A doctor can often diagnose alcohol withdrawal syndrome by taking a person’s medical history and doing a physical exam. PAWS symptoms include irritability, depression, insomnia, fatigue, restlessness, alcohol cravings, and distractibility. These are most severe in the first 4 to 6 months of abstinence and diminish gradually over several years of sustained abstinence. Although there is some evidence for targeted pharmaco-therapy for treating specific PAWS symptoms, there are few recent, robust, placebo-controlled trials, and the level of evidence is low. In addition, as the presence of PAWS appears to contribute to relapse, there is a need for specific criteria for PAWS to be developed and tested and high-quality treatment studies done involving agents addressing the neurobiological underpinnings of symptoms. Although our review found limited, mixed-quality evidence for different pharmacotherapeutic classes in managing specific PAWS symptoms (such as sleep disruption, mood, or anxiety symptoms), there remains a need to enhance the evidence base for PAWS and its treatment.
However, if a person already has alcohol use disorder, they can help prevent some of the withdrawal symptoms by speaking to a doctor about safe withdrawal. Doctors usually use a type of drug called benzodiazepines to reduce alcohol withdrawal symptoms. Alcohol withdrawal syndrome occurs when a person with alcohol use disorder stops or suddenly decreases their alcohol intake. Tracking your triggers, managing stress, and taking care of your basic needs might help keep your symptoms in control. Therapy and support groups can help you cope with the maverick house sober living mental and physical stress of PAWS.
Keep reading to learn more about PAWS, the causes and risk factors, and how to cope in recovery. All authors contributed to this study’s design, the interpretation of the data, subsequent manuscript drafts (and revisions), and final approval for submission. One author (A.B.) wrote the initial draft of the work and managed revision feedback from the other authors. Several neurobiological and endocrinological features appear unique to PAWS, including enhanced glutamatergic activity in the nucleus accumbens, increased hypothalamic–pituitary–adrenal axis activity, decreased serotonin, and orexin availability, and contribute to the report of subjective symptoms. During PAWS, the brain is proposed to enter a relative state of hyperexcitability by activating central stress systems (Ahveninen et al., 1999).
The initial symptoms may be relatively short-lived, but they can be very dangerous. They may include nausea and an increased heart rate, for example.Withdrawal symptoms may linger or develop later on, possibly a few months into recovery from substance misuse disorder. During this second, or “post-acute” phase of withdrawal, a person may experience symptoms that are more psychological than physical.
However, for negative affect and sleep symptoms, more evidence supports using gabapentinoids (gabapentin and pregabalin) and anticonvulsants (carbamazepine and oxcarbazepine). Although preliminary data support acamprosate, there were no controlled trials. Despite an older treatment trial showing some positive data for amitriptyline for mood, the clinical measures used were problematic, and side effects and safety profile limit its utility. Finally, there is no evidence that melatonin and other agents (homatropine, Proproten-100) show PAWS symptoms.
Summary of evidence
Ultimately, Satel and colleagues found insufficient empirical evidence for the existence of PAWS to justify its inclusion in the DSM (Satel et al., 1993). The protracted withdrawal period from alcohol appears to induce transient alterations in multiple cognitive domains, including concentration, initiative, pessimism, and even a sense of humor (Voltaire-Carlsson et al., 1996). Furthermore, persons experiencing PAWS have lower executive functioning measures, including selective attention, visual scanning ability, visual-motor scanning, and cognitive flexibility (Cordovil De Sousa Uva et al., 2010). Although these symptoms typically last a few weeks to months, some subtle residual effects often remain for up to a year of abstinence (Vik et al., 2004). Although the evidence of irreversible effects is less clear for alcohol, subtle lingering cognitive impairment is often undetected and unaddressed (Vik et al., 2004). Fortunately, there appears to be a gradual normalization back to baseline levels for some cognitive symptoms, and mental symptoms are comparatively stable compared with mood and anxiety symptoms (Voltaire-Carlsson et al., 1996).
Graduate School of Addiction Studies
- We did not find any additional articles through reviewing reference lists of identified articles.
- Seeking help for addiction may feel daunting or even scary, but several organizations can provide support.
- By learning to successfully manage post-acute and acute withdrawal symptoms, you will feel better physically and emotionally, improve your self-esteem and reduce the risk of relapse.
The doctor may ask for evidence that there has been a decrease in alcohol use after regular heavy use. If a loved one is experiencing PAWS, you can show support by reminding them that you’re there for them and encouraging them to reach out to you for help. With most substances, PAWS is less common — salvia trip explained not everybody experiences it — and the symptoms are usually less intense.
General PAWS symptoms
Post-acute withdrawal symptom (PAWS) is a condition where you experience withdrawal symptoms for an extended period of time — in other words, long after the typical acute stage is over. While acute withdrawal symptoms generally resolve in a few weeks, PAWS symptoms can last for a few months or up to a year. PAWS symptoms can be uncomfortable and distressing, and they can be risk factors for relapse. Having a strong self-care routine, working with medical professionals, and having support from people who understand can help.
Due to a lack of scientific evidence, protracted withdrawal and its causes are not well-documented. People with severe symptoms remain in the hospital for part or all of the detox process so a doctor can closely monitor their blood pressure, breathing, and heart rate and provide medications to ease the process. When a person is detoxing from alcohol, the symptoms may begin anywhere from 6 hours to a few days after their last drink. Alcohol use disorder or drinking heavily over an extended period can change a person’s brain chemistry due to the continued exposure to the chemicals in alcohol. Sian Ferguson is a freelance health and cannabis writer based in Cape Town, whats in whippets South Africa. She’s passionate about empowering readers to take care of their mental and physical health through science-based, empathetically delivered information.
