Does Opioid Relapse Restart Post-Acute-Withdrawal Syndrome (PAWS)?

Learn more about post-acute-withdrawal syndrome (PAWS) and the potential for opioid relapse to restart it.

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What is Post-Acute-Withdrawal Syndrome (PAWS)?

When someone stops using a substance that they have become reliant upon, such as drugs or alcohol, they can develop withdrawal symptoms that stem from the brain and body recalibrating itself after not being able to receive that substance anymore.

These withdrawal symptoms are generally short-lived, but post-acute-withdrawal syndrome, or PAWS, can develop after these initial symptoms have subsided and often include predominantly psychological symptoms. PAWS may not start for a few months after the individual has stopped their substance usage, but it can last anywhere from six months to years after the individual has gone through recovery.1
Post-Acute-Withdrawal Syndrome

What Does PAWS Feel Like?

PAWS symptoms develop as the brain adjusts to life without the substance an individual was dependent on. While the first stages of withdrawal symptoms are more physical and can include nausea, migraines, sweating, and spasms, post-acute symptoms are much more psychological. This means that PAWS generally feels more like mood swings, fatigue, brain fog, or lack of motivation.

Does Opioid Relapse Restart PAWS?

Post-acute-withdrawal syndrome often sets in after a few months of no longer taking substances. However, the question of if opioid relapse restarts PAWS symptoms is multi-layered and depends on many factors. For instance, this answer may change depending on each person’s genetics, how long they’ve been using, and the amount of drugs they consumed.

Generally, however, if you have a relapse of only a few days or so, then opioid relapse does not typically restart PAWS, as there hasn’t been enough time for your body to cycle through the first withdrawal symptoms again. If you have not used drugs for months or years, then relapsing can definitely restart PAWS symptoms.

Signs and Symptoms of PAWS from Opioids

There are many different signs and symptoms of post-acute-withdrawal syndrome from opioid usage or opioid relapse. The severity of these can vary from person to person, but some common symptoms include:2

  • Insomnia
  • Aggression
  • Anxiety
  • Depression
  • Inability to focus
  • Unstable and unpredictable moods
  • Panic attacks
  • Fatigue
  • Poor impulse control
  • Cravings
  • Chronic pain
  • Brain fog

Time Frame Which Symptoms Persist

Depending on the duration of sobriety, some of the symptoms listed above may present themselves for a longer amount of time as well. While PAWS symptoms can persist for years for some individuals, if they are already prone to symptoms like migraines or fatigue due to physical reasons or co-occurring mental health conditions, these symptoms can potentially last for even longer.

If you have a co-occurring mental health condition or another physical ailment that could impact the type and intensity of PAWS symptoms, it’s important to speak to your doctor so they can help during the withdrawal phases.

Causes and Risk Factors of Post-Acute-Withdrawal Syndrome

Some people are more at risk for PAWS symptoms than others are, but some common causes of PAWS are chemical changes, homeostatic adjustment, dopamine shortages, and physiological adaptations.

Chemical Changes in the Brain

After someone has been addicted to a substance for some time, suddenly stopping the use of that substance can create chemical changes in the brain. Neurotransmitters were accustomed to working through the use of substances, and the sudden shift in consumption can make someone more apt to develop PAWS symptoms.3

Homeostatic Adjustment and Physiological Adaptations

This refers to the brain’s general balance and the body’s physiological attempt to maintain a stable internal environment. Drug and alcohol misuse can often send this stable environment reeling, therefore putting individuals at a greater potential risk of later developing PAWS.4

Dopamine Shortage

A shortage in overall dopamine can also potentially lead to someone developing post-acute-withdrawal syndrome, especially if someone already has a co-occurring mental health condition like anxiety or depression. The lack of this “feel good” chemical may put someone at higher risk of the side effects of PAWS.

How to Treat Post-Acute-Withdrawal Syndrome

Since PAWS is still not a scientifically proven syndrome, despite countless people experiencing it, there has not been much research done on how to successfully treat its symptoms. Many scientists and rehab centers will often treat it the same way that they treat normal withdrawal symptoms during recovery, which helps patients to cope with some of the symptoms. This can include therapy and medication to help treat mental health conditions, along with helping to support the patient by cultivating healthy coping mechanisms to help prevent relapsing and potentially restarting PAWS symptoms.

Ways to Treat PAWS

Some common ways to treat PAWS can include:

  • Avoiding relapse causes: If you are in or near an environment that encourages drug or alcohol use after you’ve stopped, it’s important to take a step back in order to mitigate any potential causes of relapse.
  • Being patient: As PAWS tends to occur over a longer period of time, patience is important. PAWS doesn’t last forever, and taking care of yourself over the long term will help alleviate any symptoms you may be experiencing.
  • Self-care: Practicing good self-care can put you ahead of the curve when it comes to mitigating PAWS.
  • Exercising regularly: Getting good exercise is not only healthy for you physically, but it can also help you curb cravings and alleviate other symptoms related to PAWS.
  • Assessing co-occurring disorders: As stated above, treating any co-occurring disorders can greatly reduce the likelihood of PAWS symptoms.

Getting PAWS Treatment at Soledad House

Soledad House is a women-only rehabilitation clinic that specializes in helping patients undergo detox and cultivate healthy relapse prevention skills along the road to achieving long-term sobriety.

Our supportive, caring, and highly-trained staff can help you every step of the way on your recovery journey, from when you initially go through detox all the way to if you develop PAWS and beyond. We are invested in making lasting changes for our patients, including improving overall mental, physical, and emotional health in a myriad of ways.

PAWS symptoms

Reach Out and Begin Healing

We offer detox services, along with many types of therapy, including individual and group therapy, aftercare addiction programs, exercise therapy, and yoga and meditation therapy. We will cultivate a care plan that is specific to you and your needs. If you or a loved one think you may have PAWS after an opioid relapse, please contact us today, and we can aid you every step of the way on your road to recovery.

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