What Is Post-Acute Withdrawal Syndrome (PAWS)?

Last Updated on October 3, 2023

If you want to get sober, withdrawal symptoms are a normal part of the process. Although they are uncomfortable, they are often short-lived and are very manageable with medical treatment. However, many people experience mild withdrawal symptoms that persist or randomly re-appear in the early months of recovery. These types of withdrawal symptoms are known as Post-Acute Withdrawal Syndrome or PAWS and they can become a risk factor for relapse if they are left untreated.

What Happens to Your Body During the Process of Withdrawal?

When a person is addicted to a substance like alcohol or heroin, they may experience acute withdrawal symptoms immediately following abrupt cessation of the drug. This occurs because the body needs the drug(s) to function normally. Once those substances are removed, it has to adjust and re-learn how to function without them. Many of the withdrawal symptoms people experience are a result of the toxic effects that the chemicals found in drugs and alcohol have on the body and brain.

Some drugs are more likely than others to cause withdrawal symptoms and they may be more mild or severe depending on factors like how frequently the person used drugs, how much they used each time, the method of administration, and certain individual physiological factors.

Although withdrawal symptoms are unpleasant, they typically end after about two weeks, especially if a person receives medical treatment during detox. People who consume large amounts of drugs for a long time are more likely to develop Post-Acute Withdrawal Syndrome or PAWS.

What is Post-Acute Withdrawal Syndrome (PAWS)?

Immediate withdrawal from drug and alcohol abuse is a frightening and difficult process, and many people require medical intervention to get through it. Post-Acute Withdrawal Syndrome, or PAWS, is a lingering effect of substance abuse. PAWS is a more insidious appearance of nagging discomforts through the first month to six months of recovery, or sometimes longer. It’s often described as feeling like a “rollercoaster of withdrawal symptoms” that come and go randomly without any apparent stimulus.

Although there is quite a bit of scientific research available about post-acute withdrawal syndrome, PAWS is not an official medical diagnosis. It is primarily self-reported symptoms from people in recovery and they are very difficult for medical professionals to measure.

According to the Semel Institute for Neuroscience and Human Behavior, an estimated 90 percent of recovering opioid users experience PAWS to some degree as do 75 percent of recovering alcohol and psychotropic users.¹

What are the Symptoms of (PAWS)?

Common symptoms of PAWS include:

• Anxiety
• Irritability
• Mood swings
• Disturbed sleep or insomnia
• Memory problems
• Agitation
• Increased sensitivity to stress
• Difficulty concentrating
• Low energy/fatigue
• Chronic pain

People who are trying to quit the following substances may be more likely to experience symptoms of PAWS.

• Alcohol: Someone who suddenly stops drinking alcohol after using it regularly for a long time may suffer from delirium tremens (DTs) and has a higher risk of experiencing PAWS symptoms, such as feeling generally ill, exhausted, and having long-term cravings.
• Marijuana: Insomnia is a common marijuana withdrawal symptom. If it is left untreated, it can progress into PAWS and last for months or years.
• Benzodiazepines: Many people quickly become physically dependent on benzodiazepines, which is why they aren’t recommended for long-term use. Benzo withdrawal symptoms are similar to that of panic disorder, which they are designed to treat. So people often struggle to stop using them once they are addicted. Even once a person has broken their physical dependence on benzodiazepines, PAWS symptoms such as strong cravings, insomnia, and fatigue can sometimes last for months.
• Opioids: If a person tries to quit opioids cold turkey, he or she is likely to experience PAWS. Very long-lasting symptoms like cravings, exhaustion, and cognitive problems often are the result.
• Stimulants: Recovery from a stimulant drug addiction can be made much more difficult if withdrawal is not managed properly. Without medical assistance, long-lasting PAWS symptoms like fatigue and depression can be very difficult to manage without help.

Not surprisingly, these symptoms can be a huge roadblock to recovery for many individuals who are recovering from alcohol and drug addiction. Often, people will revert to abusing drugs or alcohol just to find relief from these ongoing symptoms, even though they want to be sober.

How Long Do PAWS Symptoms Usually Last?

There is no set timeline for how long PAWS symptoms usually last. Unfortunately, the duration of these symptoms is highly dependent on the person, the substance they abused, how long they were addicted, and the individual’s overall health.

Many people only experience mild withdrawal symptoms for one to two weeks after quitting their drug of choice. However, some people may continue to experience PAWS symptoms for months or years after getting sober. PAWS symptoms often come on unexpectedly in waves and last for a few days before dissipating. There may or may not be a trigger for the episode of PAWS.

Not knowing how long PAWS will last is incredibly discouraging, but it’s important to remember that each episode will come to an end eventually and PAWS symptoms can be managed over time with medical and clinical treatment.

What Causes PAWS in Recovery?

More research is needed and generally, scientists and researchers don’t agree on one single cause of PAWS, but contributing factors include:

• Brain chemistry changes due to drug abuse
• Physiological changes due to drug abuse
• Stress response triggered by a variety of reasons

What Conditions Worsen Symptoms of PAWS?

Certain conditions may also exacerbate the symptoms of PAWS or make the experience more difficult to handle, including:

• The type of drug(s) a person abused
• How long a person used drugs
• How frequently a person used drugs
• How much of a drug a person used each time
• If a person experienced psychological problems early in recovery
• If the person has any co-occurring mental health or physical conditions
• What type of professional support (or lack thereof) the person received early in recovery

How Long Does It Take for Brain Chemistry to Return to Normal?

Many international scientific organizations accept that addiction is a treatable complex disease that affects the interactions among circuits found in the brain.² These harmful effects on the brain can sometimes take months or years to heal. 

Even after the immediate effects of a drug wear off, the brain suffers ongoing damage as a result. Consistent substance abuse changes the way the brain functions, damages neurons, and produces negative side effects that interfere with a person’s ability to function normally, such as:

• Depression
• Anxiety
• Insomnia
• Irritability
• Mood swings
• Cognitive problems
• Memory loss
• Cravings
• Loss of self-control

These effects are the direct result of drug-related damage and altered brain chemistry. Although the outlook of addiction is often bleak, many of these side effects can be reversed and an addicted person’s brain chemistry will eventually return to normal after they get sober.

In some instances, a person’s brain chemistry may revert to normal after some time and once all the drugs are processed out of their body. Unfortunately, some drugs can cause lasting damage to the brain that may take years to heal.

For example, the National Institute on Drug Abuse (NIDA) states that chronic meth users may suffer long-lasting brain damage that can result in the following issues, which can last for years:³

• Cognitive problems
• Memory problems
• Difficulty regulating emotions
• Psychosis
• Aggressive behavior
• Parkinson’s disease

Similarly, chronic cocaine users may suffer from the following problems as a result of lasting damage to the brain:

• Difficulty concentrating
• Problems completing motor tasks
• Inability to control impulses
• Difficulty making decisions

Regular drug or alcohol abuse is very damaging to the brain and body so achieving physical and psychological recovery will take time. People with severe substance use disorders often need professional medical and clinical treatment to fully recover and achieve long-lasting sobriety.

Can PAWS Be Avoided or Prevented?

Aside from not using addictive substances in the first place, it is difficult to prevent or avoid PAWS as it can manifest after withdrawal from almost any addictive drug or alcohol. However, completing a medical detox program can greatly reduce the likelihood that a person will experience PAWS or relapse because of it.

During medical detox treatment, doctors, nurses, and clinical therapists can provide proper treatment for drug withdrawal symptoms and address any psychological issues that may arise as a result of withdrawal. If PAWS does occur, addiction treatment professionals will have the knowledge and experience necessary to recognize it and provide immediate treatment to reduce its severity.

How is PAWS Treated?

People who experience PAWS after getting sober don’t have to endure the suffering alone or try to manage it without support. Many PAWS treatment options can help people get through the difficult experience and still maintain their sobriety.

• Medical detox and drug rehab: Drug detox and rehab programs provide a great deal of educational information about addiction and recovery. They also provide several medical and clinical interventions to help people through the possibly derailing experience of PAWS. Speaking with an addiction specialist in the medical field is a great step. Also, talk therapy, group therapy, and other forms of psychology can help a recovering addict contextualize the feelings associated with PAWS.
• Individual therapy and group therapy: Discussing discomfort and learning to deal with the emotions experienced in recovery can not only help with PAWS, but it can also help people in recovery improve their ability to transition to a more productive life.
• Holistic treatment for insomnia: Insomnia and sleep problems can make PAWS extremely difficult to manage. Holistic treatments such as meditation and mindfulness, chamomile and other herbs, regular exercise, eliminating caffeine, and improving sleep hygiene may help reduce sleep problems associated with PAWS.
• Regular exercise and healthy diet: Maintaining a healthy lifestyle with regular exercise and balanced nutrition will help individuals feel better all around, but it will also promote healing within the brain and body as it gradually recovers from the damaging side effects of chronic substance abuse.
• Treatment for co-occurring disorders: Many individuals with PAWS also suffer from other physical or psychological co-occurring disorders, which may emerge or reemerge randomly in recovery. It’s important to get medical and clinical treatment for these issues so they don’t exacerbate the symptoms of PAWS.
• Mutual support groups: Many people also benefit from 12-step programs and other types of action-based and community-based interactions. Hearing someone else’s experience with PAWS and being assured the symptoms do get better over time is a strong motivator to walk through them. Also, finding purpose in working through even the toughest parts of recovery can help people make it through low spots.

Get Help for Long-Term Addiction Recovery and Relapse Prevention

If you or a loved one is suffering from the uncomfortable symptoms of PAWS, please know that there is help for these symptoms and you are not alone. The large majority of people in recovery report great improvements in PAWS symptoms over time. Getting help, staying busy, and learning a bit about what is happening are great steps toward success. If it is overwhelming for you or a loved one, please reach out for help. Call (512) 605-2955 to speak with a representative at Nova Recovery Center today.