Post-Acute Withdrawal Syndrome (PAWS) is a phenomenon that occurs when someone with a severe alcohol addiction goes through medical detox and their body has an extreme reaction. For a simple explanation, it’s withdrawal symptoms that last for a long, protracted time.
While the most intense withdrawal symptoms typically take place in the first few days or weeks, PAWS refers to a prolonged and recurring set of symptoms that can continue for months or even years. The body and brain may continue to struggle to regain balance after substance use stops, often causing emotional, mental, and physical challenges.
This ongoing process can be discouraging, as individuals may feel they are regressing instead of improving. However, this is not the case. Understanding PAWS is crucial for individuals and their support systems, as it helps them to anticipate these symptoms and develop strategies for long-term recovery.
What Causes PAWS?
PAWS is rooted in the changes that long-term substance use causes in the brain and body. Chronic abuse of alcohol, opioids, or benzodiazepines disrupts the brain’s ability to regulate its mood, energy, stress, and reward systems. Over time, the brain adapts to the presence of these substances by altering its chemistry — reducing dopamine production or lowering sensitivity to calming chemicals like GABA, which is why many individuals turn to alcohol rehab or other treatment programs for support.
When the substance is removed during detox, the body and brain can undergo intense withdrawal. But in some cases, the brain needs months or even years to fully recalibrate itself. During this time, withdrawal-like symptoms can resurface intermittently, often triggered by stress, emotional upheaval, or environmental cues.
Key contributors to PAWS include:
- Prolonged withdrawal process: Some withdrawal symptoms persist due to how deeply the brain has adapted to substance dependence.
- Certain substances: PAWS is most commonly associated with alcohol, benzodiazepines, and opioids due to their impact on the central nervous system.
- Long-term use: The more prolonged and heavy the substance use, the more pronounced and lengthy the post-acute withdrawal phase tends to be.
Research published in the Journal of Substance Use and Addiction Treatment (2022) underscores that PAWS is a distinct and recognizable phase of the withdrawal timeline. Understanding its progression can improve recovery outcomes.
Common Symptoms of PAWS
PAWS can vary significantly from person to person, but there are several hallmark symptoms that most people experience in some form. These symptoms tend to come and go in waves, often without a clear pattern, and can be exacerbated by stress or environmental triggers.
People with PAWS often describe feeling mentally “sluggish” or “foggy.” It can be hard to think clearly, solve problems, or retain information. This may be due to the brain’s slowed rebalancing process and lingering neurological deficits.
Many people in post-acute withdrawal report heightened emotional sensitivity. This can include random waves of anxiety, irritability, or even panic, often requiring professional anxiety treatment to manage effectively. Seemingly small stressors may feel overwhelming.
A deep sense of hopelessness or disinterest in activities once enjoyed is common for people going through PAWS. This depressive state can last for days or weeks and may occur unexpectedly, even if things seem to be going well externally.
Staying focused can become a daily challenge. People with PAWS may start tasks but struggle to finish them, or get easily distracted during conversations.
Short-term memory loss or forgetfulness is frequently reported. Individuals may forget appointments, names, or where they put items just moments earlier.
Some people experience a slight decline in motor functions, making them feel clumsy or uncoordinated. This may include dropping objects, bumping into things, or having slower physical reactions.
Insomnia, vivid dreams, or disrupted sleep cycles can continue long after the initial detox phase. Poor sleep, in turn, can worsen other symptoms like mood swings and cognitive fog.
Even long into recovery, sudden cravings for the previously abused substance can emerge. These are particularly dangerous because they may feel out of sync with a person’s current motivation to stay sober.
Another challenging PAWS symptom is anhedonia, the inability to feel joy or pleasure from activities that once brought happiness. Hobbies, relationships, or accomplishments may feel dull and/or meaningless. This is often linked to disrupted dopamine pathways in the brain and can contribute to relapse risk if not addressed.
In some cases of PAWS (particularly if symptoms include intense depression or emotional pain), suicidal ideation may emerge. This is a medical emergency and should be taken seriously. If you or someone you know is experiencing suicidal thoughts, professional help should be sought immediately.
How to Cope With PAWS
The good news is that PAWS is a temporary condition. While it can feel overwhelming at times, symptoms typically diminish in frequency and severity with time. By taking a proactive approach to physical, mental, emotional, and social well-being, a person can reduce the impact of PAWS and support their own long-term recovery.
One of the most effective ways to cope with PAWS is to prioritize your physical health. The brain and body are trying to recover from the chemical imbalances caused by long-term substance use, and giving them the right tools makes a big difference. Eating balanced, nutrient-rich meals fuels brain function, while regular exercise helps boost endorphins, reduce stress, and improve sleep. Staying hydrated can also support mood regulation and overall well-being. Avoiding excessive caffeine, sugar, or processed foods can prevent unwanted mood spikes and crashes.
Sleep problems are common in PAWS. Insomnia, nightmares, or restless sleep can worsen emotional instability and cognitive fog. Create a consistent sleep routine, including steps like waking up and going to bed at the same times every day, avoiding screens before bed, and creating a calm environment in the bedroom. Relaxing nighttime rituals, such as stretching, meditation, or taking a warm shower, can help your body wind down. Avoid consuming stimulants like caffeine or nicotine too close to bedtime.
Recovery is not a straight line, and harsh self-criticism can be damaging during the vulnerable post-detox period. Practice self-compassion and allow yourself space to feel without judgment. Mindfulness meditation, breathing exercises, journaling, or grounding practices can help create emotional stability and relieve stress. Recognizing emotional shifts early and responding with self-care strategies can help prevent relapse and support long-term healing.
If you’re feeling isolated, don’t hesitate to ask for help and rebuild your support system. PAWS can make people feel misunderstood or alone — especially if others assume recovery ends after detox. Reaching out to friends, family, recovery peers, or therapists creates meaningful connection and accountability. Support groups like Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and SMART Recovery offer shared experiences, tools for coping, and nonjudgmental spaces to talk openly about what you’re going through.
If you’re experiencing intense depression, anxiety, insomnia, or emotional instability, talk to a doctor or mental health professional. Medications may be helpful in stabilizing your mood, improving sleep, or reducing anxiety. Therapy, especially cognitive behavioral therapy (CBT) or trauma-informed approaches, can help you process what you’re feeling. The right modality of therapy can help you reframe negative thought patterns and develop coping strategies tailored to your needs.
PAWS symptoms can be triggered by the same things that led to substance use in the first place, such as stress, boredom, certain people, or emotional pain. Make a list of your personal triggers and plan out how to respond to them. Avoid old environments that may encourage relapse and replace them with safe, supportive places in which you can spend time. Having an emergency plan for high-risk situations can protect your sobriety.
Recovery is not about being perfect. It’s about staying committed even when it’s hard. Celebrate the wins along the recovery journey, no matter how small. Whether it’s resisting a craving, a full week of solid sleep, or reaching out for help, these moments deserve recognition. Keep track of your milestones and remind yourself that healing from addiction takes time.
Heal From Addiction at Cypress Lake Recovery
At Cypress Lake Recovery, we know that healing doesn’t stop at detox. That’s why we support clients through every stage of the recovery journey. With personalized care, medical support, and therapeutic tools designed for long-term success, our team is committed to helping you rebuild a meaningful, healthy life.
If you’re struggling with Post-Acute Withdrawal Syndrome or early recovery, reach out today — you’re not alone in this journey.
