Self-Care in Battling PAWS (Post-Acute Withdrawal Syndrome)

My favorite group to do with our patients is on Post-Acute Withdrawal Syndrome (PAWS). If you are new to this acronym, PAWS refers to the random cravings, dreams, mood swings, body aches, sweats, and other symptoms that come a few weeks after the initial withdrawal and detox – and they can keep coming up to a year after.
They come from the connections in the brain that are deeply rooted and are not ready to rewire into recovery; it preys on the individual’s knowledge that continued use helps withdrawal symptoms. Researchers tell us that it doesn’t matter if you’re coming off of alcohol, opiates, benzos, anything; it is almost a guarantee that you will experience some duration and some type of PAWS. I tell the patients that detox is their way of physically attacking their addiction, but PAWS happens when the parts of their addiction that are the most deeply rooted attack back.
It is no surprise that this happens to almost everyone when realistically, every person with a substance use disorder has something deep down, like trauma or other mental health conditions, that they are self-medicating for. PAWS is sometimes described as “going through the withdrawals all over again,” and this overwhelming feeling can sneak up on someone when they aren’t regularly taking time for themselves.
When I start this group, I ask every person to come up with a number for me. I ask, “how many minutes or hours do you spend on a typical day taking care of others or spending your time on others?” This applies to work, taking care of family members, kids, pets, everything. The average answer is usually between 600-720 minutes (10-12 hours) or more. Some people tell me that their entire day is dedicated to others. Then I ask, “how many minutes or hours do you spend on just you?” I restrict this to true self-care and checking in with one’s self, and not tasks are done out of necessity like paying bills or taking a shower.
The numbers usually range from 5-to 60 minutes. Most people are shocked when they hear themselves say such a low number.

Stigma tells us that “addicts only think about themselves,” but these numbers show us a different perspective. These numbers tell us that people with substance use disorders dive into investing their time into others. It is great to have work and strong family relationships, but not when it is at the expense of someone’s self-care. I emphasize to our patients that they need to have time dedicated just to themselves every day – and they absolutely and whole-heartedly deserve it. A little bit of time to self-assess can help someone track the trends with anxiety, mood, energy levels, aches, and cramps. and it can lead to recognizing PAWS and taking action. It can be hard to sit with themselves at times and especially early in the recovery process, but a daily check-in could be the difference between picking up the phone for help or relapse.

As friends, family, and other members of the support system, there are a few things you can do to help your loved ones as they go through PAWS. First, provide support and patience, especially in the first year; some of those connections in the brain know nothing except how to cope without that substance and will try to manifest every physical symptom to make that person use it again. Second, guide them in putting aside some time for them to relax on their own and do something that they enjoy. It does not have to be done alone, and they may enjoy the company. Third, remind them that they deserve that time and it is an invaluable investment into their recovery. If they can put so much time into others, why not put a small part of that into themselves?

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