Author: Carolyn Rennie, Foothills Centre for Change

Post-Acute Withdrawal Syndrome (PAWS) is one of the two stages of withdrawal which occurs when someone stops using substances. There are two main stages: the acute stage (detox) and the post-acute stage (PAWS). The acute stage lasts at most a couple of weeks and symptoms are primarily physical in nature. The severity and types of symptoms differ by individual and type of substance whereas post-acute withdrawal symptoms are more common to everyone.

The 2nd stage, PAWS, will last much longer (up to 2 years) and is characterized by less physical symptoms and more emotional and psychological withdrawal symptoms. When someone stops using substances, their brain chemistry will gradually return to normal. As the brain improves, levels of brain chemicals fluctuate as they approach the new equilibrium, and this is what causes PAWS symptoms.

Common symptoms of PAWS:

  • Mood swings
  • Anxiety
  • Irritability
  • Tiredness
  • Variable Energy
  • Low Enthusiasm
  • Variable concentration
  • Disturbed sleep

Post-acute withdrawal symptoms feel like a rollercoaster. In the beginning they will change minute to minute and hour to hour. Later, as you continue practicing abstinence from substances, symptoms will disappear for weeks or months. Although good stretches without symptoms will get longer and longer, the bad periods of PAWS can be just as intense, so it’s important to remain vigilant. Each episode usually lasts a few days and will eventually lift. After a while you can develop confidence to get through PAWS knowing each episode is limited. As mentioned previously PAWS can last up to 2 years.

So, if PAWS is going to be a part of your life, what can you do? How can you make sure PAWS doesn’t lead you to relapse?


  1. Be Patient: Recovery is one day at a time
  2. Go with the Flow: Symptoms are uncomfortable but the more you resent them the worse they’ll seem. There are lots of good days, enjoy them. On the bad days try not to do too much.
  3. Practice Self-Care: Be good to yourself and give yourself lots of little breaks. Sometimes you’ll have little enthusiasm for anything so don’t overbook your life.
  4. Be Aware – PAWS can be a trigger for relapse: Don’t get caught off guard, symptoms can hit after weeks.
  5. Being able to relax will help you through post-acute withdrawal: When you’re tense you tend to dwell on symptoms and make them worse, when relaxed it’s easier not to get caught up in them
  6. DON’T RELAPSE: Relapsing will undue all the work your brain has done to repair the damage from substances
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