Dry Drunk Syndrome and Alcohol PAWS: Dealing With Behavior Patterns

Last Updated: April 1, 2021

Authored by Nena Messina, Ph.D.

Reviewed by Michael Espelin APRN

The dry drunk syndrome (DDS) may sound like an oxymoron, but this syndrome is genuine and is more common than one might think. The term “dry drunk” is used to describe a person who has stayed away from alcohol for some time but continues to behave as if he or she is still addicted. This condition is commonly linked with Alcohol Post Acute Withdrawal Syndrome (PAWS) – a heterogeneous set of protracted withdrawal symptoms, usually connected with more significant personality changes and sometimes resemble the onset of mental illness. This condition is known to happen as a result of drug abuse as well.

Often a person who has PAWS or dry drunk syndrome hasn’t made behavioral or emotional changes or has started to regress to old ways of thinking. These conditions are dangerous because dry drunk syndrome can easily trigger an alcohol relapse if not appropriately managed.

Whether a loved one has the dry drunk syndrome, take heart. This condition can be cured. Going through PAWS and dry drunk syndrome does not mean that anyone has lost their chance at sobriety. It only means that there is a need to get back on the right track. Learn how to do that.

Dry Drunk And PAWS Syndrome Overview

Dry drunk manifests as a part of the condition called post-acute withdrawal syndrome. PAWS refers to a wide variety of symptoms that begin to appear after acute alcohol withdrawal has resolved. Patients describe it as a rollercoaster of symptoms, which manifest unexpectedly.

Post-acute withdrawal syndrome is characterized by a persistent deficit in various areas of functioning. In contrast, acute withdrawal syndrome is marked by intense craving and physical side effects such as tremor, nausea, and flu-like signs. PAWS symptoms can last for a few days for each, and patients can suffer from it for a year after quitting alcohol.

While some practitioners believe that PAWS does exist, the American Psychiatric Association didn’t include it in the newest edition of the Diagnostic and Statistical Manual of Mental Disorders.

The dry drunk syndrome is also largely behavioral. A person might start to suffer from a low stress tolerance or behave impulsively, repeatedly engaging in unhealthy or dangerous behaviors. One might even start dreaming about alcohol or getting nostalgic about the “good old” drinking days. Such an attitude may become constantly negative, and the person will lose interest in previously cherished activities and become occupied with negative thoughts or self-pity. It may be hard for them to recognize that anything needs to be changed. Such a person feels miserable in their skin.

Why is Dry Drunk Syndrome Dangerous?

This syndrome is usually caused by no longer focusing on mental or emotional recovery. People may start to believe that since they are no longer alcoholics, there isn’t anything else that needs to be done, but suddenly they cannot brush off negative thoughts. One may resist completing all the rehab program modules and stop regularly attending alcohol support group meetings.

Woman crying at her daughter.

The origins of the term “Dry Drunk Syndrome” are in the Alcoholic Anonymous (AA) program. First, it appeared in R.J. Solberg’s book in 1970. Solberg’s dry drunk meaning was:

"the presence of actions and attitudes that characterized the alcoholic prior to recovery."

Nowadays, there is a concern about using this term because of its negative connotation. Some said that using any kind of stigmatizing words won’t help people in recovery and may turn into negative reactions from their side.

Controversy About Alcohol PAWS

According to the Semel Institute, about 75% of all people who struggle with alcohol abuse will develop some form of post-acute withdrawal symptoms. It means that most addicts with PAWS will manifest signs like depression, fatigue, or psychosocial dysfunction.

If prolonged alcohol abstinence with opiate PAWS are compared, it has to be said that opiates are more unambiguously linked with protracted signs of abstinence (in 90% of all cases). More research is needed to assess PAWS diagnostic criteria, which would then be included in psychiatric diagnostic manuals.

Alcohol post-acute withdrawal syndrome has been a subject of much debate over the years due to insufficient research and evidence. While clinicians working at the rehabilitation centers often notice signs of protracted withdrawal syndrome, it is hard to keep track of all patients who stopped abusing alcohol.

Authors have long ago complained about the lack of systematic research on the subject of PAWS. It still isn’t included in DSM, nor is it mentioned in the International Classification of Diseases (ICD-11). This state of affairs raises a lot of questions concerning the diagnosis of alcohol protracted abstinence problems.

Causes of Dry Drunk Syndrome

Before one delves into the causes, here’s what one should know about the nature of alcohol addiction:

  • Alcohol abuse and alcoholism are behavioral disorders
  • In many cases, alcohol abuse stems from unhealthy stress-coping mechanisms
  • Behavioral modification is critical for sustained sobriety
  • Quitting alcohol usually only resolves the chemical dependency issues

When one understands the nature of alcohol addiction and how it affects the individual’s mind, it is easy to understand why these syndromes develop.

The Most Common Causes Of The Dry Drunk Syndrome Are Described Below:

Not Being Able to Alter Behavioral Responses

For many patients in recovery, drinking was a way of coping with the stresses in their lives. If these people do not learn alternative healthy coping mechanisms, they will naturally fall back to their old ways. They respond to stress by reaching out for a drink because that’s how they have “learned” to cope with it.

Not Being Able to Brush Off Negative Thoughts

Learning not to react impulsively to negative thoughts and feelings is an integral lesson of behavioral therapy. During these sessions, people in recovery are taught how to tide over negative thoughts and feelings that daily living stresses almost inevitably bring on. If they cannot cope with negativity healthily, they feel compelled to reach out for a drink.

Returning to a Life Filled With Stressors

For many people in recovery, the expectation after going through an alcohol rehab program is to return to their earlier “normal” lives and function independently and efficiently without drinking. But the “normal” life they had once led is probably still filled with those stressors that had triggered their addiction in the first place. With their coping mechanism not in place, it is not hard to understand why some people start to romanticize their drinking days.

Tired young man feel feel stressed.

Not Completing All the Modules of the Rehab Program

Comprehensive rehab programs include intensive counseling and therapy sessions that help abusers alter attitudes, beliefs, and behavioral responses. Not completing all the modules means that the person has had no chance of doing the inner work that would have prepared him or her to cope with the stressors that prompted alcohol addiction in the first place.

Not Attending Alcohol Support Group Meetings

Attending alcohol support groups regularly, even after leaving rehab, has been proven to prolong sobriety for years. AA meetings create opportunities for people in recovery to interact with those who have traveled along the same path and learn tips and tricks for staying sober from them. The interactions provide the much-needed emotional support and guidance that go a long way in helping a person identify and alter unhealthy behavioral responses.

Harboring Unrealistic Assumptions About Recovery

Sobriety is not just a destination to arrive at after quitting alcohol, going through detoxification, and attending a rehab program; sobriety is a lifelong journey. But not all people realize this. The belief is that once they have quit drinking or completed rehab, there will be an improvement in all the currencies of their lives. So when this doesn’t happen or happens too slowly, discouragement, frustration, and depression set in.

It is generally admitted that alcohol abuse causes persistent structural brain changes, which are in the very definition of PAWS. The brain changes may affect various manifestations of this abstinence disorder and precipitate the onset of numerous mental health issues.

Mental Health Issues

While prolonged substance abuse and subsequent post-acute withdrawal may affect significant personality changes and cause a psychiatric disorder, it also goes the other way around. For instance, a substantial proportion of individuals with mental health issues use alcohol self-medication to cope. In this case, the underlying mental health issues would be the cause of PAWS.

Neurotransmitter changes can be regarded as the most important, as they develop numerous psychological symptoms. PAWS neurotransmitter changes include the hypofunction on GABA receptors, enhanced activation of NMDA receptors.

Comorbidity between mental health disorders, substance abuse, and withdrawal syndromes varies from 7% to 85%, according to the EU’s 2016 Report.

While most psychiatric clusters of symptoms are connected with substance abuse and protracted abstinence disturbances, these are the most reliable connections:

  • Major depression disorder (MDD)
  • Generalized anxiety disorder (GAD)
  • Antisocial personality disorder (APD)
  • Borderline personality disorder (BPD)
Young man felling depressed without alcohol.

Symptoms of Having Dry Drunk Syndrome or PAWS

Learn to recognize the signs of the dry drunk or PAWS syndrome is essential because some don’t take them seriously. All post-acute withdrawal symptoms can be divided into two groups, psychological and physical.

Psychological Signs Of PAWS

The syndrome often incorporates deleterious cognitive changes, which impair normal academic and professional functioning. By definition, PAWS is linked with memory problems, inability to think lucidly, and lack of initiative.

Behavioral Signs Can Be as Follows:

  • Depression
  • Anhedonia
  • Pessimistic thinking
  • Psychotic-like manifestations
  • Anxiety

Physical Signs Of Alcohol Post Acute Withdrawal

PAWS can be noticed on a physical level by:

  • Disturbances in the autonomic nervous system
  • Insomnia or sleep problems
  • Excessive fatigue
  • Specific impairments of coordination

Signs of psychosocial dysfunction are prominent in most long-term alcohol abstinence cases, including impeded social functioning and integration in society. Fatigue and alcohol withdrawal are frequently comorbid.

Signs most commonly linked with abstinence syndromes, like alcohol withdrawal sweating, are generally uncommon among protracted abstinence problems, just like most other acute withdrawal signs.

Dry Drunk Syndrome Signs

Dry Drunk Syndrome is also known as “untreated alcoholism” in 12-step circles. The moniker is not entirely unfounded. In a way, the symptoms of sober drunk mimic the emotional and mental states of an alcoholic.

The Following are the Most Common Symptoms of Dry Drunk Syndrome:

  • Exhibiting low stress tolerance: The individual has an abnormally low tolerance for stress. He or she flies off the handle or is upset at even the average daily stressors that most other people can deal with without becoming agitated.
  • Impulsivity: Low tolerance for stress can manifest as impatience and impulsive behavior. During the drinking days, a person was accustomed to instant gratification. Now, when things don’t go the way the former alcoholic planned or hoped for, stress kicks in. The person acts with little or no regard for the harm his or her behavior might unleash.
  • Engaging risky behaviors: The individual may have given up alcohol but still turns to other substances of abuse to cope with stress.
  • Getting nostalgic about the “good old” drinking days: Forgotten are the brushes with the law. Forgotten are the broken relationships. The person now only remembers what was good about his or her drinking days. In many cases, people in recovery who feel nostalgic about their alcohol addiction past are just a step away from a relapse.
  • Showing a lack of interest in previously cherished activities: It is expected that with alcohol out of the system, the person in recovery will show increased enthusiasm for the activities they once used to enjoy. But people suffering from dry drunk syndrome lose interest in the activities they enjoyed before. It seems as if they have lost the willingness to rebuild their lives.
  • Harboring negative thoughts: Dry drunks tend to harbor negative thoughts about themselves, their family and people around them, and the events unfolding in their lives. They think they are no good because they have failed to “recover.” They believe alcohol rehab programs are a waste of time because they have ended up being miserable. Negativity breeds stress that, in turn, magnifies the symptoms of the dry drunk.
  • Displaying self-pity: A person harbors feelings of discontentment with the way his or her life is shaping up. Self-pity is one of the most worrying symptoms of the dry drunk syndrome. Feeling low and feeling helpless at being unable to chart the course of their life can drive a person to depression or, worse, suicide.
  • Denying that life needs to change: An individual with substance use disorder on recovery is as prone to denying the futility of his or her current situation as a practicing addict. The person refuses to accept that they are stuck in recovery and need to do some inner work to change the status quo.
Frustrated young man talking to psychiatrist.

How Long Does PAWS Last?

If patients succeed in abstaining from alcohol, most signs will subside. However, even ten years after, the individuals may have gone through their first abstinence crisis. Some disturbances remain persisted, those related to sleep, for instance. More specifically, sleep instability peculiar to PAWS is an essential source of continuing abstinence symptoms.

When Does Alcohol PAWS Peak?

In the case of PAWS, there is no discernible peak. Post-acute withdrawal syndrome thus persists as a chronic and often subclinical disorder. It is also possible that PAWS never stops due to long term brain changes resulting from substance abuse, to which patients adapt more or less successfully.

The post-acute withdrawal syndrome timeline shows progressive improvement, which is the fastest at the initial period of alcohol abstinence. Longer alcohol withdrawal timeframes are linked with less risk of relapse and recurrence of substance abuse disorder. To avoid alcoholism relapse, it is always best to seek professional help.

Avoiding Dry Drunk Syndrome

The dry alcoholic syndrome can be avoided by treating the core issues of alcoholism. Be aware of and on the lookout for the symptoms that indicate slipping back into old ways of thinking. If one hasn’t undergone behavioral therapy or counseling that targets people who abused alcohol, it is advised to enroll in such a program.

Other Ways To Prevent Dry Drunk Are:

  • Be aware of and look out for the symptoms. The sooner one spots them, and the earlier one can stem the downward spiral that can eventually trigger a relapse.
  • If one has not undergone behavioral therapy or counseling that targets people who abused alcohol, consider enrolling in such program.
  • Join 12-step or non-12-step programs to learn tips and tricks from people who overcame the obstacles an ex-alcoholic may face now. Participation in these programs also ensures that it is necessary to have role models to look up and examples to follow.
  • Adjust the expectations of what “recovery” is. Remember that recovery is a commitment to a life that one has to work at continuously. If there is a feeling of being stuck, it’s a signal that something is not going right. One has to correct the course.

Is It Possible To Cope With PAWS Without Medical Treatment?

While it is possible to cope with post alcohol withdrawal syndrome without medical help, getting back to the premorbid functioning levels is the most efficient with the assistance of a medical professional.

People should not attempt to alleviate their symptoms of PAWS by self-medicating. Always consult a medical professional first to get the right treatment advice.

How Is It Treated In Medical Settings?

Usually, drugs and alcohol post-acute withdrawal syndrome are treated in medical settings when an individual’s capacities are severely affected. Specific PAWS treatment will only be available once the disorder has been officially recognized, but patients can find help in addiction recovery houses and rehabilitation centers.

Post-acute Withdrawal Syndrome Treatment Can Be:

  • Symptomatic: taking care of the disorder’s most prominent symptoms without necessarily focusing on the underlying cause.
  • Aetiological: This is a characteristic of some psychotherapies that try to find the cause of symptoms, which is especially helpful when there are comorbid mental health issues.

Individuals who notice symptoms of alcohol PAWS should contact their doctor or rehab center immediately. Professional treatment will reduce the severity of the symptoms.

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Page Sources

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Published on: March 9th, 2018

Updated on: April 1st, 2021

About Author

Nena Messina, Ph.D.

Nena Messina is a specialist in drug-related domestic violence. She devoted her life to the study of the connection between crime, mental health, and substance abuse. Apart from her work as management at addiction center, Nena regularly takes part in the educational program as a lecturer.

Medically Reviewed by

Michael Espelin APRN

8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care.  He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.