At Westlake Village Recovery Center, we often see clients struggling with lingering symptoms even after they’ve stopped using substances. These persistent challenges have a name: Post-Acute Withdrawal Syndrome, or PAWS. Understanding PAWS is crucial for anyone in recovery from addiction, as it helps explain why the journey can feel like an uphill battle even after detox is complete.
What is Post-Acute Withdrawal Syndrome (PAWS)?
Post-Acute Withdrawal Syndrome (PAWS) refers to a set of symptoms that persist after the initial, acute withdrawal phase from substances has ended. It is most likely to occur when people are recovering from addiction to alcohol, opioids, and benzodiazepines.
While acute withdrawal typically lasts days to weeks and involves (primarily) physical symptoms, PAWS symptoms are mostly psychological and cognitive in nature. PAWS symptoms may last for weeks, months, or even years after stopping substance use. The brain needs time to heal and rebalance itself after substance dependence, and PAWS can occur during this healing process.
How Does PAWS Differ From Acute Withdrawal?
Acute withdrawal syndrome refers to the immediate, physical symptoms that occur when someone stops using a substance. These symptoms can be uncomfortable and sometimes dangerous, depending on the substance.
PAWS symptoms are the lingering psychological and cognitive symptoms that follow. These might include mood swings, anxiety, sleep disturbances, and trouble concentrating. During both phases, the brain is working to heal and rebalance itself after substance use.
According to the National Institute on Drug Abuse (NIDA), the brain can take months or even years to fully recover from changes caused by substance use. This explains why PAWS can last so long.
Common Symptoms of PAWS
PAWS symptoms can vary widely from person to person, but most people experience a combination of emotional, cognitive, and physical challenges. These symptoms typically come in waves. They may be intense for a few days, then improve, then return again.
General PAWS symptoms include:
* Mood swings
* Anxiety
* Depression
* Trouble sleeping
* Difficulty concentrating
* Low energy
* Increased sensitivity to stress
The emotional symptoms of PAWS can be particularly challenging. Many people describe feeling like they’re on an emotional roller coaster.
Common emotional symptoms of PAWS include:
- Anxiety and panic: Feeling nervous, worried, or experiencing sudden panic attacks without an obvious trigger.
- Depression and mood swings: Feeling sad, hopeless, or experiencing rapid shifts in mood.
- Irritability and hostility: Becoming easily frustrated or angry.
- Anhedonia: The inability to feel pleasure from activities that were once enjoyable.
These symptoms can come and go, sometimes feeling intense and at other times barely noticeable. This fluctuation is normal as the brain continues to heal.
PAWS also affects thinking and sleep patterns. Cognitive symptoms often include:
- Memory problems: Trouble remembering recent events or information.
- Difficulty concentrating: Finding it hard to focus on tasks or conversations.
- Poor decision-making: Making impulsive decisions or having trouble weighing options.
- Sleep disruptions: Insomnia, vivid dreams, or irregular sleep patterns.
These symptoms can make daily life and responsibilities feel overwhelming, but they typically improve over time as the brain heals.
The symptoms of PAWS can vary depending on the substance used:
- Alcohol: PAWS symptoms from alcohol addiction often include anxiety, sleep problems, and mood swings. Alcohol-related brain changes can persist for months or years.
- Opioids: Symptoms may include fatigue, irritability, and trouble feeling pleasure. A 2022 study found that up to 90% of people recovering from opioid use experience some form of PAWS.
- Benzodiazepines: Unique challenges include anxiety, sensory sensitivity, and cognitive issues. Benzodiazepine-based PAWS symptoms can last longer than other substances, sometimes continuing for 18 months or more, which is why many people benefit from benzodiazepine addiction treatment.
Other substances: Withdrawal from stimulants and cannabis can also cause PAWS, though symptoms may differ. Stimulant-based PAWS symptoms often involve fatigue and depression, while cannabis-based PAWS symptoms may include sleep disturbances and irritability.
How Long Can PAWS Last?
The duration of PAWS varies by substance and individual factors. For example, alcohol-based PAWS symptoms may last several months, while opioid-based PAWS can persist for a year or more.
Factors that influence duration include:
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- Substance type and half-life
- Duration and intensity of use
- Individual factors (such as genetics and overall health)
- Co-occurring mental health disorders
- Quality of support and treatment
PAWS symptoms usually come in waves, with periods of improvement followed by temporary setbacks. This pattern can be frustrating, but understanding it as a normal part of recovery can help reduce anxiety when symptoms return.
How To Manage Post-Acute Withdrawal Syndrome
Managing PAWS requires a combination of support, healthy habits, therapy, and sometimes medication. While we can’t eliminate PAWS entirely, we can reduce its impact on daily life and recovery.
Social support is crucial for recovery. Connecting with others who understand what you’re going through can provide comfort and practical advice.
Helpful support options include:
* Recovery support groups (in-person or online)
* Individual therapy or counseling
* Family and trusted friends
* Recovery community organizations
* Peer support specialists
Daily habits can have a significant impact on PAWS symptoms. A structured routine that supports brain healing includes:
- Sleep hygiene: Going to bed and waking up at consistent times, creating a relaxing bedtime routine, and limiting screen time before sleep.
- Nutrition: Eating regular, balanced meals with plenty of fruits, vegetables, and whole grains.
- Exercise: Engaging in regular physical activity, even if it’s just walking for 30 minutes a day.
- Stress management: Practicing mindfulness, deep breathing, or gentle yoga.
Research shows that these lifestyle factors can significantly improve brain function during recovery. For example, regular exercise increases the production of brain-derived neurotrophic factor (BDNF), which helps the brain form new connections.
Professional addiction-focused therapy can provide tools for managing PAWS symptoms. Effective approaches can include:
- Cognitive Behavioral Therapy (CBT): Helps change negative thought patterns and behaviors.
- Mindfulness-Based Relapse Prevention: Teaches skills to manage cravings and stress.
- Acceptance and Commitment Therapy (ACT): Encourages acceptance of difficult feelings and commitment to positive actions.
These evidence-based therapies help develop coping skills for the emotional and cognitive challenges of PAWS. People who engage in therapy during PAWS have significantly better outcomes than those who try to manage symptoms on their own.
When To Seek Professional Care for PAWS
While many PAWS symptoms can be managed with self-care and support, some situations call for professional help. Warning signs that professional care is needed include:
- Severe depression or anxiety that interferes with daily functioning
- Suicidal thoughts or feelings
- Inability to work, maintain relationships, or handle basic responsibilities
- Return to substance use or intense cravings
- Symptoms that worsen rather than gradually improve
Addiction specialists, psychiatrists, and therapists can provide assessments and recommend the best treatment options. Tools like the PAWS Assessment Scale may be used to evaluate symptom severity and guide care.
Moving Forward Toward Lasting Recovery
The key to navigating PAWS successfully is understanding that it’s a normal part of the recovery process, not a sign of failure. The brain is resilient and continues to heal over time. Recovery from PAWS is possible, and symptoms are temporary even if they feel overwhelming at times. Many people go on to live healthy, fulfilling lives after PAWS.
As you move forward in recovery, remember that progress isn’t always linear. There may be difficult days, but they become less frequent and less intense over time. Each day without substances allows the brain more time to heal and adapt to a new, healthier way of functioning.
At Westlake Village Recovery Center, we offer a comprehensive, compassionate approach to treating PAWS and supporting lasting recovery. We understand that PAWS can feel overwhelming. But with the right support, it becomes a manageable part of the healing process. To learn more about our programs, verify your insurance, or begin your recovery journey, contact us today.
Frequently Asked Questions About PAWS
PAWS symptoms typically emerge after acute withdrawal ends and fluctuate over time. If you’re experiencing persistent symptoms that don’t follow this pattern, consult a healthcare provider to rule out other conditions.
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PAWS symptoms like anxiety, depression, and sleep problems can increase vulnerability to relapse by making it harder to cope with stress and cravings. Understanding that these symptoms are temporary and having strategies to manage them can significantly help reduce relapse risk.
Yes, certain medications can help with specific PAWS symptoms. But they should always be prescribed and monitored by a medical professional knowledgeable about addiction. Not all medications are appropriate for people in recovery, and some carry their own risks.
PAWS is most common when someone is withdrawing from alcohol, opioids, benzodiazepines, and some stimulants. But it can occur with other substances as well. The likelihood and severity of PAWS typically correlate with how long and how heavily the substance was used.
