What Is PAWS?

Typical withdrawal symptoms likely fade within weeks. However, some people develop post-acute withdrawal syndrome (PAWS).

What Is Post-Acute Withdrawal Syndrome (PAWS)?

Early in the addiction recovery process, most people experience acute withdrawal. That means they face unpleasant withdrawal symptoms as their bodies adjust to life without drugs. 

These symptoms likely fade within two weeks, especially if the person undergoes supervised medical detox. However, some people develop post-acute withdrawal syndrome (PAWS).

What Is Post-Acute Withdrawal Syndrome (PAWS)?

PAWS is a condition in which a person experiences withdrawal symptoms long after they stop using drugs. Often, PAWS symptoms will appear for a couple days, go away, and later reappear. These cycles typically last between six months and two years. 

Symptoms Of Post-Acute Withdrawal Syndrome

Acute withdrawal mainly includes physical withdrawal symptoms (such as sweating and shaking). In contrast, PAWS mainly includes psychological symptoms. The most common symptoms of PAWS include:

  • drug cravings
  • anxiety
  • irritability
  • depression
  • mood swings
  • anhedonia (inability to feel pleasure) 
  • poor impulse control
  • trouble concentrating, remembering, or thinking clearly
  • lower libido
  • fatigue
  • sleep disturbances, such as nightmares and insomnia (trouble falling or staying asleep)


The specific symptoms you will experience depend on personal factors, such as the drug(s) you used, how often you used drugs, whether you seek professional help, and whether you have any co-occurring physical or mental health conditions. 

What Causes PAWS?

When you become addicted to a drug, your body starts relying on it to function normally. This can cause chemical imbalances in your brain. 

For example, dopamine is a neurotransmitter (brain chemical) that helps regulate your mood and behavior. Addictive drugs flood your brain with dopamine. With continued drug use, your brain will start producing less dopamine naturally. 

Once you stop using drugs, it takes time for your brain to start producing the right amount of dopamine again. The temporary lack of dopamine can cause the uncomfortable symptoms associated with PAWS. 

PAWS Risk Factors

Anyone who becomes addicted to a drug and then stops using it may develop PAWS. However, you’re more likely to experience it if you quit drugs too suddenly (also called “going cold turkey”) or if you don’t seek professional help at a medical detox program.

You also face a higher risk of PAWS if you used any of the following drugs:

Alcohol

Although it’s one of the most popular drugs in the world, alcohol poses a high risk of various PAWS symptoms, including fatigue, trouble concentrating, and lower libido. 

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), you may experience PAWS symptoms two or more years after your last drink.

Antidepressants

Antidepressants are medications used to treat depression, anxiety, and other mental health concerns. The most common antidepressants linked with PAWS are selective serotonin reuptake inhibitors (SSRIs) such as Lexapro, Paxil, Prozac, and Zoloft. 

PAWS symptoms that have been associated with these drugs include anxiety, irritability, and strange dreams. 

Benzodiazepines

Benzodiazepines are medications used to treat anxiety, seizures, and insomnia. Some of the most popular benzodiazepines are alprazolam (Xanax), clonazepam (Klonopin), and diazepam (Valium). 

They often cause PAWS symptoms that resemble the issues they were originally prescribed to treat, namely anxiety and insomnia.  

Marijuana

Marijuana is a mix of dried leaves, flowers, and other parts of the cannabis plant. Some of the most common PAWS symptoms associated with marijuana are strange dreams and trouble sleeping.

Opioids

Opioids, also called opiates, are pain relievers that change how your body responds to pain. They include prescription drugs like oxycodone, hydromorphone, and hydrocodone as well as the illegal drug heroin

PAWS symptoms often linked to these drugs include anxiety, irritability, depression, and trouble sleeping. 

Stimulants

Stimulants are a class of drugs that speed up your central nervous system. They include ADHD medications like Adderall and Ritalin along with illegal drugs like cocaine and methamphetamine. O

ne of the most common PAWS symptoms associated with stimulants is poor impulse control.

Treatment Options For PAWS

Although PAWS is uncomfortable, it’s typically not life-threatening. 

However, it makes you much more likely to relapse (start using drugs again). That’s why it’s important to manage your PAWS symptoms as much as possible. The most effective ways to manage your symptoms include:

Therapy

In therapy, you can learn how to cope with anxiety, depression, and other psychological PAWS symptoms. You can also learn how to manage drug cravings and any co-occurring mental health conditions you experience. 

Support Groups

At a support group, you can discuss your challenges with other people affected by PAWS. You can also learn helpful coping strategies from group members who have been experiencing PAWS longer than you. 

Self-Care

When recovering from any type of drug addiction, it’s essential to practice self-care. 

For instance, you should eat plenty of nutritious foods, exercise regularly, get at least seven hours of sleep each night, and discuss your feelings with supportive loved ones. You should also make time for relaxing activities such as journaling, meditating, and spending time in nature. 

If you or someone you love is struggling with PAWS, please contact Ohio Recovery Center. Our inpatient treatment programs offer medical detox, therapy, and a variety of other residential services to help you stay drug-free.

Written by
Ohio Recovery Center Editorial Team

Published on: April 19, 2022

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This page does not provide medical advice.

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