People may suffer Post-Acute Withdrawal Syndrome (PAWS), also known as withdrawal symptoms, in the initial days and weeks after stopping their drug and alcohol usage. PAWS symptoms can vary from mild to intense, depending on the substance, frequency, duration, and quantity taken. 

Post-acute withdrawal syndrome from alcohol, prescription drugs, and illegal substances might last a few days or many weeks, depending on the substance. 

How long does PAWS last? Some drugs can cause prolonged PAWS, characterized by signs and symptoms of acute withdrawal that persist, change, or appear well after the typical time frames for acute withdrawal. Sometimes, they last for several months or even years. 

When coping with PAWS symptoms or quitting substance use, it’s wise to consult a healthcare expert who can assist you in managing your withdrawal symptoms, which can be unpleasant and even hazardous. Our goal at Liberty Bay Recovery Center is to assist you with a personalized plan for PAWS treatment and support.  

What Is Post-Acute Withdrawal Syndrome (PAWS)? 

The name Post-Acute Withdrawal Syndrome (PAWS) started to be used more than 20 years ago to characterize a condition in which some people who had completed benzodiazepine therapy had somewhat milder but still bothersome withdrawal symptoms over time. 

Eventually, the term PAWS became overused to refer to any prolonged period of withdrawal symptoms associated with any drug. Since then, the word has disappeared chiefly from medical literature. However, it is still used online despite the lack of solid evidence to support it. 

Even when the initial withdrawal symptoms subside, long-term drug abuse can alter the molecular, cellular, and neuro-circuitry in the brain that controls emotions and behavior.  

PAWS vs. Acute Withdrawal Syndrome 

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), PAWS varies distinctly from acute withdrawal symptoms, the first ones that emerge after suddenly discontinuing the use of a substance. Post-acute withdrawal symptoms occur due to prolonged usage of a substance, which has more psychological effects. 

Common Symptoms of PAWS 

Since long-term substance misuse may affect the brain in many ways, most of the symptoms of prolonged withdrawal are psychological. The National Institute on Drug Abuse (NIDA) notes that addictive drugs activate the brain’s reward system, which sends neurotransmitters like dopamine coursing through the body of the user. 

Drug usage at the early stages of addiction overstimulates the nervous system or produces too much dopamine, which makes a person feel euphoric or “high.” Eventually, the brain may become less able to make these substances on its own, leaving a deficiency. Due to the brain’s dependence on the substance, those who battle addiction will discover that they need more of it to feel the same way or to feel pleasure at all. 

Human brain changes cause the prolonged withdrawal known as PAWS. Before we delve into PAWS recovery strategies and related factors, here are some “common symptoms:  

• Clouded reasoning, “brain fog,” and difficulty in remembering
• Impulses and cravings
• Hatred or irritability
• Sleep disturbances like vivid dreams or insomnia
• General body emaciation due to poor eating habits
• Fatigue
• Problems coordinating fine motor skills
• Sensitivity to stress
• Panic attacks or anxiety
• Depression
• Absence of initiative 
• Impaired concentration
• Mood swings

Clients with these symptoms are more likely to relapse when enduring prolonged symptoms. A few months, a year, or even years may pass between some of these symptoms. Making a plan for the first few days after discharge, in case such symptoms arise, can sometimes be helpful when switching from inpatient to outpatient rehabilitation. It’s not a good idea to overwork or overstress right away because this might make PAWS symptoms worse and increase the likelihood of relapse. Creating a new set of constructive coping skills, exercising often, and participating in recovery groups are more strategies to address PAWS symptoms. 

Why Does PAWS Occur? 

Following the acute withdrawal stage, post-acute withdrawal syndrome develops naturally as the brain gradually returns to normal over time. Post-acute withdrawal symptoms may vary as the brain tries to find a healthy balance once the brain chemicals start to stabilize.  

The brain uses PAWS to make up for whatever chemical abnormalities it experienced when the addiction was active. Those people addicted to alcohol, benzodiazepines, or opioids are more likely to experience PAWS, both frequently and intensely. 

PAWS Risk Factors 

It might not be possible to stop PAWS for those recovering from a substance use disorder (SUD). However, working with healthcare providers and implementing self-care techniques can be beneficial. 

Although professionals don’t know the exact reasons for them, “risk factors include: 

• Sudden cessation of the abuse
• Length of time the misuse occurred
• Severity of the misuse
• Additional illnesses arise related to the body or mind
• Genetic factors

Additionally, if the overused drugs were alcohol, opioids, or benzodiazepines, there may be an increased chance of getting PAWS or more severe symptoms.  

Common Drugs and the Symptoms of Their Post-Acute Withdrawal 

Several medications might cause more severe post-acute withdrawal symptoms. They include: 

• Cannabis: Numerous studies suggest that after acute detox, abruptly quitting marijuana usage may cause post-acute withdrawal syndrome. Insomnia, anxiety, irritability, headaches, and other physical symptoms, including nausea and stomachache, are commonly associated with marijuana use.
• Cocaine: Several long-lasting symptoms are associated with cocaine use. Numerous users report experiencing weariness, low motivation, poor impulse control, and depression-like symptoms. 
• Opioids: Opioid-related side effects include stiff muscles, poor impulse control, anxiety, despair, and sleeplessness.
• Methamphetamines: Typical side effects of methamphetamine include agitation, sleeplessness or disrupted sleep, and poor impulse control.
• Benzodiazepines: Common symptoms associated with benzodiazepines, such as Xanax, Ativan, and Klonopin, include extreme anxiety, panic attacks, irritability, and sleeplessness. 

Duration of PAWS Symptoms 

Acute withdrawal entails physical symptoms that might last days or weeks. Quitting alcohol can cause intense withdrawal symptoms. 

When the brain reboots after active addiction, it is the second detox stage. Psychological and emotional symptoms dominate post-acute withdrawal, unlike physical withdrawal symptoms. Post-acute withdrawal might take months, depending on alcohol or drug use. After one to two years without addictive drugs, post-acute withdrawal symptoms decrease in severity and frequency. Post-acute withdrawal syndrome (PAWS) can be painful and erratic, leading many individuals to relapse despite their best efforts. 

Factors Influencing PAWS Duration 

Someone might endure months or years of PAWS, depending on various factors. After a person tapers off benzodiazepines, withdrawal symptoms typically disappear between six and 18 months. According to anecdotal reports, specific effects might last a decade after quitting. 

In 2021, the Food and Drug Administration (FDA) held a workshop to discuss the impact of benzodiazepine and explained that its withdrawal effects might endure for weeks to years.  

A 2020 study indicated that discontinuing antidepressant use can cause severe PAWS. The median symptom duration was 6.5 years and ranged from six months to 23 years.  

Coping Strategies for Managing PAWS 

Depending on the drug consumed, PAWS can continue for six months to two years, depending on a person’s period and type of addiction. However, PAWS is manageable. 

Here are some helpful tips for PAWS recovery: 

• Look for patterns: PAWS symptoms, including mood swings, concentration issues, and weariness, come in waves. Stress- and addiction-provoking people and locations often provoke flare-ups. Keep a notebook to identify your triggers and most disruptive symptoms.
• Be kind to yourself: PAWS bouts usually last a few days and decrease in severity as you recover. Remembering that these sensations will pass will help you cope.
• Eat well: Balanced blood sugar from healthy meals will help you prevent mood swings and handle PAWS cravings.
• Maintain good sleep hygiene: PAWS leads to insomnia or poor sleep patterns, but maintaining a consistent bedtime and eliminating caffeine in the afternoon and evening can help significantly. Also, avoid distractions to create a relaxing evening routine that can help you sleep.
• Adjust your timetable: If you have trouble focusing, plan your most challenging chores for when you’re most energetic. Take lots of breaks.
• Reach out to your support network: Support each other. PAWS sufferers often feel less alone in 12-step programs like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA). Accountability from friends, family, and spiritual leaders can also help.
• Get help from an expert: Lifestyle changes may not be adequate to manage PAWS symptoms. Counseling and medication may be necessary. PAWS symptoms treatment involves the use of antidepressants to regulate serotonin levels. Share your problems with your care provider to develop a solution. 

Treatment and Support for PAWS 

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) does not list PAWS as a diagnosis despite clinical observations and anecdotal accounts of symptoms endured by some individuals beyond the acute withdrawal stage. It is challenging to screen for, diagnose, and discuss the syndrome since experts disagree about what it is and how to treat it. Therefore, to recover quickly from PAWS, you need precise medical attention. 

Treatment and Management 

Relapse can be a problem for people with long-term withdrawal symptoms who may want resume using the substance to which they became addicted. After a formal treatment program, you can sustain long-term recovery with aftercare or continued care, which may include: 

• Education: Understanding that some people may endure prolonged withdrawal symptoms following symptom-free abstinence can help patients prepare for and manage the early days of their recovery.
• Celebration: Every rehabilitation achievement merits praise.
• Medical appointments: Meeting with doctors who can assess your requirements during recovery is crucial.
• Sleep: Maintain healthy sleep habits to avoid exhaustion.
• Activities: Mental and physical workouts increase sleep, mood, stress, trigger avoidance, and symptom distraction.
• Patience: Recovery takes time. Avoid trying to do too much or be too active, which might aggravate stress and discomfort.
• Medications: Prescription drugs may reduce cravings and help you avoid relapse.
• Mutual-aid groups: AA and NA can help with long-term rehabilitation.
• Therapy: Cognitive Behavioral Therapy (CBT) can aid with impulse control and problem solving.

Our experts offer detox, evidence-based therapy, and aftercare that can lessen acute and extended withdrawal symptoms and relapse risk.  

Recovery From PAWS 

At Liberty Bay Recovery Center, we assure you that you can get well and begin recovery with our guidance. We ensure that you understand PAWS in addiction recovery, and our team of dedicated professional counselors and medics will guide you through it. Patience, perseverance, and self-care are essential for achieving a healthy, happy life of sobriety. 

Is the prevention of post-acute withdrawal syndrome feasible? While we cannot prevent PAWS, we can effectively manage its symptoms. Mastering the management of acute and post-acute withdrawal symptoms can improve physical and mental well-being, increase self-assurance, and lessen the possibility of relapse. 

PAWS is manageable, and you can recover from it entirely. If you pay attention to the factors that we have highlighted here, such as good work habits, social relationships, healthy living, therapies, proper medication, and patience, you can experience encouraging results in as little as a few months, depending on your level of addiction.  

Give us a call to find out more about our treatment plans and how we can assist with your withdrawal.