We remain open and committed to providing critical addiction treatment. For information on Coronavirus (COVID-19), including symptoms, risks, ways to protect yourself and our commitment to patient & staff safety,  click here

What Is PAWS (Post-Acute Withdrawal Syndrome)?

PAWS (Post-Acute Withdrawal Syndrome) | Just Believe Detox

In This Article

Drug or alcohol withdrawal symptoms are hallmarked by effects that occur when an individual has become dependent on a substance suddenly discontinues use or significantly cuts back. Both prescription and illicit drugs can produce withdrawal symptoms, and they may last anywhere from a few days to several weeks or longer. While the physical side effects from dependence usually wane after a week, people in recovery may encounter emotional symptoms for much longer—months, in some instances. When this occurs, it is referred to as post-acute withdrawal syndrome or PAWS.

Health providers usually try to work with their patients to manage withdrawal symptoms related to prescription drugs, such as opioids, benzodiazepines, or other central nervous system (CNS) depressants. Those who have an addiction to illegal substances may face severe withdrawal effects if they attempt to quit the drug abruptly or “cold turkey.” This can sometimes occur if the person is forced into abstinence due to the drug becoming unaffordable for them.

Post-Acute Withdrawal Syndrome (PAWS)

Although acute (short-term) withdrawal symptoms can be extremely uncomfortable, most usually subside within one or two weeks, especially when the individual is medically monitored during the detox process. However, some substance abuse can lead to a longer duration of withdrawal effects that persist for months. People who use drugs or alcohol excessively for an extended period are more likely to encounter this unfortunate problem.

PAWS is a condition characterized by a combination of ongoing withdrawal symptoms, which are typically psycho-emotional, and involve depression, anxiety, agitation, and moodiness. These effects can last long after acute withdrawal symptoms have subsided.

Although PAWS rarely includes aches and pains, nausea, or other physical effects common to withdrawal, it can be just as challenging and uncomfortable as short-term withdrawal. If this problem is left untreated, it may ultimately place a person at an increased risk of relapse, as they may turn to substance abuse to relieve some discomfort.

About PAWS

People who experience symptoms related to PAWS can feel as if they are on a rollercoaster of unwanted effects and emotions that tend to wax and wane without warning. Each episode can last for many days and continue to reoccur cyclically for a year in some cases. These symptoms can onset after the extended use of any intoxicant, although PAWS most often occurs among those who are in recovery from the abuse of the following substances:

Alcohol

Suddenly stopping alcohol use can be dangerous and potentially life-threatening, because it can induce a severe disorder known as delirium tremens (DTs) that includes both psychosis and seizures. Furthermore, if this occurs, it can also increase the chances of PAWS occurring. Alcoholics who experience PAWS may experience anxiety, depression, sleep disturbances, cravings, impaired concentration, and problems with impulse control for months.

PAWS (Post-Acute Withdrawal Syndrome) | Just Believe Detox

Antipsychotics

Antipsychotics bind to dopamine receptors in the brain and work to reduce symptoms related to hallucinations, delirium, and other psychological issues. When their use is terminated without the use of a tapering schedule, the individual could encounter withdrawal symptoms, such as mood swings and rebound symptoms for months.

Benzodiazepines (Benzos)

Benzos, such as Xanax or Klonopin, are prescription medications that can be beneficial for many who suffer from anxiety and panic disorders, but they also have the potential for chemical and emotional dependence and abuse. Most health providers do not prescribe benzos for a prolonged period because addiction can rapidly develop.

Withdrawal symptoms related to benzos tend to mimic the symptoms they are meant to treat, including anxiety and panic disorders, which can make it much more challenging to stop use. PAWS symptoms, which are not unlike those associated with alcohol, may include insomnia, fatigue, and severe cravings that can last for months after chemical dependence has diminished.

Opioids and Opiates

Whether opioids are misused by prescription or abused illegally (e.g., heroin or fentanyl), prolonged exposure to these drugs can lead to the development of PAWS if they are not weaned off properly. Moreover, individuals who experience very severe acute withdrawal symptoms are more likely to experience PAWS, which can include strong cravings, exhaustion, and cognitive impairments that may take a significant amount of time to resolve.

Stimulants

Prescription drugs, such as Adderall, and illegal stimulants, such as cocaine or meth, can contribute to the development of PAWS if withdrawal is not handled properly. An individual who has withdrawn from stimulants may experience extreme fatigue and lethargy, severe depression, and physical weakness long-term, and these symptoms can be quite difficult to manage.

Possible effects of PAWS other than those already mentioned include the following:

  • Hostility
  • Aggression
  • Loss of sex drive
  • Anhedonia
  • Memory impairments
  • Sensitivity to stress

PAWS Symptoms Causes: The Theories

PAWS is a complex syndrome that has no single, identifiable cause. Psychiatrists and health providers do not entirely agree on the exact reasons that 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.

Theories regarding the development of PAWS include the following:

Homeostatic Regulation

A person’s dependence on drugs or alcohol is the result of brain chemistry alterations over time. When the system is no longer exposed to the substance that triggers neurochemicals to release, it can no longer achieve balance or stability. It can take an extended period for the brain to regain equilibrium, and this delay can lead to fatigue, mood swings, insomnia, and other psycho-emotional symptoms.

PAWS (Post-Acute Withdrawal Syndrome) | Just Believe Detox

Stress

It can be very psychologically challenging to quit using a psychoactive substance, especially for those who attempt to do it suddenly or without medical intervention. This stress can result in relapse or otherwise result in the continued development of withdrawal symptoms as the individual attempts to reestablish a life balance without the use of intoxicants.

Habit

One of the main goals of rehab is to help people alter their behaviors and responses to the use of drugs and alcohol. Recovering heroin addicts, for example, may have fond memories of injecting drugs, while others who are in recovery from alcohol use disorder mourn the loss of certain social situations. Returning to habits associated with substance abuse frequently results in relapse. Still, the loss of that practice or ritual can also produce stressful psychological symptoms, such as depression, cravings, or anxiety, eventually contributing to PAWS.

Getting Treatment for PAWS

Because PAWS symptoms are primarily emotional, continued support from therapies and counselors early in recovery is critical for reducing the severity of this experience.

The following are measures that medical and addiction health providers may take to help patients relieve chronic withdrawal symptoms:

  • Provide education about the detox process and withdrawal and what to expect.
  • Encourage celebration of completed milestones and having patience throughout the process.
  • Find natural methods to help with sleep difficulties, such as melatonin.
  • Encourage engaging in exercise and eating a healthy diet.
  • Prescribe certain medications that help minimize symptoms.
  • Evaluate potential co-existing conditions, which may re-emerge during recovery.
  • Encourage participation in support groups and other therapeutic activities.

The risk of encountering PAWS symptoms can sometimes be minimized by undergoing a medical detox, participating in an intensive treatment program, and receiving long-term emotional support well after initial addiction treatment has been completed.

If you suspect that you or someone you love is addicted to drugs or alcohol, call Just Believe Detox today 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!

Don't forget to share this post!

Share on facebook
Share on twitter
Share on email
Share on linkedin
Share on reddit
Share on whatsapp