Medically Reviewed:
Dr. Randy Gelow, MD, FASAM
Ray Hamilton, DNP, PMHNP-BC, FNP-C
Last Updated: April 16, 2025
Recovery from substance use disorder is not always a straightforward journey. After detox, many people believe the hardest part is over. However, this is not always the case. For some, post-acute withdrawal syndrome (PAWS) begins after the initial withdrawal ends. PAWS can prolong the recovery process, making it essential to understand what it is, how long it lasts, and how to manage its effects.
Post-acute withdrawal syndrome, also known as protracted withdrawal syndrome, refers to the lingering mental, emotional, and physical symptoms that occur after the acute withdrawal stage has passed.
Unlike the initial phase, which may involve life-threatening complications such as seizures or increased heart rate, PAWS includes more subtle but equally disruptive issues like mood swings, anxiety, and fatigue.
These symptoms are not just inconvenient; they can interfere with everyday life and even lead to relapse. PAWS affects the brain’s ability to regulate stress and emotions due to chemical imbalances caused by prolonged substance use.
PAWS is the result of long-term changes in brain function due to active addiction. When someone uses drugs or alcohol for an extended period of time, the brain adapts to those substances. Once substance use stops, the brain takes time to heal and adjust. This adjustment period can lead to symptoms of PAWS that persist well beyond detox.
PAWS can occur after withdrawal from alcohol, opioids, benzodiazepines, stimulants, or other substances. The longer the use and the more severe the addiction, the higher the risk of experiencing PAWS.
Not everyone in recovery will experience PAWS but many people with long histories of drug and alcohol use are often at risk. Those who have underlying mental health disorders, such as anxiety or depression, are more likely to experience intensified symptoms during post-acute withdrawal.
Understanding the common symptoms of PAWS is critical for maintaining sobriety. These symptoms are primarily emotional and psychological, although physical symptoms can occur as well.
Common Symptoms of PAWS Include:
In people recovering from benzodiazepine use, specific benzodiazepines withdrawal symptoms such as muscle pain, tremors, and cognitive fog may also persist for months.
While acute withdrawal symptoms may be intense and short-lived, symptoms of PAWS are more subtle and may fluctuate in intensity over time.
If left untreated, PAWS can lead to relapse, depression, and in severe cases, suicidal thoughts. The unpredictability of symptoms can be discouraging, but recognizing them as part of the healing process is key.
For those with a history of severe addiction or co-occurring disorders, professional care is critical. Ignoring PAWS can result in a return to substance use disorder and undo months of progress.
PAWS symptoms generally begin after acute withdrawal ends, which usually lasts from a few days up to two weeks. It can last from several months up to 1-2 years, with symptoms gradually reducing in severity and frequency over time.
The duration of PAWS varies depending on several factors such as the type of substance used, length of use, overall physical and mental health, age, and gender.
For example, people recovering from withdrawal from alcohol or opioids may experience PAWS for up to a year. Those recovering from benzodiazepines may find their symptoms extend even longer.
While PAWS can feel overwhelming, it is manageable with the right tools and support. Here are evidence-based ways to reduce symptoms and support your long term recovery:
A structured treatment program provides professional support through therapy, medication management, and relapse prevention strategies. These programs help individuals learn coping skills and manage triggers.
Support groups like 12-step programs, sober living homes, or group therapy sessions can help. Talking with others who have experienced PAWS reduces feelings of isolation and offers practical advice.
Cognitive Behavioral Therapy (CBT) and trauma-informed therapy are particularly effective for addressing emotional symptoms. Therapy can also help with long-standing issues that may have contributed to active addiction.
In some cases, medications may help manage mood symptoms, sleep issues, or benzodiazepines withdrawal symptoms. Always consult a healthcare provider before starting or stopping any medication.
Even though PAWS can last for an extended period of time, it does not last forever. With the right support and consistent self-care, symptoms typically become less severe over time.
Understanding that post acute withdrawal syndrome PAWS is a normal part of recovery helps people stay committed to their goals. While healing isn’t linear, every symptom managed is a step toward lasting wellness.
If you or someone you care about is battling drug addiction, getting professional help is a crucial first step. There are many treatment options available, such as inpatient and outpatient rehab, counseling, therapy, and support groups.
At The Hope House, we offer a supportive environment and a compassionate team committed to helping you recover. Contact us today to begin your journey toward lasting sobriety.
