Learn / Successful Treatment, Despite Experiencing Post-Acute Withdrawal Syndrome (PAWS)

Successful Treatment, Despite Experiencing Post-Acute Withdrawal Syndrome (PAWS)

Hannah Friedman
 October 3rd, 2022|   Clinically Reviewed by 
Rajnandini Rathod

So you’ve done the hard work of detoxing. But now you’re having trouble remembering details. Or, you’re even more anxious than you were when you first quit. These feelings can be overwhelming, and you might not understand why. For many people, there’s a simple answer.

Post-acute withdrawal syndrome (PAWS) refers to a group of symptoms that continue long after you stop using drugs or alcohol. This condition can make it hard to focus on the work you’re doing in rehab. Thankfully, many rehab centers are prepared to treat PAWS. Talk to your providers, so they can help you manage your symptoms and avoid relapse.

What Is Post-Acute Withdrawal Syndrome?

PAWS, sometimes known as prolonged withdrawal syndrome, is a set of symptoms you experience after you’ve already gone through initial detox and withdrawal.1 It can last for weeks to years after you last use drugs.

Almost all drugs have the potential to cause this condition. And if you’re recovering from alcohol, benzos, or opioids, you’re more likely to experience PAWS. In fact, 90% of people recovering from opioid addiction and 75% of people recovering from alcohol or other drug addictions have post-acute symptoms.

The Symptoms of PAWS

While regular withdrawal symptoms are mental, physical, and emotional, PAWS symptoms are mainly psychological. It’s common to feel these effects of protracted withdrawal:2

  • irritability
  • depression
  • difficulty concentrating
  • short-term memory issues
  • fatigue
  • sleep problems like insomnia
  • anxiety
  • decreased sex drive
  • mood swings
  • intense drug or alcohol cravings
  • physical complaints of pain without a cause

These symptoms are similar for most people, but some substances lead to specific issues. For instance, people recovering from marijuana addiction often have strange dreams. And recovering from a benzodiazepine addiction can trigger obsessive-compulsive disorder or schizophrenia.

If you have acute withdrawal symptoms, they’ll set in immediately after detox. Some people also experience PAWS after that, but it may not set right away. You might not even have symptoms until 1-2 months into abstinence. Those symptoms might ebb and flow over time, or be triggered by stressful events.

The Causes of PAWS

When you consistently overuse a substance for a long time, it can make long-lasting changes to brain function. Usually, those changes are in the emotional or behavioral control centers.3 This explains why most PAWS symptoms are psychological.

How PAWS Affects Treatment

PAWS is frustrating at best. And at worst, it can interfere with your recovery. Data shows that PAWS is a common cause of relapse.4

Stressful events can be triggers, and starting residential treatment is stressful. It’s no wonder that PAWS can get worse when you arrive at rehab. In this early stage of recovery, patients’ ability to deal with stress is already reduced by recent substance abuse. Add in lack of sleep, mood swings, or increased anxiety, and it gets very difficult to stay focused on recovery.

In this phase of treatment, patients are still learning healthy coping skills.

PAWS can mirror the same feelings that lead to addiction.

If you used alcohol to deal with anxiety, then PAWS-related anxiety might be even harder to handle. Or, if you used benzos to sleep, insomnia caused by PAWS might trigger cravings.

These symptoms can lead to other mental health issues. For instance, PAWS might make you feel like you’re not making any progress. You might wonder why you’re still dealing with the lingering effects of your addiction long after you’ve stopped using. People with PAWS sometimes even “catastrophize their chances of recovery.”4 And these fears are valid. But with the right coping strategies, you can avoid relapse and recover from your addiction.

Plan for Success in Rehab

Recovery means more than quitting a substance. After detox, you’ll face the emotional issues that caused your addiction in the first place. It’s a lot for anyone to handle, even with professional support. And during early recovery, people are especially vulnerable to stress.5 Thankfully, you can use certain techniques to manage that stress. And that’s the first step in healing from PAWS.

Come Prepared

You can prepare for PAWS even before you start detox. If you’re in inpatient treatment, you’ll be surrounded by experts who know how to help. If you’re not in rehab, you can talk to your doctor, therapist, or another healthcare provider. They’ll help you come up with a plan to manage ongoing symptoms. Then, if and when you’re triggered, you’ll already know what to do first.

Build Your Support System

Community support is vital to addiction recovery.6 In residential rehab, you can connect with other patients in the program. And outside a program, there are many different places to find support. Start by telling your therapist or doctor what symptoms you’re experiencing, so they can help you manage them. You can also attend group therapy or support groups to find peers going through the same thing.

Let your loved ones know how you’re feeling. Some symptoms, like mood swings or irritability, can put a strain on your relationships. By telling your support network about your symptoms, you’re offering them validation and support. In turn, that will help them support you.

Give Yourself Time Limits

A lot of people struggle with concentrating when they’re going through PAWS. And it can be frustrating to feel like you can’t focus. But there are several ways to work through this common symptom.

Instead of forcing yourself to concentrate, set a timer. Give yourself a limited amount of time to focus on one task. Start small. Limit yourself to 10 or 15 minutes, and then take a break. As your attention span improves, you can gradually increase the amount of time on the timer. Gradually increase the amount of time as you notice you’re able to concentrate for longer.

Keep Moving

Physical exercise can be a valuable part of addiction treatment. Staying active gives you a way to focus your excess energy. It also lets you practice new coping skills, which you can continue using in every stage of recovery. And best of all, the benefits of physical activity match up with some of the most common issues caused by PAWS.

Physical fitness improves both physical and mental health.7 Specifically, it helps people sleep, reduces anxiety and depression, and improves thinking and judgment skills. Keeping active can also help you manage your stress, which may help prevent flare-ups.

As effective as physical activity can be, it’s not right for everyone. If your body is still recovering from addiction, you might not be ready for strenuous exercise. That’s also true for people with chronic conditions, including chronic pain. It’s important to know your own limits. The better you understand your needs, the more easily you can meet them.

Learn Your Triggers

Because stressful events can intensify PAWS, managing stress can help you heal. Start by identifying stressful situations. In some cases, you can avoid these. If reality TV stresses you out, you can just change the channel. But it’s not always that simple. Sometimes, types of stress are unavoidable. For instance, talking about trauma in therapy can be stressful. But that doesn’t mean you should avoid it. Instead, prepare yourself before entering these situations. Rehab can help you grow coping skills you can use to face triggers.

Be Patient With Yourself

It can take anywhere from 6 to 24 months to recover from PAWS.8 Some people may find themselves dealing with it for years after that. Eventually, though, your symptoms will go away. Until then, be patient with your progress. Celebrate small wins. Some days may be more difficult than others, but every moment is another step forward. Treatment can also pave the way for a faster recovery—or just an easier one.

Treatment Options for PAWS

Coping strategies are essential, but they’re just one part of healing. You can also make use of more formal treatments to heal from PAWS.1 Talk to your care team to see which of these options fits into your recovery plan:

  • medications, such as acamprosate1 for recovery from alcohol addiction, or methadone9 for recovery from opioid use disorder
  • psychotherapy
  • behavioral therapy
  • group therapy sessions

Depending on your needs, these modalities may be a good fit in many stages of recovery. Because of this, they can help treat long-term symptoms of PAWS. Some treatments, like talk therapy, may even be helpful long after you complete inpatient rehab.

Managing PAWS Is a Step Toward Recovery

Early recovery can be overwhelming. Your life is changing rapidly—and so is your brain chemistry. PAWS symptoms can make it feel hard to keep up.

Remember that you set the pace of your recovery. There’s no external timeline you have to follow. By accepting your own symptoms, you can practice self-compassion and self-love. And that’s an important part of healing from addiction.

Don’t let PAWS get in the way of your recovery. Connect with an inpatient rehab center to learn about their treatment methods, onsite medical care, pricing, and more.

Reviewed by Rajnandini Rathod

  1. Post-Acute Withdrawal Syndrome (PAWS) | Semel institute for Neuroscience and Human Behavior. (n.d.). Retrieved from https://www.semel.ucla.edu/dual-diagnosis-program/News_and_Resources/PAWS [] [] []
  2. Substance Abuse Treatment Advisory: Protracted Withdrawal. (2010). Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment. []
  3. Abuse, N. I. on D. (2022, March 22). Drugs, Brains, and Behavior: The Science of Addiction. National Institute on Drug Abuse. https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/drugs-brain []
  4. Melemis, S. M. (2015). Relapse prevention and the five rules of recovery. The Yale Journal of Biology and Medicine, 88(3), 325–332. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553654/ [] []
  5. The Rebound Effect. (n.d.-a). Substance Misuse Prevention Newsletter: A Collection of Readings, 4(4). https://usm.maine.edu/sites/default/files/uhcs/Newsletter%20-%20January%20The%20Rebound%20Effect%20Jan%2022%20%288%29%20%281%29.pdf []
  6. Social support and stress as predictors of relapse in early recovery from alcohol and substance abuse—ProQuest. (n.d.). Retrieved from https://www.proquest.com/openview/89aae0f1bce52fe4e89b92a9caaa3bee/1?pq-origsite=gscholar&cbl=18750&diss=y []
  7. CDC. (2022, June 16). Benefits of physical activity. Centers for Disease Control and Prevention. https://www.cdc.gov/physicalactivity/basics/pa-health/index.htm []
  8. Carty , B. (2016). Post-Acute Withdrawal Syndrome. University of Texas Health School of Biomedical Informatics. https://sbmi.uth.edu/heroes/documents/Post-Acute-Withdrawal.pdf?language_id=1 []
  9. Protracted Withdrawal.(2010). Substance Abuse and Mental Health Services Administration. https://store.samhsa.gov/sites/default/files/d7/priv/sma10-4554.pdf []

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