Post-Acute Withdrawal Syndrome

Post-acute withdrawal syndrome (PAWS) consists of several uncomfortable symptoms, and it affects a great many of those who manage to break free of addiction’s grip. It is more than what you experience during detox; rather, it builds upon that experience. Why PAWS manifests in some and not in others isn’t fully understood, and this can be troublesome for many who want to understand why it’s happening to them. Whether you’ve been using for years or you’re fairly new to drug abuse and addiction, you’re at risk. Post-acute withdrawal syndrome can stem from hard substance abuse, smoking cigarettes or regular binge drinking that allows dependence to form.

When Does PAWS Occur?

Man with Post-Acute Withdrawal SyndromeEven persistent use or abuse of pharmaceuticals can leave you with post-acute withdrawal syndrome. Per the Comprehensive Handbook of Drug and Alcohol Addiction, 10 to 15 percent of individuals who complete withdrawal from benzodiazepines develop PAWS. It occurs after the initial acute withdrawal period has passed, and it stems from the body’s reaction to the absence of the abused substances it was accustomed to. PAWS can make life persistently difficult for the individual who suffers from it.

When PAWS develops depends on the substance that was abused and how long the first stage of withdrawal takes to complete. For example, alcoholics can detox in as little as a week’s time and find themselves battling PAWS a week after that, but someone who is detoxing from painkillers might not develop it until much later if they don’t fully detox for weeks or months. PAWS typically sets in around one to two weeks after the first stage of withdrawal is over. Generally, the physical side effects of withdrawal will remain at bay, but PAWS will intensify and stir up a lot of psychological effects and emotions that can be uncomfortable to deal with.

Post-acute withdrawal syndrome can creep up out of the blue weeks to months after you thought you left your drug detox experience behind you. This can be disheartening for many, but ignoring it will not make it go away. You may become very forgetful at times and have difficulty learning new things or retaining new information. Emotional responses in someone suffering from PAWS can be extreme and over the top in reaction to stimuli. Racing thoughts and feeling like your mind is all over the place are also to be expected with PAWS.

Merlin O. Baker’s Understanding Alcohol and Drug Addiction: An LDS Perspective states that 75 to 95 percent of recovering alcoholics experience post-acute withdrawal syndrome. The vast majority of recovering heroin and prescription opioid pain reliever addicts will also have to deal with the syndrome. If you find that you are well past your initial withdrawal period and experiencing the following symptoms, you may have PAWS:

  • Mood swings
  • Anxiousness
  • Irritable mood
  • Fatigue
  • Lethargy
  • Strong cravings and urges
  • Loss of interest in activities you previously enjoyed
  • Loss of ability to experience pleasure
  • Memory problems
  • Loss of coordination
  • Bursts of energy that come and go
  • Difficulty concentrating
  • Trouble sleeping
  • Vivid dreams

Learn More

Almost anyone who endures drug withdrawal can end up with PAWS, but certain people are at more of a risk than others. Those who abuse these substances for a long period of time are at heightened risk:

  • Heroin or other opiates
  • Antidepressants
  • Benzodiazepines
  • Alcohol
  • Cocaine
  • Methamphetamine
  • Psychotropic drugs

Individuals withdrawing from milder drugs like marijuana and nicotine can also experience PAWS, but it is less common. Infants born to maternal drug users are at risk for developing PAWS, too. Your mental state going into and during withdrawal may play an important factor in whether or not you develop this syndrome, but research is limited on the correlation. Regardless, many addicts are diagnosed with mental health issues while in treatment and must learn to cope with them following withdrawal.

Approximately 53 percent of drug addicts and 37 percent of alcoholics struggle with severe mental health disorders, Helpguide reports. The symptoms of PAWS can often mimic those of mental illness. Thus, if you have a mental health disorder, it is important to seek professional help in determining which issue is at play. It can be especially confusing for the newly diagnosed since symptoms can simply come and go, but triggers — especially stress — can bring them out or make them worse.


In the beginning, symptoms will likely cycle every few minutes or hours, but this pattern dissipates over time. Post-acute withdrawal syndrome can make staying clean and sober even harder if you’re one of the unfortunate sufferers who must deal with the cravings it inflicts. Preventing PAWS may not be possible, but successfully managing it is. If you find yourself waking up in a distasteful mood and unable to snap out of it, remember how your life will continue to improve because of your recovery from addiction. The longer you’re able to stick it out, the more you’ll start to believe that you can handle life in recovery, with or without PAWS.

It can take time for your body to bounce back from addiction. Detox and substance abuse treatment are just the beginning, but you can weather this storm. Remember that the drug abuse you engaged in seriously damaged the pathways in your brain that helped you manage stress, regulate sleep, and experience pain relief and pleasure. Now, you need to give your brain the time it needs to heal and regain those abilities.

One of the best things you can do to stay in recovery and avoid letting PAWS coax you into relapse is to stay involved in continued treatment. Support groups like Narcotics Anonymous and Alcoholics Anonymous are great components for any recovering addict’s life. You can get your family involved in groups like Al-Anon, too. In one National Institute on Alcohol Abuse and Alcoholism review, 51 percent of problem drinkers who attended AA in addition to completing formal treatment were still abstinent at the three-year follow-up mark. Having a sponsor often helps addicts to remain abstinent by having someone to turn to who understands when they have a craving or psychological issues that make them want to use again.

Specifics of Treatment

Man at follow-up careWith a complete treatment approach that includes both detox and continued follow-up care, you can be better prepared to handle any possible outcome in your future as a drug-free and sober individual. There is no official standard of treatment for post-acute withdrawal syndrome. The Fix reports the use of naltrexone and acamprosate in the treatment of PAWS in alcoholics, and there is potential for successful treatment with flumazenil in withdrawing benzodiazepine addicts, but most of the knowledge we have about treating PAWS is still in its experimental stages. The syndrome can last for up to two years in some patients, though it generally remains milder in those cases.

The National Institute on Drug Abuse reports that around 2.6 million of the 23.5 million people who needed treatment in 2009 got it. The majority of those treated have just as much of a chance of developing PAWS as you do. You are not alone, and help is available.

Michael’s House is a leader in treating addiction and coping with post-acute withdrawal syndrome. Here, you’ll meet people who will inspire you, and you’ll learn how to make the necessary changes in your life to ensure that addiction stays in the past while you walk into your future. Call today for more information.

Speak with an Admissions Coordinator 877-345-8494