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Post Acute Withdrawal Syndrome

Clinically Reviewed by Linda Whiteside, LPCC

Medically Reviewed by: Dr. Ryan Peterson, MD

Post Acute Withdrawal Syndrome

Table of Contents

What is Post Acute Withdrawal Sysmptoms or PAWS?

When people quit using drugs and alcohol after a long period of addiction, the result can be unpredictable. Some individuals report being on a “pink cloud,” or experiencing a profound sense of euphoria and optimism about the future. However, others find the initial period of early sobriety to be profoundly challenging. They may face emotional problems that, after years of numbing their pain, are suddenly very apparent. Many individuals report feelings of depression during the initial first months of sobriety. 

While it is important to treat these feelings and take them seriously, assessing whether a person is actually suffering from depression or not is the first step. Many of the side effects of major depressive disorder are similar to the side effects of post-acute withdrawal syndrome (PAWS). If you have recently withdrawn from an addictive substance, there is a chance your negative experiences can be attributed to PAWS.

Symptoms of Post-Acute Withdrawal Syndrome

When people stop taking drugs or alcohol, they generally go through a withdrawal process that can last anywhere from a few days to a few weeks, depending upon the substance. While some substances, like alcohol and benzodiazepines, have life-threatening withdrawal symptoms, others are excruciating without being life-threatening, like opioids. 

Some substances have relatively minor withdrawal effects, like cannabis, though cravings can nonetheless make withdrawal difficult to endure. Even though it can subjectively feel like a long time, acute withdrawal generally ends after a short period. Afterwards, people can begin to rebuild their lives and develop the strong foundation of tools they need to remain sober over the long-term.

Post-acute withdrawal syndrome, which affects a small subset of people in recovery, causes them to experience withdrawal symptoms long after their bodies have physically detoxed. Certain substances, like benzodiazepines, are more likely to lead to post-acute withdrawal syndrome. Symptoms of post-acute withdrawal syndrome include:

  • Irritability, hostility, and a sense of being “on edge”
  • Mood swings
  • Cognitive problems related to problem solving, learning, or memory recall
  • A prevailing sense of panic or floating anxiety
  • Depressed mood or low affect
  • Low energy or fatigue
  • Interpersonal problems, including problems maintaining social relationships
  • Sleep problems, ranging from insomnia to oversleeping
  • Obsessive-compulsive behaviors
  • Lack of libido
  • Decreased resilience to stress
  • Strong cravings for the substance one was addicted to
  • Apathy, indifference, or pessimism

Most of these symptoms wax and wane over a long period. Some people experience the symptoms of post-acute withdrawal syndrome months after detoxing successfully. The negative symptoms of PAWS can also be triggered by environmental factors. People with untreated emotional issues, those living in stressful environments, and individuals who suffered from addiction for longer periods of time are more likely to develop post-acute withdrawal syndrome.

How Long Does Post-Acute Withdrawal Syndrome Last?

The research on post-acute withdrawal syndrome is relatively scarce, and there is no set timeline for how long post-acute withdrawal syndrome lasts. Most sufferers report a range of timelines. For some, post acute withdrawal syndrome lasts a few extra weeks after acute withdrawal. 

Others experience symptoms for several years. However, people who suffer from PAWS can do a lot to control how long symptoms will last. It isn’t just a matter of waiting it out and hoping for the best. If you or someone you love is suffering from PAWS, the best way of reducing symptoms is seeking the help of an addiction treatment center.

Treatment For Post-Acute Withdrawal Syndrome

Ultimately, the best course of action for anyone suffering from emotional difficulties following withdrawal is speaking to an addiction expert or medical professional. If a psychiatrist diagnoses you with major depressive disorder, they will likely recommend talk therapy or an antidepressant prescription. If you suffer from PAWS, enrolling in an addiction treatment program is generally the best course of action.

It is crucial to understand that most people who suffer from addiction, whether they develop PAWS or not, require additional support after acute withdrawal ends. Addiction is not a condition that can be “cured.” After a person successfully withdraws from a substance, it is generally best that they work hard to develop the tools they need to manage their addiction and avoid relapse down the line. 

Research shows that people who remain in addiction treatment programs for longer periods of time have significantly lower relapse rates and find it easier to rebuild new and prosperous lives in sobriety. Intensive outpatient treatment centers, partial hospitalization programs, and outpatient centers programs can help individuals by providing behavioral therapy and other coping tools. These programs also help individuals develop strong sober social support networks, which not only helps people deal with the emotional problems associated with PAWS but reduces their chances of relapse. 

If you suffer from post-acute withdrawal syndrome, an addiction rehabs in Los Angeles CA can help you manage your condition.

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Written By: Linda Whiteside

Licensed Clinical Professional Counselor who has been providing mental health services for over 10 years.

Medically reviewed by: Dr. Ryan Peterson

Went to medical school at The George Washington University School of Medicine in Washington, D.C.

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