Post-Acute Withdrawal Syndrome

Post-acute withdrawal syndrome (PAWS) is the second stage of withdrawal from psychoactive substances, which may occur after the initial acute stage. Because PAWS can bring ongoing symptoms that are difficult to manage, it can interfere with recovery and increase the risk of relapse. This is why it’s important to receive treatment for symptoms of PAWS.

When the body is dependent on a psychoactive substance, it has adapted to functioning with the drug or alcohol in its system. At this point, withdrawal symptoms can develop when the substance is suddenly taken away. At first, the person goes through an acute withdrawal phase. After that, it’s possible to experience post-acute withdrawal syndrome (PAWS).

PAWS does not always occur, and certain factors play a role in its onset and severity. While the acute withdrawal phase tends to be over relatively quickly, PAWS is an extended withdrawal period. Professional treatment can help manage symptoms of PAWS, which is important to continuing with recovery and avoiding relapse.

What to Expect From Post-Acute Withdrawal Syndrome


PAWS could occur after stopping use of any psychoactive substance that has created changes to the brain and had lasting effects on emotions, behaviors, and cognitive functioning. The brain and body adapt to the continuous substance use, and it can take time for the body to function without the substance.

Some of the substances that have been associated with PAWS include:

  • Alcohol
  • Benzodiazepines (benzos), such as Valium or Xanax
  • Barbiturates, such as Seconal or Amytal
  • Opiates, such as heroin or OxyContin
  • Antidepressants

PAWS has a significant effect on emotions and moods. Post-acute withdrawal symptoms include:

  • Insomnia
  • Severe drug cravings
  • Anxiety
  • Panic attacks
  • Irritability
  • Anger
  • Depression
  • Mood swings
  • Reduced feelings of pleasure (anhedonia)
  • Cognitive impairment, including short-term memory problems and difficulty with concentration, decision making, and problem-solving
  • Suicidal ideation and suicide
  • Ongoing fatigue

Additional symptoms have been associated with PAWS, and the symptoms can vary based on the substance.

How Long Does PAWS Last?


PAWS is an ongoing problem. Many of its alternate names refer to its lasting effects, including extended withdrawal, long-term withdrawal, and protracted withdrawal. While acute withdrawal symptoms tend to last from a few days to a few weeks, PAWS symptoms can last for weeks or months. In some cases, certain symptoms last for a year or longer.

PAWS may not occur at all, but when it does the length of time it lasts can vary. It will depend on factors that affect PAWS, which relate to the substance use. These factors include:

  • Substance type
  • Amount
  • Frequency of use
  • Duration of use

During this withdrawal phase, symptoms may go away and then return. They can also change in severity.

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Reducing the Risk of Relapse


The difficult and lasting symptoms of PAWS can encourage people to turn back to substance use for relief, which can bring on relapse. Being aware of PAWS provides an understanding that these symptoms are part of recovery and won’t last forever. Nonetheless, many symptoms are difficult to endure on your own. Treatment can provide relief to make it easier to stick with recovery and to help improve life on a daily basis.

Professionals should assess whether there is an underlying problem, such as depression, that is separate from PAWS and requires its own treatment. Treatment for PAWS can include therapy, especially to help with the emotional and mood symptoms, as well as medication to manage symptoms. Holistic treatment may be recommended, such as learning coping strategies and being physically active. Peer support groups may also help.

After getting past the initial acute withdrawal symptoms through the support of a detox program, a residential treatment program can help with PAWS symptoms. This type of program provides comprehensive treatment that addresses the myriad of ways dependence and addiction have affected your body and your life. Inpatient treatment can help you work on creating lasting change to stick with recovery. If PAWS symptoms continue to linger, it may help to follow inpatient treatment with an outpatient program for continued support.

Symptoms of post-acute withdrawal syndrome can linger and complicate recovery from substance dependence and addiction. When PAWS is not managed, it can lead a person to relapse. Being aware of this stage of withdrawal and seeking treatment can make the process easier and reduce the risk of relapse, helping you move forward with recovery.