PAWS stands for post-acute withdrawal syndrome, and it affects people in addiction recovery. It is generally a less-severe version of the symptoms that occur during the original detox process, and it usually occurs four to eight weeks post-withdrawal.
It is important to note that not everyone in addiction recovery experiences PAWS, but knowing about the phenomenon can be helpful for people who worry that their recovery may be in danger. The severity of PAWS is affected by a person’s age, the general state of health, and how long and how severe the addiction was.
PAWS Varies Depending on Addictive Substance
The symptoms of PAWS vary depending on what the addictive substance of choice was, but there are some common themes. Typical symptoms, regardless of the drug of choice, include:
- Emotional instability
- Anxiety
- Difficulty coping with stress
- Lack of energy
- Sleep problems
- Memory problems
- Balance and reflex problems
- Dizziness
- Heightened risk of accidents
The following table lists primary PAWS symptoms for various addictive substances, though the list is not definitive. In other words, it is possible for someone in addiction recovery from alcohol to experience some of the same symptoms as someone in recovery from opioid addiction.
| Drug |
Primary PAWS Symptoms |
| Opioids |
Anxiety, depression, sleep dysfunction |
| Methamphetamine |
Deficits in executive functions (cognitive processes needed for attainment of goals) |
| Cocaine |
Difficulties with emotional regulation and impulse control |
| Marijuana |
Sleep disturbances and unusual dreams |
| Alcohol |
Agitation, depression |
| Benzodiazepines |
Anxiety, hostility, irritability |
During active addiction, the brain’s dopamine signaling system is altered, and as a result, brain levels of dopamine, serotonin, GABA, and glutamate may be affected. In general, the longer the addiction, the longer symptoms of PAWS last.
Addiction alters brain chemistry. In some cases, treating PAWS symptoms with antidepressants can offer relief.
Why the Timing of PAWS Can Be Vexing
One of the biggest problems with PAWS is that symptoms tend to peak four to eight weeks after detoxing. That often coincides with the completion of 30- or 60-day addiction rehabilitation programs. In other words, PAWS may peak precisely when a person leaves rehab, and this can make the transition to the home environment more challenging.
Understanding what PAWS is, why it occurs, and what to expect can help people in addiction recovery cope with what is happening. Unfortunately, PAWS can increase the risk of relapse, so it is important to know what it is and how to cope with it in healthy ways.
Treatment of Co-Occurring Disorders Important
People in addiction recovery who have co-occurring disorders like depression must monitor their mental health and ask for help from their mental health professional if symptoms are severe. In some cases, adjusting the dosage of antidepressants, or changing the medication mix can improve PAWS symptoms. It is important to have access to a support network at all times, including a 12-step sponsor, rehabilitation counselor, or others who understand the addiction and can help determine whether problems are due to PAWS or something else.
Practical Steps for Coping with PAWS
Self-care is essential for coping successfully with PAWS and making it through until addiction recovery starts to feel positive again. Identifying your support system is one of the most helpful things you can do. Other steps that can assist with PAWS include:
- Identifying emotional triggers like boredom, loneliness, and anger
- Setting aside time each day for relaxation
- Trying to maintain a regular sleep pattern
- Consuming a healthy diet high in fruits, vegetables, and unprocessed foods
- Participating in regular exercise, even if it is just a daily walk
- Practicing self-kindness
- Understanding that PAWS will abate with care and time
It is important for people in addiction recovery to celebrate accomplishments, such as sobriety milestones or learning new coping skills. PAWS is not permanent, and medical and mental health treatment can help.
Addiction recovery is like recovery from any other serious illness. It takes time for the mind and body to heal. Understanding PAWS and being prepared with a strong support network and healthy coping skills can help ensure that the syndrome does not result in relapse. If you have questions about addiction recovery, we encourage you to contact us today.
