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Post-Acute Withdrawal Syndrome
Withdrawal symptoms are a frequent part of the recovery process. They can range from mild and uncomfortable to severe and life-threatening. But for many people, the symptoms do not end after the first few days or weeks. Post-acute withdrawal syndrome (PAWS) refers to a set of lingering, and sometimes delayed, symptoms that can stay for months after stopping drugs or alcohol. These symptoms can affect mood, sleep, and cognitive function and make relapse more likely if not understood or managed.
This article discusses what PAWS is, how it differs between substances, and the ways you can cope with it and stay steady in long-term recovery.
What Is Post-Acute Withdrawal Syndrome (PAWS)?
Post-acute withdrawal syndrome is a second phase of withdrawal that follows the initial, physical symptoms experienced during drug or alcohol detox. While acute withdrawal focuses on the body’s immediate response to quitting substances, i.e., nausea, tremors, and elevated heart rate, PAWS is an indicator of the brain’s longer-term process of rebalancing after addiction.
Chronic drug and alcohol use can alter the brain’s molecular and neurological structure, especially areas involved in mood, impulse control, sleep, and stress regulation. These changes do not immediately reverse after detox. As a result, people may experience lingering psychological and cognitive symptoms that fluctuate over weeks or months, sometimes even years.
Post-Acute Withdrawal Syndrome for Different Substances
PAWS symptoms are primarily psychological and emotional. This phase of withdrawal can begin weeks or even months into recovery and may come and go in waves. Although temporary, these symptoms can feel overwhelming and increase the risk of relapse when you do not have proper support.
Although research on post-acute or protracted withdrawal is still limited, especially for substances other than alcohol, clinical observations and anecdotal reports provide some insight into how long symptoms may last and what they can look like:
- Alcohol: Protracted withdrawal from alcohol has been well documented. Symptoms like anxiety, irritability, mood swings, depression, fatigue, trouble concentrating, low sex drive, and unexplained physical pain have all been reported. These symptoms can persist for up to two years or longer after someone stops drinking. Sleep difficulties, in particular, can last for one to three years, according to sleep studies.
- Benzodiazepines: It can be difficult to separate protracted withdrawal from the “rebound” symptoms that happen when someone stops using benzodiazepines. Rebound symptoms like anxiety, restlessness, and insomnia are often more intense versions of the person’s original symptoms and usually fade within a few weeks. In contrast, protracted withdrawal symptoms tend to come and go, may be new rather than familiar, and can last for months before gradually improving with continued sobriety.
- Marijuana: Several studies show that people who stop using marijuana may continue to experience unusual dreams and disrupted sleep for more than a month after their last use.
- Opioids: After opioid detox, people may experience ongoing sleep disruption, low mood, anxiety, irritability, fatigue, and a decline in cognitive control. These symptoms may linger for weeks or even months.
- Cocaine: Research has shown that people may continue to struggle with impulse control even after four weeks of stopping cocaine use.
While the types and timelines of symptoms depend on the substance in question, there are several common symptoms of post-acute withdrawal that people report, including:
- Anxiety and depression
- Irritability, anger, or hostility
- Fatigue or low energy
- Sleep disturbances, including insomnia
- Difficulty with memory or concentration
- Strong cravings for the substance
- An inability to experience pleasure (also known as anhedonia)
- Difficulty staying focused on tasks
- Reduced sexual desire
- Chronic, unexplained physical pain
How Is Protracted Withdrawal Treated?
Some people get tempted to return to substance use in order to relieve the discomfort that PAWS brings. Inspire Recovery uses these strategies to help you build lasting recovery:
- Education: Knowing that these symptoms can show up unexpectedly, even after a period of feeling stable, can help people prepare and respond instead of panic or relapse.
- Celebrating Progress: Recovery is not just about getting through the milestone moments. Celebrating each small win helps build confidence and reminds you that healing is happening, even if it’s slow.
- Prioritizing Sleep: Sleep issues are a common part of protracted withdrawal. Creating consistent bedtime routines and practicing good sleep hygiene can make a big difference.
- Staying Active: Exercise, mindfulness, hobbies, and creative outlets can help manage stress, lift your mood, and shift your focus away from cravings or emotional lows.
- Taking It Slow: Recovery is a marathon, not a sprint. Pushing yourself too hard or too fast can backfire. It is okay to take your time, pace your goals, and listen to your body and mind.
- Peer Support: Mutual-help groups like Alcoholics Anonymous, Narcotics Anonymous, or LGBTQ-affirming recovery spaces offer encouragement, accountability, and a reminder that you are not alone.
- Ongoing Therapy: Continued therapy can support emotional regulation, improve coping skills, and help you work through triggers and setbacks.
Sustained Recovery with Inspire Recovery
Inspire Recovery will help you through your healing process, including the post-acute withdrawal phase. Our LGBTQ-affirming team offers therapy, sober living homes, and aftercare planning so you never have to face recovery alone. Whether you are just starting or months into recovery, we will guide you through the ups and downs with compassion. Reach out today at 561-786-2655 to get the tender and solid support you deserve.
Can I avoid post-acute withdrawal syndrome?
Post-acute withdrawal syndrome can’t be completely avoided—but it can be managed. These symptoms are a normal part of the healing process for many people, especially after long-term substance use. While you may not have control over when symptoms show up, you do have control over how you respond. By building effective coping strategies, staying connected to support systems, and getting professional help, you can reduce the impact of protracted withdrawal on your daily life.
What are the risk factors for having post-acute withdrawal syndrome?
Many factors can increase the risk of having post-acute withdrawal syndrome. These include stopping substance use abruptly, using substances for a long time, or using them in large amounts. Co-occurring physical or mental health conditions and certain genetic traits may also play a role. People who misuse alcohol, opioids, or benzodiazepines are especially likely to experience more severe or prolonged symptoms. While PAWS cannot always be prevented, working with Inspire Recovery and practicing self-care can help reduce its impact.
Does everyone in recovery experience PAWS?
Not everyone in recovery experiences post-acute withdrawal syndrome. Its occurrence and severity depend on the type of substance used, how long and intensely it was misused, and individual differences. People recovering from alcohol, benzodiazepine, or opioid addiction may be more likely to experience PAWS. While some folks never experience it, others may have symptoms that span months.
Are you or is someone you know addicted to drugs?
Call Inspire Recovery today at 561-899-6088 for a free & confidential consultation.
