PAWS, which stands for post-acute withdrawal syndrome, typically emerges after a period of withdrawal from alcohol or controlled substances like opioids and benzodiazepines. During initial sobriety, patients undergo the initial period of acute withdrawal, which lasts from a few days to few weeks. This period of withdrawals is often medically supervised to accommodate the symptoms, like muscle soreness, nausea, headaches.

PAWS is less severe than the acute withdrawal period, butPAWS can last for months, and occasionally longer than a year. The symptoms ‘come and go,’ and vary in intensity over time. They include:

● Difficulty with problem solving, memory recall, or learning

● Problems with irritation or hostility

● Depression

● Obsessive-compulsive behaviors

● Cravings of prior abused substances

● Problems with maintaining social relationships

● Issues with anxiety

● Insomnia

To reduce the severity of PAWS, experts recommend extending the treatment time frame, and medication assisted treatment (MAT).

Why PAWS Emerges After the Initial Detox

During the post-acute withdrawal syndrome period, the brain recalibrates following an active addiction. Compared to the physical discomfort of the acute withdrawal period, PAWS symptoms often present themselves in psychological and emotional ways. 

Furthermore, the symptoms can trigger a relapse. This can even affect people who are committed to abstaining from drugs or alcohol.

The most frequent and severe cases of PAWS are seen in people who are addicted to alcohol, opioids, benzodiazepines, or a combination of drugs.

Extending Professional Drug Treatment to Manage PAWS

Continuing drug counseling or outpatient treatment for several months after initial sobriety can help newly recovered people manage the symptoms of PAWS. 

Newly sober people can benefit from undergoing counseling in the form of behavioral therapy or group therapy (or both) to learn how to control their symptoms.

Medication-Assisted Treatment for PAWS

Medication Assisted Treatment (MAT) is the practice of prescribing medication to reduce withdrawals and cravings during early sobriety. This has done wonders for many in recovery from opioids and alcohol.

MAT can help ease some of the complications related to early sobriety. It reduces the temptation to use and can help manageunexpected withdrawal symptoms that may occur after the first few weeks of sobriety.

Patients who have had opioid use disorder (OUD) often are treated with medications like methadone, naltrexone, or buprenorphine.  People who have an alcohol use disorder (AUD) can take medication like naltrexone or acamprosate.

Final Thoughts

If you expect PAWS and plan for it, it can be managed.  Talking with a professional counselor is a great step toward overcoming PAWS. To see what resources are available in your area, contact SAMHSA’s confidential, 24/7 National Helpline at 1-800-662-4357.  If you or your loved one are in California, you can also contact Confidential Recovery at 1-619-452-1200.

About the Author

Scott H. Silverman is one of nation’s the leading subject matter experts on addiction, having written The Opioid Epidemic and made countless public and media appearances to discuss the challenges we face as a society. He is the CEO of Confidential Recovery, an outpatient rehab in San Diego.

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