Post Acute Withdrawal Syndrome: Symptoms and Treatment

What is Post-Acute Withdrawal Syndrome (PAWS)?

Post-acute withdrawal syndrome (PAWS) is a collection of persistent withdrawal symptoms that occur after the acute phase of detox. While acute withdrawal symptoms typically last days or weeks, PAWS can persist for months or even years.

It is also known as protracted withdrawal syndrome and is most common in people recovering from alcohol, opioids, benzodiazepines, and stimulants.

PAWS results from long-term substance use, which alters brain chemistry. The body struggles to regain balance, leading to ongoing emotional, cognitive, and physical symptoms. Though PAWS is not life-threatening, it can make recovery more challenging and increase the risk of relapse.

Symptoms of Post-Acute Withdrawal Syndrome

The symptoms of PAWS (post-acute withdrawal syndrome) vary between individuals and substances. This means withdrawal symptoms from alcohol can differ from benzodiazepine withdrawal symptoms. However, common symptoms include:

Emotional and Psychological Symptoms

• Mood swings – Rapid shifts between happiness, sadness, irritability, and anxiety.
• Depression and anxiety – Feelings of hopelessness, nervousness, or fear.
• Cravings – Strong urges to return to active addiction.

Cognitive Symptoms

• Brain fog – Difficulty thinking clearly or making decisions.
• Memory problems – Trouble remembering details or events.
• Lack of concentration – Struggling to stay focused on tasks.

Physical Symptoms

• Increased heart rate – A lingering effect of substance withdrawal.
• Fatigue – Persistent tiredness, even after rest.
• Sleep disturbance – Insomnia, vivid dreams, or irregular sleep patterns.
• Headaches and dizziness – Discomfort due to neurotransmitter imbalances.

How Does PAWS Differ from Acute Withdrawal Symptoms?

Post-acute withdrawal syndrome and acute withdrawal symptoms differ significantly in terms of timing, duration, and the nature of symptoms.

For acute withdrawal, symptoms typically begin shortly after stopping substance use, often within hours to a few days. On the other hand, PAWS symptoms emerge after acute withdrawal, often starting days or even months after substance use. These can persist for several months or years.

The symptoms of protracted withdrawal are more psychological and emotional compared to acute withdrawal, which is usually physical and severe.

Causes and Risk Factors of PAWS

Several factors contribute to the development of PAWS, including:

• Substance type – PAWS is more common after long-term opioid, alcohol, benzodiazepine, or stimulant use.
• Duration of use – The longer a person uses substances, the higher the risk of PAWS.
• Mental health conditions – People with anxiety or depression may experience more severe PAWS symptoms.
• Lack of medical supervision – Detoxing without professional help increases PAWS severity.

How Long Does Post-Acute Withdrawal Last?

The duration of PAWS varies depending on several factors, including the substance used, the length of addiction, and overall health.

While acute withdrawal typically lasts from a few days to a couple of weeks, PAWS can persist for months or even years. Symptoms often occur in waves, with periods of relief followed by flare-ups.

General PAWS Timeline:

• First 1-2 Months: Symptoms are most intense. Mood swings, cravings, and sleep disturbances are common.
• 3-6 Months: Symptoms gradually improve but may still appear periodically.
• 6 Months to 2+ Years: PAWS episodes become less frequent, but stress or environmental triggers may cause flare-ups.

Managing and Coping with PAWS

Although PAWS can be difficult, several strategies can help people manage symptoms and prevent relapse.

1. Therapy and Counseling

Professional therapy provides essential tools for managing PAWS. Cognitive-behavioral therapy (CBT) helps change negative thought patterns and cope with cravings. Support groups, such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), provide peer support and accountability.

2. Healthy Lifestyle Choices

Regular physical activity helps release endorphins, which improve mood and reduce stress. Exercise can also help manage cravings and improve overall mental health.

Eating a balanced diet rich in fruits, vegetables, lean proteins, and whole grains provides essential nutrients for recovery. Stable blood sugar levels can help prevent mood swings and manage cravings.

Maintaining a consistent sleep schedule and creating a relaxing bedtime routine can improve sleep quality. Adequate sleep is crucial for reducing the severity of PAWS symptoms.

3. Avoid Triggers and High-Risk Situations

Triggers can cause PAWS symptoms to worsen or lead to relapse. To avoid triggers:

• Stay away from environments associated with substance use.
• Build a strong support system of sober friends and family.
• Practice mindfulness and relaxation techniques to handle stress effectively.

4. Medication and Medical Supervision

In some cases, medications may help manage PAWS symptoms. Doctors may prescribe antidepressants for mood swings or sleep aids for sleep disturbance. Medical supervision ensures that any underlying conditions are addressed safely.

5. Stress Management and Mindfulness

Stress worsens PAWS symptoms. Practices like mindfulness, meditation, yoga, and deep breathing exercises can reduce anxiety and stress. These techniques help improve mental clarity and emotional stability.

Practicing self-care through positive affirmations, expressing emotions, and maintaining positive relationships is also vital to support long-term recovery.

Finding Rehab Near Me

Recovering from drug and alcohol addiction often requires professional help. Various treatment programs and rehab facilities provide support for those experiencing PAWS to prevent life-threatening complications. These include inpatient and outpatient treatment programs, support groups, medical detox, and counseling.

If you or someone you care about is battling drug or alcohol addiction, taking the first step toward recovery is crucial. Our Scottsdale treatment facilities operate 24/7, providing expert evidence-based programs tailored to each individual’s unique journey toward lasting healing.