Post-Acute Withdrawal Syndrome (PAWS)

What Is Post-Acute Withdrawal Syndrome (PAWS)?

Post-acute withdrawal syndrome, or PAWS, refers to a group of symptoms that can linger for weeks or even months after you stop using alcohol, opioids, benzodiazepines or other substances. These symptoms can come as a surprise and catch you off guard, especially after completing detox. Common PAWS symptoms include:

• Mood swings
• Sleep problems
• Fatigue
• Cravings
• Difficulty concentrating

Unlike the intense physical effects of acute withdrawal, PAWS—sometimes called protracted withdrawal—affects your emotional balance, energy and focus long after detox ends. Acute withdrawal marks the beginning of recovery. PAWS follows and can last much longer.

If recovery feels harder than expected, and you're feeling foggy, anxious or emotionally raw, PAWS may be the reason. Many people in recovery experience these symptoms, and when symptoms persist or intensify, the risk of relapse can increase. Recognizing PAWS early and building a support plan can help you respond proactively.

At Hazelden Betty Ford, care is available when PAWS symptoms begin to disrupt daily life, offering support to help you regain stability and continue building your recovery.

PAWS Symptoms by Substance Type

Symptoms of Post-Acute Withdrawal Syndrome can vary depending on the substance(s) you've used and how long. Here are some symptoms you might notice.

• Alcohol: Anxiety, depression, sleep problems, cravings, irritability, fatigue
• Opioids: Mood swings, insomnia, low motivation, difficulty concentrating
• Benzodiazepines: Cognitive fog, muscle pain, tremors
• Stimulants: Depression, fatigue, poor impulse control
• Cannabis: Vivid dreams, irritability, headaches, disrupted sleep

These symptoms often cycle. One day you feel clear and focused, the next you struggle to get out of bed or manage your emotions. That unpredictability can feel discouraging, especially when you're committed to recovery. Recognizing these patterns can help you stay focused and respond with resilience instead of frustration.

PAWS Timeline: How Long Symptoms Last

PAWS symptoms can last anywhere from a few months to two years. The duration depends on a number of factors, including:

• How long and how heavily you used substances
• Your physical and mental health
• Your support system and recovery plan

Symptoms often peak during the first few months and gradually fade. Stressful moments and situations can trigger a return of symptoms, so stay connected to your recovery support system.

Coping with Protracted Withdrawal in Recovery

Managing long-term withdrawal symptoms takes intention and consistency. These strategies support relapse prevention and help you stay grounded in recovery.

Create a Healing Routine

• Choose balanced meals and stay hydrated 
• Prioritize regular sleep and movement
• Track symptoms and identify triggers

Stay Connected

• Schedule time with a therapist or counselor
• Join a recovery group that fits your needs
• Reach out to people who understand your experience

Explore Treatment Options

• Consider medications that may ease anxiety and sleep disruptions
• Try therapy to help navigate cravings and emotional symptoms of withdrawal
• Explore personalized care plans that support your unique recover needs

Hazelden Betty Ford offers synchronized support through therapy, medication management and peer connection, individualized to help you move forward with strength and clarity.

When to Reach Out for Help

If your symptoms feel overwhelming or you're worried about relapse, reach out. Feeling discouraged is natural and it doesn't mean you're failing. In fact, it's an indication that your brain is healing. Support can make this phase easier to navigate.

Hazelden Betty Ford offers compassionate, evidence-based care for every stage of recovery. Whether you need outpatient support, virtual therapy, recovery coaching or a deeper level of care, you'll find the tools and guidance to keep making progress.

Call us today at  1-866-831-5700, or explore our programs to find the support that fits your life and goals.