Post-Acute Withdrawal Syndrome Symptoms

Withdrawal symptoms typically dissipate within a few weeks. But for people who experience post-acute withdrawal syndrome, the timeline can stretch to months or even years.

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What Is Post-Acute Withdrawal Syndrome?

Post-acute withdrawal syndrome, or PAWS, refers to a group of symptoms that persist for considerably longer than the usual withdrawal timeline. The condition is sometimes also referred to as protracted withdrawal.

Though this syndrome has not received the same amount of public attention that other addiction-related topics have, it is by no means a new concept:

• One of the earliest published references to this phenomenon is from an October 1954 article in the Canadian Medical Association Journal. That article, by Marvin Wellman MD, discussed “late withdrawal symptoms of alcohol.”
• The term “post-acute withdrawal syndrome” seems to have first appeared in the 1970s or 80s. Some claim that U.S. neurobiologist George Koob PhD coined the term, while at least one journal article credits Russian researcher B.M. Segal. 

Initial research on the symptoms and timeline of post-acute withdrawal syndrome focused on individuals with alcohol use disorder (alcoholism). Today, experts understand that PAWS can affect people who are attempting to end their use of several addictive substances.

Who Is at Greatest Risk of PAWS?

There’s no way to predict with 100% accuracy who will or won’t experience PAWS, but factors that may raise a person’s risk include:

• Withdrawing from alcohol, opioids, or benzodiazepines
• History of long-term, heavy substance use
• Having gone through withdrawal before
• Dual diagnosis (having a co-occurring metal health concern)
• Certain genetic variations

Symptoms Associated With PAWS

Psychological concerns are more common among people who have PAWS, but there can be a physical impact as well. The type and intensity of a person’s symptoms can also be influenced by many factors, including which drug they had been using. 

The emotional and cognitive impact of PAWS may include:

• Continued drug cravings
• Anxiety
• Irritability
• Mood swings
• Low motivation
• Anhedonia (difficulty experiencing pleasure)
• Dysphoria (general sense of dissatisfaction)
• Slowed responsiveness
• Diminished ability to focus and concentrate
• Short-term memory problems

From a physical perspective, PAWS has been known to include:

• Dizziness or lightheadedness
• Lack of energy
• Fatigue and exhaustion
• Persistent aches and pains
• Impaired coordination
• Insomnia
• Sexual dysfunction

Though PAWS symptoms can be uncomfortable and disruptive, they shouldn’t be as severe or continuous as what you dealt with during the acute phase of withdrawal. 

Post-Acute Withdrawal Syndrome Timeline

It’s impossible to precisely predict or track the post-acute withdrawal syndrome timeline. But generally speaking, here’s what you can expect:

• Acute withdrawal usually lasts 10-14 days.
• PAWS symptoms typically become noticeable in the immediate aftermath of the acute phase.
• PAWS symptoms are usually strongest during the first 30-90 days (one to three months) after they begin.
• Though PAWS symptoms should begin to ease somewhat within three months, it’s not uncommon for people to deal with ongoing effects for up to two years after they initially completed withdrawal.

During the extended phase of the post-acute withdrawal syndrome timeline, some symptoms may disappear completely for a while, only to resurface later, while others may be relatively constant but vary in intensity.

Tips for Coping With PAWS Symptoms

Unfortunately, there’s no way to speed up the post-acute withdrawal syndrome timeline or make your symptoms simply disappear. But there are several steps you can take to ease your discomfort and manage PAWS-related stress more effectively:

• Diet and exercise: Eating nutritious food and moving your body on a regular basis can improve your motivation and energy levels, and help you cope with stress more effectively.
• Sleep hygiene: To improve the quality of your sleep, it can help to limit your caffeine use, wake up and go to bed at the same times every day, not eat for two or three hours before you go to bed, and stop looking at your phone or tablet an hour before bedtime.
• Holistic practices: Mindfulness, meditation, yoga, and similar practices can help you to calm your mind and ease tension that you’ve been storing in your body.
• Self-soothing: Journaling, deep breathing exercises, and other stress-management strategies can help with anxiety, mood swings, and other negative emotions.
• Personal support: Avoid the urge to isolate when you’re not feeling great. Sometimes, just talking through your challenges with a loved one can ease your burden. Also, peer-led groups like AA and SMART Recovery can be valuable sources of support.

If none of these steps are as helpful as you’d hoped they would be, you may want to consider a return to treatment. Depending on what type of care you’ve already received, in-person or online outpatient therapy may be right for you. 

Find Addiction Treatment in Jacksonville

Design Recovery is a trusted source of personalized outpatient care for adults who have been living with addictions and co-occurring mental health concerns.

Treatment options at our rehab in Jacksonville, FL, include a partial hospitalization program (PHP), an intensive outpatient program (IOP), and a virtual (online) program. In each environment, you can expect to receive customized services and compassionate support from a team of skilled professionals who are truly invested in your success.

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