Often, individuals who have undergone medical detox think that, after that step, they will be free from any withdrawal symptoms. Unfortunately, there are instances where this is not true. Post-acute withdrawal syndrome, also known as PAWS or protracted withdrawal, is a grouping of symptoms that can occur after acute withdrawal (which takes place during medical detox). The University of Wisconsin states that an individual’s history of drug or alcohol use can affect the severity and duration of post-acute withdrawal syndrome. These symptoms can also disappear and reappear after a period of time.

Individuals who experience these symptoms may notice their occurrence shortly after the medical detox process, and such symptoms can last weeks or even months after the initial withdrawal period. These symptoms are most likely to affect individuals who have withdrawn from alcohol, opioids, and benzodiazepines. According to the Journal of Substance Abuse Treatment, these substances carry the highest risk of causing post-acute withdrawal syndrome; however, PAWS can also affect those who have withdrawn from any psychoactive drug.



The symptoms of post-acute withdrawal syndrome can manifest as anxiety, mood swings, insomnia, and difficulty with cognitive tasks, such as learning and memory. The Huffington Post lists other symptoms individuals may experience as:

  • Apathy
  • Emotional outbursts
  • Depression
  • Obsessive-compulsive behaviors
  • Inability to properly manage stress
  • Strained relationships at home, work, and school
  • Cravings
  • Increase in pain
  • Changes in sleep patterns (may include nightmares)
  • Fatigue
  • Panic attacks
  • Suicidal ideations

Not surprisingly, these symptoms can become worse when individuals are stressed. Symptoms can persist for six months to several years after individuals complete the medical detox process, depending on how severe their dependence was. Different substances may also cause different symptoms, as stated by the Substance Abuse and Mental Health Services Administration.


What Causes PAWS?

Since drug or alcohol abuse and dependence can cause changes in the brain, the brain needs time to heal after individuals have withdrawn from using a substance. However, it cannot heal overnight, meaning that individuals may feel worse as their bodies adapt to life without drugs or alcohol.

There are also changes to the brain’s reward center that must be reversed, according to Psychology Today. Individuals may not feel pleasure during PAWS because their brain has been rewired to associate that pleasure – due to a flood of dopamine – with drug or alcohol use; the brain will respond to the effects of drugs or alcohol quicker than in response to an activity an individual may enjoy. This may also contribute to their severe cravings for drugs or alcohol, as well as depression. Individuals with chronic pain may experience an increase in pain, due to the decrease in the body’s natural painkillers: endorphins.

Drugs and alcohol can also affect the autonomic nervous system, which is the branch of the nervous system that controls the functions of the body that are not performed on a conscious level, such as heart rate, blood pressure, digestion, and breathing. After individuals withdraw from drugs or alcohol, their autonomic nervous system sends the body into a “fight-or-flight” response, meaning that the body will be in a constant stressed state. Like the brain, the autonomic nervous system needs time to heal, which will also take time.


Treating Post-Acute Withdrawal Syndrome

Individuals may feel that beginning to use drugs or alcohol again may help lessen their symptoms. These individuals should be assured that post-acute withdrawal syndrome does not last forever and be educated on what symptoms they may possibly experience. This education can help individuals become aware of what they can expect, which may reduce their risk of relapse.

With behavioral therapy, individuals can learn skills to cope with the symptoms of PAWS, such as anxiety and depression, and this can also reduce the risk of relapse. Support groups, such as Alcoholics Anonymous and Narcotics Anonymous, can also help as they can provide individuals with a sponsor – another individual in the recovery process – and this support can help individuals maintain sobriety. SAMHSA indicates that when individuals share their experiences and provide support to others, they increase the likelihood of maintaining their own abstinence.

Individuals may also be prescribed medications to alleviate some of the symptoms of PAWS. Medications may include antidepressants, methadone, acamprosate, naltrexone, or buprenorphine. As always, medications is prescribed on a case-by-case basis, and its use should be closely monitored by medical professionals.

  • The American Academy of Family Physicians states that acamprosate is often used for individuals who have been dependent on alcohol. It functions by repairing neurotransmitter systems in the brain that have been disrupted by alcohol use, and it can discourage individuals from drinking alcohol. However, it will not produce adverse effects if individuals do consume alcohol while taking the medication.
  • SAMHSA describes buprenorphine — also known as Suboxone – as a medication that can be both prescribed and monitored by a primary care physician’s office. It provides a weaker effect than that caused by opioids such as heroin, but the “high” only reaches a certain level, even with an increased dose of the medication, thereby discouraging abuse.
  • Methadone has been used for years as treatment for opioid dependence, such as dependence on heroin or prescription pain medications. SAMHSA states that it works by inhibiting individuals from feeling high if they use an opioid drug while taking the medication. It can be addictive, so individuals must stick to their treatment plan and refrain from misusing the medication. Again, close medical supervision is recommended.
  • Naltrexone can be used for both opioid and alcohol dependence. It also blocks individuals from feeling high if they use drugs or alcohol, and it helps reduce cravings, according to SAMHSA.

While medications sometimes augment the recovery process, they must be used in conjunction with therapy.

Individuals may also use other natural relaxation techniques, such as deep breathing, meditation, and yoga. Exercise can also help, as it has been linked to reductions in stress and the release of endorphins. A balanced diet is also needed, as some symptoms may be caused or exacerbated by nutritional deficiencies.

It is important for individuals to maintain good relationships with their support system during this time as well. A good support system can help individuals to maintain sobriety, as well as prevent people from isolating themselves due to the symptoms of PAWS.