Post-Acute Withdrawal Syndrome or PAWS is a condition some people experience in the period after withdrawal or a medical detox. While acute withdrawal symptoms, like nausea, sweating, and tremors typically fade within days or weeks, PAWS symptoms may linger for months, affecting mood, cognition, and overall well-being. 
In this article, The Living Room at Princeton explains the symptoms and causes of Post-Acute Withdrawal Syndrome and how they are treated. We will also offer some practical advice for anyone concerned about PAWS

Understanding Post-Acute Withdrawal Syndrome

Specifically, PAWS refers to persistent withdrawal symptoms that can occur after the initial detox phase. These symptoms are primarily psychological and emotional, rather than physical. However, they can still be a challenge to someone in early recovery who has just cleared the hurdle of medical detox and is on the road to wellness. 

What Are The Symptoms of PAWS?

PAWS symptoms vary by individual, but some of the most common include:

• Mood swings – Sudden shifts between anxiety, depression, and irritability.
• Fatigue – Persistent exhaustion, even after adequate rest.
• Cognitive difficulties – Trouble concentrating, memory issues, and brain fog.
• Sleep disturbances – Insomnia or disrupted sleep patterns.
• Cravings – Strong urges to use substances, even after months of sobriety.
• Sensitivity to stress – Difficulty coping with everyday stressors.
• Social withdrawal – Feeling disconnected or uninterested in social interactions.

These symptoms can come and go, sometimes triggered by stress or environmental cues that remind individuals of past substance use.

More About PAWS Symptoms: Duration and Intensity

Who Gets Post-Acute Withdrawal Syndrome?

PAWS symptoms can fluctuate in intensity. The length of time they occur varies from person to person. People experiencing PAWS often have “good days” and “bad days” as well. The relative unpredictability of PAWS is part of the challenge of managing it. 

Post-Acute Withdrawal Syndrome is most common in individuals recovering from addiction to opioids, alcohol, benzodiazepines or stimulants. The brain undergoes significant changes during addiction, and PAWS reflects the time it takes for the brain to heal and regain balance.

How Was PAWS Discovered?

Dr. George Koob of the Scripps Research Institute studied Post-Acute Withdrawal Syndrome (PAWS) in the late 1970s and early 1980s, coining the term. His research validated long-held suspicions by addiction sufferers and clinicians alike —- that withdrawal lasts beyond the short term, impacting brain function and emotional health in recovery.

Is There a Way to Prevent Post-Acute Withdrawal Syndrome?

Other than avoiding substance misuse in the first place, there is no known way to entirely eliminate the possibility of Post-Acute Withdrawal Syndrome. However, there are many effective approaches to reducing and managing PAWS symptoms.

How is PAWS Treated or Managed?

The good news about Post-Acute Withdrawal Syndrome is that we understand it better than ever before. Much research has been done into managing the symptoms of PAWS over just the past two decades. At The Living Room, we rely on an integrated holistic approach to managing PAWS. 

Here are some of the evidence-based methods we use to manage PAWS:

Treating PAWS With Lifestyle Changes

It is believed that the majority of Post-Acute Withdrawal Syndrome symptoms are a direct result of imbalances in brain and body chemistry. Simple lifestyle changes alone can provide meaningful improvements in PAWS.

• Regular cardiovascular exercise – Physical activity boosts mood and brain function.
• Better diet and nutrition – Nutrient-rich foods, including EFAs, help support brain recovery.
• Improving sleep health – Establish a consistent routine to ensure restful sleep.

Managing PAWS with Mental Health Treatment

In addition to addressing Post-Acute Withdrawal Syndrome from the biological standpoint, we can also have a significant impact on PAWS by counteracting symptoms with mental health treatment. 

• Cognitive Behavioral Therapy (CBT) – Helps manage negative thoughts and behaviors.
• Dialectical Behavioral Therapy (DBT) – To regulate emotions, manage stress, and improve relationships.
• Individual counseling – Addresses individual growth, goal-setting and relapse prevention.

Transcending PAWS with Mindfulness Practices 

Diet, nutrition, exercise and sleep health address the body. Mental health therapy takes care of the mind. But what about spiritual wellness? This is where wellness and awareness practices take the lead.

• Meditation and deep breathing – Meditation is proven to raise awareness, help stabilize moods and increase focus.
• 12-Step Programs – Provide peer support while fostering personal growth and responsibility. 
• Recovery Journaling – Promotes self-reflection, introspection and realization .  

Should I Be Concerned About PAWS in Early Recovery?

Many, if not most people, do not experience Post-Acute Withdrawal Syndrome. The intensity of symptoms for the people who do have PAWS can vary, as does the length of time they continue. PAWS is most common in people in recovery from an opioid use disorder (OUD) of addiction to alcohol, benzodiazepines or amphetamines, like crystal meth or Adderall. 

If you or someone you love is in early recovery, or about to enter substance use disorder treatment, PAWS is something to be aware of. 

Worry alone never solves anything. But awareness is invaluable when it comes to being prepared and heading off problems early. If your personal experience included addiction to alcohol, opioids, benzos (like Xanax) or stimulants—then becoming more informed about PAWS is wise, just in case. 

Begin Your Transformation at The Living Room

The Living Room at Princeton is perhaps New Jersey’s most forward-thinking addiction treatment program. Our unique blend of evidence-based clinical care methods is perfectly balanced by our holistic approach to addiction care. Our mission is simple. To both heal and  empower the people entrusted to our care to manage their own personal growth for successful long-term recovery. 

Let’s talk about what The Living Room can do for you or the one you love, today.