What is Post-Acute Withdrawal Syndrome?

What is post-acute withdrawal syndrome? Post-acute withdrawal syndrome or PAWS is a set of unpleasant drug withdrawal symptoms that may persist for weeks or even many months after the acute drug withdrawal phase has passed. It’s thought to be caused by drug-induced changes in the brain that affect its neurotransmitter levels. Until these levels normalize, PAWS may continue.

Abusers of benzodiazepines appear to be most at risk of PAWS, but it can and does happen as a result of opioid abuse as well. In fact, PAWS can happen to anyone who has used an addictive substance for any length of time. Even chronic marijuana use can result in symptoms of PAWS in some people.

It’s also possible to experience PAWS after stopping antidepressant and anti-psychotic drugs. Although these are not normally drugs of abuse, they still affect the brain’s neurotransmitter system and can result in symptoms of PAWS. Neurotransmitters are chemicals the brain uses for brain cell function and communication. Examples are norepinephrine and dopamine. Dopamine is linked to substance abuse because it’s associated with feelings of pleasure and reward.

Symptoms of PAWS

These are more subtle but no less disturbing than those of acute withdrawal. PAWS is discouraging and interferes with the responsibilities and pleasures of everyday life. Sometimes, it may seem like it will never end. Common symptoms include:

  • Difficulty with memory and learning
  • Irritability and anxiety
  • Depression and inability to experience pleasure
  • Apathy and mood swings
  • Drug cravings
  • Increased stress
  • Insomnia
  • OCD
  • Difficulty with social relationships

PAWS may also involve explained chronic pain and the emergence of other physical symptoms that led to the use of the drug in the first place.

Drug Classes and PAWS

It’s interesting that different drug classes tend to produce specific PAWS symptoms. For example, PAWS after opioid abuse often results in depression, sleep dysfunction, anxiety, fatigue and drug cravings. Methamphetamine PAWS is associated with a cognitive dysfunction that makes it hard for a person to attain goals. PAWS from marijuana may involve sleep disturbances and vivid, unusual dreams. Symptoms from other drugs may include:

  • Cocaine: lack of impulse control and mood swings
  • Benzodiazepines: anxiety, insomnia and panic attacks

Coping with PAWS

There is no specific treatment for PAWS symptoms. It’s often just a waiting game while the brain adjusts its neurotransmitter levels. A medication called acamprosate may help to ease some of the symptoms of PAWS. Acamprosate is also used to help reduce cravings for alcohol in recovering alcoholics.

PAWS symptoms may come and go and can be unpredictable. You may feel fine one day and rotten the next. It takes patience to deal with PAWS.

Although there are no specific remedies for PAWS, supportive self-care may help you to get through it faster and may help reduce the intensity of some symptoms.


Exercise may help PAWS by inducing the body to release its own natural opiates called endorphins. These brain chemicals elevate mood and work to relieve pain. Exercise also relieves stress and improves muscle tone and heart health. It may boost your mood further to walk or jog along the beach or along a forest pathway. Sunshine and ocean waves both work to elevate mood, too.

Nutritional Therapy

Medical nutritional therapy is called MNT and may help to alleviate symptoms of PAWS by supplying the body with the nutrients it needs to recover after substance abuse. Because PAWS is probably caused by disturbances in the brain’s neurotransmitter system, it makes sense that providing the body with the raw materials it needs to make these neurotransmitters would improve PAWS symptoms.

The body makes neurotransmitters in part from amino acids. These are the building blocks present in protein-rich foods like meat, cheese and dairy products. Some amino acids can be produced by the body. Others cannot. These are called essential amino acids because they must be obtained from food.

Healthy carbohydrates like whole grains help the body produce the neurotransmitter serotonin, which is associated with normal mood and feelings of happiness.

You may want to consult with a nutritionist or dietitian knowledgeable in the dietary management of PAWS.

For More Help with PAWS

If you’re struggling with PAWS, you’re not alone. Know that it will eventually end. In the meantime, we can assist you with some information and resources to make coping with PAWS easier. Don’t let PAWS result in your relapse. Just call us anytime at 844-639-8371 and a trained counselor will be happy to help you .

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