• Nicole Arzt

A Guide to Understanding Post-Acute Withdrawal Syndrome


Post-acute withdrawal syndrome (PAWS) refers to the various physical and psychological difficulties that can linger for several weeks or months after stopping from substance use. These symptoms range in severity, but they may last anywhere from 6-24 months. If left untreated, PAWS can cause serious distress and potentially lead to a relapse.


While PAWS can be uncomfortable, having awareness is key. Understanding symptoms- and learning how to manage them- can help you feel more empowered in your recovery. Let's get into what you need to know.


Who Is at Risk for PAWS?

PAWS is most common among people who experience addiction to alcohol, opioids, or benzodiazepines.

However, anyone can develop complications after abstaining from drugs or alcohol. Some complications arise very quickly and present themselves during detox. Others may not emerge for several months into recovery.


Substance abuse affects one's neurobiology, which fundamentally impacts how your brain reacts to stress and stimulation. Subsequently, you are more vulnerable to experiencing difficulties reintegrating back into a healthy routine.


You may also be at a heightened risk for PAWS if you:

  • have a chronic medical condition.

  • struggle with polysubstance abuse.

  • lack healthy social support.

  • have a co-occurring mental health condition like depression or anxiety.

  • have a history of PAWS during previous abstinent periods.

What Are Common PAWS Symptoms?

Many people describe PAWS as "being on a rollercoaster." In this sense, it's normal to experience varying ups and downs and different twists and turns. This, of course, can feel unnerving, particularly if you are trying to build a recovery rooted in consistency and structure.


Some of the most common PAWS symptoms include:

  • increased irritability and agitation towards oneself and others

  • depression

  • anxiety and hypervigilance

  • mood swings

  • fatigue

  • fluctuating energy levels

  • poor concentration

  • anhedonia (lack of interest in usual hobbies or relationships)

  • sleep disturbances or trouble sleeping

  • increased feelings of chronic pain

  • libido problems

  • obsessive-compulsive issues

  • intense cravings for the desired substance

The symptoms often feel more intense at the beginning of recovery. Your mood may seemingly shift every hour, and it's challenging to know how you will feel on a given day. In addition, as you progress along with your recovery, certain symptoms may disappear- only to reemerge several weeks or months later.


How Can You Cope with PAWS?

Even the best treatment cannot safeguard you against the difficulties of early recovery. It's crucial to avoid blaming yourself or assuming you did something wrong if you're struggling with PAWS. Here are some tips to help you cope with these challenging symptoms.


Educate Yourself

Learn about the common PAWS symptoms and spend some time reflecting on which ones you identify with having. Then, think about any destructive patterns that you want to change and identify any supportive people who you believe can help you on your journey.


Be Honest With Yourself (And Others)

Be careful of the insidious lies like, I'm fine, or That doesn't trigger me. Be mindful of how you try to tell yourself everything is okay, even when it absolutely isn't.


Personal accountability is the first step of any successful coping. You must be willing to be honest about your feelings and experiences. While honesty can feel vulnerable and scary, it's often much easier than dealing with the tumultuous consequences of a relapse.


Discipline Yourself to Use Coping Skills

Get in the habit of taking care of yourself. Practice stress management by adhering to a routine that honors your physical and emotional well-being. This routine can include important activities like exercise, practicing enjoyable hobbies, socializing with friends, attending religious events, or setting boundaries.


Aim to use coping skills even when you don't feel stressed or upset. The more you can practice them when things are going well, the more second-nature self-care becomes. This pattern positions you to feel more comfortable using them during difficult times.


Practice More Mindfulness and Acceptance

Even with the best coping strategies in place, PAWS can still feel challenging and defeating. Mindfulness entails embracing the present moment without trying to ruminate on the past or plan the future. Practicing mindfulness can help you learn how to withstand stress.


Acceptance also entails embracing the present moment. But it also requires allowing yourself to cope with whatever challenges life presents. Rather than try to fight or change the situation, you simply learn to adapt to it.


The more you can integrate these key principles into your life, the more you will learn to trust yourself and the world around you. Having this trust can be an integral part of succeeding in your recovery.


Final Thoughts

Post-acute withdrawal syndrome can undoubtedly be a frightening and frustrating experience. It may also feel confusing, especially if you identify as being motivated for your recovery. However, educating yourself and recognizing how to cope with challenging stressors can help you feel more empowered during difficult times.


At The Resurface Group, we recognize that recovery transcends formal treatment episodes. We know it's a long game, and we're here to help you embrace the rollercoaster, no matter how scary it may feel. Contact us today to learn more!