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Post-Acute Withdrawal Syndrome (PAWS): Everything You Need to Know

April 18, 2022

Table of Contents

Post-acute withdrawal syndrome (PAWS) is a set of symptoms that persist for weeks or even months after you’ve achieved sobriety from a substance. 

PAWS poses a significant threat to your recovery. Left untreated, these symptoms may cause individuals to crave to use again. 

What is Post Acute Withdrawal Syndrome (PAWS)?

Many people have the misconception that substances - and opioids in particular -cause acute withdrawal symptoms in the first hours to days after discontinuation that then resolve after a few days. It is true that the immediate severe withdrawal symptoms tend to be worse in the first few days. However it is a misconception that these symptoms dissipate entirely after a few days. In fact, opioids change the chemistry of the brain so profoundly that we are recognizing “withdrawal” symptoms weeks to even months after discontinuation. 

PAWS is most common in people who misuse Alcohol, Opioids and Benzodiazepines. PAWS has also been linked to long-term marijuana use. 

What Does PAWS Feel Like?

Symptoms will vary depending on the drug, length of use, and extent of use. Some common symptoms of PAWS include: 

  • Mental Fogginess: You may feel unable to learn new things or solve complex problems. A fog seems to settle over your brain, leaving you feeling unfocused. 
  • Emotions: You may feel overly sad or depressed. You may wonder if things will get better, and you may feel overwhelmed at the idea of living like this forever. 
  • Stress: You may experience periods of panic, even in situations you once handled easily. You may begin to fear your reactions in certain imagined scenarios.
  • Sleep: You may experience difficulty sleeping. This might include difficulty falling asleep, staying asleep, or waking up early. 

How Long Does PAWS Last?

Duration of symptoms varies widely. Some people have symptoms for just a few weeks, while others struggle for months or even years.[6]The severity of cravings may also ebb and flow, and for many individuals may never disappear completely.

Can PAWS be Prevented?

Eliminating drug misuse is the most straightforward and reliable way to ensure that you don't develop PAWS. Researchers say PAWS severity is partially related to how much people use before they attempted to quit.[7] The smaller your dose, the less likely it is that you'll have symptoms. However, everybody is different. Genetics and luck may play a role: some people notice severe symptoms even with minimal substance misuse while others can use in higher quantities and have no PAWs whatsoever. Thus, whether an individual will develop PAWs can be very hard to predict.   

How Is Post-Acute Withdrawal Syndrome Treated?

For some people, medication assisted treatment (MAT) like buprenorphine or methadone can be incredibly helpful with PAWs just as they are for more acute, immediate withdrawal symptoms. MAT helps to replace chemicals missing within your recovering brain, and they ameliorate symptoms of PAWS. Homeopathic remedies may also be helpful for some people.[4]

Most people with PAWS also benefit from therapy. You may go to individual sessions with a therapist, or you may attend group sessions with other people also struggling with PAWS. In these sessions, you can learn how to cope with symptoms without relapsing.[5]

Tips to Try at Home

PAWS should be treated by a professional. But you can take steps to help your brain heal at home. Experts recommend the following:[6]

  • Get social help. Find friends and family members who don't use substances. 
  • Eat right. Develop a diet that supports your recovering brain and body. 
  • Exercise. Find a form of fitness you love and practice it regularly. 
  • Meditate. Learn to calm an overactive mind with breathing exercises. 

Most of all, remember that PAWS is temporary. The discomfort you feel is part of healing from substance abuse, and it will pass, particularly with support and treatment.

Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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Citations

  1. Identification and Evidence-Based Treatment of Post-Acute Withdrawal Syndrome. The Journal for Nurse Practitioners. https://www.sciencedirect.com/science/article/abs/pii/S1555415521005523 March 2022. Accessed April 2022. 
  2. Post-Acute Withdrawal Syndrome (PAWS). Semel Institute for Neuroscience and Human Behavior. https://www.semel.ucla.edu/dual-diagnosis-program/News_and_Resources/PAWS. Accessed April 2022. 
  3. Acute Withdrawal, Protracted Abstinence, and Negative Effect in Alcoholism: Are They Linked? Addiction Biology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3268458/. April 2010. Accessed April 2022. 
  4. Post-Acute Withdrawal Syndrome, Relapse Prevention, and Homeopathy. Alternative and Complementary Therapies. https://www.liebertpub.com/doi/abs/10.1089/act.2017.29139.lbu. December 2017. Accessed April 2022. 
  5. Post-Acute Withdrawal Syndrome: The Major Cause of Relapse Among Psychoactive Substance Addicted Users. Archives of Pharmacy Practice. https://archivepp.com/storage/files/article/cf5338cf-5a1b-4ea5-83db-ebc05dfc1e69-ljSsBfmYBes2FROT/archiveapp-vol12-iss4-91-97-1285.pdf. 2021. Accessed April 2022. 
  6. Protracted Withdrawal Syndrome After Stopping Antidepressants: A Descriptive Quantitative Analysis of Consumer Narratives From a Large Internet Forum. Therapeutic Advances in Psychopharmacology. https://journals.sagepub.com/doi/full/10.1177/2045125320980573. December 2020. Accessed April 2022. 
  7. The Cannabis Withdrawal Syndrome: Current Insights. Substance Abuse and Rehabilitation. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5414724/. April 2017. Accessed April 2022. 

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