The good thing about PAWS is that it eventually goes away. The bad thing about PAWS is that it varies quite a lot from person to person, so there isn’t a single treatment protocol for PAWS that will work for everyone. But there is a basic framework we follow which patients respond well to.

Managing PAWS Symptoms

When it comes to Post-Acute Withdrawal Syndrome (PAWS), the pressing issue for most is managing their symptoms. During the substance use period, the body starts developing all of the symptoms of PAWS, but the substance use itself overshadows it.

Mood swings, depression
Anxiety, hostility, irritability
Sensitivity, low libido
Fatigue, exhaustion
Sleep problems
Difficulty concentrating
Memory problems
Cravings
Difficulty controlling impulses
Social withdrawal

Some days will be much worse than others, but the good news is that it gets better. For some, the symptoms may last 2-3 years, but they rarely will be as severe as the first ~500 days.

Managing symptoms involves prioritizing the most troublesome issues and always focusing on preventing relapse. Some will have a dominance of dopamine withdrawal, others will have excess catecholamines, while others will still have trouble with their sex hormones.

Ruling Out Other Causes

In medicine, we always want to rule out other potential causes before treating PAWS, which may mimic its symptoms.

PTSD
Alzheimer’s
Thyroid issues
Liver disease
Insulin resistance
Hypogonadism
Perimenopause
Depression
Sleep apnea
Personality disorder
Fibromyalgia
Chronic fatigue syndrome

At DNH, we start by taking an extensive history, often over several visits, focusing on which of the patient’s current habits or medications might prevent faster PAWS resolution.

We will not only review old blood tests but also suggest new ones to dive in deeper and rule out other potential causes.

Treatment Protocol for PAWS

The goal of treatment is to make the symptoms of PAWS more tolerable. There is no protocol that we are aware of that gets rid of all symptoms fully.

Education
Support
Self-care
Therapy
Medical treatments

1. Education

We educate our patients regarding the progression of PAWS and help them recognize their symptoms. Learning how to tune into the body is an important skill to develop because it then allows us to make changes to improve symptoms.

2. Support

We are humans, not machines. PAWS is quite overwhelming, so having support from friends, family, or a support group is critical. You’re not alone, and many are going through PAWS without even knowing what PAWS is.

3. Self-Care

Exercise leads to severe fatigue in PAWS, but there are certain exercise regimens that are quite helpful. The goal is a very low-intensity exercise with HR tracking.

Diet has to be individualized, but usually, we titrate down stimulating foods, which often include caffeine, saturated fats, and sugars. We also adjust meal timing to improve cortisol levels.

4. Therapy

Life goes on even when you’re suffering with PAWS. Therapy is amazing when you connect with the right therapist. From cognitive behavioral therapy (CBT) to guided imagery to biofeedback – lots of effective therapies are available.

Meditation, mindfulness, and hypnosis might seem too hokey for some, but they are much more straightforward than popular media makes it out to be.

5. Medications

From herbals to supplements to prescription medications, there are many options to treat the most severe of symptoms of PAWS, and it remains an important part of a proper PAWS treatment protocol.

However, medications have many downstream effects because they are designed to work on a single biochemical pathway in the body. This often creates other imbalances, which sometimes complicate things. For example, we have found that sleep medications often create much more problems and offer little long-term benefit.

PAWS Supplements

This list isn’t to insinuate that these are the right supplements for patients to use for their PAWS. Instead, a good clinician can discover which part of your system is overfiring and focus their treatment on that.

Ashwagandha: It can improve sleep quality and cognitive function.
Rhodiola: It can help to improve mood, energy levels, and resilience to stress.
L-theanine: It has been shown to have anxiolytic and calming effects.
Omega-3 fatty acids: They have been shown to improve mood and reduce anxiety and cognitive function.
Turmeric: Curcumin may improve mood, reduce anxiety, and may have protective effects on the brain.
Magnesium: Magnesium deficiency has been linked to anxiety, depression, and sleep problems.
Vitamin B12: Vitamin B12 deficiency can cause various symptoms, including fatigue, anxiety, and depression.

The common error we see is to assume that a combination of these herbs will be beneficial. But adding anything to your body when the system is already on high alert is often not a good idea.

Interested in better long-term health with fewer chronic diseases? Here at Digital Nomad Health, we focus on wellbeing and quality of life. Book a free 15-minute session to get on our waitlist.