Post-Acute Withdrawal Syndrome After Detoxing

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In the first few days or weeks of staying away from drugs or other addicting substances, individuals often experience acute withdrawal symptoms. The severity of these symptoms can vary from person and person and is usually dependent upon what substance the person was addicted to.

Once the acute withdrawal symptoms subside, post-acute withdrawal syndrome (PAWS) may set in.

Symptoms of PAWS

PAWS can be a major barrier for many pursuing recovery from addiction.

The symptoms involved in PAWS can vary and are dependent upon many factors, such as the type of dependency, physical size and gender, and overall health.

PAWS is unique as compared to other withdrawal issues because of how extensive it is; PAWS can last from six months up to two years after the person stops using the substance.

Common symptoms include:

  • Irritability, aggression or hostility
  • Depression, sadness, and anxiety
  • Mood swings with severe highs and lows
  • Low energy
  • Fatigue or insomnia
  • Thought fog
  • Limited ability to focus
  • Lack of interest in sex
  • Chronic pain

Causes of PAWS

While most recreational drugs and even alcohol can cause PAWS symptoms, some drugs are more likely to trigger PAWS than others. According to American Addiction Centers, these include:

  • Marijuana: Stopping marijuana use can cause insomnia, which if left untreated, can lead to PAWS.
  • Cocaine: For weeks and even months after becoming sober, prolonged symptoms of impulse control and depression is possible among those recovering from cocaine addiction.
  • Methamphetamine: For those recovering from meth addiction, impulse control functions are inhibited, sometimes for years.
  • Opiates: After cessation of opiate use, people can experience PAWS symptoms for months, including insomnia, anxiety, depression and decreased impulse control.
  • Benzodiazepines: Since many people receive a prescription for benzodiazepines for conditions like depression or anxiety, ending that dependency can be particularly difficult. Stop taking the medication, and symptoms of anxiety can return as well as PAWS symptoms, which can worsen the initial issue as well. Many people will experience panic attacks or extreme anxiety or insomnia during their withdrawal period. Recovering from this dependency often requires significant oversight from a therapist or doctor.

How Long Does PAWS Last?

Unfortunately, there is no set timeline for how long PAWS will last. It is very dependent on the substance abused, duration of addiction and the physical health of the individual.

Some people may experience minimal withdrawal symptoms that may last for days or just a few weeks; others will continue to experience PAWS symptoms for years.

While PAWS can be severe, it can be controlled with professional oversight and medical intervention. Access to resources such as support groups, therapy or some medication, such as Acamprosate, which is often used to treat those with alcohol addiction, which is prescribed and monitored by a physician, can help mitigate the worst of the symptoms. This can allow you to get back to normal life, even as you face withdrawal.

Personalized care and long-term support from both addiction specialists and family can help recovery significantly. Therapy can help people manage withdrawal symptoms as they occur and remain in recovery without relapse.

While withdrawal symptoms like PAWS can be long-lasting and severe, they are worth working through in order to reach recovery. If you or someone you love is facing addiction issues, it's important to consult with a doctor or therapist.

If you or a loved one are struggling with substance use or addiction, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

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Article Sources
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  1. American Addiction Centers. Drug and Alcohol Withdrawal Symptoms, Timelines, and Treatment. Updated February 4, 2020.

  2. Hazelden Betty Ford Foundation. Post-Acute Withdrawal Syndrome. October 31, 2019.

  3. American Addiction Centers. Post-Acute-Withdrawal Syndrome (PAWS): An In-Depth Guide. Updated February 3, 2020.

  4. Brett J, Murnion B. Management of benzodiazepine misuse and dependenceAust Prescr. 2015;38(5):152–155. doi:10.18773/austprescr.2015.055

  5. UCLA Semel Institute for Neuroscience and Human Behavior. Post-Acute Withdrawal Syndrome (PAWS).

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