Understanding Post-Acute Withdrawal Syndrome (PAWS) in Addiction Recovery
- modernrecoveryx
- May 8
- 4 min read
Learn what Post-Acute Withdrawal Syndrome (PAWS) is, how it affects recovery, and how to manage symptoms effectively to prevent relapse.
Recovery from addiction is often thought of as a linear process—detox, then healing. But for many people, withdrawal doesn’t end when the body clears the substance. Long after acute detox, lingering symptoms can return or persist unexpectedly. This phenomenon is called Post-Acute Withdrawal Syndrome (PAWS), and it can make the journey of recovery more challenging than most expect.
In this article, we’ll explore what PAWS is, why it happens, how long it lasts, and—most importantly—how to manage it effectively for a successful and lasting recovery.
What is Post-Acute Withdrawal Syndrome (PAWS)?
Post-Acute Withdrawal Syndrome (PAWS) refers to a set of prolonged withdrawal symptoms that persist after the initial, acute withdrawal phase is over. While acute withdrawal lasts days to weeks and involves physical symptoms, PAWS typically affects emotional, psychological, and cognitive functioning and can last for months—or even years.
Common Substances Associated with PAWS:
Alcohol
Benzodiazepines (e.g., Xanax, Valium)
Opiates (e.g., heroin, oxycodone)
Stimulants (e.g., cocaine, methamphetamine)
Antidepressants (SSRI discontinuation syndrome)
Symptoms of PAWS
The symptoms of PAWS can vary widely between individuals and substances, but commonly include:
Category | Symptoms |
Mood disturbances | Depression, anxiety, irritability, mood swings |
Sleep issues | Insomnia, vivid dreams, interrupted sleep |
Cognitive problems | Brain fog, memory issues, trouble concentrating |
Physical symptoms | Fatigue, low energy, hypersensitivity to stress |
Emotional dysregulation | Cravings, emotional numbness, extreme reactions |
Anhedonia | Inability to experience pleasure or motivation |
These symptoms tend to come and go in waves, often triggered by stress, life events, or even without a clear cause.
Why Does PAWS Occur?
Substance abuse causes long-term changes in brain chemistry, especially in areas regulating mood, motivation, and stress response.
The most affected systems include:
Dopamine System – Central to pleasure, motivation, and reward.
GABA/Glutamate Balance – Governs anxiety and mood regulation.
Endorphin System – Affects pain relief and emotional stability.
When the substance is removed, the brain requires time to re-balance these systems. PAWS occurs during this neurological “rebooting” process. The more prolonged and intense the substance use, the more likely—and severe—PAWS may be.
How Long Does PAWS Last?
The duration of PAWS depends on several factors:
The type of substance used
Duration and intensity of use
Genetic and biological factors
Presence of co-occurring mental health conditions
Support system and recovery plan
Typical PAWS Duration:
Alcohol & Benzos: 6–24 months
Opioids & Stimulants: 3–12 months
Antidepressants: Weeks to months after cessation
While these symptoms can be alarming, they generally decrease in intensity and frequency over time—especially when managed with proper support.
The Dangers of PAWS: Relapse Risk
One of the biggest challenges with PAWS is that it can lead to a false sense of failure in recovery. Individuals may feel like they’re "not getting better" or that something is wrong with them. This discouragement, combined with cravings and emotional instability, significantly increases the risk of relapse.
Recognizing PAWS for what it is—a normal part of recovery—can be a crucial step in navigating it without returning to substance use.
How to Manage PAWS Effectively
Managing PAWS requires a combination of awareness, healthy routines, and emotional support.
Here’s how:
1. Education
Understanding PAWS normalizes the experience. Knowing it’s part of the healing process can reduce fear and shame.
2. Therapy and Counseling
Cognitive Behavioral Therapy (CBT) is especially useful for managing mood swings, cravings, and distorted thinking.
Trauma-informed therapy can help if PAWS is rooted in unresolved emotional issues.
3. Medication-Assisted Treatment (MAT)
Certain medications (e.g., buprenorphine, naltrexone, SSRIs) can help manage symptoms and reduce relapse risk, especially in opioid and alcohol recovery.
4. Healthy Lifestyle Habits
Regular sleep routine
Balanced nutrition (especially omega-3s, B-vitamins, and protein)
Daily exercise (even walking improves dopamine function)
Hydration
5. Mindfulness & Stress Management
Practices like meditation, journaling, deep breathing, and yoga can help regulate the nervous system and reduce symptom intensity.
6. Support Groups & Peer Support
12-Step groups, SMART Recovery, and other peer-based systems provide encouragement and accountability.
Talking to others who’ve experienced PAWS helps reduce isolation and offers strategies that worked for them.
7. Routine & Structure
Creating a consistent daily schedule reduces stress, enhances motivation, and supports cognitive healing.
Expert Perspectives on PAWS
According to Dr. Kevin McCauley, addiction recovery expert and former naval flight surgeon:
“PAWS is the echo of addiction in the brain. It doesn't mean you're failing—it means you're healing.”
The Substance Abuse and Mental Health Services Administration (SAMHSA) notes that long-term care and monitoring are essential in addiction recovery due to the potential duration and severity of PAWS symptoms.
Final Thoughts: You’re Not Broken—You’re Rewiring
If you're experiencing PAWS, know this: You’re not regressing—you’re progressing. Recovery is not a straight line. It’s a neurochemical, emotional, and spiritual journey. Post-Acute Withdrawal Syndrome is evidence of that healing in motion.
With the right support, tools, and patience, you can outlast these waves and continue building a fulfilling life free from substance dependence.
You can learn more about PAWS from Catalina Behavioral Health here
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