PAWS Symptoms (Post-Acute Withdrawal Syndrome)

When a person is addicted to alcohol or certain drugs, their body has become physically dependent. Withdrawal syndrome is seen when a person abruptly discontinues use of that substance. Both illegal and prescription drugs can induce withdrawal symptoms, which can persist anywhere from two days to several weeks.

Although the physical side effects from dependence usually subside after a week, people in recovery may experience emotional symptoms for much longer—months, in some cases.

Doctors usually try to work with their patients to control withdrawal symptoms related to prescription drugs, such as benzodiazepines or other depressants. However, those addicted to illicit substances may face intense withdrawal effects if they try to stop using  “cold turkey”.

Post-Acute Withdrawal Syndrome (PAWS)

Although acute withdrawal symptoms can be extremely unpleasant, most usually subside in one or two weeks. This is especially true when the person is medically monitored during the detox process. However, some substance abuse can result in a longer duration of withdrawal effects that continue for months. People who use drugs or alcohol heavily for a prolonged period are more likely to experience this unfortunate problem, also referred to as post-acute withdrawal syndrome or PAWS.

PAWS is a condition hallmarked by a combination of ongoing withdrawal symptoms, which are typically psychological, emotional. They can involve depression, anxiety, agitation, and mood swings. These effects can persist long after acute withdrawal symptoms have diminished.

Although post-acute withdrawal symptoms rarely include aches and pains, nausea, cramping, or other physical effects common to withdrawal, it can be just as intense and unpleasant as short-term withdrawal. If this condition is left untreated, it may ultimately place an individual at an increased risk of relapse, as they may resort to substance abuse in an attempt to alleviate their discomfort.

About PAWS

People who encounter symptoms related to PAWS can feel like they are undergoing a rollercoaster of adverse effects and emotions that wax and wane without warning. Each episode can last for several days and continue to reoccur in a cycle for up a year. These symptoms can manifest after the prolonged use of any intoxicant, although PAWS most often occurs among people who discontinue the abuse of the following substances:


Suddenly discontinuing alcohol use can be hazardous and even life-threatening, because it can induce a severe condition known as delirium tremens (DTs) that includes seizures and psychosis. Furthermore, if this occurs, it may also increase the likelihood of PAWS occurring. Alcoholics who experience PAWS may suffer for months with anxiety, sleep difficulties, cravings, and impaired concentration, and impulse control.


Antipsychotics attach to dopamine receptors in the brain to reduce symptoms related to hallucinations, delirium, and other psychiatric issues. When use is terminated without a tapering schedule, the person could encounter withdrawal symptoms for months.

Benzodiazepines (Benzos)

Benzos are medications that can be beneficial for many people who have anxiety and panic disorders. However, they also have a high potential for physical dependence and abuse. Most doctors do not prescribe benzos long-term because addiction can develop.

Withdrawal symptoms related to benzos tend to resemble anxiety and panic disorders, making it much more difficult to discontinue use. PAWS symptoms may include insomnia, fatigue, and intense cravings. These can last for months after physical dependence has diminished.


Whether opioids are misused by prescription or abused illicitly as in the case of heroin, long-term exposure to these drugs can result in the development of PAWS if they are not tapered off properly. Moreover, people who experience very intense acute withdrawal are more likely to encounter PAWS, which can include intense cravings, exhaustion, and cognitive impairments that may not improve much for an extended period.


Prescription drugs, such as Adderall, and illicit stimulants, such as cocaine, can contribute to PAWS if withdrawal from them is not executed appropriately. A person who has detoxed from stimulants may encounter extreme fatigue, severe depression, and physical weakness long-term, and these effects can be challenging to manage.

Other potential effects of PAWS other than the aforementioned include the following:

  • Hostility
  • Aggression
  • Loss of libido
  • Anhedonia (inability to feel pleasure)
  • Memory impairments
  • Hypersensitivity to stress

PAWS Symptoms Causes: Theories

PAWS is a complicated syndrome with no single, specific cause. Psychiatrists and doctors do not completely concur on the exact reasons for the syndrome. Still, some posit that stress response in addition to changes to specific regions of the brain during active addiction may contribute to the onset of PAWS.

Theories about factors that are related to the development of PAWS include the following:

Homeostatic Regulation

A person’s chemical dependence on drugs or alcohol results in brain chemistry changes over time. When the system is denied the substance’s presence that triggers neurotransmitters to release, it can no longer reach a balance or stabilize on its own. It can take a prolonged period for the brain to achieve equilibrium fully. Unfortunately this delay can lead to fatigue, moodiness, insomnia, and other psychological symptoms.


It can be psychologically challenging to quit using a psychoactive substance, especially for those who attempt to do it abruptly or without medical supervision. This stress can lead to relapse or otherwise result in the continued appearance of withdrawal symptoms as the individual attempts to reestablish an emotional life balance without the use of drugs or alcohol.


One of the main objectives of rehab is to help individuals alter their behaviors and responses to the use of drugs or alcohol. Recovering heroin addicts, for instance, may have fond memories of cooking and injecting drugs. Others who are in recovery from alcohol use disorder mourn the loss of certain social situations. Returning to habits associated with substance abuse frequently results in relapse. Still, the loss of that practice or ritual can also produce stressful psychological symptoms, such as depression, cravings, or anxiety, eventually contributing to PAWS.

Getting Treatment for PAWS

Because PAWS symptoms are primarily psycho-emotional, continued support from counselors and therapists early in recovery is essential for reducing the severity of this experience.

The following are measures that medical and addiction health professionals may take to help patients relieve chronic withdrawal symptoms:

  • Provide education about the process of detox and withdrawal and what to expect
  • Encourage recognition of completed milestones and having patience throughout the process
  • Find natural methods to help with sleep disorders, such as melatonin
  • Encourage exercise and a healthy diet
  • Prescribe certain medications that help reduce symptoms
  • Evaluate potential co-occurring conditions, which may re-emerge during recovery
  • Encourage participation in peer support groups

The risk of encountering PAWS symptoms can sometimes be reduced by undergoing a medical detox, enrolling in an intensive rehab program, and receiving long-term support well after initial addiction treatment has been completed.

If you or a loved one are struggling with substance abuse or addiction, contact us today. We help people achieve long-lasting sobriety so they can begin to experience the fulfilling lives they deserve. Find out how you can take that first step towards freedom.

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