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What is Post-Acute Withdrawal Syndrome (PAWS) and How Can a Drug Rehab Center Help?

Medically Verified: 2/1/24

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All of the information on this page has been reviewed and verified by a certified addiction professional.

Addiction is a chronic and progressive disease that requires a continuum of care to obtain long-term recovery. One of the first steps in addiction recovery is detox. When you are addicted to a substance, your body becomes dependent on that drug, causing you to experience symptoms of withdrawal when you suddenly stop taking it.

Withdrawal symptoms can be uncomfortable, painful, and even life-threatening without proper medical attention, so professional detox is such an important step in the recovery process. While most withdrawal symptoms subside after two weeks, some linger past the typical timeline.

When you experience withdrawal symptoms beyond two weeks, you may be dealing with something referred to as post-acute withdrawal syndrome (PAWS). Being aware of what PAWS is and how a drug rehab center can help might motivate you to receive the help you need.

What is Post-Acute Withdrawal Syndrome (PAWS)?

PAWS is a condition characterized by drug or alcohol withdrawal symptoms that linger for several weeks, months, or years after getting sober. According to the Semel Institute for Neuroscience and Human Behavior, “Post-Acute-Withdrawal Syndrome (PAWS) refers to a set of impairments that can persist for weeks or months after the abstaining from a substance of abuse.”[1]

Typically, when someone is suffering from post-acute withdrawal syndrome, the symptoms they experience are similar to that of a mood or anxiety disorder. For example, symptoms can include mood swings, insomnia, increased levels of anxiety, and more. PAWS is most common among individuals who have completed the withdrawal process from an opioid, benzodiazepine, or alcohol, however, any psychoactive substance can result in the development of this condition.

The Semel Institute for Neuroscience and Human Behavior also reports, “that 90 percent of recovering opioid users experience the syndrome to some degree as do 75 percent of recovering alcohol and psychotropic abusers.”[1]

Common Symptoms of Post-Acute Withdrawal Syndrome (PAWS)

Withdrawal symptoms are one of the leading causes of addiction relapse, especially among individuals who do not attend a medical detox program. This is because dealing with these symptoms can cause you to crave drugs or alcohol because your body knows that is the only way to feel better. Unfortunately, PAWS can be uncomfortable and are one of the many causes of relapse.

Symptoms may vary from one person to the next, but the most common symptoms of post-acute withdrawal syndrome include:

  • Foggy thinking or issues with memory
  • Urges and cravings to abuse substances
  • Irritability or hostility
  • Sleep disturbances like insomnia or vivid dreams
  • Fatigue
  • Issues with fine motor coordination
  • Stress sensitivity
  • Anxiety or panic
  • Depression
  • Lack of initiative
  • Impaired ability to focus
  • Mood swings

Symptoms may fluctuate and come and go unexpectedly. As a result, it is important to know how to cope when symptoms arise.

Coping With Post-Acute Withdrawal Syndrome During Rehab

Experiencing post-acute withdrawal syndrome while you are attempting to recover from addiction can be very difficult. Oftentimes, it feels unfair to experience prolonged symptoms while others do not. However, having the proper treatment, support, and tools provided by an addiction rehab program can make coping with PAWS much easier.

Behavioral Therapy

Many of the symptoms of PAWS include psychological issues like depression, anxiety, sleep issues, or mood changes. These symptoms can be successfully managed through evidence-based behavioral therapies. Behavioral therapy helps you learn how to prevent unhealthy patterns of thinking to turn into negative behaviors. It can also help you process painful emotions and feel more supported while navigating your symptoms. Your therapist can even make symptom-specific suggestions to help you cope.

Holistic Care

Addiction treatment programs also use holistic care to treat lingering symptoms of PAWS. Holistic treatments may include nutritional therapy, exercise, learning about self-care, and participating in support groups. All of these services help you recover mentally, physically, and spiritually, providing you with a full-person approach to addiction recovery.

Holistic care is all about using healthy lifestyle changes to provide you with relief from the symptoms of your post-acute withdrawal syndrome. Exercise and healthy eating are proven to help stress reduction, promote healthy sleeping patterns, and even alleviate symptoms of depression.[2]

Medication Management

Some symptoms of post-acute withdrawal syndrome are best managed through the use of medications. For example, if your PAWS stems from alcohol withdrawal, you may be prescribed Vivitrol (naltrexone). This once-monthly medication prevents alcohol cravings, which is one of the most difficult symptoms associated with alcohol-related PAWS.

If you are experiencing post-acute withdrawal syndrome due to another substance, you might be given medications that are specific to your symptoms. If you are suffering from depression that is not responding to therapy, you might be prescribed antidepressant medications like selective serotonin reuptake inhibitors (SSRIs). On the other hand, severe symptoms of insomnia are treated with non-habit-forming sleep aids.

Other Coping Strategies for Post-Acute Withdrawal Syndrome (PAWS)

While drug and alcohol rehab centers will provide you with the support and treatments necessary to control your PAWS, it can still be difficult to deal with without proper coping mechanisms. As a result, you should continue to practice self-care techniques that help you remain calm, motivated, and focused on recovery.

Tips for coping with post-acute withdrawal syndrome during rehab include:

  • Practice self-care by eating well, following a sleep schedule, daily exercise, and engaging in activities that you enjoy and help you unwind
  • Lean on your support system and continue attending support groups like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA)
  • Be patient with yourself and allow your body the time it needs to adjust to sobriety
  • Begin journaling your experiences to identify triggers, when symptoms are at their worst, and identify alternative ways of coping
  • Research holistic ways to cope with certain symptoms, like refraining from caffeine and exercising if you suffer from insomnia

Get Help Managing Post-Acute Withdrawal Syndrome Today

If you or a loved one suffers from a substance use disorder, help is available. While withdrawal symptoms can be extremely difficult to cope with, an addiction treatment center can provide you with the support and tools you need to remain comfortable, healthy, and safe during the early recovery process.

At Carolina Center for Recovery, Our team is composed of doctors, clinicians, therapists, mentors, and recovery coaches with decades of experience in the field. Carolina Center for Recovery is lucky to have some of the most qualified and personally experienced addiction specialists in the country. We pride ourselves on carefully selecting men and women who are not only thoroughly informed and knowledgeable about addiction, but also those who have personally experienced the trials and blessings of recovery themselves.

If you or a loved one are ready to start your recovery journey, please contact us today.