Medically reviewed by Kevin Wandler, MD, Chief Medical Advisor
Many people expect to feel steadily better once detox is over. So it can be confusing, and discouraging, when weeks later they are still dealing with poor sleep, irritability, low energy or sudden cravings. These lingering symptoms are often described as post-acute withdrawal syndrome, or PAWS.
This article explains what PAWS is, which symptoms are common, why it happens, how long it may last and what you can do to cope. Understanding PAWS can help you recognize it as part of healing rather than a sign that something has gone wrong.
What Is Post-Acute Withdrawal Syndrome?
Withdrawal is often described in two stages. The acute stage happens soon after stopping a substance and involves mostly physical symptoms. The post-acute stage can follow, with symptoms that are more emotional and cognitive and that may come and go over a longer period.
PAWS is not a formal diagnosis in the main psychiatric diagnostic manual, and researchers are still learning about it. But the Substance Abuse and Mental Health Services Administration and many clinicians recognize that people in early recovery commonly experience protracted or lingering withdrawal symptoms. Naming it can help people prepare for it.
Common PAWS Symptoms
Symptoms vary from person to person and substance to substance, but frequently reported ones include:
- Mood swings, irritability or feeling easily overwhelmed
- Anxiety or restlessness
- Low mood or trouble feeling pleasure
- Sleep problems, including insomnia or vivid dreams
- Trouble concentrating, remembering things or thinking clearly
- Low energy and fatigue
- Increased sensitivity to stress
- Cravings that seem to come out of nowhere
A hallmark of PAWS is that symptoms often come in waves. You may have several good days, then a rough stretch, often triggered by stress, poor sleep or reminders of past use.
Why PAWS Happens
Alcohol and drugs change the brain’s chemistry over time, especially the systems that regulate mood, stress, reward and sleep. After the substance is gone, those systems need time to rebalance. The acute physical withdrawal may be over, but the brain is still recalibrating. PAWS reflects that ongoing healing process.
Lingering symptoms have been described after stopping many substances, including alcohol, benzodiazepines, opioids, stimulants and cannabis. People who used heavily or for a long time may notice them more.
How Long Does PAWS Last?
There is no set timeline. For some people, lingering symptoms fade over a few weeks. For others, they come and go over several months, gradually becoming less frequent and less intense. The general trend, with continued recovery and support, is toward improvement.
If symptoms are getting worse rather than better, or if they are severe, it is important to talk with a medical or mental health professional. What looks like PAWS can sometimes be a separate condition, such as depression or an anxiety disorder, that deserves its own treatment.
Practical Ways to Cope
- Expect it. Knowing PAWS may happen makes it less alarming when it does.
- Protect your sleep. Keep a consistent schedule, limit caffeine later in the day and create a calming bedtime routine.
- Eat regularly and move your body. Balanced meals and gentle exercise support mood and energy.
- Practice stress management. Mindfulness, slow breathing and grounding techniques can help during difficult waves.
- Break tasks into small steps. If concentration is hard, write things down and take on one thing at a time.
- Stay connected. Talk with your therapist, support group or trusted people when symptoms flare.
- Track your symptoms. A simple journal can help you see patterns and notice gradual progress.
Our article on the emotional stages of addiction recovery offers more perspective on the ups and downs of this period.
When PAWS Raises the Risk of Relapse
Because PAWS can make people feel frustrated and low, it can also make returning to use seem tempting. Remember that these symptoms are temporary and part of healing. If you notice cravings getting stronger or feel your commitment slipping, reach out to your care team right away.
If a return to use does happen, be careful. Tolerance drops after a period without substances, which raises overdose risk. Withdrawal from alcohol and benzodiazepines can be life-threatening, so do not stop those abruptly again without medical guidance. Call 911 in an emergency, and if you have thoughts of suicide, call or text 988.
How Treatment Helps With PAWS
Ongoing treatment gives you tools and support during the months when PAWS is most likely. At Promises Dallas-Fort Worth, therapy approaches such as dialectical behavior therapy teach skills for tolerating distress and managing intense emotions, while cognitive behavioral therapy and mindfulness-based approaches help with cravings and anxious thinking.
For many people, our virtual intensive outpatient program is a helpful bridge after more intensive care, meeting online several days a week for adults anywhere in Texas. Every client also receives aftercare planning that anticipates challenges like PAWS. If you have not yet started, our medical detox services are the first step.
Frequently Asked Questions
Is PAWS a sign that treatment is not working?
No. Lingering symptoms are a common part of early recovery as the brain heals. They usually improve with time and support.
Can PAWS happen after quitting alcohol?
Yes. Lingering sleep, mood and concentration problems are commonly reported after stopping alcohol, as well as other substances.
Should I take medication for PAWS?
Talk with your provider. They can evaluate your symptoms and recommend treatment, which may include medication for co-occurring conditions when appropriate.
Get Support Through Every Stage of Recovery
PAWS can be hard, but you do not have to push through it alone. Our admissions team is available 24/7 to talk about treatment options at every stage of recovery.
Our team can look up your benefits through free, confidential insurance verification. Start with our insurance options page, call (469) 546-9303, or send us a message online.