Post-Acute Withdrawal Syndrome (PAWS): Symptoms, Causes, and Treatments

Post-acute withdrawal Syndrome (PAWS) is a set of prolonged withdrawal symptoms that persist after the initial detox phase, often lasting weeks, months, or even years. These symptoms occur as the brain struggles to adjust to prolonged abstinence after an extended period of substance use. According to the Substance Abuse and Mental Health Services Administration (SAMHSA, 2020), approximately 50% of individuals who stop using substances like alcohol or opioids experience acute withdrawal syndrome.

The main symptoms of PAWS include anxiety, mood swings, irritability, insomnia, and cognitive difficulties. These symptoms are sporadic and vary in intensity, often triggered by stress or environmental factors, prolonging the withdrawal state. 

PAWS is primarily caused by long-term substance use, which alters brain chemistry, making it difficult for the brain to return to its normal state even after the substance is no longer used. This results in a prolonged withdrawal state as the brain attempts to rebalance. American Journal of Drug and Alcohol Abuse, 2020 research indicates that up to 80% of individuals undergoing treatment for opioid dependence experience acute withdrawal symptoms, which can significantly impact their recovery process. 

Treatment for PAWS includes medications, psychotherapy, lifestyle changes, and strong support systems. These treatments aim to alleviate symptoms, prevent relapse, and restore mental and physical health. According to Smith, Journal of Substance Abuse Treatment (2022), and American Addiction Centers (2023), an integrated approach is most effective in managing PAWS.

PAWS following alcohol withdrawal is often more severe, with intensified mood swings, anxiety, and sleep disturbances due to alcohol’s significant impact on neurotransmitter systems. This makes PAWS harder to manage and leads to prolonged symptoms compared to withdrawal from other substances.

What is Post-Acute Withdrawal Syndrome (PAWS)?

Post-acute withdrawal Syndrome (PAWS) is defined as a hypothesized set of persistent impairments that occur after the initial withdrawal phase from substances like alcohol and opioids. 

These impairments are a collection of protracted withdrawal symptoms that linger even after the acute withdrawal period has ended, reflecting the lingering effects of drug use on the brain and body. According to Johnson, Journal of Addiction Medicine (2023), PAWS can include cognitive and emotional instability, which can hinder the recovery process and increase the risk of relapse.

The duration of PAWS varies widely, but it generally lasts anywhere from a few months to several years, depending on the individual and the substance involved. The initial period of PAWS begins shortly after the acute withdrawal phase and persists as a stage of opioid withdrawal or after someone stops drinking alcohol. According to Smith, Archives of Clinical Psychiatry (2022), PAWS typically lasts between 6 months to 2 years, although some symptoms may linger longer in cases of severe dependence or prolonged substance use.

This extended duration of PAWS shows that individuals with PAWS are at a higher risk of returning to substance use. The syndrome is considered a critical aspect of supporting neuroadaptation during the extended recovery process. It emphasizes the need for comprehensive care and support systems to maintain cognitive and emotional stability during this vulnerable period.

What Are the Symptoms of Post-Acute Withdrawal Syndrome (PAWS)?

The most observed symptoms of Post-Acute Withdrawal Syndrome (PAWS) are mood swings, cognitive impairment, and sleep disturbances. These symptoms occur to individuals during recovery as the brain and body continue to adjust to the absence of the substance. ‘

These symptoms persist for an extended period, making it difficult for individuals to maintain stability and resist relapse. According to Smith, Archives of Clinical Psychiatry (2022), and the National Institute on Drug Abuse (NIDA, 2022), these symptoms represent the ongoing neurobiological challenges faced during the recovery process and highlight the need for comprehensive treatment approaches that address both physical and psychological aspects of PAWS.

The most common symptoms of Post-Acute Withdrawal Syndrome are given below:

• Mood Swings: Mood swings in PAWS refers to sudden and unpredictable changes in emotional states, ranging from irritability and anxiety to depression. These fluctuations are frequent and can be triggered by stress, fatigue, or reminders of substance use. The severity of mood swings can make it difficult for individuals to manage day-to-day activities and maintain emotional stability. According to Johnson, Journal of Addiction Medicine (2023), these mood disturbances can persist throughout the recovery process, significantly impacting overall well-being.
• Cognitive Impairment: Cognitive impairment in PAWS refers to difficulties with memory, concentration, and decision-making. These cognitive deficits are common and can vary in severity, often exacerbated by stress or fatigue. The impact on daily functioning is considerable, as individuals may struggle with tasks that require focus or problem-solving. Smith, Archives of Clinical Psychiatry (2022), notes that cognitive impairment can persist for months or even years, prolonging the recovery process.
• Sleep Disturbances: Sleep disturbances include insomnia, frequent awakenings, and poor sleep quality. These issues are prevalent in PAWS and can be triggered by anxiety, stress, or physical discomfort. The chronic lack of restorative sleep exacerbates other symptoms like mood swings and cognitive impairment, creating a cycle that hinders recovery. According to the National Institute on Drug Abuse (NIDA, 2022), sleep disturbances can be one of the most persistent and challenging symptoms to manage in PAWS.
• Physical Symptoms: Physical symptoms are lingering effects of substance withdrawal, such as headaches, fatigue, and muscle pain. These symptoms are typically less severe than during acute withdrawal but can persist and contribute to overall discomfort and stress. Triggers for physical symptoms include stress, poor nutrition, and lack of physical activity.
• Cravings: Cravings are intense desires to use the substance again, often triggered by stress, environmental cues, or emotional distress. These cravings can occur frequently and vary in intensity, making them a significant challenge for maintaining sobriety. The duration of cravings can extend well into the recovery process, increasing the risk of relapse. 
• Emotional Dysregulation: Emotional dysregulation refers to difficulty managing and responding to emotional experiences. Individuals with PAWS may experience exaggerated emotional responses, such as anger or sadness, triggered by minor events. This symptom is frequent and can exacerbate other symptoms like mood swings and cravings. The inability to regulate emotions effectively can lead to social withdrawal and isolation. 
• Anhedonia: Anhedonia is the inability to experience pleasure from once enjoyable activities. This symptom is a common part of PAWS and is closely linked to the brain’s reward system being disrupted by prolonged substance use. Anhedonia can contribute to feelings of hopelessness and depression, which may trigger relapse if not properly managed. Smith, Archives of Clinical Psychiatry (2022), points out that this symptom can be particularly persistent and challenging to overcome.
• Social Withdrawal: Social withdrawal involves the tendency to isolate oneself from friends, family, and social activities. This behavior is often a response to the emotional and physical challenges of PAWS, leading to further isolation and loneliness. The frequency of social withdrawal can increase over time, especially if other symptoms, like mood swings and emotional dysregulation, are not adequately managed. 
• Increased Sensitivity to Stress: Increased sensitivity to stress is a common symptom of PAWS, where individuals react more intensely to stressful situations than they would have prior to substance use. This heightened stress response can trigger other symptoms, such as cravings or mood swings, making it difficult to cope with daily challenges. The severity of this symptom often correlates with the duration and intensity of substance use. According to the National Institute on Drug Abuse (NIDA, 2022), managing stress effectively is crucial for preventing relapse and supporting long-term recovery.
• Delayed Recovery: Delayed recovery refers to the extended duration of PAWS symptoms, which can last for months or even years. This prolonged recovery period is influenced by factors such as the type of substance used, the length of substance use, and the presence of co-occurring mental health disorders. Delayed recovery can lead to frustration and hopelessness, increasing the risk of relapse if not properly addressed. 

What Are the Causes of Post-Acute Withdrawal Syndrome (PAWS)?

The causes of Post-Acute Withdrawal Syndrome are brain recalibration, physiological adaptations, and reversible tolerance. Post-acute withdrawal Syndrome (PAWS) primarily arises as the brain recalibrates after prolonged substance use, trying to restore normal functioning after the disruptive effects of active addiction. 

During substance use, the brain undergoes significant physiological adaptations to cope with the drug’s presence, altering neurotransmitter levels and receptor sensitivity. These changes result in a state where the brain becomes dependent on the substance to maintain balance. When substance use stops, these adaptations do not reverse immediately, leading to a state known as reversible tolerance. 

In this state, the brain struggles to function normally without the substance, causing persistent symptoms such as mood swings, anxiety, and cognitive impairments. Stressful situations further worsen these symptoms, as the brain’s ability to manage stress is compromised during this recalibration period. ‘

According to Johnson, Journal of Addiction Medicine (2023), and the National Institute on Drug Abuse (NIDA, 2022), these underlying neurobiological changes are central to the development of PAWS and show the importance of understanding the complex recovery process.

What Are the Challenges of Post-Acute Withdrawal Syndrome (PAWS)?

The challenges of Post-Acute Withdrawal Syndrome (PAWS) are the persistence of symptoms, the risk of relapse, and the impact on daily functioning. Persistence of symptoms that can last for months or years, significantly increasing the risk of relapse. These symptoms severely impact daily functioning, making it difficult for individuals to maintain stability in their emotional, cognitive, and physical health. 

Managing stress becomes particularly challenging, as the brain’s ability to cope with stressful situations is compromised, further complicating the recovery process. 

The most common challenges of Post-Acute Withdrawal Syndrome are given below:

• Persistence of Symptoms
• Risk of Relapse
• Impact on Daily Functioning
• Emotional Instability
• Cognitive Impairment
• Social Isolation
• Difficulty Managing Stress
• Physical Discomfort
• Sleep Disturbances
• Reduced Quality of Life

According to Johnson, Journal of Addiction Medicine (2023), and Smith, Archives of Clinical Psychiatry (2022), these challenges necessitate comprehensive and long-term treatment approaches to support individuals through the extended recovery period associated with PAWS.

What Are the Treatments for Post-Acute Withdrawal Syndrome (PAWS)?

The treatments of Post-Acute Withdrawal Syndrome (PAWS) include medications, psychotherapy, and lifestyle changes. These treatments aim to manage the persistent and challenging symptoms of PAWS, which are often hard to treat due to the complexity of the syndrome. 

Accurate diagnosis is crucial, as PAWS symptoms can mimic other mental health conditions, making targeted treatment essential for effective recovery. According to Recovery First Treatment Center (2023), treating PAWS requires a combination of therapies, including ongoing counseling, stress management techniques, and the development of a strong support system. 

Medications

Medications used for PAWS are drugs designed to alleviate specific symptoms such as anxiety, depression, and insomnia, which are common during the syndrome. These medications help stabilize the brain’s neurotransmitter levels, making it easier for individuals to cope with the persistent symptoms of withdrawal.

Medications are helpful in PAWS because they directly address the chemical imbalances in the brain that cause mood swings, anxiety, and other symptoms. By stabilizing these neurotransmitters, medications reduce the severity of symptoms and improve the individual’s ability to function daily. According to Alcohol Rehab Help (2023), medications play a significant role in reducing the severity of PAWS symptoms.

Subtypes/Classes of PAWS Medications include:

• Antidepressants: Used to treat symptoms of depression and anhedonia.
• Benzodiazepines: Prescribed for short-term relief of anxiety symptoms.
• Sleep Aids: Help manage insomnia and improve sleep quality.
• Anti-Craving Medications: Reduce the intensity of cravings for the substance.

According to the National Institute on Drug Abuse (NIDA, 2022), medications are a critical component of PAWS treatment, offering relief from the most debilitating symptoms.

Psychotherapy

Psychotherapy involves psychological counseling aimed at addressing the emotional and cognitive challenges of PAWS. It helps individuals develop coping strategies, manage stress, and deal with the psychological aspects of withdrawal.

Psychotherapy is beneficial for PAWS because it provides individuals with tools to handle the emotional dysregulation, cognitive impairments, and social challenges that accompany the syndrome. It also helps identify triggers and develop strategies to avoid relapse.

Subtypes/Classes of Psychotherapy include:

• Cognitive Behavioral Therapy (CBT): Focuses on changing negative thought patterns and behaviors.
• Dialectical Behavior Therapy (DBT): Combines CBT with mindfulness strategies to manage intense emotions.
• Motivational Interviewing (MI): Helps increase motivation to maintain sobriety and cope with PAWS symptoms.
• Relapse Prevention Therapy: Provides strategies to prevent a return to substance use.

Recovery First Treatment Center (2023) emphasizes psychotherapy in addressing the psychological and behavioral aspects of PAWS.

Self-Care and Lifestyle Changes

Self-care and lifestyle changes involve adopting personal habits and routines that promote physical, mental, and emotional well-being. These changes are designed to support the recovery process by improving overall health and resilience.

Self-care and lifestyle changes are crucial in PAWS as they empower individuals to take an active role in their recovery. By focusing on healthy living, individuals reduce the severity of PAWS symptoms, enhance their mood, and build a more stable and fulfilling life post-addiction.

Subtypes/Classes of Self-Care and Lifestyle Changes include:

• Regular Physical Activity: Engaging in regular exercise, such as walking, swimming, or yoga, helps reduce stress, improve mood, and boost overall physical health.
• Balanced Nutrition: Consuming a diet rich in fruits, vegetables, whole grains, and lean proteins supports the body’s recovery, stabilizes mood, and reduces cravings.
• Mindfulness and Meditation: Practicing mindfulness and meditation helps manage stress, improve emotional regulation, and reduce anxiety, which are common in PAWS.
• Adequate Sleep: Establishing a regular sleep schedule and ensuring adequate rest is vital for cognitive and emotional recovery.
• Hydration: Staying well-hydrated aids in detoxification and reduces fatigue, helping the body recover more efficiently.

According to Smith, Journal of Substance Abuse Treatment (2022), and the National Institute on Drug Abuse (NIDA, 2022), self-care and lifestyle changes are foundational to the management of PAWS. They provide a holistic approach to supporting long-term recovery and improving quality of life.

Support Systems

Support systems refer to the network of family, friends, and professionals who provide emotional, psychological, and practical support during recovery from PAWS. They are vital in PAWS because they provide the encouragement and accountability needed to maintain sobriety and cope with the syndrome’s challenges. Strong support systems reduce feelings of isolation and increase the chances of successful recovery.

Subtypes/Classes of Support Systems include:

• Family Support: Involves close family members actively participating in the recovery process.
• Peer Support Groups: These include groups like Alcoholics Anonymous (AA), where individuals share experiences and provide mutual support.
• Professional Support: Consists of ongoing counseling and therapy provided by trained professionals.
• Community Resources: Access to local organizations that offer assistance and support for individuals recovering from substance use disorders.

According to the Recovery First Treatment Center (2023) and American Addiction Centers (2023), a strong support system significantly increases the likelihood of long-term recovery and helps manage the ongoing challenges of PAWS.

How Is Post-Acute Withdrawal Syndrome (PAWS) Different After Alcohol Withdrawal?

The main difference between Post-Acute Withdrawal Syndrome (PAWS) and alcohol withdrawal is the duration, psychological symptoms, and emotional recalibration. While acute alcohol withdrawal typically lasts for a few days to weeks, PAWS persist for months or even years after someone stops drinking. PAWS primarily involves prolonged psychological and emotional symptoms as the brain recalibrates to function without alcohol.

After someone stops drinking, the brain must adjust from a state of dependency on alcohol, which alters neurotransmitter levels. This recalibration process leads to persistent psychological symptoms like anxiety, depression, and mood swings, which are more subtle but longer-lasting compared to the more immediate physical symptoms seen in acute alcohol withdrawal. 

PAWS symptoms often include emotional instability, such as irritability and sensitivity to stress, which are less common in the acute withdrawal phase but can severely impact daily life during the extended recovery period.

According to the National Institute on Drug Abuse (NIDA, 2022), these differences show the prolonged challenge that PAWS presents compared to the more acute phase of alcohol withdrawal. It underlines the need for ongoing treatment and support long after the initial withdrawal symptoms have subsided.

Are Mood Swings Worse in Post-acute Withdrawal Syndrome (PAWS) After Quitting Alcohol?

Yes, mood swings are worse in Post-Acute Withdrawal Syndrome (PAWS) after quitting alcohol. Mood swings are a prominent symptom of PAWS and tend to be more severe after quitting alcohol due to the significant impact alcohol has on the brain’s neurotransmitter systems. 

After prolonged alcohol use, the brain undergoes substantial recalibration, leading to heightened emotional instability. These mood swings are more intense and persistent compared to those experienced during the acute withdrawal phase, as the brain struggles to restore balance over an extended period.

According to Johnson, Journal of Addiction Medicine (2023), the emotional symptoms, including mood swings, are particularly challenging in PAWS after alcohol cessation, making ongoing support and treatment essential for managing these prolonged effects.

Does Alcohol Withdrawal Make Post-acute Withdrawal Syndrome (PAWS) Harder to Manage?

Yes, alcohol withdrawal does make Post-Acute Withdrawal Syndrome (PAWS) harder to manage. The severity and complexity of alcohol withdrawal, particularly its impact on the brain’s neurotransmitter systems, contribute to the difficulty in managing PAWS. 

The prolonged emotional and psychological symptoms associated with PAWS, such as mood swings, anxiety, and depression, are often more intense and challenging to treat in individuals recovering from alcohol use compared to other substances.

According to Johnson, Journal of Addiction Medicine (2023), and the National Institute on Drug Abuse (NIDA, 2022), the unique challenges posed by alcohol withdrawal exacerbate the symptoms of PAWS, making the overall management of the syndrome more difficult and requiring a comprehensive, long-term treatment approach.

Is Anxiety More Intense in Post-acute Withdrawal Syndrome (PAWS) After Alcohol Use?

Yes, anxiety is more intense in Post-Acute Withdrawal Syndrome (PAWS) after alcohol use. Anxiety is a common and often more intense symptom in individuals experiencing PAWS after alcohol cessation. The prolonged disruption of neurotransmitter balance caused by alcohol leads to heightened and persistent anxiety during the recovery process. 

This increased anxiety is a significant challenge in managing PAWS, as it can contribute to other symptoms, such as sleep disturbances and mood swings. According to Smith, Journal of Substance Abuse Treatment (2022), and the National Institute on Drug Abuse (NIDA, 2022), anxiety tends to be particularly severe in PAWS following alcohol withdrawal, requiring targeted therapeutic interventions to help individuals manage this distressing symptom.

How to Boost Sleep During Alcohol-Related Post-acute Withdrawal Syndrome (PAWS) in Las Vegas?

To boost sleep during alcohol-related Post-Acute Withdrawal Syndrome (PAWS), establish a consistent sleep schedule and practice relaxation techniques like deep breathing or meditation before bed. Additionally, avoid caffeine and electronics before sleep to enhance restfulness.

Improved sleep significantly manages Alcohol-Related Post-Acute Withdrawal Syndrome (PAWS) by reducing the intensity of symptoms such as anxiety, irritability, and cognitive impairments. Quality sleep aids the brain’s recovery by supporting the recalibration of neurotransmitter levels disrupted by prolonged alcohol use. This enhanced rest helps stabilize mood, reduce cravings, and improve overall emotional and mental health, making the recovery process smoother and more manageable.

Research by Smith, Journal of Substance Abuse Treatment (2022), and the National Institute on Drug Abuse (NIDA, 2022) indicates that individuals who maintain a regular sleep schedule and engage in sleep-promoting behaviors experience fewer and less severe PAWS symptoms. Improved sleep has been linked to better cognitive functioning, emotional regulation, and reduced stress levels, all of which are critical in the recovery from alcohol-related PAWS. 

To improve sleep during alcohol-related Post-Acute Withdrawal Syndrome (PAWS), therapy or treatment is available at The Nestled Recovery Center, where comprehensive care is provided to support your journey toward a full and healthy recovery.