Post-Acute Withdrawal Syndrome, Symptoms and Survival

For many people recovering from addiction, the most significant challenge to a lasting recovery is PAWS. PAWS sets in after a person stops using drugs or drinking and has completed detoxification. At this stage, the severe symptoms of acute withdrawal have passed and a person can begin to focus on their recovery on a cerebral level. However, PAWS sometimes makes this extraordinarily difficult to do because it has a severe impact on a person’s thought processes, decision making, ability to control emotion, ability to maintain physical coordination and challenges one’s spirituality. These effects require proper management as they often compel an addict to use again in order to obtain relief. And because PAWS can occur and recur for up to two years or even longer for some people, understanding how to recognize and cope with this condition is the most critical factor for long term recovery success.

There are two stages of withdrawal:

  1. The Acute Stage;
  • Usually lasts at most a few weeks.
  • During this stage, you may experience physical withdrawal symptoms.
  1. The Post-Acute Withdrawal Syndrome (PAWS)
  • Experience fewer physical symptoms.
  • More emotional and psychological withdrawal symptoms.
  • PAWS occur because your brain chemistry is gradually returning to normal.
  • As your brain improves the levels of your brain chemical fluctuate as they approach the new equilibrium causing post-acute withdrawal symptoms

Most people experience some post-acute withdrawal symptoms. In the acute stage of withdrawal, every person’s experience is different. In post-acute withdrawal, most people have the same symptoms.

The most common post-acute withdrawal symptoms are:

  1. Mood swings
  2. Anxiety
  3. Irritability
  4. Tiredness
  5. Variable energy
  6. Low enthusiasm
  7. Variable concentration
  8. Disturbed sleep


Additional symptoms can be described as;

  1. The inability to process and organize thoughts. Recovering addicts are often unable to solve simple problems, maintain their focus on a specified task, or reason in the abstract which can leave them feeling helpless and unable to take action, therefore, may exacerbate all other PAWS symptoms.
  2. “Temporary” damage may become evident in the form of memory issues both in long and short term memory as the body’s CNS (central nervous system) recovers.
  3. Emotional incapacitation. PAWS can cause a person to overreact to benign stimuli or to not feel anything at all which can lead to depression due to the inability to find joy in daily life, or to a lowered sense of self-esteem after embarrassing inappropriate behavior.
  4. Sleep disorders range from insomnia to narcolepsy to sleep apnea, the most commonly reported problem is the inability to maintain a regular sleeping cycle.
  5. Lack of physical coordination includes problems with balance, hand to eye coordination, fine motor skills and impaired reflexes which can lead to depression and damaged self-esteem. (the term dry drunk was actually derived from the physical symptoms of PAWS)
  6. Inability to cope with stress. Stress management abilities destabilize in a person suffering from PAWS. The results are often completely unpredictable in that an individual might completely overreact to a situation that did not warrant it, or they might not react at all to a very grave situation. And they might feel stressed all the time without being able to articulate why.

Post-acute withdrawal as has been illustrated to feel like a rollercoaster of symptoms. In the beginning, symptoms change minute to minute and hour to hour. As you recover they will disappear for a few weeks or months only to return again. The further you continue to recover the longer the good stretches will get but the bad periods of PAWS can be just as intense and last just as long.

Each PAWS episode usually last for a few days and usually with no obvious trigger. You will wake up one day and your withdrawal will hit you like a ton of bricks. You will be feeling irritable and have low energy. And if you are not prepared for it or you think you will be different then everyone else and your PAWS will only last a few months you will get caught off guard. But, if you know what to expect you can do this. If you hang on for just a few days, it will lift just as quickly as it started. Your confidence that you can get through PAWS will develop because you will know that each episode is time limited.

The most important things to remember are;  

  • PAWS are completely normal, it happens to everyone.
  • PAWS usually will last for 2 years!
  • Thinking otherwise will get you caught off guard and increase the likelihood of relapse!


For proven Tips and Techniques to Survive PAWS or to discover how our clients learn to move through the uncomfortable you can complete an inquiry form or contact us directly at (805) 710-2513 or email

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