If you or a loved one have struggled with alcohol use and have completed the detoxification process, you have made the first step toward long-term recovery. However, other challenges are part of the work of recovery. In particular, you may have some long-term withdrawal symptoms that linger after detox, including post-acute withdrawal syndrome, or PAWS.

What Is PAWS?

Post-acute withdrawal syndrome, or PAWS, refers to withdrawal symptoms you may have after the acute withdrawal, or detox, phase of recovery from alcohol or other drugs. However, not everyone will experience PAWS. Because PAWS can be highly uncomfortable, it is a common barrier to staying sober if you are not expecting it.

While the acute stage of recovery involves intense physical symptoms over one to two weeks, PAWS symptoms may persist, disappear and then reappear after months. The emotional and mental distress caused by PAWS can be tough to handle. However, if you are aware of the causes and prepare yourself for the symptoms, you will be well-equipped to manage PAWS.

Alcohol Addiction, Recovery, and PAWS

Both acute and delayed alcohol withdrawal symptoms occur because your body has to adjust to the absence of alcohol. Chronic alcohol use changes the cells in the brain as well as overall brain structure. While physical withdrawal symptoms tend to resolve in a couple of weeks, the chemicals in the brain take much longer to rebalance themselves. This effect may lead to a series of long-term withdrawal symptoms that can be stressful. Sometimes the PAWS symptoms may go away for a while but then come back again.

Fortunately, knowing what to expect and preparing for PAWS can help in approaching and managing these symptoms.

Symptoms of PAWS

Many different symptoms can be experienced during PAWS. Some people have no PAWS symptoms at all. Not everyone with PAWS will experience all symptoms, which often come and go. Symptoms include:

  • Anger and irritability
  • Low mood
  • Mood swings
  • Disinterest in sex
  • Unexplained pain and physical complaints
  • Lack of pleasure or interest in your surroundings
  • Feeling anxious
  • Having a hard time making decisions and solving problems
  • Problems with sleep
  • Trouble trying to focus your mind
  • Memory lapses, especially with your short-term memory
  • Feeling constantly tired
  • Cravings
  • Having problems controlling your impulses

How Long Do PAWS Last?

While acute withdrawal symptoms generally resolve in a few weeks, PAWS symptoms can last for as long as two years.

However, most PAWS symptoms are not persistent, and they will come and go. You may find that certain situations, environments and other factors may influence when and how you experience PAWS symptoms.

As time goes on, the PAWS symptoms show up less often. Eventually, they will go away entirely.

Managing PAWS

The first step to overcoming PAWS is anticipating it ahead of time, and knowing that it is a normal part of the recovery process. Knowing what to expect will help you immensely. That said, doctors think that long-term recovery from alcohol addiction is unlikely unless you enroll in a treatment program to help you recover from your alcohol use even after detox.

A treatment program can support you in managing PAWS through:

  • Therapy: Doctors recommend individual or group therapy when you are in recovery. Having people with first-hand knowledge to talk with can help put your situation into perspective and motivate you.
  • Medications: Depending on your circumstances, your doctor may prescribe you a medication to help lessen your cravings for alcohol or other substances. Some medicines may even help to improve PAWS symptoms.

You can also take other actions to help reduce the symptoms of PAWS, including

  • Identifying and avoiding triggers: Pay attention to your triggers to revert to alcohol use, or the different situations, behaviors, environments, and people that may bring about withdrawal symptoms. Write them down, keep them with you and always remind yourself that what you’re feeling is nothing more than your brain rewiring itself.
  • Exercising regularly: Physical activity can help lessen PAWS symptoms. You don’t have to do anything too strenuous, and a relaxed walk will get your blood pumping and help you clear your head. Exercise helps release brain chemicals called endorphins. These chemicals help your body feel good, which will help fight the negative thoughts and emotions you may have with PAWS.
  • Building a strong support system: Don’t go through PAWS alone. Tell your friends and family what you are going through. Ask them for support and understanding while you go through this process.

Remember, PAWS is a normal part of the recovery process. The emotional and mental hurdles of PAWS are a temporary setback. Expect them, get help in treating them and remember that you’ll soon be free of their influence.

Key Points: Alcohol and PAWS

Important points to remember about alcohol and PAWS include:

  • Post-acute withdrawal syndrome, or PAWS, is a variety of uncomfortable symptoms that may last for years after you detox from alcohol
  • The symptoms of PAWS are due to your brain rewiring itself to be without alcohol and will eventually go away
  • Doctors recommend treatment for PAWS to increase your chances of staying sober

If you struggle with alcohol use and are trying to quit drinking, you do not need to go through your recovery journey alone. The Recovery Village is here to help. Contact our trained professionals at The Recovery Village to learn how we can help you stop using alcohol.

  1. Muncie HL, Yasinian Y, Oge L. “Outpatient Management of Alcohol Withdrawal Syndrome.” American Family Physician, published November 1, 2013. Accessed April 28, 2019.
  2. Substance Abuse and Mental Health Services Administration. “Substance Abuse Treatment Advisory: Protracted Withdrawal.” Published July 2010. Accessed April 28, 2019.