During acute withdrawal, which takes place in the first few days and weeks following detox, you are likely to experience physical and emotional side effects of quitting drugs or alcohol. However, some people experience lingering symptoms months afterward or develop new ones as they progress through recovery. When this occurs, it is called post-acute withdrawal syndrome (PAWS). Because PAWS symptoms can emerge during the first few months following detox, understanding PAWS and planning ahead is essential to managing your recovery.  

PAWS symptoms can range from mild to intense and are different for everyone. You may also notice symptoms change over the course of your recovery. While acute withdrawal symptoms during and immediately after detox tend to be more physical, PAWS symptoms tend to be psychological. For instance, some people experience brain fog or depression.  

It is normal to experience fluctuations as your mind and body recover from substance use disorder. However, speaking with a professional is recommended if you experience new or worrying symptoms. Your doctor or therapist can offer support and have PAWS resources they can share with you. 

Symptoms of PAWS 

Common symptoms of post-acute withdrawal syndrome include: 

• Fatigue
• Reduced sleep quality
• Insomnia
• Vivid dreams
• Anxiety
• Difficulty remembering things or concentrating
• Increased sensitivity to stress
• Urges and cravings
• Irritability or hostility that is difficult to control
• Depression
• Lack of motivation
• Mood swings

PAWS Duration 

There is no exact timeline for PAWS. Some people experience it for several weeks, others for months, and, unfortunately, some for years. Factors like people’s substance of choice and the severity of their addiction will affect how they experience symptoms. For instance, people struggling with an alcohol use disorder may experience PAWS systems for up to two years after their last drink and have a higher risk of relapse as a result. Alternatively, for individuals whose drug of choice was cocaine, PAWS systems may only last for four weeks. However, they are more likely to experience mood swings than people suffering from other addictions.  

Everyone’s body processes drugs and alcohol differently and detoxes from them uniquely as well. Detox allows your body to get used to working properly without substances. Alternatively, the symptoms of PAWS develop as the brain adjusts to you embracing a sober lifestyle.  

People who have been using substances for longer periods of time have a higher risk of developing prolonged PAWs. This is because it takes the brain longer to readjust after addiction. Sometimes, there are permanent changes to the brain after substance abuse. The harm caused to the brain makes it function differently than before and may increase the symptoms of preexisting mental health conditions like bipolar, depression, and anxiety disorders. Similar to a person with a physical health condition like heart disease, individuals managing the symptoms of PAWS on their road to recovery may need help from a professional to understand and manage their symptoms as they evolve. 

It’s important to remember that even if it lasts a long time, post-acute withdrawal syndrome is a temporary condition. Because PAWS is one of the greatest risk factors of relapse, understanding it and preparing for it is key to staying sober.  

Managing PAWS Symptoms 

PAWs is best managed through a combination of self-care and professional support. It can be challenging to abstain from a substance you have been using for a long time, only to find yourself struggling with fatigue, moodiness, and even intense waves of depression and anxiety. It is essential to keep in mind that these symptoms will get better with time, and they do respond to the proper treatment. 

Successful recovery requires using professional resources as needed while developing self-care skills. For example, stress management techniques, relaxation exercises, and lifestyle changes, such as avoiding triggers related to your substance of choice and exercising regularly, can make a huge difference in how you feel daily. 

Most importantly, finding the right self-care techniques help give you a sense of control over PAWS. You can’t decide when your symptoms flare-up or how long they last. But you can build skills that help you combat them and stay in control of your recovery, even on tough days that may turn into difficult weeks.  ]

Professional Help Versus Self-Care 

Therapy and group therapy can be beneficial as you manage PAWS. Therapy can also be helpful after drug or alcohol treatment because a professional can offer you guidance when addressing anything new that emerges during the recovery period. Depression or anxiety, mood swings, and other challenges are common with PAWS, and a therapist can help you navigate these experiences to reduce your risk of relapse.  

Coping Strategies for PAWS 

There are many ways you can cope with PAWS. It’s important to experiment and find what works best for you. Just because yoga and meditation do wonders for someone does not mean these techniques will work for you, and that’s okay. Remember to concentrate on taking care of yourself every day. 

Multiple coping strategies are helpful because they let you pick what works best on any given day. Sometimes, it may be a long walk or jog. Other times, you may benefit from some relaxation techniques, like practicing breathwork or doing muscle relaxation exercises.  

There are other important ways you can set yourself up for success while trying to embrace a sober lifestyle:  

• Maintain a healthy routine: Staying active, eating well, and following a sleep schedule as best you can will help you feel more stable in your daily life.
• Reach out when you’re struggling: It’s okay to need alone time, but a support system can make a huge difference when you are dealing with difficult thoughts, feelings, or cravings.
• Set goals: Realistic goals help you continue to make progress in your life and recovery, so you don’t only focus on PAWS and how it negatively affects you.
• Practicing mindfulness: Learning to live in the present, dealing with discomfort, and making a plan to move forward despite challenges can make coping with PAWS easier.

Support groups and peer networks like 12-Step Programs for people on the road to recovery can also help. You can hear from others who have gone through similar experiences and receive tips and suggestions. 

Recovering From PAWS 

PAWS recovery improves with time, but it is normal if your symptoms vary in intensity. You may notice they are almost absent for a while before returning. This does not mean you are getting worse; it is a natural part of recovery. What matters most is staying consistent with treatment, taking care of yourself, and not letting the symptoms of PAWS discourage you.  

Patience, perseverance, and a realistic understanding of the challenges you will face will help you navigate the recovery process and achieve the goals you have set for yourself. It is normal to have bad days, suffer from anxiety or wrestle with self-doubt. 

PAWS Treatment Options 

Treatment for post-acute withdrawal syndrome includes therapy, lifestyle changes, medication management and holistic treatments. Tailored treatment plans can be important when it comes to addressing symptoms. They ensure you are given individualized care based on your unique needs and preferences. 

While there are certain therapies clinically proven to treat substance use disorders, this doesn’t mean therapists won’t personalize their approach. Every type of therapy has a broad range of techniques that licensed counselors can choose from to help their clients. 

Working with licensed substance abuse therapists will ensure you get the best care for your needs as you navigate PAWS and life after deciding to stay sober. 

Support Resources for PAWS 

Support groups play an integral role in helping people move through recovery. There are many unexpected feelings and moments that will arise even when you think that you have progressed beyond the possibility of relapse. This is where support groups are invaluable; they let you connect with people who are all in different stages of recovery so that you can help one another. 

Some resources you can explore include 12-step programs like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), which have meetings throughout the United States. Often, you can also attend support groups and group therapy offered by the rehab center you attended. In addition, you can find online support forums for people going through recovery from drug or alcohol dependence. 

Professional Support During PAWS 

Regular check-ins and tracking symptoms can make managing PAWS easier. Collaborating with healthcare professionals and therapists to ensure you are receiving the level of support you need, depending on the intensity of your PAWS symptoms, is crucial. 

A doctor or psychiatrist can offer medication management for mental health conditions and withdrawal symptoms. Your therapist or counselor can teach you coping strategies and new skills to improve your distress tolerance and make living with PAWS easier. 

Having a designated healthcare team is important because it ensures you have professionals on your side who can monitor your unique situation. As symptoms appear, improve, or evolve, you can receive personalized care to stay informed and as comfortable as possible. 

Navigating PAWS With Support 

Post-acute withdrawal syndrome isn’t preventable, but it is manageable. Although the symptoms of PAWS can wax and wane over the course of recovery, the condition does improve gradually over time.  

While you are navigating this period of your life, remember to be good to yourself. Practice self-care, stay committed to your recovery goals and do not be afraid to ask for help when you need it. Support is always available.  

If you are struggling with PAWS symptoms or planning for recovery and need support, we are here to help. Contact Liberty Bay Recovery Center in Portland, Maine to learn more about what we have to offer.