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Post Acute Withdrawal Syndrome (PAWS): What Is It?

What’s standing in the way of your recovery? For some, it’s the thought of how painful and uncomfortable detox and withdrawal can be. Withdrawal is the body’s response to quitting drugs or alcohol cold turkey. Besides being highly uncomfortable, it can be dangerous due to potential medical complications. When you first stop using drugs or alcohol, you may go through what are known as acute withdrawal symptoms. These symptoms range from mild to intense depending on the person and the substance being abused. An issue known as post acute withdrawal syndrome (PAWS) can sometimes follow initial withdrawal symptoms. The symptoms of PAWS can make sustaining sobriety a challenge.

If you need help making it through withdrawal, turn to a treatment center like Vogue Recovery Center. We are committed to providing evidence-based and holistic addiction treatment. Our clinical team can get you through PAWS and on to the brighter future on the other side.

What Is Post Acute Withdrawal Syndrome?

PAWS is a set of longer-term withdrawal symptoms that can occur after the acute phase of substance withdrawal is over. Initial withdrawal involves immediate physical and mental withdrawal symptoms. PAWS refers to a longer and more persistent set of symptoms that can last for weeks, months, or even years after you initially withdraw. For most people, PAWS lasts for a period between 6 and 24 months following withdrawal. 

PAWS can have a significant impact on your recovery journey. Appropriate support, treatment, and ongoing care are essential for managing symptoms and achieving long-term recovery. That’s why working with a professional addiction treatment center is such a good idea for those struggling with drugs and alcohol.

What Causes PAWS?

Post Acute Withdrawal Syndrome

PAWS occurs in people who have a history of substance abuse and addiction. It is believed to be a result of adaptations in the brain that develop because of chronic substance abuse. Long-term substance abuse upsets the balance of neurotransmitters in the brain. When you quit drugs or alcohol cold turkey, your brain needs time to adjust. This can lead to imbalances in neurotransmitters that result in withdrawal symptoms during the acute phase. It also contributes to the symptoms seen in PAWS.

What Are the Symptoms of PAWS?

PAWS symptoms that can last for up to two years following sobriety. Symptoms, their severity, and their duration depend on certain factors like:

  • How long you used a drug or consumed alcohol
  • How frequently you use the substance
  • The specific substance used
  • The number of detox attempts in the past 

The most common PAWS symptoms can include:

  • Trouble thinking, or “brain fog”
  • Poor memory
  • Emotional instability
  • Sleep issues like nightmares
  • Coordination and motor function issues
  • Increased sensitivity to stress

It’s important to get help right away if you or someone you love is struggling with withdrawal symptoms. A team of medical professionals understands the detox process and can help guide you through it safely and comfortably. Fear of facing withdrawal symptoms shouldn’t keep you from getting the help you need from an addiction treatment facility like Vogue Recovery Center.

What Drugs Cause PAWS?

Post Acute Withdrawal Syndrome

Post acute withdrawal syndrome is linked to several different substances. These substances all cause significant chemical changes in the brain when used over time and in large doses. How long PAWS lasts and the specific symptoms depend on the substance being abused.

The substances known to cause PAWS include:

Alcohol: PAWS related to alcohol withdrawal can include symptoms such as:

  • Anxiety
  • Depression
  • Irritability
  • Fatigue
  • Difficulty concentrating
  • Memory problems
  • Sleep disturbances

Opioids: Withdrawal from opioids like heroin and prescription painkillers can lead to PAWS symptoms. These symptoms include:

  • Mood swings
  • Anxiety
  • Depression
  • Insomnia
  • Decreased energy
  • Poor concentration
  • Cravings

Benzodiazepines: PAWS associated with benzodiazepine withdrawal may involve symptoms such as:

  • Anxiety
  • Panic attacks
  • Irritability
  • Sleep disturbances
  • Memory problems
  • Difficulty concentrating

Stimulants: Withdrawal from stimulant drugs, such as cocaine or amphetamines, can result in PAWS symptoms including:

  • Depression
  • Fatigue
  • Difficulty experiencing pleasure
  • Sleep disturbances
  • Cognitive impairment

Cannabis: Although less common and milder than with other substances, PAWS related to cannabis withdrawal can include symptoms like:

  • Irritability
  • Anxiety
  • Depression
  • Sleep difficulties
  • Decreased appetite

Who Is at Risk for PAWS?

Anyone who has undergone substance abuse and withdrawal may experience PAWS. Not everyone who struggles with addiction will develop the condition. Certain factors may increase your risk of developing PAWS.

The risk factors for PAWS include:

  • People with a long history of substance abuse and withdrawal cycles
  • Using substances like alcohol, opioids, benzodiazepines, or stimulants
  • Polysubstance abuse (using more than one drug)
  • Pre-existing medical conditions
  • Pre-existing mental health disorders

How to Get Through Post Acute Withdrawal Syndrome

Post Acute Withdrawal Syndrome

Managing PAWS is crucial for a successful recovery. A rehab center with a dedicated staff of professionals can help you learn impulse control and healthy coping strategies necessary for long-term recovery. Treatment programs at Vogue Recovery Center are designed to help you from the withdrawal stage through aftercare. We offer personalized treatment plans and unique levels of care so you can find the path to a brighter future that best suits your needs.

Our levels of care for addiction treatment include: 

  • Medical detox: Medical detox is the first step in addiction recovery. Your clinical team will manage the serious side effects that come with acute and prolonged withdrawal. Detox at Vogue Recovery Center is part of a unique treatment plan from the team of board-certified therapists that oversees your progress.
  • Inpatient treatment: Residential recovery is an intensive approach to substance use disorder recovery. Clients live at our treatment facility full-time, attending meetings and working towards their goals. The medical staff on hand offer programs and therapies designed to help you cope with triggers and develop skills to avoid substance abuse in the future.
  • Partial hospitalization program (PHP): A PHP is helpful because it allows more flexibility in recovery than inpatient rehab does. You attend treatment for six hours per day in total, then live at home and take part in your daily life outside of treatment. This helps when you have other obligations like family, work, or school.
  • Intensive outpatient program (IOP): An IOP helps you start the transition back to your everyday life. It involves learning valuable coping skills to use when triggers happen in the future. During intensive outpatient treatment, you’ll only go to meetings or therapy a few times per week.
  • Outpatient rehab: Outpatient addiction treatment is the most flexible level of care offered at Vogue Recovery Center. Clients only attend treatment programs once or twice per week. Your treatment counselors are available around the clock in case you need support after finishing treatment.

Evidence-Based Addiction Treatment

Vogue Recovery Center uses the latest evidence-based behavioral therapies to help you recover from drug and alcohol addiction.

Some of the most common behavioral therapies for addiction include:

Cognitive behavioral therapy (CBT): CBT is a type of psychotherapy that helps you identify and alter negative patterns of thought and action. These negative patterns can contribute to mental health issues like depression or anxiety. People often use substances as an escape from mental health disorders. This creates a dangerous cycle that’s difficult to break from.

CBT is centered around the idea that negative thoughts can lead to negative behaviors and emotions. By identifying and changing negative thoughts, you can improve emotions and behaviors. CBT involves structured sessions with a licensed counselor. You learn techniques for recognizing and challenging negative thoughts and beliefs and developing coping skills and problem-solving strategies.

Dialectical behavior therapy (DBT): DBT is another type of behavioral therapy that was first used to treat people with borderline personality disorder (BPD). It is now used as part of a treatment plan for many different mental health issues.

DBT emphasizes the importance of finding a balance between opposing forces or ideas. It helps you learn to balance acceptance and change. It focuses on four main areas:

  1. Mindfulness
  2. Distress tolerance
  3. Emotion regulation
  4. Interpersonal communication

Coping Strategies for PAWS

Managing PAWS can be a challenge because the symptoms can last for a long time after you’ve reached sobriety. There are things that can help you cope with PAWS so it doesn’t negatively impact your life.

PAWS coping strategies include:

  • Live a health lifestyle, including a nutritional diet, exercise, and regular sleep patterns.
  • Attend peer support group meetings like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA).
  • Educate yourself on the facts and dangers of substance abuse.
  • Improve memory and concentration by keeping a journal or making to-do lists.
  • Set realistic goals for yourself.
  • Seek help from professional addiction treatment therapists.

Vogue Recovery Center is here for you throughout the recovery process and in the event of PAWS. We are committed to providing compassionate clinical care and recovery services for those struggling with their sobriety. Contact our team today and learn more about how to pay for treatment through insurance.


Evan Gove

Evan Gove

Evan Gove is a writing and editing professional with ten years of experience. He graduated from Hobart and William Smith Colleges with a degree in Writing & Rhetoric. When not writing, you can find him enjoying his sunny hometown of Delray Beach, Florida.
Evan Gove

Latest posts by Evan Gove (see all)

Published by Evan Gove

Evan Gove is a writing and editing professional with ten years of experience. He graduated from Hobart and William Smith Colleges with a degree in Writing & Rhetoric. When not writing, you can find him enjoying his sunny hometown of Delray Beach, Florida.

Medically Reviewed by Kelsey Jones, MS, LPC