Tree House Recovery NC

Post Acute Withdrawal Syndrome (PAWS)

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During the first few days or weeks after not using substances, people often experience withdrawal syndrome. 

Withdrawal syndrome is characterized by a set of symptoms that people experience when they suddenly stop using substances after chronic use. Both illegal and prescription drugs can cause withdrawal syndrome.

The first part of withdrawal syndrome is acute withdrawal, which has physical side effects like vomiting, shaking, sweating diarrhea, and constipation. With medical supervision, these effects rarely last more than a full week.

However, people with a history of taking large amounts of substances for long periods of time may experience another longer phase called post-acute withdrawal syndrome (PAWS). Tree House Recovery has many resources that can help people suffering from PAWS with our unique and comprehensive treatment program.

What is Post-Acute Withdrawal Syndrome? (PAWS)

Post-Acute-Withdrawal Syndrome (PAWS) is the second part of withdrawal syndrome. Unlike acute withdrawal, PAWS is characterized primarily by psychological symptoms like depression, anxiety, loss of balance, and inability to feel pleasure. These may tempt a person to return to use in order to end PAWS symptoms.

Withdrawal syndrome can be intimidating or even dangerous. If someone is struggling with withdrawal syndrome, our team of experts can guide you to a detox facility. Call 910-812-1728 and we can help you set up a unique treatment plan.

PAWS Symptoms:

PAWS symptoms often come and go unexpectedly. It can feel like an unexpected wave of emotions. PAWS episodes can last for days, and these cycles can continue for a year or more after sobriety.

There are many different symptoms of PAWS. Which ones a person experiences normally depends on the substance they are quitting, and it is unlikely that a person will experience all the symptoms below.

Common PAWS Symptoms: 

  • Depression
  • Mood Swings
  • Hostility and irritability
  • Trouble sleeping
  • Lack of coordination
  • Exhaustion
  • Less interest in sex
  • Inability to feel pleasure (anhedonia)
  • Anxiety or panic
  • More sensitive to stress
  • Trouble concentrating
  • Memory problems

It’s possible for anyone coming off substances to experience these symptoms. However, people who have a history with the following drugs may be more likely to experience PAWS:

  • Benzodiazepines: Drugs like Xanax and Klonopin are prescribed to help people with panic attacks and anxiety disorders. However, it is very easy to become physically dependent on them. Withdrawal symptoms usually mimic things benzodiazepines are intended to treat like anxiety and panic attacks.
  • Opioids: Both prescription painkillers and illicit substances like heroin can cause long-lasting PAWS symptoms like exhaustion, anxiety, and cravings. People who experience the full range of acute withdrawal symptoms from opioids are more likely to experience post-acute withdrawal syndrome.
  • Stimulants: Drugs like cocaine and methamphetamines create adverse effects like tremors, anxiety, and paranoia. After acute withdrawal, PAWS symptoms have opposite effects like depression, anhedonia, and fatigue.
  • Marijuana: Marijuana users frequently experience PAWS symptoms when they stop. Marijuana creates calming effects, so PAWS symptoms are the opposite—anxiety, insomnia, cravings, and stress.
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Things That Make PAWS Worse:

Everyone will experience PAWS differently and for different amounts of time. Some people may not experience PAWS at all. But the following things increase the likelihood of more intense PAWS symptoms:

  • A person’s drug of choice
  • How long the person used the drug
  • How much of the drug the person used regularly
  • Co-occurring mental disorders
  • Whether or not a person seeks professional or medical support during detox and recovery

What Causes PAWS?

The exact causes of PAWS are not entirely understood. For most people with PAWS, the most confusing element is its timeline. Some people continue to experience symptoms years into recovery. Sometimes, symptoms are always present, and other times, they appear in waves or disappear altogether for months at a time.

Although the exact cause of PAWS is not entirely known, research suggests that changes to the brain during the course of addiction and the stress of recovery are both contributing factors.

Neurological readjustment: Drugs and alcohol create their effects by altering dopamine, which is responsible for euphoria, satisfaction, and motivation. During active addiction, substances flood the brain with dopamine. With time, the brain will stop producing it naturally. When substances are withdrawn the brain is left with a large neurological deficit, which causes PAWS symptoms.

Stress: When people use substances for a long period of time, they begin to rely on them for certain effects. But withdrawal symptoms are often the opposite of a person’s drug of choice. This makes early recovery particularly stressful for a person’s body and mind. People are more likely to experience PAWS symptoms during periods of high stress.

Dealing with Post Acute Withdrawal Syndrome

PAWS symptoms don’t last forever and will fade with time. But that doesn’t mean a person won’t be tempted to resume substance use to be rid of the symptoms. Below are some effective actions that can reduce the duration and severity of PAWS.

How to End PAWS Faster:


There is a growing body of research showing that gut health has a substantial effect on brain health [1]. An unhealthy gut can worsen or even create symptoms of depression, anxiety, or other psychological disorders. However, the opposite is also true. Improving gut health (with eating well) can help lessen symptoms of depression, anxiety, or anhedonia, which are major symptoms of PAWS.

There is also evidence saying that certain foods may contribute to enhanced brain cell growth. Since current wisdom argues that PAWS symptoms last while the brain recovers from the damage of active addiction, eating well can be a strong tool for treating the causes and effects of PAWS.

Daily Exercise:

The reason taking opioids creates a high is because the brain has natural opioid receptors meant for endorphins. Endorphins are the brain’s natural feel-good chemical. They can decrease the sensation of mental and physical pain, promote euphoria, improve mood, and decrease stress.

There is no faster way to create endorphins than exercise. And daily aerobic exercise (anything that increases heart rate) has prolific documented success with controlling PAWS symptoms.

  • One study showed that daily exercise decreased opioid cravings and increased quality of life [4].
  • Another study showed that daily exercise had a significant effect for quitting smoking [5]
  • A third study showed decreased cravings for people recovering from stimulant addiction (meth and cocaine) [6].

Daily exercise (aerobic exercise and/or resistance training) is an invaluable part of any rehab program. Not only can it treat the symptoms of withdrawal, but some evidence may also suggest it could help treat the cause as well.

Exercise and Brain Growth:

Most people are familiar with the sore feeling after a workout. After taxing your muscles, the body creates proteins that work to make muscles more durable, and over time this increases muscle size/strength. What most people don’t realize is that exercise taxes your brain as well. And the same proteins that repair muscles also stimulate brain-cell growth [7].

The growth of brain cells (neurogenesis) begins when these proteins trigger the release of brain-derived neurotrophic factor (BDNF) [7]. BDNF acts as a sort of fertilizer for brain cells. As BDNF is shuttled around the brain, cells begin to form new connections and build more capillaries that provide more blood flow. As a result of the increased blood flow, the cells grow or regrow [2].

So, if PAWS is the product of damage to the brain’s reward pathway, then stimulating that reward pathway while also promoting brain growth would be a very effective treatment method both in the short and long term [3].


Nothing feeds cravings and addiction quite like isolation. Navigating sobriety, particularly early sobriety, is twice as difficult by yourself. Not only is support invaluable, but socialization helps improve mood, reduce anxiety, and decrease depression—all common PAWS symptoms.

But not all socialization is created equal when it comes to pushing back PAWS symptoms. Studies have shown that we get the most dopamine and oxytocin from deep meaningful interactions.

If you or someone you love is struggling with post-acute withdrawal syndrome, don’t wait to reach out. Call Tree House Recovery today.

If you or someone you love is struggling with PAWS, don’t wait to reach out. Call today 910-812-1728.
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Derek Swain: Addiction Writer