Addiction Coping and Recovery Overcoming Addiction Help and Support for Post-Acute Withdrawal Syndrome How to Cope When Withdrawal Symptoms Linger By Elizabeth Hartney, BSc, MSc, MA, PhD Elizabeth Hartney, BSc, MSc, MA, PhD Elizabeth Hartney, BSc, MSc, MA, PhD is a psychologist, professor, and Director of the Centre for Health Leadership and Research at Royal Roads University, Canada. Learn about our editorial process Updated on May 05, 2021 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by John C. Umhau, MD, MPH, CPE Medically reviewed by John C. Umhau, MD, MPH, CPE John C. Umhau, MD, MPH, CPE is board-certified in addiction medicine and preventative medicine. He is the medical director at Alcohol Recovery Medicine. For over 20 years Dr. Umhau was a senior clinical investigator at the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health (NIH). Learn about our Medical Review Board Print PeopleImages/Getty Images Post-acute withdrawal syndrome, or PAWS, is the condition of continuing to experience drug withdrawal symptoms—for weeks, months, or years—even though you’ve completed a drug addiction treatment program and are no longer “using.” Other names for post-acute withdrawal syndrome include post-withdrawal syndrome, prolonged withdrawal syndrome, and protracted withdrawal syndrome. Which Drug Addictions May Lead to PAWS? Post-acute withdrawal syndrome typically begins after someone has withdrawn from alcohol, a benzodiazepine tranquilizer, or a narcotic drug (opioid), such as heroin. About 90 percent of people who were addicted to opioids experience some degree of post-acute withdrawal syndrome, which occurs in about 75% of recovered alcoholics. However, it may also occur after withdrawal from other addictive drugs. People recovering from abusing benzodiazepines seem to experience post-acute withdrawal syndrome most often and for the longest periods of time, often for years. Causes The exact cause or causes are not yet known, but they’re continuing to be investigated. Many scientists currently believe that the physical changes addiction causes in the brain, particularly the changes related to increasing a person’s tolerance to the drug, continue to cause withdrawal symptoms even after his or her recovery is complete. Symptoms In general, the symptoms of post-acute withdrawal syndrome are similar to the symptoms of anxiety and mood disorders. They may range from mild to severe in a single individual; they may also go away entirely for a period of time and then reappear. Some of the most common symptoms of post-acute withdrawal syndrome include: Problems with thinking (cognitive) tasks, such as problem-solving, learning, or memory recallIrritabilityAnxiety or panicDepression Less often, a person may experience: Obsessive-compulsive behaviorsProblems with social relationshipsCravings for the addictive drug they usedPessimism or lack of interest (apathy)Sleep disturbancesIncreased sensitivity to stress Stress can make any of these symptoms of post-acute withdrawal syndrome worse, but this can also happen without any apparent cause. Treatment A medication often used to help alcoholics recover, acamprosate, can sometimes be effective in managing symptoms of post-acute withdrawal syndrome. Treatment may need to be prolonged, depending on how long the symptoms last, and may also include other medications and counseling using behavioral therapy methods. Tips for Coping If you're struggling with post-acute withdrawal syndrome, the following may help: Some of the methods you used for getting through acute withdrawal may also help in this situation. Give them a try. Talk honestly about your symptoms and feelings with an understanding (non-using) friend or therapist. Learn about your addiction. Understanding more about what happened can help you gain a greater perspective on your current problem. Explore spirituality. Most people have a spiritual side they may or may not know much about. You may find that your spirituality provides meaningful comfort during this difficult time. Work toward moderation and balance in every area of your life. Meeting the Challenge People who go through the painful and difficult experiences of drug addiction, detoxification, and withdrawal treatment likely feel justified in thinking that they’ve been through enough in achieving their recovery goal. Yet post-acute withdrawal syndrome may lie ahead. Yes, it’s a challenge to deal with a recurrence of symptoms, but they can be managed with the combination of effective medication and supportive therapy. Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Gorski T, Miller M. "Staying Sober — A Guide For Relapse Prevention." Independence Press (1986). By Elizabeth Hartney, BSc, MSc, MA, PhD Elizabeth Hartney, BSc, MSc, MA, PhD is a psychologist, professor, and Director of the Centre for Health Leadership and Research at Royal Roads University, Canada. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? 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