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What is PAWS?

Without a doubt, one of the worse parts of seeking help for substance abuse is experiencing withdrawal symptoms. For some, withdrawal symptoms can start after a few hours of their last dose. Hopefully, with medical attention, these symptoms get better rather quickly. Unfortunately, for others, the possibility of experiencing post-acute withdrawal syndrome (PAWS) means their symptoms will not go away for weeks or months. 

Understanding PAWS

PAWS is the term used to talk about any symptoms that persist after acute withdrawal is resolved. Most of the time, these symptoms come and go unexpectedly, and episodes can last a few days, weeks, or continue up to a year. 

The term encompasses psychological and mood-related symptoms that continue after acute withdrawal ends. However, PAWS can also include aches, pains, headaches, crampings, and nausea. All of these symptoms can put someone on the verge of relapse. The most common PAWS symptoms include:

  • Foggy thinking
  • Intense cravings
  • Irritability
  • Sleep problems
  • Fatigue
  • Fine motor coordination issues
  • Stress
  • Anxiety or panic
  • Depression
  • Mood swings
  • Difficulty to focus

When Does It Happen?

Unlike acute withdrawal, PAWS symptoms can appear weeks or months after physical dependence has stopped. Often, symptoms are triggered by intense stress levels, brought up by specific situations, or involve people or places that remind people of using drugs or alcohol.

Many people describe PAWS symptoms as a rollercoaster of emotions that sort of has an on-off switch. In the early days of recovery withdrawal, symptoms are more intense and repetitive. With PAWS, symptoms can appear less frequently but continue for months. 

How Long Does It Last?

Most common symptoms end after a couple of weeks, some even after a few hours. However, there’s so much that goes into determining how long do withdrawal symptoms will linger that it’s impossible to have an accurate timeline. 

Because drugs and alcohol alter the brain and body’s chemical state, the system has to go through a recalibration process. Some believe that it takes the brain anywhere between six months to two years to recalibrate. That is when it will take the brain to start producing endorphins, dopamine, and serotonin at a natural rate without the need for substances. So, many believe that PAWS symptoms can last anywhere between six to two years or more. 

Post-Acute Withdrawal Syndrome by Substance

Although post-acute withdrawal syndrome can occur with any type of substance, these drugs are the most common to cause long-lasting withdrawal effects. 


PAWS was first introduced for those withdrawing from alcohol back in the early 90s. People who try to quit alcohol cold-turkey can experience delirium tremens and increase the likelihood of struggling with a post-acute withdrawal syndrome. Symptoms include long-term cravings, feeling ill, and exhaustion. 


While antidepressants addiction is rare, changing the levels of dosage can alter serotonin levels in the brain. Overall, people struggling with depression are using antidepressants. When quitting, they can experience an intense depression that could continue for months even after seeking treatment. 


While benzos are used to treat people with anxiety and panic disorders, they’re highly addictive. Usually, these are short-term prescriptions for two weeks maximum. When people become addicted and quit using these addictive substances without assistance, they can experience panic attacks, insomnia, fatigue, and cravings that can last for months after physical dependence ends. 


Although marijuana has become a legal drug in many states, marijuana can still be addictive. When people stop taking the drug, they are likely to experience stress episodes, depression, and paranoia. One of the most common PAWS symptoms is insomnia that can become troublesome and chronic without assistance. 


Opioids are by far one of the most commonly abused drugs in the country. Whether prescription or illicit versions like heroin, opioids can quickly cause PAWS when not appropriately tapered. Symptoms include sleep disruption, anxiety, depression, and a decrease in executive control functions. At the peak of their symptoms, they experience cravings, cognitive impairment, and exhaustion that can last up to a year. 


Drugs like cocaine can cause post-acute withdrawal syndrome when people try to quit on their own. It’s common for them to experience effects like paranoia, aggression, and tremors. However, they may also experience deep depression, fatigue, and physical weakness that take a toll on their mental health and make the recovery process much gruesome. 

What Causes PAWS?

Everything from the drugs of choice, the frequency, and the length of addiction play a role in managing post-acute withdrawal symptoms. However, there’s a lot of controversy around PAWS. Because there’s no specific cause, no one clearly defines timelines and particular symptoms. Some people in recovery will never experience these symptoms, while others will struggle with those for years. 

While doctors and psychologists continue to argue on the root cause of post-acute withdrawal symptoms, many attribute the cause to stress and the many changes to the brain. However, even stress responses can be triggered by a wide range of reasons. Some of the most prevalent causes of PAWS include:

  • Homeostatic adjustment: the time it takes for the brain to reach complete homeostasis without chemical help might cause post-acute withdrawal syndrome symptoms.
  • Physiological adjustment: drugs affect the mind and body differently, it takes time for heart rate, blood pressure, and other physiological processes to go back to normal. 
  • Stress: by far, the most prevalent cause of PAWS is that stress can cause prolonged withdrawal symptoms. 

Still, even though many people experience PAWS, it’s not an official medical diagnosis. There’s very little research about PAWS, but most symptoms and evidence are self-reported by people experiencing them. Unlike other conditions, PAWS symptoms are challenging to measure and compare. 

Although acute withdrawal is recognized by the medical community, PAWS isn’t. The syndrome remains controversial and lacks a medical definition to diagnose correctly. 

Unfortunately, some people believe PAWS is merely an excuse for relapsing. Others think it’s a marketing gimmick to push for more extended treatment programs. Some practitioners believe PAWS is withdrawal and believe withdrawal symptoms should be measured in months and years rather than days and weeks. 

Treatment Options

Since PAWS isn’t a medical condition per se, there isn’t a treatment protocol to follow. However, ongoing support from psychologists and medical staff is vital to manage the psychological, emotional, and physical symptoms of PAWS. Overall, treatment focuses on:

  • Educating patients about the process of withdrawal and what to expect in addiction recovery
  • Finding natural and safe alternatives to help with specific withdrawal symptoms like sleep problems
  • Following a healthy exercise routine and diet
  • Assessing potential co-occurring disorders that emerged
  • Using therapy to help manage impulse control
  • Prescribing medication (as needed) for any acute symptoms

Much like during drug and alcohol detox, some medicines can help with withdrawal symptoms. For example, naltrexone can help those withdrawing from alcohol or opioid addiction experiencing long-term cravings. 

Antidepressants can be helpful for those overcoming stimulants or psychoactive drug addiction. These prescription medications can help stabilize mood swings and support a more sound recovery. 

Of course, one thing to notice is that PAWS symptoms are more common among those that tried to quit a substance by themselves. The risk of PAWS can be reduced when people seek professional help for detoxing. Experts agree that a comprehensive treatment that offers medical attention, psychological support, and ongoing monitoring is the key to find long-lasting recovery. 

How to Find Treatment Near Me?

If you believe you might be struggling with PAWS, first, you have to start learning some strategies for coping with the symptoms. Most of these strategies are the ones that helped you through treatment. It’s just a matter of practicing and enforcing them:

  • Continue seeing a mental health professional for psychiatric and psychological care
  • Practice self-care by exercising and eating healthy
  • Keep attending 12-step meetings, speaking to your sponsor, and your friends and family
  • Make a note of the triggers that cause your PAWS symptoms
  • Start a journal to document your triggers and find healthier alternatives to cope with them
  • Find natural remedies for your sleep problems, limit caffeine, and start a nighttime routine to help you sleep better
  • Remember to be realistic and recognize that recovery takes time 

If you or a loved one is experiencing PAWS in addiction recovery, please seek help. Our aftercare rehab program at Lighthouse Recovery Institute is designed to help those struggling after leaving inpatient or outpatient rehab programs. We understand that early recovery can be challenging and that PAWS is a possibility for many.

In our aftercare program, we help those with co-occurring mental health and substance use disorders, anyone experiencing PAWS, or those who’ve relapsed and are trying to find their way back to recovery. In our aftercare program, you’ll receive the tools for preventing relapse:

Let our light show you the path towards recovery. It doesn’t matter your struggles or challenges. Together we can help you find the strength to fight through the battle and emerge victoriously. Don’t let PAWS take away what you’ve worked so hard to achieve. If you’re struggling today, call us now, and let’s find the way to help you.

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