What is PAWS? How Long Does it Last?

What is Post-Acute-Withdrawal Syndrome (PAWS)?

Medications for the long-term treatment of substance abuse disorder have been around for some time. 

A person suffering from PAWS experiences symptoms commonly associated with mood disorders like anxiety, mood swings, and insomnia. These symptoms can vary in duration and severity depending on the original substance. Alcohol, benzodiazepines, and opioids are the prime substances that cause PAWS to occur, but other psychoactive drugs are also thought to lead to the condition.
PAWS symptoms tend to begin after the period of acute withdrawal is over. Acute withdrawal symptoms are the difficult physical symptoms that begin immediately after an addicted person stops using drugs or alcohol. Unlike acute withdrawal, which has more concrete timeframes, PAWS is a bit more tricky to pin down.

Not currently listed in the Diagnostic and Statistical Manual of Mental Disorders, PAWS is seen as being controversial by some. However, the syndrome has been reported by millions of people in recovery and by health care professionals around the world.

Signs & Symptoms

Rather than a single symptom, PAWS is a bundle of symptoms umbrellaed under a single heading.

Unlike physical withdrawal symptoms that cause things like nausea, headaches, pain, hallucinations, and even seizures, PAWS symptoms are psychological and emotional. However, this does not imply that they aren’t severe. In fact, PAWS can lead people to relapse back to their past drug abuse.
Because of this, it’s important to get seek help and get treatment should you or a loved one be experiencing some, or even all, of the following symptoms:

  • Irritability and hostility
  • Depression
  • Anxiety or panic
  • Mood swings
  • Low energy
  • Fatigue
  • Insomnia
  • The trouble with cognitive tasks (inability to focus or concentrate)
  • Loss of libido
  • Chronic pain
In some cases, PAWS may also manifest with the following symptoms:

  • Anhedonia (sense of malaise, loss of interest in life)
  • Depersonalization (feeling like you are not really yourself)
  • Obsessive-compulsive behaviors
  • Difficulty managing relationships (work, family, friends)
  • Cravings for the original substance
  • Sense of apathy
  • Becoming highly sensitive to stress

Current thinking also suggests that symptoms may be different depending on the substance that was previously being abused:

  • Marijuana: insomnia, fatigue
  • Cocaine: depression, impulse control
  • Methamphetamines: impulse control
  • Opiates: insomnia, anxiety, depression, impulse control
  • Benzodiazepines: anxiety, panic, insomnia

In addition to physical cravings, someone with an addiction issue will also spend a tremendous amount of time thinking about their drug of choice. These thoughts become a compulsion and impossible to control, which leads to drug-seeking behavior that can sometimes be criminal.

Feelings of depression, sadness, anxiety, despair, and the like are often at the root of substance abuse. The substance might temporarily mask these feelings, but they return once the high wears off, creating a vicious circle of drug abuse.

Taking a substance will temporarily stop the cravings and compulsion for it, but soon the same feelings return. In time, it takes more and more of the same substance to achieve the same effect it once had.

People addicted to drugs and alcohol may feel like they have no control over their drug use. Refraining from using or stopping seems to be an impossibility for them. The substance controls them, rather than the other way around.

Someone addicted to drugs or alcohol will continue to seek them out even if their addiction has made them lose friends, family, spouses, and jobs. Drug-seeking behavior can even lead to diseases such as hepatitis and HIV/AIDS.

What Causes PAWS?

The reasons for why people get PAWS remains unclear. The UCLA Dual Diagnosis Program suggests that “physical changes to the brain that occur during substance abuse are responsible for increased tolerance to the substance and are responsible for the recurring symptoms.”

It’s well known that drug and alcohol abuse makes physical changes to the brain that lead to addiction and related withdrawal symptoms when substance use is stopped. It’s now thought that long-term drug use makes other changes to the brain that limits its ability to handle stress. This inability to emotionally cope with common, everyday situations may give rise to the common PAWS symptoms.

Some drugs are thought to more commonly cause PAWS then others. However, they all have one thing in common: each makes substantive changes to the brain.

Mental Health Daily breaks them down as follows:


Even if properly tapered off, people report PAWS-like symptoms for months after their last drink. This area has been studied since the 1990s.


It’s never recommended to go off antidepressants like SSRIs “cold turkey.” However, even when gradually tapering off, the brain has to contend with less serotonin, which could lead to PAWS symptoms.


Antipsychotics inhibit stimulation from dopamine. Once this inhibition is removed, PAWS-like symptoms can linger on for months or even years.


Someone addicted to “benzos” should always tape off with medical supervision. But even with a slow winding down of use, PAWS can materialize and can take months or years to fully go away.


Current thinking believes that reduced production of endorphins associated with opioid withdrawal leads to PAWS symptoms.


People who abuse psychostimulants like methamphetamine frequently take higher and higher dosages to get the same effect. When the drug is stopped, the lack of dopamine in the brain must be replenished, which can take some time and lead to PAWS.


Long-term withdrawal of corticosteroids is serious business. PAWS symptoms might persist for years and lead to relapse. Some people prefer not to even try then suffer through these symptoms.

If you are considering treatment for yourself or a loved one, call us today.

What Triggers PAWS Symptoms?

Because PAWS symptoms tend to be psychological or emotional in substance, it’s no surprise that they can occur depending on the situation. While symptoms might be triggered by everyday work and life stressors, they can also arise in situations that remind the person of their past drug or alcohol use. Symptoms also tend to come in “waves” with people experiencing a rapid up and down cycling of thoughts and feelings.

How Long Does PAWS Last?

While there have been some cases of people experiencing PAWS for several years, it is not considered to be a permanent condition.

So just how long does PAWS last?

The severity and duration of PAWS depends on the substance abused and for how long the addiction lasted. In many cases, symptoms dissipate in two to three months. But because everyone is different, it may take longer – sometimes up to two years for the brain to fully recover. It’s generally thought that the longer a person took the substance, the longer it will take to work through PAWS symptoms. The frequency a substance was consumed and its dosage may also play a factor in the duration of overcoming PAWS.

It’s important to remember that someone experiencing PAWS may not have symptoms all the time; they may come and go, depending on life situations that are occurring at any given time. Although PAWS can be distressing, it’s important to work through the symptoms in a productive way in order to avoid relapse.

What Helps in Recovery from PAWS?

The question “what helps PAWS?” gets asked a lot. Support groups, cognitive behavioral therapy, and even medication to treat symptoms can all be an effective part of a holistic strategy to get through this difficult process.

For benzodiazepine withdrawal, the drug Flumazenil, which is used to treat drowsiness, has shown to be helpful; some people report success taking Acamprosate for alcohol withdrawal – Acamprosate is a prescription drug specifically created to reduce cravings for alcohol.

Because it can take some time to fully recover from PAWS, treatment needs to be ongoing to avoid the potential of relapse. The Hazelden Betty Ford Foundation lays out ten things that you might try to help recover from PAWS as part of a comprehensive program:


  1. Seek psychological care with a mental health professional
  2. Treat yourself well by healthy eating and exercise/stay positive!
  3. Talk about your symptoms with your 12-step group, sponsor, or other peers
  4. Determine events that increase symptoms and avoid them when possible
  5. Create a journal and write about your experiences with PAWS
  6. If concentration is an issue, take tasks in small chunks rather than all at once
  7. Break up your routine to interrupt negative thoughts
  8. Keep note pads on hand to write things down if you’re experiencing memory issues
  9. For those with insomnia, limit caffeine and practice good sleep habits
  10. Be patient – give PAWS time to run its course

If you have any questions about PAWS or think you might need help managing the symptoms, reach out to Nexus today for a free and confidential consultation.

If you or a loved one are suffering from drug or alcohol addiction, we’re here to help. Contact us today and speak with one of our trusted recovery advisors.

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