What Is Post-Acute Withdrawal Syndrome (PAWS)?

A woman with red hair looking at her phone.


Many people who withdraw from substances find themselves struggling with post-acute withdrawal syndrome (PAWS). Most commonly, this occurs in complex scenarios where a person has used substances for a long period at a high frequency. Otherwise, it could occur when multiple substances are used at once.

What Is PAWS?

PAWS, also called protracted withdrawal, affects some people with substance use disorder (SUD). Undoubtedly, the condition can impact their ability to function during and after treatment. The lingering effect of certain substances on the brain can significantly influence behavior, thoughts, and cognition.

According to the Yale Journal of Biology and Medicine, “Unlike acute withdrawal, which has mostly physical symptoms, post-acute withdrawal syndrome (PAWS) has mostly psychological and emotional symptoms.†The effects can lead to complications during rehabilitation that may require an extended period of treatment. The care team at Newport Beach Recovery Center uses evidence-based methods to help clients address and manage symptoms related to SUD, including PAWS.

How Does PAWS Affect Recovery?

PAWS causes extended symptoms of withdrawal that can last for weeks or months. According to the online article “Post-Acute Withdrawal Syndrome (PAWS)†by the Semel Institute for Neuroscience and Human Behavior, “It is estimated that 90 percent of recovering opioid users experience the syndrome to some degree as do 75 percent of recovering alcohol and psychotropic abusers.â€

Symptoms of PAWS

Some substances have a more profound effect on the brain and body, causing extended symptoms that can leave affected individuals feeling on edge, emotionally overwhelmed, or disconnected from their recovery. PAWS manifests differently for everyone, and clients may experience mild, severe, or intermittent symptoms. Sometimes, PAWS can entirely disappear and reappear many months later.

A few of the most common side effects of PAWS include:

  • Unusual irritability
  • Mood swings
  • Memory issues
  • Difficulty learning new tasks, concentrating, or problem-solving
  • Anxiety or panic
  • Depression or apathy
  • Obsessive-compulsive behaviors
  • Sleep disturbances

PAWS directly affects mental health, and clients often benefit from a combination of individual therapy, peer support, and prescription medication. Clients with PAWS have a lower stress threshold, and symptoms may reappear or worsen during moments of high stress. We offer treatments that provide stress relief, relapse prevention strategies, and essential coping skills. Individuals with PAWS can use those resources to continue healing during symptom flare-ups during ongoing recovery.

What Are Common Risk Factors for PAWS?

Post-acute withdrawal can happen to anyone. The severity of symptoms can differ depending on multiple factors. Most people experience issues with emotional regulation and mood swings. Some individuals may have an increased risk of PAWS if they have a history of mental health disorders, current co-occurring mental health issues, or have very little emotional support. Individuals with opioid use disorder (OUD) and alcohol use disorder (AUD) have a higher risk of experiencing PAWS.

The Impact of PAWS on Physical and Mental Health

PAWS causes physiological changes in the brain. Neurotransmitters affected by substance abuse may have difficulty communicating, which leads to emotional, cognitive, and behavioral symptoms. The syndrome affects everyone differently depending on various factors, including age, genetics, family history, and co-occurring issues. Anyone can be diagnosed with PAWS. However, some individuals may be predisposed to developing the syndrome due to the substances they abused or certain environmental and biological factors. Medical and mental health professionals cannot predict who will experience protracted withdrawal symptoms.

How Is PAWS Treated?

Treatment programs usually address the symptoms of PAWS using a combination of therapy and medication. The condition is unique to each individual, which makes it essential to have a personalized treatment plan.

Common treatments for PAWS include:

  • Psychotherapy and counseling
  • Peer support
  • Prescription medication

At Newport Beach Recovery Center, we use various assessments to determine how best to approach the treatment of PAWS and other conditions.

How Can You Cope With PAWS During Ongoing Recovery?

Recovery is not a linear process. Many people find themselves falling back into old behaviors or experiencing symptoms of SUD during moments of high stress. Treatment is not a cure for SUD. Instead, it provides a stabilizing influence and prepares clients to overcome challenges related to recovery.

Clients can reduce the impact of PAWS on their recovery by doing the following:

  • Using their support system and not being afraid to ask for help
  • Practicing self-care and improving overall health by making lifestyle changes
  • Being mindful of emotional health and prioritizing mental health
  • Using coping skills to decrease the negative effect of everyday stressors
  • Strengthening the mind-body connection and paying attention to physical cues that indicate stress

Clients diagnosed with PAWS can benefit from having realistic recovery goals. Therapy, peer support, and other resources can provide motivation and inspiration for continued healing and recovery. Living with PAWS requires determination and a desire to make lasting positive changes. The treatment programs at Newport Beach Recovery Center can help clients achieve their goals by learning essential coping skills.

Post-acute withdrawal syndrome results from changes to the brain caused by prolonged substance abuse or other factors. In many cases, individuals with PAWS have co-occurring mental health issues that increase their risk of developing the condition. Some side effects can include more severe withdrawal symptoms and symptoms that reappear after weeks or months. Clients may experience prolonged issues with mood swings, depression, anxiety, difficulty focusing, and other mental health complications that can interfere with the effectiveness of traditional rehabilitation treatment. At Newport Beach Recovery Center, we use personalized care plans and evidence-based methods to help clients recover from substance use disorder and cope with related issues, including PAWS. Our care team has decades of combined experience assisting individuals in overcoming challenges related to treatment and ongoing recovery. To learn more about our programs, call our office today at (855) 316-8740.