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Sober Nation

Putting Recovery On The Map

05-09-19 | By

Post-Acute Withdrawal Syndrome: What is it, and What You Need to Know

Post-Acute Withdrawal Syndrome, or PAWS, is a condition that is experienced by individuals with prolonged drug use after cessation of use. This includes mental health medications as well as prescription and illicit drug use. PAWS occurs after the initial acute withdrawal symptoms have passed and can last from a few months to upwards of two years, with each individual episode lasting anywhere from a couple of days to two weeks.

Why Does PAWS Happen?

PAWS occurs when the brain’s chemistry changes rapidly after an individual stops using drugs. During the time of active drug use, the brain makes changes to adapt to the onslaught of neurotransmitters and feel-good chemicals reaching the brain receptors. This spike in neurotransmitters causes excitability and, once use has stopped, a ‘comedown’ is inevitable.

Risk Factors Associated With PAWS

There are a number of factors that increase the prevalence and severity of the PAWS experience. These can include:

  • The type of substance used
  • The length of time of use
  • Genetic factors
  • Psychological predispositions
  • Any underlying emotional or physical conditions

These are all factors that play a huge part in how each individual experiences PAWS.

What Drugs Can Cause PAWS?

Post-Acute Withdrawal Syndrome occurs after the initial acute withdrawal associated with stopping drug use ends. The severity and length of time PAWS last depend on the substance used, and the duration of use. The main substances are:

  • Alcohol
  • Benzodiazepines
  • Opioids
  • Stimulants

Some prescription drugs such as anti-depressants and anti-psychotics can also cause PAWS because, like illicit drugs, these drugs alter the brains chemistry, specifically, serotonin, norepinephrine, and dopamine levels. As stated earlier, the duration of use dictates the extent of the changes in these chemicals. Drugs such as marijuana and anabolic steroids may possibly result in post acute withdrawal-like symptoms upon discontinuing use, but research to prove this has not been established.

Most Common Post-Acute Withdrawal Symptoms

There are a plethora of symptoms that are unique to each specific substance used. These are the symptoms that are universal across the board with PAWS, however some of the most common symptoms can include:

Mood Swings

Periods of mania or depression are common during post-acute withdrawal. Each episode can last for a couple of days to a couple of weeks.


This is when the individual experiences a markedly decrease in enjoyment of activities in general, including those that they used to enjoy.


Feelings of impending doom, extreme sensitivity to stress and overactive stress response, shaking, scattered or unwanted thoughts, sweating, and heart palpitations are common with anxiety and can be extremely scary.

Sleep Disturbances/Insomnia

Inability to fall or stay asleep. Waking up multiple times through the night, or sleeping to an unhealthy excess are all part of this symptom.


The feeling of needing the substance, or cravings are common with post-acute withdrawal syndrome. Feeling as though survival is not possible without it. This can include a physical reaction as well as psychological reactions. Sweating, shaking, anxiety and rapid thoughts along with an inability to concentrate are all common for this symptom.

How Long Will This Last?!?!

Depending on the substance(s) used, and the length of time they are used, post-acute withdrawal can last anywhere from a few months up to two years. During this time the brain is making chemical changes to achieve homeostasis within itself. Until this happens, symptoms of PAWS will persist. Each episode of PAWS usually lasts a couple of days to a couple of weeks. As time goes on, they become less severe.

Part of The Process

Although PAWS can be scary and is definitely highly difficult to deal with, it is a normal part of the early recovery process. There will be moments where you may feel as if you can not get through it, that it will kill you – however, it won’t. It is not forever, and is but a small grain of sand in the ocean that is the rest of your life.


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