Post Acute Withdrawal Syndrome

Post–acute withdrawal syndrome (PAWS) is symptoms that persist after the withdrawal from a drug or narcotic substance. PAWS refers to a set of symptoms that can occur after the initial stage of withdrawal from drugs or alcohol. It is not something that everyone experiences but for those who do, it can be challenging to deal with. These symptoms can last for weeks, months or even longer, depending on the individual.

Symptoms of post-acute withdrawal syndrome (PAWS) can vary widely, often presenting in waves that come and go with symptoms fluctuating in severity. Individuals may experience cognitive impairments, mood disturbances such as irritability, depression and anxiety, which can be intense enough to trigger a relapse. Extended withdrawal from substances like benzodiazepines, opioids and alcohol can mirror conditions such as generalized anxiety disorder and panic disorder making abrupt cessation inadvisable due to the severity of potential withdrawal symptoms.

Research into the prolonged withdrawal symptoms associated with substance abuse, particularly beyond alcohol, is limited and primarily consists of anecdotal evidence and clinical observations. For alcohol, protracted withdrawal symptoms are well-recognised and can include anxiety, irritability, mood swings, fatigue, insomnia, cognitive difficulties, reduced libido and physical pain with some symptoms potentially lasting over two years post-abstinence. Sleep issues specifically may continue for up to three years after ceasing alcohol intake.

In the case of benzodiazepines, distinguishing between protracted withdrawal and symptom rebound—where intensified symptoms reappear briefly after cessation—is challenging. However, protracted symptoms often fluctuate over time, presenting new challenges that gradually lessen with ongoing sobriety. Marijuana withdrawal can result in sleep problems and unusual dreams for over a month. Opioid detox may lead to enduring issues like sleep disruption, anxiety, depression and decreased mental sharpness. Cocaine withdrawal has been associated with ongoing struggles with impulse control weeks into abstinence. Across different substances, protracted withdrawal can manifest as irritability, depression, anxiety, low energy, sleep issues, memory problems, impaired concentration, cravings, diminished executive function, anhedonia, focus difficulties, decreased sexual desire and unexplained chronic pain.

The array of hypothesized symptoms associated with PAWS includes emotional and psychological challenges like psychosocial dysfunction, anhedonia, depression and feelings of guilt, as well as physical and cognitive issues such as sleep disturbances, extreme fatigue and memory problems. These symptoms may be triggered or exacerbated by stress, multitasking and social conflicts, among other factors. Notably, disturbances in mental function post-benzodiazepine withdrawal can persist for months or years with documented cases of protracted psychotic depression. Similarly, long-term use of dopamine agonists and subsequent withdrawal can lead to a range of symptoms including anxiety, depression and physical discomfort, which for some, may persist for an extended period, highlighting the complex and enduring nature of PAWS.

Acute withdrawal typically lasts for a shorter period of time and involves more intense physical symptoms like tremors, nausea and sweating. PAWS, on the other hand, is often characterised by more subtle but persistent psychological and emotional symptoms.

While the exact causes of PAWS are not fully understood, it is believed to be related to the impact of long-term substance use on the brain and nervous system. Prolonged exposure to drugs or alcohol can disrupt the normal functioning of neurotransmitters and other chemical messengers in the brain, leading to these withdrawal symptoms.

What is Post Acute Withdrawal Syndrome? - A Guide to PAWS

Post–acute withdrawal syndrome (PAWS) is symptoms that persist after the withdrawal from a drug or narcotic substance. Get help from qualified counsellors.

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    Founded in 2008, WeDoRecover has evolved from an advisory service for addiction treatment into a comprehensive provider of care, following its 2019 merger with Changes Addiction Rehab in Johannesburg. Specialising in connecting patients to top-tier addiction treatment centers in the UK, South Africa and Thailand, WeDoRecover supports individuals globally, including those from the United Arab Emirates and Europe. Accepting both South African medical aid and international health insurance our organisation facilitates access to high-quality treatment for substance and alcohol use disorders, offering individualised care that addresses the physical, mental and social needs of patients.



    Our team, led by Gareth Carter, offers empathetic and professional support, guiding you through every step of the treatment process. Whether you're in South Africa or abroad, our acceptance of various insurance plans makes quality care accessible, providing a platform for lasting recovery and a healthier future.


    Inpatient Rehab

    Rehab care is a good option if you are at risk of experiencing strong withdrawal symptoms when you try stop a substance. This option would also be recommended if you have experienced recurrent relapses or if you have tried a less-intensive treatment without success.

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    If you're committed to your sobriety but cannot take a break from your daily duties for an inpatient program. Outpatient rehab treatment might suit you well if you are looking for a less restricted format for addiction treatment or simply need help with mental health.

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    Therapy can be good step towards healing and self-discovery. If you need support without disrupting your routine, therapy offers a flexible solution for anyone wishing to enhance their mental well-being or work through personal issues in a supportive, confidential environment.

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    Are you having persistent feelings of being swamped, sad or have sudden surges of anger or intense emotional outbursts? These are warning signs of unresolved trauma mental health. A simple assesment by a mental health expert could provide valuable insights into your recovery.


    Finding the right rehab close to you is simple with WeDoRecover. Our network includes the finest rehab centers, ensuring personalised, quality care for your recovery needs. Let Gareth Carter and our empathetic team help guide you to a center that feels right for you, offering expert care and support. Start your healing today by choosing a rehab that's not just close to you, but also that truly cares about your loved ones recovery.


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