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. We restricted eligibility to human adult populations (ages ≥18), examining any descriptive component of PAWS. In addition, we restricted eligibility to English-language articles or those with an available English-language translation. We considered randomized controlled trials and nonrandomized intervention studies (e.g., pre-post studies).
High-quality treatment studies involving agents addressing its neurobiological underpinnings are also recommended. Most symptoms last for a few days at a time, although this is dependent on the type of alcohol or drug addiction, and the amount and frequency of substance use (every person’s withdrawal pattern is a little different). Typically, the brain recalibration process takes anywhere from six months to two years before the brain once again naturally produces endorphins and dopamine. Tracking your triggers, managing stress, and taking care of your basic needs might help keep your symptoms in control.
In addition, much of the literature on PAWS is dated, and there is a shortage of robust, randomized, controlled trials. Furthermore, there is a lack of standardization of PAWS across studies, and the extent of post-acute withdrawal abstinence was highly variable. Finally, as a scoping review, the search was limited to only a few databases and published literature. However, it is unclear if this significantly affected the overall conclusions. Unlike a traditional systematic review, only one author (A.B.) reviewed and identified the articles for inclusion, and the second reviewer only reviewed the excluded articles. With future studies, a more extensive systematic review or meta-analysis could be conducted.
Post-acute withdrawal syndrome symptoms by substance
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According to a 2021 study, PAWS is one of the major causes of relapse in people with alcohol use disorder. If auditory, visual, or tactile hallucinations in the setting of alcohol withdrawal are present, the patient is likely experiencing alcohol hallucinosis, which affects approximately 2%.[11] The altered mental status that accompanies this presentation is concerning for alcohol withdrawal delirium. We restricted eligibility to human adult populations (ages ≥ 18 years), examining any pharmacological (e.g., medications) or nonpharmacological (e.g., psychotherapy) interventions for the treatment of PAWS. We restricted eligibility to English-language articles or those with an available English-language translation.
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You can also regularly send them messages or call them to remind them that you’re thinking of them. Certain drugs and medications can change the structure and chemistry of your brain.
We also excluded treatment studies, as these were the focus of a parallel review. Post-acute withdrawal syndrome (PAWS) was a phrase first used more than 20 years ago to describe a phenomenon of relatively milder, but persistently troublesome withdrawal symptoms that lingered in some individuals who had discontinued benzodiazepine therapy. PAWS can also be called protracted withdrawal how does flakka affect your brain syndrome or prolonged withdrawal syndrome.
Consequently, the interprofessional healthcare team must ascertain the most suitable setting based on a patient’s symptoms. The primary limitation is the high heterogeneity between studies owing to the nebulous nature of PAWS, the lack of a shared consensus definition, the variable durations of symptoms presented as components of PAWS and the small sample sizes of the component studies. Furthermore, there is a lack of standardization of PAWS across studies, and the extent of post-withdrawal abstinence was highly variable. 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.
You may also receive other medications or treatments for related health issues, like IV fluids for dehydration and electrolyte imbalances or antinausea medicines if you experience vomiting. It’s difficult to predict who will and who won’t experience alcohol withdrawal — and how severe it will be. Go to the nearest emergency room or call 911 (or your local emergency service number) if you or a loved one has any concerning symptoms of alcohol withdrawal.
Because most studies were at high risk of bias, we downgraded the overall strength of evidence. We conducted a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-guided systematic review of articles from two databases for English-language randomized and nonrandomized studies involving PAWS published between database inception and December 2020. Sian Ferguson is a freelance health and cannabis writer based in Cape Town, South Africa. She’s passionate about empowering readers to take care of their mental and physical health through science-based, empathetically delivered information. After the acute withdrawal stage, some uncomfortable symptoms may linger.
- These symptoms—termed post-acute withdrawal syndrome (PAWS)—were first described more than six decades ago (Satel et al., 1993).
- Symptoms from posttraumatic stress disorder (PTSD) and trauma can overlap with some of the PAWS’ mood, anxiety, concentration, and sleep issues.
- In 1954, Wellman described “late withdrawal symptoms” in abstinent alcoholic-dependent persons, which consisted of irritability, depression, insomnia, fatigue, restlessness, and distractibility, constituting a physical syndrome most severe during the first 6 months of abstinence (Wellman, 1954).
- The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes.
- Accordingly, individuals experiencing acute and protracted AWS have higher reported basal serum cortisol levels (Heilig & Koob, 2007).
- We also excluded treatment studies, as these were the focus of a parallel review.
Similarly, SSRIs can be used to help people eco sober house who are experiencing depression and anxiety, but not everybody responds well to SSRIs. 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. These symptoms are common across substances — in other words, no matter which substance you used, you might experience one or more of the above. This, as well as impulse control disorders, can last up to 4 weeks after discontinuing use. The above-mentioned review states that there’s a lack of research on PAWS from benzodiazepines, but that it can persist for 6 to 12 months — in some cases, even years after stopping benzodiazepine use.
At the same time, endogenous GABA is downregulated.[3] Thus, when alcohol is withdrawn, a relative deficit of GABA may occur and simultaneous excess in glutamate, resulting in the excitatory symptoms seen in alcohol withdrawal syndrome. 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. Consequently, one strategy for improving PAWS research is to recognize it formally. We hope that the present review’s findings—by synthesizing literature across approximately four decades of research—may create a stronger argument for formalizing PAWS as a diagnostic entity. Furthermore, considering that PAWS symptoms are mainly related to the neuro-adaptive changes of GABA and NMDA systems, traditional treatments for AUD—such as naltrexone, nalmefene, and disulfiram—may not be able to suppress PAWS symptoms (Caputo et al., 2020). A small pilot open study confirmed the efficacy of acamprosate in maintaining abstinence and reducing PAWS in 18 recently detoxified alcohol-dependent outpatients (Gualtieri et al., 2011).
One reviewer (A.B.) extracted the following data gas-x and alcohol interaction from included studies, while another (D.C.) confirmed the extracted data for accuracy. We reviewed studies for eligibility using Covidence, a web-based review manager, and Zotero citation manager (Roy Rosenzweig Center for History and New Media, 2018; Veritas Health Innovation, 2019). After removing duplicates, one reviewer (A.B.) independently selected the studies, reviewed the main reports and supplementary materials, extracted the relevant information from the included trials, and assessed the risk of bias; a second author (N.E.) reviewed excluded studies for erroneous selection. Often, symptoms are triggered by stress or brought on by situations involving people, places or things that remind the individual of using. Many people in recovery describe the symptoms of PAWS as ebbing and flowing like a wave or having an “up and down” roller coaster effect.
Dr. Bahji also received financial support from a 2020 Research Grant on the Impact of COVID-19 on Psychiatry by the American Psychiatric Association and the American Psychiatric Association Foundation. Currently, Dr. Bahji has been awarded doctoral studies research funding from the Canadian Institutes of Health Research (CIHR) Fellowship and the Harley N. Hotchkiss Graduate Scholarship in Neuroscience from the University of Calgary. Furthermore, Dr. Bahji has received research funding through the Calgary Health Trust. However, the content is solely the authors’ responsibility and does not represent the official views of NIDA, the University of Calgary, the CIHR, or the Calgary Health Trust. We conducted a PRISMA (Preferred Reporting Items for Systematic Revision and Meta-Analyses)-guided scoping review of the published PAWS literature, searching six electronic databases (from their inception through December 2020) for English-language randomized and nonrandomized studies. Due to a lack of scientific evidence, protracted withdrawal and its causes are not well-documented.
One reviewer (A.B.) extracted the following data from included studies while the other two (D.C. and N.E.) confirmed the extracted data for accuracy. We used a standardized tool to extract information about authors, study objectives, sample characteristics, inclusion/exclusion criteria, study design, and outcome variables in Covidence, which we transferred to a Microsoft Excel spreadsheet (Veritas Health Innovation, 2019). Whether you’ve experienced addiction or are withdrawing after using prescription medication, it can be helpful to find a support group. In some cases, these sleep disturbances — which may include strange, vivid dreams — persist for weeks or even months. However, after stopping antidepressants after using them for a long time, some people do experience prolonged withdrawal symptoms.