Trauma, Addiction and Post-Acute Withdrawal (PAWS)

Video · Trauma · Addiction

Summary

Stopping a substance is not the same as a settled nervous system. PAWS — post-acute withdrawal — is the longer wave after the acute phase: mood swings, anxiety, irritability, bouncing energy and concentration, flatness, and sleep that will not stabilize. That distress can throw you back into a predictable relapse cycle. This is education from trauma and recovery work. It is not detox advice, not medical care, and not a substitute for treatment.

What this video covers

  • What PAWS is and why it threatens abstinence
  • Mood, energy, focus, anhedonia, and sleep as warning signs
  • Honesty with yourself and with accountability people
  • Why isolation rarely works for a real compulsion
  • Self-care you need — without using it to flee your life
  • Follow established wisdom instead of “I’m the exception”

Key takeaways

  • PAWS is a high-risk window, not proof that recovery failed.
  • Addiction runs on covering up, leaving things out, and rewriting the plan midstream.
  • Ask for help. A book and a decision are not enough for most people in this pattern.
  • Take the self-care you need, not more than you need.
  • If you decide the relapse-stage guidelines do not apply to you, that is often the trap.

Who this is for

  • Adults who stopped using and feel worse than they expected
  • People whose relapse-cycle talk landed and who want the next layer

Who this is not for

  • Anyone in medical withdrawal or crisis — call 911 or 988
  • DIY detox

Next step

Transcript

When it comes to recovering from addictions, compulsions, and bad habits, there is something important you need to know about. It is called post-acute withdrawal symptoms. In the clinical world people sometimes call it PAWS.

PAWS can threaten your abstinence. It can throw you back into the cycle of relapse — a cycle that is very predictable. Post-acute withdrawal threatens abstinence because it is a point where you start to become very distressed.

What I see in clients: mood swings. Anxiety, fear, irritability. Energy in the whole body-mind system goes up and down. Exhausted, then excited and energized. Concentration gets bouncy, all over the place. Sometimes low enthusiasm — flat, anhedonic, not enjoying things. A key sign is sleep problems: oversleeping, undersleeping, or sleep all over the place.

Here are some rules that matter for managing post-acute withdrawal.

Cut through the details and look at the big picture. The important message is: it is time to change your life. You do not want to rearrange the deck chairs on the Titanic. Put everything on the table. Do what you need to do to beat the addiction, the compulsion, the bad habit.

Next: commit to being completely honest with yourself and with other people — especially the people you turn to for accountability: therapists, counselors, accountability buddies. Addiction is fueled by lying. I do not mean that in a judgmental way. I mean covering up, avoiding, leaving things out, being dishonest with yourself. Anything on autopilot — an addiction or a compulsion — we distort.

Example: someone I work with who is dealing with a food and alcohol addiction started telling me that instead of counting calories they were going to be a little looser with the plan, because they did not want to be a rigid person. That gets slippery. This person has a dangerous history of bulimia and anorexia — years in a binge-and-purge cycle that put them in medical danger. It is no small thing when they say they are no longer counting calories and are just winging it. Over the time I have known them, they have been very prone to misperceive what is going on with food consumption.

Next rule: ask for help. You cannot do this in isolation. Occasionally I meet someone who read a book, made a decision, and stopped, and it was relatively easy. Some people can do that. If you are really dealing with an addiction or compulsion, you need help. Ask for it.

Next rule: practice self-care. Take as much self-care as you need — but not more. Why? I have worked with men and women whose addiction or compulsion made them self-centered. They damaged marriages, friendships, family. Take the self-care you need. Do not use “self-care” to flee your life and your responsibilities, or to make the world go away so you do not have to deal with it. Sometimes you do have to step back and prioritize the addiction. Over the long haul, disappearing from your life will not serve you.

Next rule: follow established wisdom. Be wary of doing it your own special way. We are unique. That is true. You still want to be discerning. You may need to adapt a recovery plan to your situation. That is wise. I cannot tell you how many people I have worked with who think they are the exception — that the guidelines, especially the stages of relapse, do not apply to them. Sometimes that is where a harm-reduction idea backfires and keeps people stuck in an endless cycle of relapse.

Disclaimer

Educational content only. Not therapy, not medical advice, not a crisis service. If you are in immediate danger, call 911 or 988. Psychotherapy is available to California residents in San Francisco, Palo Alto, and online.