Post Acute Withdrawal Syndrome Alcohol

What is PAWS?

Post-acute withdrawal syndrome (PAWS) is characterized as a condition where psychological withdrawal symptoms last for a duration ranging from a few months to years. PAWS is often called post-withdrawal syndrome as it is a phase after initial acute withdrawal symptoms for a drug. Prolonged use of a drug like alcohol, benzodiazepine, and opioids changes the physiology of the central nervous system which then affects the normal behavioral pattern of a person even after the acute withdrawal symptoms phase. When an addictive drug is taken regularly or substance abuse is there, the brain adjusts its physiology by influencing the activities of neurotransmitters. And when there is a deficiency of that drug, the drug influenced level of neurotransmitters results in excitability and the symptoms are summed up as withdrawal symptoms for that drug. In case these withdrawal symptoms persist over a certain duration, the person is said to be suffering from PAWS.

When Does Alcohol Post Acute Withdrawal Syndrome Occur?

The brain functions in a way that it releases a neurotransmitter called gamma-amino butyric acid (GABA) to produce a pleasant effect in the body. The physiology for this is called the reward center which is activated when there is an achievement or satisfaction. Consuming alcohol activates the reward center without any actual natural stimulus. It does this by influencing the functioning of neurotransmitters i.e. increasing the activation of GABA and decreasing glutamate. As soon as you stop consuming alcohol, the changed chemistry of the brain results in symptoms that are,

  • Anxiety
  • Irritability
  • Loss of appetite
  • Slow movements
  • Lack of concentration
  • Sleep problems

As the changed chemistry of the brain can not be undone overnight, a person experiences psychological discomfort after acute withdrawal symptoms which are generally physical. The severity of the symptoms depends on how long you have been consuming alcohol and how bad the alcohol abuse was.

Common Symptoms and Signs for Post Acute Withdrawal Syndrome From Alcohol

Drinking alcohol once in a while may not cause withdrawal symptoms when you quit its consumption completely. But if you are consuming alcohol for a long time and your body has developed a dependency on alcohol, it is not easy to escape from withdrawal symptoms once you quit its consumption. It starts with mild symptoms like headache, nausea, vomiting, and restlessness that begin to appear within 6-8 hours after the last drink.

If you do not consume alcohol even after 6-8 hours, the second phase of acute withdrawal symptoms starts within a day which is characterized by an irregular heartbeat, fever, anxiety, insomnia, and lack of concentration. After this period, the individual’s condition becomes severe and can be difficult to manage without a professional. At this stage, the symptoms include abnormal behavior, seizures, intense headaches, anxiety, dysthymia, and delirium. All these stages of symptoms are collectively characterized as acute withdrawal symptoms.

There are several detox stages each comprising a different set of symptoms and effects over the body. Your body takes time to restart normal functioning after initial withdrawal signs and the time for this can range from a few weeks to months. The psychological symptoms of PAWS are,

  • Anxiety 
  • Irritability
  • Insomnia
  • Lack of concentration
  • Stress
  • Lack of motivation
  • Depression
  • Cravings for alcohol

How Long Do PAWS Alcohol Symptoms Usually Last: Timeline

The timeline for the PAWS symptoms for alcohol, like any other addictive substance, depends on certain factors that are,

  • Quantity of alcohol consumption
  • Frequency of alcohol consumption
  • The physical and mental health of the alcohol addict

If your body stays dependent on alcohol for a long period and it develops a tolerance against alcohol up to a certain level, you cannot just quit drinking alcohol without facing the complications. It is because the brain chemistry changes over time because of alcoholism. The brain takes time to re-calibrate the normal physiology which can take time from 12-20 months depending upon the individual’s conditions.

The severity and frequency of symptoms decreases over time in this stage of the detox process. The symptoms that are related to mental health are common in post acute withdrawal syndrome unlike the acute withdrawal symptoms which are mainly physiological. The timeline for PAWS also depends on how you react to those withdrawal symptoms. Seeking a medical professional can benefit you in the recovering phase and can reduce the timeline for psychological symptoms.

How to Treat Post Acute Withdrawal Syndrome From Alcohol

PAWS do not always require immediate medical treatment. In most cases, when the addiction is not intense, your body can overcome the PAWS with its homeostatic mechanism. While in others, PAWS can cause extreme discomfort leading to a relapse. The unpredicted frequency of symptoms can result in extreme disturbances in mental health and brain damage. But with the combination of drugs and psychotherapy, the adverse effects of PAWS symptoms can be minimized and made manageable.

Here are some treatment protocols that you or your loved ones can follow to get through the stressful phase of withdrawal.

Home PAWS Treatment

Home treatment for PAWS mainly involves the principle of self-care through different means that includes,

  • Taking a balanced nutritional diet
  • Performing physical exercise regularly
  • Maintaining the optimal fluid content in the body
  • Try to keep calm
  • Avoid things and events that triggers the PAWS
  • Do not hesitate sharing your mental state to your loved ones

Professional Treatments

Professional treatment is not always required but recommended to avoid severe complications of withdrawal. As the symptoms for PAWS last for a long duration, professional treatment is also administered over that extended period of withdrawal symptoms. Above self-care, professional treatment involves the combination of drugs and therapy to deal with PAWS.

Acamprosate that is prescribed to drug addicts under the supervision of professionals is found to be effective in suppressing the severity of PAWS symptoms for alcohol. Drugs that slow down the activity of the CNS and produce a sense of relaxation, like benzodiazepines, are used under the supervision of a medical professional. The professional treatment thus helps the patient to fight and win against the emotional symptoms of PAWS.

Can post acute withdrawal syndrome be avoided?

Post acute withdrawal syndrome cannot be avoided in most cases but the severity and frequency of PAWS symptoms can be made manageable with the combination of drugs and psychotherapy.

How do you know if you have PAWS?

Some common symptoms that are evident in PAWS sufferers are anxiety, stress, irritability, loss of concentration and loss of appetite. You need to seek a medical professional if you start experiencing these symptoms again and again,

Can alcohol withdrawal symptoms be fatal?

Yes, alcohol withdrawal symptoms can be fatal. The severity of withdrawal symptoms depends on the quantity and frequency of alcohol consumption.

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