surprisingly, the things that help PAWS are those same good lifestyle habits that reinforce sobriety and a life worth living. They include:

Good nutrition.



Interpersonal coping skills.

Talking it out – therapy or group support.

Writing it out – journaling.

If the symptoms make it extremely difficult to maintain sobriety or to maintain a normal daily life, medication may be necessary and you should, of course, consult with an addiction professional.

It’s fortunate that we now know the biological causes of post acute withdrawal and don’t have to be strapped with labels like “dry drunk”. I believe my PAWS was worsened by the guilt I felt that I wasn’t working the program properly, that my character defects were unchecked and that I didn’t have enough conscious contact with my higher power. The truth is, guilt on top of PAWS will only exacerbate the problem.

Today I know that my daily program must include good nutrition, exercise and relaxation and that I should try and keep my stress levels to a minimum. Next I’m going to write about the Relapse Cycle as Terrence Gorski describes it and talk about how I think PAWS kept me going through that damned thing over and over again.


AngelP said...

Hi Angela,

Thanks for this great education. I hope this will ultimately explain why I'm so sad and isolating so much since I got sober!

So glad you're doing well.

Keep sharing.


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Mike said...

Thanks for the post.
Thank you, thank you, thank you.
I read a lot of blogs on recovery and this comment here, " guilt on top of PAWS will only exacerbate the problem" had been very helpful.
I went through that...guilt of not feeling like I was working my program properly. I feel better..thanks!!!

Anonymous said...

This is all very educational. I'm so glad you are posting regularly. Big hug to you, K