Post-Acute Withdrawal Syndrome (PAWS)

Post-Acute Withdrawal Syndrome (PAWS)

Many people, when thinking about drug or alcohol addiction, worry most about the symptoms caused by the heavy use of alcohol or drugs.

This is completely understandable as these symptoms are often our reasons for wanting to quit our habits or attend a detoxification facility.

However, it’s important to remember that it’s often the symptoms that come with being sober that make recovery so difficult.

Withdrawal is one of these and is more than likely the most common cause of relapse.

But even if you’ve fully detoxed yourself a while ago and have rid of yourself of withdrawal symptoms, you aren’t necessarily out of the woods yet.

If your drug abuse or drinking has been heavy enough and spread over a long enough period of time for your nervous system to experience severe damage, you may be at risk of PAWS or Post-Acute Withdrawal Syndrome.

What is Post-Acute Withdrawal Syndrome?

Post-Acute Withdrawal Syndrome Sufferer

Post-Acute Withdrawal Syndrome, or PAWS, is a group of symptoms caused by a combination of the damage to the brain and nervous system from abusing addictive chemicals and the low moods that can be experienced when overcoming an addiction.

PAWS usually appears between 1 and 2 weeks after drug or alcohol use ceases, once the symptoms of regular acute withdrawal have cleared up.

Most patients find that this period is characterised by less physical pain and discomfort than the withdrawal stage, but much worse mental and emotional symptoms.

This is essentially caused by your brain re-adjusting its own chemistry and slowly returning to normal, so it’s a good sign for your recovery even though it’s an extremely difficult time to go through.

It’s interesting to note that despite being caused by different substances and the body being damaged in different ways, Post-Acute Withdrawal Syndrome from benzodiazepines, for example, is extremely similar to Post-Acute Withdrawal Syndrome from alcohol addiction.

This is because PAWS is essentially a symptom of addiction itself, caused when the body and brain are overcoming dependency and rebalancing their chemistry, regardless of what the substance actually was.

Although quite rare, some people will experience delirium tremens which is the scientific name given to the symptoms of confusion that can be caused by extreme cases of alcohol withdrawal.

DT is quite rare even amongst those who suffer from alcohol withdrawal, and tends only to rear its ugly head in the most severe of alcoholism cases.

PAWS/Post Acute Withdrawal Syndrome Symptoms

As mentioned previously, the symptoms tend to be emotional and mental as opposed to physical. These usually include:

  • Insomnia and restless sleep
  • Loss of concentration
  • Low energy and tiredness
  • Mood swings
  • Anxiety and increased nerves
  • Irritability or aggression

One of the most notable characteristics of PAWS is that these symptoms regularly come and go in waves.

Post-Acute Withdrawal Syndrome is often described as a rollercoaster because you can be feeling fine and enjoying yourself at one moment and then experiencing all of the above in the next moment.

These ‘waves’ can come and go as regularly as every few minutes at first, but they get further apart and less regular as your recovery continues, potentially only showing themselves every few months towards the end.

This can go on for up to two years, but as long as you get medical support and avoid using any drugs or alcohol, all symptoms will usually disappear eventually.

Interesting topic: What happens during codeine withdrawal

What are the Accepted Post Acute Withdrawal Syndrome Treatments?

Due to the often psychological nature of PAWS, continuing support from counsellors and therapists can go a long way towards helping manage the symptoms.

This is part of the reason we provide a comprehensive ongoing aftercare programme, allowing our patients access to these professionals whenever necessary.

Since most of the symptoms are psychological, most of the treatments are too, for example:


Making sure the patients are aware of what PAWS actually is and the fact it’s temporary can go a long way towards putting them in the correct mindset to stick through it, as opposed to using drugs or alcohol to reduce the symptoms, relapsing in the process. Many organisations will give out a Post-Acute Withdrawal Syndrome worksheet or handout for this reason.

Help With Sleep

Insomnia is often one of the most difficult symptoms to deal with while overcoming addiction, with patients feeling the temptation to use just to help them sleep. Herbal supplements, therapy sessions, meditation and more can help to mitigate this and aid a natural, healthy sleep.

Support Groups

Support groups are extremely effective as they allow the patients to socialise with others who are going through PAWS and to share tips and advice with each other. In the same way,seeing previous PAWS patients who no longer suffer from symptoms can be a huge encouragement and inspiration.

Despite the psychological nature of PAWS, there are some medications that can be used to fight post-acute withdrawal syndrome such as suboxone for patients overcoming opioid addictions or acamprosate for patients overcoming alcohol addiction.

These medications are of course completely different but essentially help in the same way: by reducing cravings, insomnia, anxiety, and withdrawal symptoms, making the whole experience as easy on the patient as possible.

One of the leading experts on Post-Acute Withdrawal Syndrome, Gorski, has created the AWARE scale which is the most effective and reliable method we have when it comes to judging how likely a specific patient is to relapse and will help us to evaluate your risk.

The most important thing to keep in mind if you are going through PAWS is that it’s a normal part of your recovery.

The biggest risk PAWS poses to your health is that of a relapse, so as long as you keep this in mind, keep in touch with your medical professionals as much as possible, and most of all focus on the benefits that will come with sobriety, there is absolutely no reason you can’t defeat PAWS and get your health back.

Our rehabilitation programme is built around spotting PAWS early and treating it as effectively as possible, allowing us to make it as manageable as possible for our patients.

Despite this, many people attempt to overcome addiction at home and without professional help, and PAWS can be a huge temptation to relapse for these people.

If you or somebody you know is suffering from Post-Acute Withdrawal Syndrome, first-stage withdrawal, or dependency to alcohol or drugs, the best thing you can do is to call us on 0800 118 2892 for some free of charge, stress-free advice on how best to get the help you need.

We also have rehabilitation clinic locations all over the UK meaning if you do end up needing to attend as an inpatient, we will be able to help no matter where you may be!

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