If you or someone you know is in crisis right now: call or text 988 (Suicide & Crisis Lifeline). For a possible overdose or any medical emergency, call 911. For help finding treatment, the SAMHSA National Helpline is free and open 24/7 at 1-800-662-4357.
The short answer
Post-acute withdrawal syndrome (PAWS), also called protracted withdrawal, describes lingering symptoms such as mood swings, anxiety, poor sleep, low energy and cravings that can continue for weeks or months after the first withdrawal phase ends. Not everyone gets it, symptoms usually improve with time, and there are practical ways to cope. If symptoms are severe or you feel unsafe, get help.
What is PAWS?
After acute withdrawal passes, the brain and body keep adjusting. Some people experience symptoms that come and go in waves. “PAWS” is a widely used term, but it is not a formal diagnosis in the main diagnostic manual, and research on how common it is and how long it lasts varies by substance. That is why symptoms should be taken seriously but also checked by a clinician.
Common symptoms
- Mood: irritability, anxiety, low mood, mood swings, feeling numb
- Sleep: insomnia, vivid dreams, unrefreshing sleep
- Thinking: trouble concentrating, memory lapses, mental fog
- Energy: fatigue, low motivation
- Body: aches, headaches, changes in appetite
- Cravings: that may come in waves, often triggered by stress
- Stress sensitivity: feeling easily overwhelmed
Symptoms can differ by substance. They are often reported with alcohol, opioids and benzodiazepines, and they can last longer with benzodiazepines. (See [Benzodiazepine Dependence: Why Tapering Should Be Medically Supervised].)
How long does it last?
It varies a lot. Many people notice improvement over weeks to a few months, and some have symptoms that fade more slowly. Symptoms tend to come in waves, with good days and bad days, rather than staying constant. Getting better is the usual pattern.
Is it PAWS, or something else?
Lingering symptoms can also come from:
- A co-occurring condition, such as depression, anxiety, PTSD or ADHD
- Sleep problems such as sleep apnea
- Medical issues, such as thyroid problems
- Medication effects
- Early signs of relapse
That is why it is worth telling your doctor or counselor about your symptoms rather than guessing. (See [Dual Diagnosis Treatment: When Addiction and Mental Health Overlap].)
How to cope
Protect the basics
- Sleep: keep regular hours, limit caffeine and screens late at night, and keep the bedroom dark and cool.
- Food and water: eat regularly and stay hydrated.
- Movement: daily gentle exercise, such as walking, can help mood and sleep.
- Routine: structure reduces stress and uncertainty.
Manage stress
- Breathing exercises, mindfulness or meditation
- Time outdoors
- Limiting overload by breaking tasks into small steps
Get support
- Therapy, such as CBT, to handle anxiety, low mood and cravings. (See [Evidence-Based Therapies in Addiction Treatment: CBT, DBT and Contingency Management].)
- Peer groups, which can normalize what you are feeling. (See [AA vs SMART Recovery vs Other Mutual-Help Groups: Which Fits You?].)
- Your care team, including a doctor who knows your history.
- Medication for substance use or for mental health, if appropriate. (See [Medication-Assisted Treatment (MAT): How It Works and Who It’s For].)
Plan for the waves
- Name it. “This is a wave, and it will pass.”
- Use your coping list. Call someone, go for a walk, attend a meeting.
- Avoid big decisions during a rough stretch when you can.
- Keep your relapse-prevention plan close. (See [What Is Aftercare? How to Build a Relapse-Prevention Plan].)
When to get help
Contact your doctor or counselor if:
- Symptoms are severe, getting worse or interfering with daily life
- You cannot sleep for days
- Cravings feel overwhelming
- You have panic, hopelessness or thoughts of using
If you have thoughts of suicide or self-harm, call or text 988 right away.
If you are a family member
Be patient. Your loved one may be moody, tired or forgetful for a while. Encourage sleep, routine and treatment, and avoid taking symptoms personally. (See [Rebuilding Relationships and Trust in Recovery].)
Frequently asked questions
What is PAWS?
Lingering symptoms such as mood swings, anxiety, poor sleep and cravings that can continue after acute withdrawal ends.
How long does PAWS last?
It varies. Many people improve over weeks to months, and symptoms often come in waves.
Does everyone get PAWS?
No. It differs by person and substance.
Is PAWS a medical diagnosis?
The term is widely used, but it is not a formal diagnosis. Talk to a clinician about your symptoms.
How can I cope with PAWS?
Protect sleep, food and exercise, manage stress, use support and tell your care team.
Sources
- SAMHSA. TIP 45: Detoxification and Substance Abuse Treatment. samhsa.gov
- National Institute on Drug Abuse. Treatment and Recovery. nida.nih.gov
- American Society of Addiction Medicine. The ASAM Criteria. asam.org
This article is for general information only and is not medical advice. Talk to a qualified health professional about your symptoms.