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Post-Acute Withdrawal Symptoms (PAWS)

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Drug and alcohol withdrawal is characterized by adverse effects occurring when a person dependent on substances abruptly quits using or drinking. Both prescription and illicit drugs can lead to significant withdrawal symptoms, typically persisting for several days up to one week. Although the worst effects of dependence usually diminish after a few days, some may experience symptoms for much longer. When this occurs, it is referred to as post-acute withdrawal syndrome or PAWS.

If you need help overcoming an active substance use disorder or managing PAWS, Guardian Recovery offers short- and long-term addiction treatment options to reduce the impact of withdrawal. We will devise a specialized care plan right for you that will address the factors contributing to the development of your substance use disorder. Contact us today to begin your recovery journey and get a new lease on life.

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What Is Alcohol & Drug Withdrawal?

People with an addiction to alcohol may encounter severe withdrawal symptoms if they try to discontinue alcohol “cold turkey.” Although short-term effects can be highly uncomfortable, most are relatively brief, especially when a person is under clinical supervision. 

Medical detox in a recovery facility will be overseen by licensed health providers who monitor a person’s vital signs, ensure safety, and address potentially severe effects. Medications can also be administered to reduce feelings of anxiety, restlessness, and depression.

Sometimes people in recovery experience withdrawal effects that last for several weeks to months. These can range from mild-severe “depending on the substance, the frequency, duration, and quantity used.” People who use drugs or alcohol excessively for a prolonged period are more likely to have this issue. 

While medical detox can treat acute withdrawal, these individuals may need ongoing therapy and peer support to help with longer lasting psychological symptoms.

PAWS Symptoms

PAWS (also known as prolonged or protracted withdrawal syndrome) is marked by various emotional withdrawal symptoms that are especially persistent. These can include anxiety, irritability, depression, and mood swings. This form of withdrawal is distinguished by the time it takes for a person to begin feeling normal again. That is, PAWS symptoms are protracted and persist long after acute withdrawal symptoms have diminished.

Although PAWS seldom includes the physical effects of acute withdrawal, such as nausea and body aches, it can be just as unpleasant and challenging. If these symptoms are unaddressed, the individual may be more likely to relapse in an attempt to alleviate unwanted psychological distress. A person suffering from PAWS-related effects can feel like they are on an emotional rollercoaster with symptoms waxing and waning without warning. Moreover, each episode can last several days and occur in cycles for a year or longer. 

Abruptly discontinuing alcohol use can be hazardous and has the potential to be life-threatening.  In extreme cases, individuals can develop a severe condition known as delirium tremens (DTs), characterized by confusion, delusions, psychosis, and seizures. If a person experiences DTs, this can increase the risk of PAWS and its many unpleasant, long-lasting symptoms.

Symptoms of Alcohol-Related PAWS Include:

  • Anxiety and sensitivity to stress.
  • Mood swings.
  • Depression and apathy.
  • Sleep disturbances.
  • Fatigue and lack of initiative
  • Difficulty concentrating, brain fog.
  • Reduced impulse control.
  • Obsessive-compulsive behavior.
  • Urges and cravings.
  • Hostility or irritability.
  • Fine motor coordination issues. 

PAWS & Other Intoxicating Substances

Alcohol withdrawal is not the only impetus for PAWS. Other common psychoactive drugs can result in symptoms upon discontinuation.

Withdrawal From Substances That Can Lead to PAWS Include:

  • Antipsychotics, such as Haldol and Seroquel.
  • Anti-anxiety medications, such as Xanax and Ativan.
  • Opioids, such as heroin, oxycodone, and morphine.
  • Stimulants, such as Adderall, meth, and cocaine.

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Potential Causes of PAWS

PAWS is a complex syndrome that has no single identifiable cause. Psychiatrists and health providers do not entirely agree on why the syndrome develops. For example, some believe that in addition to changes to specific brain regions that are affected during active addiction, stress response may also contribute to the development of PAWS. 

Causes of PAWS may include the following.

Homeostatic Regulation 

A person’s dependence on drugs or alcohol changes the brain’s molecular, cellular, and neurocircuitry that affect behaviors and emotions, persisting long after acute symptoms. 

When the brain and body are no longer exposed to the substance that triggers neurochemical release, it may take significant time to regain emotional stability. This delay can lead to fatigue, mood swings, insomnia, and various psychological symptoms.

Lack of Long-term Clinical Management

Recovery from active addiction can be challenging, especially for those who do so abruptly and without medical intervention. Overcoming physical dependence on drugs or alcohol doesn’t guarantee you won’t remain emotionally dependent for some time. 

Without ongoing treatment and therapy, an individual could experience indefinite psychological PAWS symptoms and eventually relapse if they try to reestablish a life balance without using drugs or alcohol.

Loss of Old Habits & Routines

The primary goal of addiction treatment is to help individuals break free from their self-destructive, addictive behaviors and replace them with healthier coping mechanisms to help prevent relapse. However, returning to the real world, encountering triggers, and longing for past experiences can lead to relapse, despite best efforts to cope with stressors constructively.

But unfortunately, recovery can be challenging for a person who can no longer associate with the same people or go to the same places as before. Moreover, the loss of certain rituals and routines may contribute to stressful psychological symptoms, such as anxiety, depression, cravings, and eventually, PAWS.

Dealing With PAWS

Because PAWS symptoms are primarily emotional, continued support from therapists and counselors early in recovery is vital for lessening the severity of this long-term condition. There are several measures healthcare professionals and addiction specialists can take to help relieve chronic withdrawal symptoms.

Methods to Relieve PAWS Include:

  • Providing education about the detox process and what to expect.
  • Encouraging celebration of completed milestones, such as one year of sobriety.
  • Finding effective natural methods to help with sleep difficulties, such as melatonin.
  • Encouraging regular exercise and eating a healthy diet.
  • Prescribing certain medications that help alleviate symptoms.
  • Identifying co-occurring medical and mental health conditions, which may re-emerge during recovery.
  • Encouraging participation in peer support groups and other therapeutic activities.
  • Prescribing medication to reduce cravings, treat mental health issues, or promote sleep.

You can reduce your risk of encountering significant PAWS symptoms through medical detox, participating in an intensive treatment program, and receiving long-term therapeutic support after initial addiction treatment has been completed.

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Get Comprehensive Treatment to Help Prevent PAWS

If you or someone you know is struggling with drug or alcohol dependence, Guardian Recovery can help you determine what level of care and treatment strategy is best suited for alcohol use disorder. We believe the best way to promote healing in recovery is to address your substance abuse issues while taking a holistic approach to restoring your physical, emotional, and spiritual well-being.

If you suspect you have developed a dependence on alcohol or other substances, contact us today for a free, no obligation insurance benefit check and to discuss potential treatment options. We help people achieve long-term sobriety so they can begin to experience the healthy, happy, and fulfilling lives they deserve, one day at a time.

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Disclaimer: Does not guarantee specific treatment outcomes, as individual results may vary. Our services are not a substitute for professional medical advice or diagnosis; please consult a qualified healthcare provider for such matters.

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Reviewed professionally for accuracy by:

Ryan Soave

L.M.H.C.

Ryan Soave brings deep experience as a Licensed Mental Health Counselor, certified trauma therapist, program developer, and research consultant for Huberman Lab at Stanford University Department of Neurobiology. Post-graduation from Wake Forest University, Ryan quickly discovered his acumen for the business world. After almost a decade of successful entrepreneurship and world traveling, he encountered a wave of personal and spiritual challenges; he felt a calling for something more. Ryan returned to school and completed his Master’s Degree in Mental Health Counseling. When he started working with those suffering from addiction and PTSD, he found his passion. He has never looked back.

Written by:

Cayla Clark

Cayla Clark

Cayla Clark grew up in Santa Barbara, CA and graduated from UCLA with a degree in playwriting. Since then she has been writing on addiction recovery and psychology full-time, and has found a home as part of the Guardian Recovery team.

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