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Post-Acute Withdrawal Syndrome

Recovery from addiction is a life-changing journey, but it comes with many inbuilt challenges, beginning with detox and withdrawal. While the initial phase of detox focuses on clearing substances from the body safely and comfortably, many people are surprised to discover that the healing process doesn’t stop there. 

PAWS (post-acute withdrawal syndrome) is a phase that can follow detox, which can involve emotional and psychological symptoms that linger for weeks or months. Post-acute withdrawal symptoms manifest as the brain works to restore balance after prolonged substance use. This page addresses issues like what is PAWS, what does PAWS mean for long-term recovery, and how to connect with compassionate and effective detox and addiction treatment services.

TL;DR: Post-Acute Withdrawal Syndrome (PAWS) is a challenging phase of recovery that can cause lingering emotional and psychological symptoms for weeks or months after detox—without proper support, it often leads to relapse.1 If you’re struggling with post-acute withdrawal syndrome after detox, we can help. Call Tree House Recovery at (855) 202-2138 to start treating PAWS with rehab programs designed for lasting recovery.

What is PAWS?

PAWS—post-acute withdrawal syndrome—refers to a set of lingering withdrawal symptoms that appear after the initial detox phase of addiction recovery2. Unlike the physical symptoms of acute withdrawal, which generally last a few days to a couple of weeks, PAWS is primarily psychological and emotional. It occurs as the brain and body adjust to life without drugs or alcohol. Symptoms may include anxiety, depression, mood swings, fatigue, and trouble concentrating2. 

Post-acute withdrawal is a natural part of the recovery process and results from the chemical changes in the brain triggered by substance use3. PAWS withdrawal can catch people off guard because many assume that once detox is over, the hard part of recovery is done. That said, PAWS can be more protracted and unpredictable, with symptoms coming and going in waves. While PAWS can be aggravating and taxing, it’s also manageable with the proper support.

What Causes PAWS?

PAWS may manifest because addiction changes how the brain works4. Substances like alcohol, opioids, benzodiazepines, and stimulants flood the brain with chemicals like dopamine, prompting feelings of pleasure and euphoria. Over time, the brain becomes dependent on these substances to maintain normal chemical levels. This is why, when someone moderates or discontinues use, the brain struggles to regulate itself. 

During active addiction, the brain reduces its production of feel-good chemicals, relying instead on the substance to provide them. When these substances are removed, it takes time for the brain to recover and produce these chemicals naturally. This adjustment period is what provokes the symptoms of PAWS. 

The longer someone has used additive substances and the higher the doses, the more severe brain changes can be. Health conditions, age, and other factors can also influence the intensity of post-acute withdrawal symptoms. 

PAWS is not limited to one substance or type of addiction. That said, alcohol, opioids, benzos, and stimulants are more likely to cause severe post-acute withdrawal symptoms. These substances profoundly impact the brain’s reward system, slowing and complicating healing. While everyone’s experience with PAWS differs, the underlying cause is the same: the brain’s journey to rebalance itself.5

The Dangers of Post-Acute Withdrawal Syndrome

Relapse is one of the most significant risks of PAWS. The symptoms can be exhausting, frustrating, and emotionally draining, leaving individuals vulnerable to returning to addictive substances for relief. Someone who completes detox and starts rebuilding their life may feel discouraged or hopeless when PAWS symptoms suddenly present, often without warning. In the absence of proper support and education, this emotional distress can lead to relapse.6  Unpredictability is another danger associated with PAWS. Symptoms can vary from person to person and may come in waves that appear to lessen, only to resurface weeks or months later. This lack of consistency can make it difficult for people to plan their recovery or understand what’s happening to them. Without clear guidance, many mistake the symptoms of PAWS for unrelated mental health issues or assume recovery isn’t working. This can lower their motivation to stay sober in the long term.  Beyond this, PAWS can be damaging to physical and mental health. Chronic fatigue, poor sleep, and mood swings can impact a person’s ability to function at work, in relationships, or in daily life. The emotional strain can also inflame depression or anxiety, making recovery feel unmanageable.

Post-Acute Withdrawal Symptoms

The symptoms of post-acute withdrawal syndrome affect thoughts, emotions, and mental health, making them difficult to deal with. While they differ from person to person, some of the most common symptoms of PAWS include: 
  • Mood swings: Intense and unpredictable emotional shifts, such as sudden irritability, anger, sadness, or hopelessness.
  • Depression and anxiety: Feelings of sadness, low energy, or excessive worry, sometimes accompanied by panic attacks or a sense of dread.
  • Sleep disturbance: Difficulty falling or staying asleep, distressing and vivid dreams, or waking up feeling unrested.
  • Fatigue: Persistent tiredness, even after a whole night’s sleep, making it hard to stay active and engaged.
  • Brain fog: Problems with memory, focus, and mental clarity, often prompting frustration or difficulty completing tasks.
  • Cravings: Powerful urges to use drugs or alcohol, which can feel overpowering and emotionally draining.
  • Physical symptoms: Unexplained aches, headaches, muscle tension, or other discomforts that mimic physical withdrawal. 
Symptoms can come and go, sometimes disappearing for weeks and resurging unexpectedly. PAWS might feel demoralizing, but it’s temporary. The symptoms will decrease in intensity and frequency with time, support, and effective coping strategies.7

How Long Does PAWS Last?

The duration of post-acute withdrawal syndrome depends on: 

  • Type of substance used
  • Length and severity of addiction
  • Individual health 

Most people find that PAWS symptoms are most intense in the first few months of recovery, but they may linger for a year or more in some cases.

During the early stages, symptoms often come and go in bursts. For example, someone might feel fine one day and emotionally overwhelmed the next. This unpredictable pattern can make it feel like recovery is going in circles rather than a straight line. Over time, though, the waves of symptoms become less frequent and much less intense. 

Alcohol and benzos are often associated with PAWS symptoms that last up to 2 years due to the significant brain changes they cause. Opioids and stimulants like cocaine or meth may also result in long-term psychological symptoms like mood swings, fatigue, and cravings. 

If you are affected by post-acute withdrawal syndrome, keep in mind that the brain has a remarkable ability to heal. As time goes on, symptoms become manageable and then disappear. Staying committed and using healthy coping techniques can help you work through this stage and move closer to lasting recovery, with PAWS a distant memory.

Withdrawal Treatment at Tree House Recovery

At Tree House Recovery, recovery from addiction involves more than detoxing from substances. We’ll help you heal your body, mind, and spirit with treatment programs designed to provide the tools and support to work through all stages of recovery, including post-acute withdrawal symptoms. 

Our approach combines evidence-based therapies with holistic practices to address the demands of PAWs. Individual therapy helps young men manage the emotional and psychological symptoms of withdrawal, such as anxiety, depression, and mood swings. Through techniques like CBT (cognitive behavioral therapy), individuals learn strategies to cope with stress, improve emotional regulation, and stay focused on their recovery goals regardless of difficulties and stressors. 

We prioritize physical wellness alongside therapy. Regular exercise, proper nutrition, and yoga are core components of our rehab programs for young men, helping them restore balance in their bodies while reducing stress. Exercise improves mood, boosts energy levels, and supports the brain’s recovery from the chemical changes triggered by addiction. 

Education is also an integral aspect of our treatment program. We teach young men what to expect during PAWS, helping them identify symptoms and develop healthy coping mechanisms. Knowledge empowers them to confront challenges head-on and avoid relapse during this vulnerable phase of addiction recovery. 

Our community-focused approach at Tree House ensures that young men can lean on a robust support system. Group therapy and peer support promote connection and understanding, reduce isolation, and remind individuals that they’re not alone. For immediate assistance with all aspects of recovery from drug or alcohol addiction, call Tree House at (855) 202-2138.

Common FAQs About Post-Acute Withdrawal Syndrome

After detox, recovery continues with Post-Acute Withdrawal Syndrome (PAWS), where emotional instability, anxiety, or brain fog can occur. These symptoms are normal and reflect the brain’s slow return to balance after substance use.

Your PAWS timeline will vary. Some people recover in weeks, others may take months or years, especially after long-term substance use. Recovery speed depends on personal history, health, and support, with consistent guidance being key.8

PAWS mostly affects how people feel and function emotionally and mentally. Symptoms can vary, but often include:

  • Sudden feelings of depression or sadness
  • Anxiety that comes without a clear cause
  • Mood shifts that feel intense or irrational
  • Sleep troubles, including vivid dreams or restless nights
  • Ongoing fatigue, even after rest
  • Foggy thinking or forgetfulness
  • Emotional flatness or a sense of being disconnected
  • Cravings that seem to come out of nowhere

PAWS can feel overwhelming and lead to doubt or relapse if unexpected. Recognizing the symptoms and preparing for it helps maintain recovery when challenges arise.

Detox clears substances from the body, but the brain takes longer to adjust. PAWS is the brain’s process of relearning balance after dependency. With time and support, stability and clarity return.

  1. Kosten TR, Baxter LE. Review article: Effective management of opioid withdrawal symptoms: A gateway to opioid dependence treatment. Am J Addict. 2019;28(2):55-62. doi:10.1111/ajad.12862
  2. Carty B. Post-Acute Withdrawal Syndrome. September 27, 2016. Accessed June 16, 2025. https://sbmi.uth.edu/heroes/documents/Post-Acute-Withdrawal.pdf. 
  3. Neurobiology of Substance Use, Misuse, and Addiction. Facing Addiction in America – NCBI Bookshelf. November 1, 2016. https://www.ncbi.nlm.nih.gov/books/NBK424849/. Accessed June 11, 2025. 
  4. Harvard Health. Understanding Addiction: How Addiction Hijacks the Brain – HelpGuide.org. HelpGuide.org. April 2024. https://www.helpguide.org/mental-health/addiction/how-addiction-hijacks-the-brain. Accessed June 11, 2025.
  5. Koob GF, Volkow ND. Neurobiology of addiction: A neurocircuitry analysis. Lancet Psychiatry. 2016;3(8):760–773. doi:10.1016/S2215-0366(16)00104-8.
  6. Drugs and the brain. In: Drugs, Brains, and Behavior: The Science of Addiction. National Institutes of Health; 2020. Accessed June 11, 2025. 
  7. Khan M, Ahmed S, Uddin M, Hossain S, Ullah A. A review on sexual dysfunction by atypical antipsychotic drugs. Arch Pharm Pract. 2021;12(4):91–97. doi:10.51847/zrQO2kIQJr
  8. Abdallah M, Krushinski JH. Benzodiazepine Toxicity. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559031/
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