Post Accute Withdrawal – (P.A.W.)

What Is P.A.W.?
(Post Acute Withdrawal)

Download Handout Here

P.A.W. is a group of symptoms of addiction disease that occur as a result of abstinence from addictive chemicals. These symptoms result from a combination of damage to the nervous system caused by alcohol and/or drugs and the stress of coping with life without drugs and/or alcohol. Stress aggravates the brain dysfunction and makes symptoms worse. Symptoms of P.A.W. may start as early as 7 to 14 days after abstinence begins, and typically peak 3 to 6 months after abstinence begins.

There is hope. The damage is usually reversible, meaning the major symptoms go away if proper treatment is received. This can take place within 6 to 24 months after abstinence begins.

Symptoms of P.A.W.

Inability to think clearly:

  • Inability to concentrate.
  • Rigid and repetitive thinking.

Memory problems:

  • Short term memory problems are common.
  • It may be difficult to learn new skills and information.

Emotional overreaction and numbness:

  • May become angry over what may later seem a trivial matter.
  • Emotional shutdown occurs when the overreaction puts more stress on the nervous system.

Sleep problems:

  • Some are temporary; some are lifetime.
  • Unusual and disturbing dreams.

Physical coordination problems:

  • Dizziness.
  • Trouble with balance.
  • Problems with coordination between hand and eye.
  • Slow reflexes.

Different Patterns of P.A.W.

  • Regenerative P.A.W.; it gets better.
  • Degenerative P.A.W.; it gets worse.
  • Stable P.A.W.; it stays the same.
  • Intermittent P.A.W.; it comes and it goes.

Managing P.A.W. Symptoms


  • Identify sources of stress and develop skills in decision making and problem solving.
  • Proper diet, exercise, regular habits and positive attitudes all play important roles in controlling P.A.W.
  • Relaxation can be used as a tool to retrain the brain to function properly and to reduce stress.


  • Verbalization – Talk about what you are experiencing.
  • Ventilation – Express as much as you can about what you are thinking and feeling.
  • Reality Testing – Ask someone if you are making sense.
  • Problem Solving and Goal Setting – Take action.
  • Back Tracking – Identify start of episode. What turned it on – What turned it off.

Education and Retraining:

  • Learning about addictive disease, recovery, and P.A.W. symptoms helps relieve the anxiety, guilt and confusion that tend to create the stress that intensifies P.A.W. symptoms.
  • This is normal.
  • Through retraining, you improve your ability to remember, concentrate and think clearly. This includes practicing certain skills and learning to take things step by step and to handle one thing at a time, so you do not feel overwhelmed.
  • Writing down what you want to remember and asking questions when you need to have something clarified.

Self-Protective Behavior:

  • Protect yourself from stress. Identify your own stress triggers. Learn to change these situations; avoid them, change reactions, or learn to interrupt them before they get out of control.
  • Stress is not caused by what happens to us, but is triggered by our reaction to and perception of what happens.


  • 3 well balanced meals daily.
  • 3 nutritious snacks daily.
  • Avoid sugar, caffeine, and highly processed carbohydrates.

90% of Alcoholics are Hypoglycemic (low blood sugar). When a person’s blood sugar drops below a certain level, they experience cravings for sugar and/or alcohol. Low blood sugar also creates nervousness and irritability. Learning to balance one’s blood sugar reduces cravings and supports long-term recovery.


Regular exercise produces chemicals (neuro transmitters) in the brain that help you feel good, relieve pain, anxiety, and tension, and reduce stress.


• Helps reduce and cope with stress.
~Listening to music
~Story telling
~Deep Breathing
~Guided Meditation


  • Spirituality is an active relationship with a power greater than yourself that gives your life meaning and purpose.
  • Spiritual discipline includes prayer and meditation, spiritual fellowship, and regular inventory of your spiritual growth.

Balanced Living:

  • Holistic health.
  • Balance of physical, emotional and spiritual health.

“You invest time and energy into your job, your family, your friends, as well as time for your own growth and recovery. It means allowing a Higher Power to work in your life.”
Copyright © 1986 Terence T. Gorski and Merlene Miller

Suggested Reading:

  • Staying Sober by Terence Gorski
  • Depression and Recovery by Terence Gorski
  • End Your Addiction Now by Charles Gant MD., PhD.
  • Food For Recovery by Joseph Beasley MD., and Susan Knightly
  • How To Control Your Anger Before It Controls You by Albert Ellis
  • How To Control Your Anxiety Before It Controls You by Albert Ellis
  • Why People Don’t Heal and How They Can by Carol Myss
  • Transformers by Jacqueline Small

Helpful Websites:

Therapeutic Benefits of Laughter:

Dr. Lee Berk and fellow researcher Dr. Stanley Tan of Loma Linda University in California have been studying the effects of laughter on the immune system. To date their published studies have shown that laughing lowers blood pressure, reduces stress hormones, increases muscle flexion, and boosts immune function by raising levels of infection-fighting T-cells, disease-fighting proteins called Gamma-interferon and B-cells, which produce disease-destroying antibodies. Laughter also triggers the release of endorphins, the body’s natural painkillers, and produces a general sense of well-being.

The following is a summary of his research, taken from an interview published in the Sept/Oct, 1996 issue of the Humor and Health Journal.

Laughter Activates the Immune System:
In Berk’s study, the physiological response produced by belly laughter was opposite of what is seen in classical stress, supporting the conclusion that mirthful laughter is a eustress state a state that produces healthy or positive emotions.
Research results indicate that, after exposure to humor, there is a general increase in activity within the immune system, including:

  • An increase in the number and activity level of natural killer cells that attack viral infected cells and some types of cancer and tumor cells.
  • An increase in activated T cells (T lymphocytes). There are many T cells that await activation. Laughter appears to tell the immune system to “turn it up a notch.”
  • An increase in the antibody IgA (immunoglobulin A), which fights upper respiratory tract insults and infections.
  • An increase in gamma interferon, which tells various components of the immune system to “turn on.”
  • An increase in IgB, the immunoglobulin produced in the greatest quantity in body, as well as an increase in Complement 3, which helps antibodies to pierce dysfunctional or infected cells. The increase in both substances was not only present while subjects watched a humor video; there also was a lingering effect that continued to show increased levels the next day.

Laughter Decreases “Stress” Hormones:
The results of the study also supported research indicating a general decrease in stress hormones that constrict blood vessels and suppress immune activity. These were shown to decrease in the study group exposed to humor. For example, levels of epinephrine were lower in the group both in anticipation of humor and after exposure to humor. Epinephrine levels remained down throughout the experiment.

  • In addition, dopamine levels (as measured by dopac) were also decreased. Dopamine is involved in the “fight or flight response” and is associated with elevated blood pressure.
  • Laughing is aerobic, providing a workout for the diaphragm and increasing the body’s ability to use oxygen.
  • Laughter brings in positive emotions that can enhance – not replace — conventional treatments. Hence it is another tool available to help fight the disease.
  • Experts believe that, when used as an adjunct to conventional care, laughter can reduce pain and aid the healing process. For one thing, laughter offers a powerful distraction from pain.
  • In a study published in the Journal of Holistic Nursing, patients were told one-liners after surgery and before painful medication was administered. Those exposed to humor perceived less pain when compared to patients who didn’t get a dose of humor as part of their therapy.
  • Perhaps, the biggest benefit of laughter is that it is free and has no known negative side effects.
  • More details can be found in the article, Humor and Health contributed by Paul McGhee.

Muscle Relaxation:
Belly laugh results in muscle relaxation. While you laugh, the muscles that do not participate in the belly laugh, relaxes. After you finish laughing those muscles involved in the laughter start to relax. So, the action takes place in two stages.

Reduction of Stress Hormones:
Laughter reduces at least four of neuroendocrine hormones associated with stress response. These are epinephrine, cortisol, dopac, and growth hormone.

Immune System Enhancement:Clinical studies have shown that humor strengthens the immune system.

Pain Reduction:
Humor allows a person to “forget” about pains such as aches, arthritis, etc.

Cardiac Exercise:
A belly laugh is equivalent to “an internal jogging.” Laughter can provide good cardiac conditioning especially for those who are unable to perform physical exercises.

Blood Pressure:
Women seem to benefit more than men in preventing hypertension.

Frequent belly laughter empties your lungs of more air than it takes in resulting in a cleansing effect – similar to deep breathing. Especially beneficial for patient’s who are suffering from emphysema and other respiratory ailments.

[Humor Therapy-Home][Stress Home Page][Holistic-online Home]
Copyright©1998-2007 ICBS, Inc.

Diaphramatic Breathing

Instructions for self and to teach others:

  1. Put a hand on your chest and a hand below your navel.
  2. Breathe normally.
  3. Where do you notice your breath coming from?
  4. When you are breathing normally your breath will come from your abdomen (area below your navel).
  5. Instructions:
  • When you breathe in your belly inflates; when you breathe out your belly deflates.
  • When this becomes familiar to you, your chest will appear to hardly move at all.
  • You can do this with your eyes open or closed. Start with your eyes closed for better concentration.
  • Do not force it. Simply notice what your breath is doing. With practice you will notice your breathing changing.
  • When you do this exercise pay attention to your breath.
  • When you are concentrating on breathing your mind will wander. That’s OK. When you notice that you’ve gone away from your breath then gently bring your focus back to your breath. It doesn’t matter how often or how long you go away. What matters is that you notice it and come back.


National Alliance for the Mentally Ill Colorado; (303)321-3104 / (888)566-6264 or
National Alliance for the Mentally Ill; (800)950-6264 or
National Mental Health Association; (800)969-6642 or
National Medical Association (provides list of African American doctors); (888)662-7497 or
Black Psychiatrists of America; (510)834-7103
American Association of Pastoral Counselors; (703)385-6967
Depression and Bipolar Support Alliance; (800)826-3632 or
American Psychiatric Association; (888)357-7924
Depression/Bipolar Support Alliance;
Child and Adolescent Bipolar Foundation; (847)256-8525 or

Free or Lower Cost Medications

This list is for your information. We do not endorse any program or company listed below.

  • National Relief Hotline, free medications from pharmaceutical companies; (800)291-1206
  • Partnership for Prescription Assistance, free or nearly free prescriptions for employed, unemployed, retired, students & families; (888)477-2669 or
  • Together Rx Access, income based, most cardholders save 25% – 40% on brand name medications. Must not be eligible for Medicare and not have prescription drug coverage; (800)444-4106 or
  • Total Care Rx Complete, enrollment fee is $25 with a $50 monthly fee paid quarterly at $150. Their card is good for the whole family and appears able to provide significant discounts on meds. With their drug card you are also entitled to discount services for dental, vision, medical supplies and more; (877)463-1905
  •; for medical providers
  • or (800)327-7300
  • Colorado Cares Rx Program, offers generic drugs at a discount for those without insurance or with high-deductible insurance and little or no prescription benefit. Income based, there is a one time $20 fee; (800)769-3880 or
  • Local Stores offer Discount Prescriptions – Target, K-Mart and Wal-Mart offer generics; Costco offers discounts.

Bipolar Disorder Colorado and National Groups and Organizations

This list is for your information. We do not endorse any groups or programs listed below.
Metro Denver & Statewide:

Colorado Alliance for the Mentally Ill; (303)321-3104 / (888)566-6264 or Sheri Bishop; (303)697-6808. See website, under education for state-wide program dates.

  • Family-to-Family: 12 week educational groups
  • Caminantes de Colorado: Catherine Benavidez Clayton; (303)403-0515. Similar programs as above, except in Spanish, for Latino families with attention on the influence of cultural values.
  • Wellness Recovery Action Plan (WRAP): Janet Campanion; (303)791-8706. Classes which provide tools for self-management. Separate groups for adults, children, adolescents, and family members.

Recovery Group for Bipolar Disorder; Jane Mountain Meets 3rd Thursday of every month in Denver

Jewish Family Service, Denver; (303)597-7777 x707. Small group setting for adult child, spouse, or adult family member with chronic mental illness. Focus on social support, self-care and personal well-being. Ongoing, two Thursday mornings/month. Cost is $10/session.

The Sutherland Center; University of Colorado, Boulder (303)492-5680. Helps people with financial difficulties.

  • Six week educational groups for those with bipolar disorder, and family and friends.
  • Weekly skills groups for those diagnosed with bipolar disorder.

Dialectical Behavioral Therapy (DBT) Group; Linda Willits (303)759-2006 or Denver: Wed 6-8:30 or Sat 10-12:30, 8 weeks. Adult women

The following people know of groups for consumers/clients and their families:

  • Denver county contact: Ellen Rector (303)756-0490
  • Arapahoe/Douglas county contact: Lynette Loken (303)789-0357