Updated on February 6, 2024
5 min read

What is Post Acute Withdrawal Syndrome (PAWS)?

What is Post Acute Withdrawal Syndrome (PAWS)?

In the days and weeks after you stop drinking or quit substance abuse, you may experience acute withdrawal symptoms. It is the second withdrawal stage, often called post-acute withdrawal symptoms (PAWS). It is also referred to as protracted withdrawal syndrome.

PAWS is a set of impairments that happen immediately after you experience withdrawal from alcohol or other substances. It's caused by an imbalance of neurotransmitters in the brain. As it tries to reach equilibrium, it causes brain chemicals to fluctuate until they're stable.

The condition is described as ongoing withdrawal symptoms, typically mood-related. They continue to persist after physical symptoms have stopped.

Is PAWS Dangerous?

One of the most dangerous aspects of post-acute withdrawal syndrome is the symptoms that can return after months or years. People who experience unexpected mass cravings sometimes feel powerless to handle them.

These symptoms are the prime cause of relapse for rehab patients. It can even cause sober people to start using alcohol or drugs again.

The severe effects of PAWS exacerbate the cravings you'll be going through throughout the recovery process. This can make it difficult for you to participate in counseling and therapy sessions productively.

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How to Manage Symptoms of Post-Acute Withdrawal Syndrome

Here are 12 tips that may help manage the symptoms of PAWS:

  1. Seek help from mental health professionals
  2. Practice self-care through a healthy diet, exercise, and establishing healthy relationships with the people around you
  3. Talk about what you're going through with people you trust and who will not judge you based on your circumstances
  4. Determine what triggered the flare-up of your PAWS symptoms so you will know what to do next time
  5. Avoid places, situations, and circumstances that can trigger cravings
  6. Document your experiences through a journal
  7. Keep yourself busy
  8. Set reminders or write things down if you're having difficulty remembering things
  9. Consider cutting down on caffeine if you're having a hard time sleeping
  10. Establish a sleep-wake routine
  11. Be gentle to yourself, and don't rush things
  12. Acknowledge that there will be bad days and never give up even if you relapse

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Can You Recover from PAWS at Home?

Stopping alcohol use cold turkey or attempting to recover from drug addiction is not recommended. Because of the severity of the symptoms, people often feel the need to drink or use drugs to make them go away.

You can control the symptoms with professional oversight and medical intervention at a treatment center. Working with a substance use specialist can provide methods and medications to combat PAWS symptoms.

Seeking treatment at a detox or rehabilitation center can increase the chance of a successful recovery. It can also lessen the risk of relapse because of medical support and supervision.

Difference Between PAWS and Initial Withdrawal Symptoms

The withdrawal symptoms associated with the first detox stage, called acute withdrawal, are primarily physical. Acute withdrawal can create even more severe health consequences, even life-threatening complications.

The second stage of detox, called post-acute withdrawal syndrome (PAWS), happens as the brain re-calibrates after active addiction. Unlike acute withdrawal, post-acute withdrawal symptoms are mostly psychological and emotional symptoms.

The first withdrawal stage typically lasts for a few days up to 2 weeks. After this period, you'll start to feel acute withdrawal symptoms almost immediately.

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What Does PAWS Feel Like?

PAWS symptoms are extremely uncomfortable and typically affect a person’s mental health and physical health. PAWS can sometimes feel like it comes on suddenly.

Post-acute withdrawal symptoms can be as intense as physical withdrawal symptoms, putting you at risk of relapsing. However, it rarely involves physical symptoms like:

  • Aches
  • Pains
  • Nausea
  • Cramping

PAWS typically comes in unexpected waves. For example, a person in recovery may wake up tired and extremely irritable in the morning for no apparent reason. Others may find themselves suddenly unable to balance and have no coordination.

Common Symptoms of PAWS

Although it rarely has physical symptoms, its effects on your mood can affect your body. Common physical and psychological symptoms of PAWS include:

  • Irritability and hostility
  • Feelings of anxiety or panic
  • Depression
  • Mood swings
  • Low energy and extreme fatigue
  • Sleep disruption, including insomnia
  • Limited ability to focus or think clearly
  • Lack of libido
  • Inexplicable chronic pain
  • Difficulty with cognitive tasks, such as learning, problem-solving, or memory recall
  • Obsessive-compulsive behaviors
  • Difficulty maintaining social relationships
  • Sleep disturbances 
  • Increased sensitivity to stress
  • Lack of impulse control
  • Elevated heart rate 
  • Panic attacks

Who Does PAWS Affect?

PAWS symptoms most commonly appear in people who have misused or abused highly addictive substances. These include:

  • Alcohol
  • Antidepressants
  • Antipsychotics 
  • Benzodiazepines 
  • Marijuana 
  • Opioids and opiates
  • Stimulants
  • Xanax 

How Long Does Post-Acute Withdrawal Syndrome Last?

Post-acute withdrawal is known to last for several months. In some cases, they can last up to 1 to 2 years.

During this time, symptoms tend to appear and disappear in as short as an hour. They may also disappear for weeks or months and then come back.

However, the severity and frequency of your symptoms can be affected by factors such as:

  • The intensity of drug use and alcohol addiction
  • The type of substance used
  • How long the substance use persisted
  • The physical health of the person in recovery

Because of these factors, you may experience acute symptoms for just a few days or weeks.

Can withdrawal symptoms be permanent?

Although the symptoms may come and go, they're not permanent. As time goes on, your PAWS symptoms will lessen and eventually disappear.

These symptoms typically reach their peak between three to six months after the start of abstinence. After this, they'll continue for as long as two years.

Summary

Post-acute withdrawal syndrome (PAWS) is a symptom that occurs after the initial acute withdrawal stage. Although it doesn't have intense physical symptoms, it can have intense mood-related or mental side effects.

Chemical imbalances and fluctuations in the brain cause PAWS. It typically lasts for several months or years, depending on the severity of addiction.

PAWS is a dangerous withdrawal period with a high potential to cause relapse. If you experience PAWS, contact medical professionals or addiction specialists to help manage your symptoms.

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Updated on February 6, 2024
6 sources cited
Updated on February 6, 2024
  1. Post-Acute Withdrawal Syndrome (PAWS).” Semel Institute for Neuroscience and Human Behavior.

  2. Hoffman A. "Relationship Between Severity of Alcohol Dependence and Protracted Alcohol Withdrawal Symptoms." Drugs and Alcohol, Medicolegal Library, Springer, Berlin. Heidelberg, 1986.

  3. Heilig et al. “Acute withdrawal, protracted abstinence and negative affect in alcoholism: are they linked?.” Addiction biology, 2010

  4. "Post-Acute Withdrawal Syndrome: The lingering effects of alcohol or drug withdrawal and how you can manage them." University of Texas Health Science Center at Houston.

  5. Swanson, J. "The Condition Many Recovering Addicts And Alcoholics Don't Know About." HuffPost.

  6. "Post Acute Withdrawal Syndrome: Causes, Symptoms, Treatment." Mental Health Daily.

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