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March 7, 2023

What Is Post Acute Withdrawal Syndrome (PAWS)?

Recovering from addiction is challenging, and many people experience relapses. The first stage of detox is particularly challenging due to acute withdrawal symptoms which can be debilitating and often require medical care.

Detox typically lasts no more than a few weeks. However, in some cases, withdrawal symptoms can last longer, albeit with a change in their character. This is referred to as Post-Acute Withdrawal Syndrome (PAWS).

What Are Typical PAWS Symptoms?

Symptoms during detox tend to be physical. Post-acute withdrawal syndrome causes symptoms that are typically more mental and emotional, and they include:

  • Difficulty solving problems.
  • Memory issues.
  • Issues with coordination.
  • Irritability.
  • Depression.
  • Anxiety.
  • Mood swings.
  • Sensitivity to stress.
  • Insomnia.
  • Issues with relationships.
  • Fatigue.
  • Apathy.
  • Cravings.
  • Lack of libido.
  • Chronic pain.
  • Inability to experience pleasure.


The type of drug makes some difference to symptoms. For example, alcohol tends to cause anxiety, fatigue and chronic cravings. Opioids tend to induce depression, irritability, fatigue, anxiety, insomnia, and lack of focus.

These symptoms can last for a few months and can sometimes lead to a relapse. Cravings can cause somebody to relapse, as can a desire to get rid of the withdrawal symptoms themselves. PAWS symptoms tend not to be constant, but rather episodic, and episodes generally become less frequent over time.

What Are the Risk Factors For PAWS?

Many recreational drugs can trigger PAWS, but the most likely are:

  • Alcohol
  • Marijuana
  • Cocaine
  • Opiates
  • Meth
  • Benzodiazepines (Note that these are commonly prescribed for depression or anxiety. You should never stop these medications without consulting with a doctor as the withdrawal symptoms can combine with a resurgence of the condition you are treating. This often results in panic attacks and extreme anxiety).


Another risk factor for PAWS is the amount of substance taken and the length of time they are addicted to the substance. There are likely to be other factors explaining why some people in recovery get PAWS and others do not. However, everyone in recovery should be aware of the problem, as should those around them. Some psychological symptoms such as irritability may be more obvious to others than to the patient.

What Causes PAWS?

It’s not entirely clear, again, why some people get PAWS and others don’t. Some likely reasons include the body adapting to function with the drugs, resurgence of conditions for which the person was “self-medicating,” recovery stress and potentially nutritional deficiencies caused during substance abuse. Often people who are addicted to drugs or alcohol will eat a poor diet, forget to eat, etc.

The most likely reason is changes in the brain as it adapts to functioning with the substance, and then has to change back. The longer the substance has been used, the worse these changes become. They are also related to substance tolerance, where addicts need to take more and more of a drug to gain the same result.

How Long Does PAWS Last?

The length of time PAWS lasts depends on the individual, the drug being used, the length of addiction, etc. It can last anywhere from a couple of weeks to 2 years.

This can cause problems, with the most serious being a relapse. PAWS can also make it hard for the recovering addict to sustain relationships and hold down a job. It’s vital for the recovering person to understand that these symptoms are temporary and that taking the drug is not a solution.

How is PAWS Treated?

There is no specific treatment for PAWS. Unfortunately, it is a facet of recovery that has to be endured with coping strategies and assistance. There are, however, some treatments to help manage specific PAWS symptoms during withdrawal and recovery. As PAWS is temporary and will go away on its own, managing symptoms is sufficient. Professional help is often needed, but some things which can help are:

  • Eating a healthy diet. Patients who have become undernourished or malnourished during addiction may need to work with a nutritionist to find the right diet to optimize their recovery.
  • Exercising regularly, although not to excess (recovering addicts sometimes become addicted to the endorphins produced by intense exercise).
  • Practicing stress management and self-care.
  • Seeking support, whether it’s from friends, family, or a mutual support group.
  • Educating yourself.
  • Celebrating the good days.


Those around the person can help by providing that support, not judging them for things they might do during an episode, such as snapping at them, and encouraging them to do enjoyable activities to distract them from cravings.

Therapy is vital, both to help develop coping strategies and to help the patient watch for mental health issues which might emerge during withdrawal. A therapist can help the patient manage stress, care for themselves better, and understand what is going on with their brain.

How Can Restore Detox Centers Help?

Restore Detox Centers specializes in offering inpatient residential detox and rehab for substance abuse. Along with addiction treatment, we provide an evidence-based approach to mental health with a variety of therapies such as CBT, DBT, and more.  

To find out more about detox and rehab with Restore, call us today at (858) 302-4417.

About Restore

Are you or someone you care about struggling with drug or alcohol addiction in San Diego, California? Look no further than Restore Detox Centers, the leading 24-hour residential treatment facility. Our dedicated team is committed to providing effective rehabilitation services tailored to your individual needs.

We understand the challenges you face on your path to recovery, which is why we offer a comprehensive range of programs, including medically assisted detox and residential treatment. Our ultimate goal is to guide you towards a life free from addiction and help you achieve long-term success. 

Rest assured that our facility is accredited by The Joint Commission, guaranteeing the highest standards of quality and safety. You can rely on our compassionate team of professionals to support you every step of the way. 

If you're ready to take the first step towards healing, don't hesitate to contact Restore Detox Centers today. Let us be your trusted partner in your journey to recovery.

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