What is Post-Acute Withdrawal Syndrome?

Post-acute withdrawal syndrome, sometimes abbreviated as PAWS is the name given to a set of persistent withdrawal symptoms that can continue to affect a recovering person for weeks, months, or even years after the initial phase of withdrawal from alcohol, opiates, benzodiazepines, and other substances. 

Whether or not a person experiences Post-acute Withdrawal Syndrome (PAWS) doesn’t necessarily depend on whether or not they get a medical detox and addiction treatment. However, there is evidence that detox and treatment can significantly reduce some symptoms of PAWS. 

Someone who is unfortunate enough to have to quit opioids, alcohol, or anything else using the “cold turkey” method is at just as much risk as someone who has received proper treatment for an addiction to opioids or other substances — maybe more.  

Post-acute withdrawal syndrome or PAWS is:

• A set of symptoms some people experience after the initial withdrawal period ends.
• Associated mainly with alcohol, opioids, and benzodiazepines. 
• Post-acute withdrawal syndrome doesn’t

What is Post-Acute Withdrawal Syndrome Like?

Unlike the acute withdrawal phase, which typically involves physical symptoms and lasts a short period, PAWS consists of mostly emotional and psychological symptoms. Symptoms of PAWS can vary widely among different people but commonly include mood swings, anxiety, irritability, tiredness, variable energy, low enthusiasm, concentration difficulties, and disturbed sleep patterns. 

These symptoms can fluctuate in intensity and may come and go unpredictably. The unpredictability and persistence of PAWS symptoms can be particularly challenging for individuals in recovery, as they may interfere with daily functioning and increase the risk of relapse. This is one reason why an aftercare plan and structured recovery following substance abuse treatment are so important. 

What are the symptoms of PAWS?

• Mood swings
• Anxiety
• Irritability
• Tiredness
• Low enthusiasm
• Difficulty concentrating
• Disturbed sleep patterns

How Long Does Post-Acute Withdrawal Syndrome Last?

The duration of post-acute withdrawal syndrome varies widely from person to person. Many people don’t have PAWS at all. Others may experience lingering PAWS symptoms as long as a year after their sobriety date. Don’t let concerns about PAWS discourage you though.

The reality is that even people who experience PAWS for as long as 6 months to a year see steady improvement over time. It’s also true that there are plenty of things you can do to help yourself or someone you care about manage their PAWS symptoms. 

The Best Ways to Manage and Treat PAWS

The most effective treatment for post-acute withdrawal syndrome takes a holistic approach that may include counseling, support groups, stress management techniques, and sometimes medication to manage specific symptoms. It’s important for individuals experiencing PAWS to have both sober support and/or fellowship as well as professional guidance.

Many of the symptoms of PAWS can be lessened or improved by focusing on both mental and physical health. Alcohol and drug use are hard on the body. People with PAWS who pay greater attention to eating well, exercising, and even taking supplements are shown to have less severe symptoms and recover sooner. Of course, you may not feel like running a marathon the day after you leave rehab — but bear this principle in mind and do what you can. 

What are the most effective ways to manage PAWS?

• A complete course of drug and alcohol treatment, beginning with a medical detox.
• Careful aftercare planning and following a recovery plan for at least the first year.
• Outpatient mental health therapy and medications (in some cases) can really help. 
• Don’t forget physical health. Eat nutritious food, exercise, and sleep as well as you can. 

Is There Any Way to Avoid PAWS?

While there isn’t a clear-cut path to avoiding Post-Acute Withdrawal Syndrome (PAWS) entirely, there are good reasons to have hope. First, there is scientific evidence that suggests that a medical detox, followed by substance use disorder treatment can substantially ease many of the symptoms of PAWS. 

Furthermore, following a structured recovery plan that includes PHP addiction treatment also substantially reduces a person’s chances of relapse. This is particularly important in the case of people who have PAWS. The key message here is to get all the help you can and remember that the recovery process isn’t over just because someone has completed their PHP or IOP addiction treatment. 

Recovery is both a process and a lifestyle that continues as long as we live. We can expect continued improvement over time though, as long as we follow a plan. Eventually, you will overcome PAWS and continue to thrive in recovery! 

What Causes PAWS?

The first thing you should know is that not everyone experiences post-acute withdrawal syndrome. It isn’t a given that any particular person will have PAWS following cessation of alcohol, opioid, or benzodiazepine use. But it’s important to be aware that it is a possibility. 

The exact cause of PAWS is not fully understood. Like “regular” withdrawal, it is believed to result from the brain’s attempt to regain balance and adjust to functioning without the substance it has become dependent on. In active addiction, the brain’s chemistry and circuitry undergo changes that do not immediately revert to their pre-substance state once use stops. 

Most of the return to normal biological functioning in the brain and body happens within the first 2-4 weeks after use stops, especially if that person is in substance abuse treatment. Post-acute withdrawal syndrome is what we call the set of withdrawal-related symptoms that may linger afterward.

Causes of post-acute withdrawal syndrome:

• We still don’t fully understand the causes of PAWS.
• Not everyone experiences PAWS, but the substance and timeframe play a role.
• What we do know is that PAWS does end eventually and treatment helps. 

Real Help for Addiction and Post-Acute Withdrawal Syndrom

Suffering isn’t a requirement for recovery. We won’t tell you that recovery from addiction is easy — but we can say that there’s no good reason to make it harder on yourself. 

One of the wisest things you can do for yourself is to get proper addiction treatment to start. If you do that and follow a well-designed aftercare plan afterward and take care of your body and mind — your chances of managing any PAWS symptoms well are well above average! 

If you’re looking for more information about managing PAWS or treatment for drug or alcohol use disorders — North Jersey Recovery Center is here to help. Give us a call at (877) 790-5873