What is Post-Acute-Withdrawal Symptoms: Timeline and Coping

alcohol withdrawal

For the addict that takes the important and difficult step of quitting substance abuse, the first few hours and days are some of the hardest to get through. When you take away alcohol or drugs from a body that has become dependent on them, this is where the withdrawal symptoms begin.

Withdrawal symptoms vary depending on what illicit substances an addict has been taking, how often these were taken, and for how long. Some physical symptoms are well-known to the general public as they are often portrayed in mainstream media—sweat, tremors, chills, fatigue, nausea, and vomiting. Psychological and emotional symptoms include mood swings, irritability, and difficulty sleeping.

Withdrawal syndrome occurs in two phases. The initial acute phase occurs during the first two weeks when the worst of the detox occurs. Generally, doctors will work with patients to help manage the worst of the withdrawal symptoms through close observation and some medications. The second phase occurs in people who consume a large amount of substances over an extended period. The amount of drugs in their system can lead to months of withdrawal, which is a condition called post-acute withdrawal syndrome (PAWS).

What is Post-Acute-Withdrawal Syndrome

PAWS is the term used in the addiction and recovery industry to refer to mood and psychology-related withdrawal symptoms. It occurs long after the initial acute withdrawal symptoms have passed and can be even more challenging to get through than the worst of the pain, headaches, and other physical symptoms.

A former addict on the road to recovery has to be prepared for the possibility of PAWS. In fact, 70% to 90% of addicts experience PAWS symptoms. These symptoms can range from mild to extreme. Such episodes can last a few days and can continue cyclically for several months to a year. 

Many assume that once the physical sickness is over, they are mostly recovered. However, while many addicts are prepared for physical withdrawal symptoms, they find that the mental and emotional struggle of PAWS is much more difficult. This is why most relapses can occur due to recovering addicts turning back to substances because they find it challenging to deal with PAWS.

With the increased risk for relapse, it’s essential to learn about the common symptoms so that recovering addicts are not caught off-guard. Healthy coping skills and consistent support can help them weather this debilitating phase of their recovery, and soon enough, they will be on the other side of the struggle.

Symptoms Timeline

Acute withdrawal symptoms start within the first few hours after taking an illicit substance. This is where addiction begins—it is tough to break away from the cycle because of the persistent cravings for those substances. As days and weeks pass consecutively, acute withdrawal symptoms begin. Within a few weeks, the initial phase of physical difficulty will pass.

Acute withdrawal is incredibly dangerous and can potentially be life-threatening. As such, it should not be attempted alone. Seizures are common, especially for those addicted to alcohol, barbiturates, and benzodiazepines.

Quitting cold turkey isn’t advised, either. Slow cessation of substance intake will help the body slowly adjust to the lack of chemicals, and the physical symptoms will not be so severe.

PAWS occurs in the second stage of detox, and it happens once the initial wave of withdrawal symptoms abate. This is a consequence of the brain returning to its normal processes without the interference of addictive substances. As the brain and body work to find their equilibrium and correct all chemical imbalances, the psychological, emotional, and mental difficulties begin.

Fortunately, PAWS symptoms are not persistent. They may not even occur every single day. They will come and go depending on the recovering addict’s environment, support system, and other factors.

After a few months, the brain adjusts more and more to its new normal. Within a year or so of no relapses, the symptoms will disappear entirely.

Drugs vs. Alcohol Withdrawal Symptoms

All types of substances can lead to PAWS episodes, but certain drugs can cause more severe symptoms:

Alcohol – PAWS symptoms were first defined in the 1990s due to alcohol use disorder. For addicts, spontaneously stopping alcohol consumption without the assistance of a medical professional can be incredibly dangerous. It can cause seizures and psychosis. 

Long-term PAWS symptoms include exhaustion, nausea, and long-term cravings.

Benzodiazepines – People with anxiety can develop a dependence on medication like Xanax and Ativan. This high probability of addiction is why prescriptions are generally limited to just two weeks of regular use. 

PAWS symptoms can mimic panic disorders, leading to cyclical abuse. Insomnia, cravings, fatigue, and severe sleep disturbances can last for months.

withdrawal symptoms

Cocaine – Withdrawal symptoms can occur even after just one dose of cocaine because the increase in dopamine significantly affects the brain. Post Acute Withdrawal Syndrome fluctuate over time, and symptoms include deep depression, paranoia, mood swings, reduced concentration, short-term memory gaps, and poor impulse control.

Marijuana – Because marijuana affects brain response, detoxing can lead to stress, paranoia, and depression. One of the most common marijuana withdrawal symptoms is insomnia, which can persist for an extended period.

Opioids – If not tapered off properly, acute withdrawal symptoms can be very severe. PAWS, in turn, may last for extended periods. Symptoms include exhaustion and cognitive impairment.

Other common PAWS symptoms include:

  • Hostility
  • Apathy
  • Low energy
  • Inability to focus
  • Lack of libido
  • Inexplicable chronic pain
  • Aggression
  • Lack of motivation
  • Poor memory
  • Nightmares

Coping With Post-Acute-Withdrawal Syndrome

PAWS can be incredibly challenging for a recovering addict. While physical symptoms are expected, many do not realize that months of emotional turmoil will follow. Progress will be slow, and it can be overwhelming and frustrating.

One of the most challenging aspects of PAWS is that it is very unpredictable. Several weeks can pass without struggle, followed by consecutive days of nightmares, depression, or mood swings.

Some healthy coping strategies for PAWS include:

Education – Many addicts are not even aware of PAWS. If the patient is not aware of the struggle they are about to face, they are at a greater risk for relapse. It’s critical to reassure them that their difficulty is perfectly normal and that withdrawal does not end when nausea stops.

Support – Patients are not meant to suffer through PAWS on their own. Treatment centers can offer professional support, and 12-step meetings and counselors can provide an outlet for a recovering addict’s feelings and frustrations. Support from family members, close friends, and peers is essential, too.

Self-care – Managing PAWS symptoms can be very frustrating. Exercise, good dietary habits, mindfulness, meditation, relaxation techniques, and other forms of self-care will help tremendously in getting through the worst days and weeks. Patience and positive affirmations are vital for coping with the long road to recovery.

Keep away from triggers – For some patients, it can be easy to aggravate their PAWS symptoms if they experience anxiety, insecurity, or fear. Crowds or enclosed spaces should be avoided. A safe environment is necessary to keep them from backsliding.


Post-acute withdrawal syndrome occurs after the first wave of physical withdrawal symptoms goes away. After two weeks of nausea and tremors, recovering addicts start experiencing intense emotional, mental, and psychological symptoms as their brain begins to reorient and find a new balance.

Outpatient programs can be extremely helpful to anyone experiencing PAWS. There is no reason to go through this condition alone. With the help of experienced professionals to offer knowledge and support, any relapse will likely be prevented.