Drug and alcohol abuse can cause serious, sometimes life-threatening complications. Using addictive substances can change the body and brain in ways that make it difficult to quit when you choose. Many people living with addiction require comprehensive treatment and support to stop using drugs and alcohol and avoid relapse.

Many people begin a lifelong recovery journey in a detox program. During detox, people receive treatment and support that allows them to stop using addictive substances safely. However, detox is often very challenging. People often experience uncomfortable or dangerous withdrawal symptoms as their bodies detox. In many cases, withdrawal symptoms resolve in days or weeks.

However, some people develop a condition called post-acute withdrawal syndrome (PAWS). Post-acute withdrawal syndrome can make staying sober more challenging.

In this article, we will explore post-acute withdrawal syndrome. You will learn:

  • What happens during withdrawal
  • Why post-acute withdrawal syndrome develops
  • The symptoms of PAWS
  • Strategies for managing PAWS
  • Where to find treatment

If you or someone you love struggles with addiction, you are not alone. Contact the First Step Behavioral Health specialists now to learn about our comprehensive treatment programs or to schedule an intake evaluation.

Withdrawal: An Overview

Drug and alcohol withdrawal can occur in two stages. During the acute withdrawal stage, people experience the onset of withdrawal symptoms. Symptoms last for days or weeks.

When someone develops protracted withdrawal syndrome, they may experience lingering symptoms for months–or even years.

Here is an overview of acute and protracted withdrawal.

Acute withdrawal

Acute withdrawal typically begins within hours or days after a person stops using drugs or alcohol.[1] Symptoms vary depending on the substance people used. Common withdrawal symptoms include:

  • Anxiety
  • Cravings
  • Depression
  • Elevated heart rate
  • Irritability
  • Nausea
  • Sweating
  • Tremors
  • Vomiting

Some people develop more severe complications during withdrawal, including seizures, hallucinations, and coma. Medical and emotional support during detox is essential to long-term recovery.

Protracted/Post-acute withdrawal syndrome

Some people develop post-acute withdrawal symptoms that last for months or years. Common symptoms of PAWS include both emotional and physical discomfort.

Developing PAWS puts people at increased risk of relapse.[2] People with post-acute withdrawal syndrome may need additional treatment and support to prevent relapse and improve functioning.

PAWS: Recognizing the Symptoms

Post-acute withdrawal syndrome can develop after acute withdrawal symptoms disappear. Many people with PAWS do not have physical symptoms. Instead, they live with lingering psychological symptoms.

Common symptoms of PAWS include:

  • Aggression
  • Anxiety
  • Apathy
  • Cravings
  • Depression
  • Dreams or nightmares about drug use
  • Fatigue
  • Foggy thinking
  • Increased sensitivity to stress
  • Impulsivity
  • Irritability
  • Low energy
  • Low motivation
  • Panic attacks
  • Poor concentration

These and other psychological symptoms can make it challenging for people to function in daily life. It is also a significant risk factor for relapse.

PAWS symptoms may vary depending on the type of drug the person was addicted to.[2]

  • People in recovery from opioid addiction often experience sleep disturbances, fatigue, dysphoria, and deficits in executive function
  • Protracted meth withdrawal commonly causes deficits in executive control functions
  • Cocaine withdrawal can cause poor emotional regulation and impulse control for several months
  • People in recovery from marijuana use disorder regularly report sleep difficulties and strange dreams for several months
  • Protracted withdrawal from benzodiazepines is often linked to rebound anxiety, panic attacks, and agitation lasting for several weeks or months

Medical experts believe that chemical imbalances and other factors can increase the risk of developing PAWS. This condition is more common in people with a history of mental health conditions and severe active addictions.[3]

How to Manage PAWS

Many people who develop PAWS feel discouraged or frustrated about their lingering symptoms. Living with long-lasting, disruptive symptoms can be exhausting. They may feel like they will never be “done” with withdrawal from alcohol or drugs.

There are several strategies people can use to manage the symptoms of PAWS. Here are some of the steps people with PAWS can take to feel and function better.

Learn about PAWS

People with PAWS may feel frustrated, isolated, or discouraged. Learning about post-acute withdrawal syndrome can help people feel connected with others’ experiences. It can also help to know that the condition is temporary–even when it feels like it will last forever.

Find support

Many people with PAWS require ongoing treatment and support to manage their symptoms. Addiction centers often offer support programs for people who need additional treatment and help to cope with PAWS. It is essential to seek medical and mental health support as you navigate the symptoms of PAWS.

Practice self-care

Meaningful self-care is more than finding ways to relax when you are stressed. Instead, effective self-care strategies can help you remain physically and emotionally healthy, even when PAWS symptoms are challenging.

Important self-care practices include:

  • Eating a nutrient-dense diet that includes whole grains, lean sources of protein, vegetables and fruit, and healthy fats
  • Avoiding triggers (the people, places, and situations that can cause cravings)
  • Prioritizing rest and sleep
  • Learning and practicing mindfulness
  • Staying socially active with supportive peers and family
  • Getting regular exercise, such as walking, doing yoga, or weight-training

Using these strategies can help people manage their symptoms, prevent relapse, and stay on track in recovery despite challenges and setbacks.

Find Treatment Now

If you or someone you love struggles with addiction or post-acute withdrawal syndrome, you are not alone. You will find effective, holistic treatment programs and support at First Step Behavioral Health.

Contact our intake specialists to learn more about our programs or to schedule an intake assessment. Take the first step of your recovery journey by reaching out today.


  1. National Institutes of Health (NIH): Acute withdrawal, protracted abstinence and negative affect in alcoholism: Are they linked?
  2. Substance Abuse and Mental Health Services Administration (SAMHSA): Protracted Withdrawal
  3. Science Direct: Identification and Evidence-Based Treatment of Post–Acute Withdrawal Syndrome

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