Post-Acute Withdrawal Syndrome (PAWS) In Long-Term Recovery

  • Written by:

    Bedrock Recovery Center

  • Dr. Johnelle Smith
    Medically reviewed by:

    Johnelle Smith, M.D

Post-Acute Withdrawal Syndrome

It is common for someone with a substance use disorder to experience a range of acute withdrawal symptoms in the days and weeks after they stop ingesting drugs or alcohol.

The initial wave of withdrawal symptoms typically subsides after a few weeks. Some people, however, continue to experience lingering symptoms for several months or even years.

This condition is called post-acute withdrawal syndrome (PAWS), and usually afflicts people who consumed a large number of toxins over a long period of time. 

Symptoms Of Post-Acute Withdrawal Syndrome

Post-acute withdrawal symptoms are less severe than the potentially life-threatening acute withdrawal symptoms people can experience immediately after quitting drugs or alcohol.

Unlike acute withdrawal, PAWS primarily affects a person’s psychological and emotional state and may create symptoms similar to those of anxiety or panic disorder.

Some of the most common symptoms associated with PAWS include:

  • obsessive-compulsive behavior
  • mood swings
  • issues with impulse control
  • problems with physical coordination
  • disturbing dreams or sleep disturbances
  • memory impairment
  • lack of motivation to accomplish simple tasks
  • cravings
  • fatigue
  • depression and other mental health issues 

These symptoms can come and go intermittently or be made worse by life stressors or other triggers in a recovering person’s life. They also may appear for no apparent reason. 

Over time, psychological disturbances such as the ones mentioned above will occur less frequently. People in recovery have described the symptoms as an “up and down roller coaster” sensation. 

What Causes Post-Acute Withdrawal Syndrome?

Research shows that post-acute withdrawal may be caused by the brain’s efforts to re-calibrate itself after prolonged substance abuse. This primarily affects neurotransmitters in the brain and the central nervous system. 

People who abuse drugs, particularly opioids and amphetamines, may cause damage to the dopamine and endorphin receptors in their brains. These chemicals are responsible for feelings of happiness and well-being.  

The duration and severity of PAWS symptoms are largely dependent on how intense the addiction was and what types of drugs were used.

In most cases, the brain begins producing endorphins and dopamine normally between six months and two years after addiction ends or a person receives treatment for it. 

Risks Of Post-Acute Withdrawal Syndrome

PAWS symptoms can come sporadically and create discomfort for days at a time. The main risk associated with post-acute withdrawal is that it can be a driving factor for people to relapse. 

For example, people with more severe cases of PAWS may have lasting damage to their nervous system. 

If the pleasure receptors in the brain are damaged, it may place people at a higher risk for addiction to other substances after minimal use.     

Treatment Services For Post-Acute Withdrawal Syndrome

While most cases of PAWS are improved after six months, it may take longer for more severe cases. People are typically advised to abstain from all substances for the duration of PAWS symptoms. 

Other effective treatment options for PAWS may include:

  • The medication flumazenil has been found to reduce some of the anxiety issues associated with PAWS in patients recovering from benzodiazepine addiction. 
  • Acamprosate or trazodone may be effective in helping to relieve PAWS symptoms from alcohol addiction.
  • Cognitive behavioral therapy may also assist people with PAWS symptoms when their cravings become overwhelming.
  • Self-care, which may include exercise, eating well, and developing other healthy habits can help create coping strategies for the psychological symptoms of PAWS.
  • Support groups for addiction recovery have proven to help people with long-term recovery, as they build a supportive network of other people with similar issues.

There are an array of behavioral health services available for people in recovery who are experiencing PAWS symptoms. 

Find An Addiction Treatment Center Today

If you or a loved one have a substance use disorder and want to achieve sobriety, help is available. Bedrock Recovery Center can put you on the path to long-term recovery.

Call our treatment facility today for more information on our treatment program that includes inpatient care, detox from opiates, counseling, and medication-assisted treatment (MAT). 

Sources:

National Institute of Health (NIH)  — Acute withdrawal, protracted abstinence and negative affect in alcoholism: Are they linked? 

National Institute of Health (NIH) — Relapse Prevention and the Five Rules of Recovery

Semel Institute for Neuroscience and Human Behavior UCLA — Post-Acute Withdrawal Syndrome (PAWS)