Post-Acute Withdrawal Syndrome or PAWS: Symptoms and Treatment

If you or a loved one are struggling with a substance abuse problem, then chances are that you might understand the difference between acute withdrawal symptoms and their successor, post-acute withdrawal syndrome or PAWS.

People who suffer from addiction disorders often experience acute withdrawal symptoms when they first give up a substance that they’ve been dependent on for a long period of time.

Acute withdrawal is usually not something that lasts for a very long time – it’s usually over within a few days to a few weeks – but the symptoms can be severe, very unpleasant, and occasionally dangerous, depending on the substance and the severity of symptoms.

But getting through acute withdrawal isn’t the end of it.

Once the acute withdrawal symptoms have passed, some individuals experience extended periods of a different sort of withdrawal symptoms. This is known as PAWS – post-acute withdrawal syndrome.

PAWS Diagnosis

One important thing to understand about PAWS is that it’s not an official diagnosis.

Although research has been done on PAWS, it’s not considered an official medical condition and is somewhat controversial. Different medical practitioners have different theories of what causes PAWS.

For example, some addiction experts believe that PAWS is caused by long-term changes to the brain or body due to drug use. Others believe that PAWS symptoms are caused by the psychological stress that accompanies giving up a substance that the individual is dependent on.

Still others believe that PAWS is simply another stage of the withdrawal process and that the time it takes for a person to go through withdrawal should be measured over a longer period of time than just days or weeks.

And there are some practitioners who don’t believe in PAWS at all – they see it as either an excuse for relapses or a bid by the addiction treatment industry to justify expensive long-term treatments.

Because there’s not one accepted cause or treatment plan for PAWS, it’s important for people who have addictions and their support networks to be aware of the different attitudes they may encounter from professionals with different theories when seeking treatment.

A person who is really struggling with long-term withdrawal symptoms following the acute withdrawal phase may not be well-served by seeking treatment from someone who doesn’t believe that PAWS is a legitimate medical or mental health condition.

Symptoms of PAWS

While the acute withdrawal phase of detox and recovery often involves physical symptoms like muscle aches, nausea, headaches, and increased heart rate, the symptoms of PAWS are more likely to be psychological and emotional than physical.

The symptoms vary from person to person and are at least somewhat dependent on the type of substance the individual is withdrawing from. For example, long-term withdrawal symptoms of opioids can include cravings and cognitive impairment.

Long-term withdrawal symptoms of marijuana can include paranoia and insomnia. Individuals withdrawing from stimulants may experience deep depression, severe fatigue, and physical weakness.

Some of the most common symptoms of people experiencing post-acute withdrawal syndrome are:

PAWS symptoms can be worsened or exacerbated by co-occurring physical or mental health disorders, a lack of support by family, friends, or health professionals, and emotional issues common to the first stages of recovery from addiction.

Treatment for PAWS

Treating post-acute withdrawal symptoms can be complicated both because of the different theories of the causes of the syndrome and the disparity of symptoms among teen patients.

Medical professionals who treat PAWS often start with patient education. Just knowing what to expect and being encouraged to be patient with themselves can help individuals suffering from PAWS. Addiction experts stress the importance of a healthy diet and exercise, adequate and restful sleep, and celebrating each step in the recovery process.

Because insomnia is a common problem for people in long-term withdrawal, experts encourage individuals to learn natural ways to deal with sleep problems, such as lowering the temperature in the house during sleeping hours or turning off electronic devices for a period of time before going to bed, rather than relying on medications to induce sleep.

People experiencing PAWS may find it helpful to join a mutual support group where they can meet others who have been through similar experiences and benefit from sharing their histories and coping mechanisms.

Counseling can be helpful as individuals in counseling can be assessed for co-occurring disorders that are likely to recur during this period of recovery and can learn to manage impulse control issues. Experts recommend that counselors and mental and medical health professionals take self-reported symptoms of PAWS seriously.

In some cases, medications can be used to manage certain symptoms of PAWS. For example, antidepressants may be prescribed to stabilize mood in people who are recovering from addiction to stimulants or psychoactive drugs. There are also medications used to suppress cravings for certain substances, like alcohol or opioids, that can be helpful for some individuals with PAWS.

Living with PAWS

Researchers continue to investigate and study the causes and treatment outcomes of PAWS, and there is growing concern over the problem of prolonged withdrawal, which will ultimately lead to more understanding and better treatment options for people who suffer from PAWS.

In the meantime, people who are looking for addiction treatment services should find out about their potential caregivers’ stances and treatment plans for individuals with PAWS. It’s important to find a health professional who understands PAWS and takes your symptoms and experiences seriously. It’s also important to be patient, as treatment plans may need to be adjusted if they don’t address symptoms or if they stop addressing symptoms over time.

Sometimes it takes time to find a treatment plan that works, and sometimes treatment plans that have been working become ineffective over time. This is not necessarily a failure on the part of the health professional or counselor or on the part of the patient, it’s just part of the process when treating a syndrome that can be very different from person to person.

Frequently Asked Questions

1. What Causes PAWS?

Post-acute withdrawal syndrome is not an official diagnosis because of the uncertainty behind its causes. Some experts believe PAWS is caused by long-term side affects of drug use. Others believe it derives from the psychological stressors behind giving up a substance.

2. How is PAWS Treated?

Depending on your doctor’s opinion on whether PAWS is a legitimate condition, treatment options range from inducing sleep, to joining a mutual support group, to counseling. Most importantly, education on what to expect from substance withdrawal comes first.

3. Is PAWS Difficult to Live With?

The biggest challenge for those living with post-acute withdrawal syndrome depends on their doctor’s opinion on PAWS. It’s important to find a professional who understands PAWS and takes your symptoms seriously. This way, treatment is easily accessible and executable.


Learning to successfully manage the symptoms of PAWS can prevent relapse and improve long-term outcomes for people who struggle with addiction disorders.

The more individuals understand about PAWS, the better able they’ll be to participate in their treatment and successfully manage their symptoms.