When you stop using a certain substance, you might experience withdrawal symptoms for a few days or weeks. Sometimes, though, withdrawal symptoms last a little longer. This is called post-acute withdrawal syndrome (PAWS).
PAWS can also be called protracted withdrawal syndrome or prolonged withdrawal syndrome. The symptoms of PAWS can differ from the symptoms of acute withdrawal, and are often milder and more sporadic. Not everybody experiences PAWS when they stop using or cut back on substances.
PAWS can make day-to-day tasks uncomfortable and, if a person is dealing with addiction, lead to relapses during recovery. If you or a loved one are experiencing PAWS, there are treatments to help you manage these symptoms.
The symptoms of PAWS can vary from substance to substance. It’s important to remember that the symptoms can ebb and flow.
Protracted withdrawal from alcohol is well-recorded. According to American Addiction Centers, anecdotal evidence indicates that PAWS symptoms can last 2 years or longer after someone stopped drinking alcohol.
The symptoms include:
- difficulty focusing or thinking
- unexplained chronic pain
- insomnia and other sleep problems
- low libido
- nausea and other gastrointestinal symptoms
The PAWS symptoms of alcohol withdrawal can come and go — you might feel well one day and very uncomfortable the next. According to a 2021 study, PAWS is one of the major causes of relapse in people with alcohol use disorder.
Antidepressants, including selective serotonin reuptake inhibitors (SSRIs) and serotonin noradrenaline reuptake inhibitors (SNRIs), can be an effective way to manage your mood.
However, after stopping antidepressants after using them for a long time, some people do experience prolonged withdrawal symptoms.
A 2020 review noted evidence that SSRIs might be more likely to cause PAWS than other antidepressants, with paroxetine being most likely to produce PAWS symptoms.
The symptoms can vary. A 2020 study looked at experiences of PAWS after stopping antidepressants based on self-reported symptoms on an internet forum. These experiences were recorded 5 to 13 years after stopping antidepressants.
The study recorded the following PAWS symptoms:
- brain zaps
- muscle aches
- sleep problems
- suicidal ideation
- visual changes
Lastly, researchers have identified a condition called
PSSD symptoms include:
- decreased libido
- erectile dysfunction
- genital anesthesia
- pleasure-less or weak orgasm
- premature ejaculation
Sometimes, your symptoms after stopping antidepressant use are part of the “rebound symptoms” — in other words, the symptoms you were trying to treat with antidepressants start coming back. However, these usually cease within a few weeks.
Often used to treat anxiety and insomnia, benzodiazepines include drugs like alprazolam (Xanax, Xanax XR), clonazepam (Klonopin), and diazepam (Valium). While effective at treating a number of symptoms, benzodiazepine withdrawal can be uncomfortable.
A 2020 review notes that the PAWS symptoms of benzodiazepines can include:
- cognitive impairment
- chronic pain
- gastrointestinal disturbances
- muscle cramps and spasms
- strange sensations on skin and in limbs
- tremors and jerks
The above-mentioned review states that there’s a lack of research on PAWS from benzodiazepines, but that it can persist for 6 to 12 months — in some cases, even years after stopping benzodiazepine use.
Whether used for medical or recreational reasons, stopping cannabis use might induce
Addiction Center notes that PAWS symptoms after long-term cannabis use can include:
In some cases, these sleep disturbances — which may include strange, vivid dreams — persist for weeks or even months.
According to Addiction Center, PAWS symptoms after cocaine use can include:
A 2021 study noted reports that PAWS associated with cocaine withdrawal can also include difficulties with regulating emotion.
This, as well as impulse control disorders, can last up to 4 weeks after discontinuing use. Other symptoms, though, can last months after discontinuing use.
- insomnia and other sleep problems
- poor impulse control
According to the research, these symptoms can endure weeks or even months after discontinuing use.
The Addiction Center website notes that PAWS symptoms after opioid use can include:
The available research suggests that some symptoms of opioid-related PAWS can last for weeks, and in some cases, 6 to 9 months after last use.
Some sources report that PAWS symptoms for morphine users usually start between 6 to 9 weeks after the acute withdrawal phase and persist until 26 to 30 weeks.
According to American Addiction Centers, the general PAWS symptoms include the following:
- anhedonia (the inability to feel pleasure)
- difficulty focusing or thinking
- difficulty with memory
- executive dysfunction
- increased sensitivity to stress
- inexplicable chronic pain
- insomnia and other sleep problems
- low libido
These symptoms are common across substances — in other words, no matter which substance you used, you might experience one or more of the above.
The symptoms of protracted withdrawal can come and go over time depending on triggers. In general, though, PAWS is recorded as lasting a few weeks to a few months after stopping use.
The duration of PAWS can depend on a range of factors, including the substance you used and how frequently you used it, as well as your support system.
Although the symptoms of PAWS can be challenging, it’s possible to manage your symptoms in a healthy way.
Track symptoms and triggers
You might find it helpful to take note of your symptoms and possible triggers. This can help you figure out what triggers or worsens your symptoms.
Your triggers could include stress, sleeplessness, or even certain foods. These factors can affect both your mental and physical health.
It could also be useful to track what helps ease your symptoms. In the moment, it isn’t always easy to remember what helps. Make a note, for example, “Hot bath soothed my muscle cramps” or “Avoiding caffeine helped me sleep better.”
You could use the Notes app on your phone or a notebook. There are many mood-tracking apps that might also be helpful.
Take care of your basic needs
Taking care of your basic needs is a good way to avoid worsening your mental and physical symptoms.
After all, if you’re currently experiencing fatigue and nausea, skipping meals and sleeping too little will only make you feel worse.
Regularly check in with yourself to ensure you’re meeting your basic needs. This can include:
Although PAWS can make it difficult to carry out day-to-day tasks — sometimes including meeting these basic needs — doing what you can to accomplish even one of these things can go a long way toward feeling better.
Reduce and manage stress
Stress can be a trigger for people with PAWS, and some research suggests that PAWS can lead to increased sensitivity to stress. As such, managing stress in a healthy way can be helpful.
Effective stress-relief methods can include:
- engaging in fun hobbies
- relaxing breathing techniques
- spending time in nature
Managing stress can also include reducing stressors. If certain situations, people, or activities bring you stress and no joy, consider letting them go. If your plate is full, try to avoid adding unnecessary responsibilities to the mix.
Reach out for help
Fostering social connections is important, and so is asking others for help when you need it.
This can include:
- speaking with loved ones who support you
- attending a support group
- talking with a therapist
- making an appointment with a doctor
Research tells us that having a community and nurturing your friendships can be good for our mental and physical health.
In some situations, a doctor or psychiatrist might prescribe medication to help with PAWS symptoms. Your medication options depend on the substance you used, your symptoms, and your medical history.
For example, benzodiazepines might be effective for helping people with alcohol withdrawal syndrome, but they won’t be appropriate for someone who has misused benzodiazepines in the past.
Similarly, SSRIs can be used to help people who are experiencing depression and anxiety, but not everybody responds well to SSRIs.
If you think you’re experiencing PAWS and your symptoms are becoming hard to manage, a doctor or healthcare professional might be able to help.
Not sure which kind of doctor to contact? Take a look at our article on mental health resources.
It’s an especially good idea to seek professional help if:
- your symptoms are causing you distress
- your symptoms make it hard to function on a day-to-day basis
- your work, relationships, or home chores are being affected
- you’re considering using the substance again (in the case of addiction)
- you’ve considered self-harm or suicide
If you’re concerned about the safety of calling 911 for emergency help, consider the alternatives at Don’t Call the Police.
Community is an excellent tool when it comes to withdrawal symptoms. Whether you’ve experienced addiction or are withdrawing after using prescription medication, it can be helpful to find a support group.
Addiction support groups include:
- Alcoholics Anonymous (AA)
- Cocaine Anonymous (CA)
- Crystal Meth Anonymous (CMA)
- Marijuana Anonymous (MA)
- Narcotics Anonymous (NA)
- Faces and Voices of Recovery
National Institute on Alcoholism and Alcohol Abuse National Institute on Drug Abuse
- SMART Recovery
- Women for Sobriety
You can find mental health support groups at the following links:
- Anxiety and Depression Association of America
- Attention Deficit Disorder Association
- Depression and Bipolar Support Alliance
- International Obsessive Compulsive Disorder Foundation
- Mental Health America
- National Alliance on Mental Illness
- National Eating Disorders Association
- Postpartum Support International
If you have an ongoing addiction or are finding withdrawal challenging, you can send your zip code via text message to 435748 or call 800-622-4357 for confidential, free treatment referral information from The Substance Abuse and Mental Health Services Administration.
What exactly is post-acute withdrawal syndrome?
Post-acute withdrawal symptom (PAWS) is a condition where you experience withdrawal symptoms for an extended period of time — in other words, long after the typical acute stage is over.
The symptoms of PAWS differ from substance to substance.
Is there a difference between acute and post-acute withdrawal syndrome?
Acute withdrawal happens just after you stop using a substance or medication, while PAWS can happen for weeks, months, or even years after you cease use.
With most substances, PAWS is less common — not everybody experiences it — and the symptoms are usually less intense.
What exactly causes post-acute withdrawal syndrome?
Certain drugs and medications can change the structure and chemistry of your brain.
According to Addiction Center, “PAWS is the brain’s way of correcting chemical imbalances that it suffered from during active addiction.”
In other words, PAWS could occur because your brain’s chemicals are beginning to regulate and return to their earlier state.
Can you prevent post-acute withdrawal syndrome?
It’s not clear why some people experience PAWS while others don’t.
However, you could reduce your risk of dangerous and uncomfortable withdrawal symptoms by seeking medical help instead of quitting cold turkey or adjusting your medication on your own.
In the withdrawal stage, you might benefit from:
- managing your stress in a healthy way
- taking care of your basic needs by ensuring you get enough sleep, eat a healthy diet, and stay hydrated
- seeking mental health help (e.g., talking with a therapist or attending support groups)
How can you support a loved one experiencing post-acute withdrawal syndrome?
If a loved one is experiencing PAWS, you can show support by reminding them that you’re there for them and encouraging them to reach out to you for help.
You can also:
- encourage them to attend therapy or support groups
- celebrate their wins throughout recovery, in the case of addiction
- suggest healthy ways to manage stress, like inviting them on a walk or doing a guided meditation together
- hold space for them and listen to them
If you’re not sure what to say, ask them how you can best support them. You can also regularly send them messages or call them to remind them that you’re thinking of them.
After the acute withdrawal stage, some uncomfortable symptoms may linger. Although PAWS can be challenging, there are ways to manage the symptoms and successfully avoid using the substance again.
Tracking your triggers, managing stress, and taking care of your basic needs might help keep your symptoms in control. Reach out for help if needed, including mental health help. Therapy and support groups can help you cope with the mental and physical stress of PAWS.
Sian Ferguson is a freelance health and cannabis writer based in Cape Town, South Africa. She’s passionate about empowering readers to take care of their mental and physical health through science-based, empathetically delivered information.