Research shows that only a small portion of people with AWS require medical treatment. The authors acknowledge the University of Calgary Health Sciences Librarians for their support in developing our search strategy. We also recognize that our work takes place on historical and contemporary Indigenous lands, including the territories of Treaties 6, 7 & 8 and the homeland of the Métis. We also acknowledge the many Indigenous blue eyes and alcoholism communities that have been forged in urban centers across Alberta. Pharmacological treatments involving antidepressants, sleep-promoting agents, anticonvulsants, gabapentinoids, and two novel therapies have been explored for therapeutic efficacy in PAWS management (Table 1), which we summarize here. Others may prefer to rely on a strong self-care routine and support from loved ones and others in recovery.
Delirium tremens and seizures
But there’s more to drug and alcohol withdrawal than physical symptoms of discomfort. While acute withdrawal refers primarily to the body’s process of healing, a second phase of withdrawal symptoms, known as post-acute withdrawal syndrome, or PAWS, occurs as the brain recalibrates after active addiction. These symptoms, unlike the first stage of acute withdrawal, typically involve more of the psychological and emotional aspects of withdrawal. Depending on the duration and intensity of alcohol or other drug addiction, this secondary withdrawal syndrome can occur a few weeks into recovery or a few months down the road.
Track symptoms and triggers
Alcohol withdrawal syndrome (AWS) describes a broad range of symptoms a person with AUD may experience when reducing or stopping alcohol misuse. 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.
What is alcohol withdrawal?
Although it has been nearly 30 years since the publication of the Satel et al. (1993) review of protracted withdrawal syndromes, the PAWS field has not advanced remarkably apart from animal studies, which was not the present review’s focus. Thus, research efforts into elucidating PAWS have been stalled for more than two decades, with minimal research explicitly exploring the phenomenon of protracted withdrawal, which may be a consequence of the failure to recognize PAWS as a diagnostic entity formally. Some studies have examined the relationship between protracted alcohol withdrawal and specific gastrointestinal hormones, given the established association between chronic alcohol use and pancreatic function. One such hormone is plasma pancreatic polypeptide (PP), which inhibits pancreatic exocrine function, such as amylase secretion and other digestive enzymes (Fink et al., 1983; Hajnal et al., 1993). PP levels were significantly higher in individuals with AUD than in controls and remained elevated even 2 weeks following acute withdrawal completion (Fink et al., 1983). Therefore, alcohol-related gastrointestinal dysfunction appears to persist into PAWS and may help explain the abnormal pancreatic function seen frequently in AUD (Fink et al., 1983).
Why do we experience post-acute withdrawal in recovering from substance abuse?
This chronic stress response continues during post-acute withdrawal, receding and effectively resetting only gradually over time. As a result, people come into recovery under the influence of biologically birthed higher levels of stress in combination with enhanced susceptibility to stress. Meanwhile, early recovery can be incredibly stressful in and of itself. All sorts of stressful situations inevitably arise, and the frustration, confusion, and blistering discomfort of post-acute withdrawal symptoms (stress-inducing in and of themselves) piggyback onto them to produce even more distress. Post-acute withdrawal varies in intensity and duration from one person to another; again, usually in correlation with the intensity and duration of one’s substance use.
- However, for PAWS negative affect and sleep symptoms, more evidence supports using the gabapentinoids (gabapentin and pregabalin) and the anticonvulsants (carbamazepine and oxcarbazepine).
- Sometimes, your symptoms after stopping antidepressant use are part of the “rebound symptoms” — in other words, the symptoms you were trying to treat with antidepressants start coming back.
- Seeking help for addiction may feel daunting or even scary, but several organizations can provide support.
- Lastly, researchers have identified a condition called post-SSRI sexual dysfunction (PSSD), where someone experiences sexual side effects after they stop using SSRIs.
Acute withdrawal happens just after you stop using a substance or medication, while PAWS can happen for weeks, months, or even years after you cease use. In some situations, a doctor or psychiatrist might prescribe medication to help with PAWS symptoms. alcohol poisoning symptoms and treatment Your medication options depend on the substance you used, your symptoms, and your medical history. The duration of PAWS can depend on a range of factors, including the substance you used and how frequently you used it, as well as your support system.
In addition, because of a lack of pertinent studies, it remains unclear whether all the symptoms described here are manifested equally in both sexes or in individuals with comorbid substance use disorders. Finally, for a systematic review, ideally, two individuals should review articles for eligibility. However, in this article, only one author (A.B.) reviewed and identified the articles for inclusion and the second reviewer only reviewed the excluded articles.
We considered randomized controlled trials and nonrandomized intervention studies (e.g., pre–post studies). We excluded commentaries, reviews, editorials, and case reports; we did not restrict the study’s data or location. There is credible evidence to support the concept of PAWS based on this review’s findings.
With future studies, a more extensive systematic review or meta-analysis could be conducted. They may be more psychological than physical, including mood swings and difficulty with sleep and memory, for example. PAWS symptoms can last from months to years, and they may increase the risk of a relapse.
Behavioral health treatment for alcohol problems is often (but not always) covered by insurance. In the United States, most states have low-cost or free rehabilitation programs for those who are uninsured. Many involve a combination of group psychotherapy (talk therapy) and medications. It’s important to be honest about your alcohol use — and any other substance use — so your provider can give you the best care. Alcohol (ethanol) depresses (slows down) your central nervous system (CNS). If you consistently consume significant amounts of alcohol, your CNS gets used to this effect.
Knowing how to treat PAWS is a vital part of recovering from an alcohol use disorder. If a person doesn’t expect these symptoms or understand that they are normal, they may feel something is wrong with them. When a person https://rehabliving.net/10-natural-remedies-for-alcohol-withdrawal-ark/ uses alcohol long-term, their body depends on that substance for everyday functions like digestion and sleep. As this occurs, the toxins from alcohol can also be simultaneously damaging the systems of the body.