Post Acute Withdrawal Syndrome Symptoms Treatment
Post-Acute Withdrawal Syndrome: Symptoms, Treatment Health ConditionsFeaturedBreast CancerIBD MigraineMultiple Sclerosis (MS)Rheumatoid ArthritisType 2 DiabetesSponsored TopicsArticlesAcid RefluxADHDAllergiesAlzheimer's & DementiaBipolar DisorderCancerCrohn's DiseaseChronic PainCold & FluCOPDDepressionFibromyalgiaHeart DiseaseHigh CholesterolHIVHypertensionIPFOsteoarthritisPsoriasisSkin Disorders and CareSTDsDiscoverWellness TopicsNutritionFitnessSkin CareSexual HealthWomen's HealthMental HealthSleepOriginal SeriesFresh Food FastDiagnosis DiariesYou’re Not AlonePresent TenseVideo SeriesYouth in FocusHealthy HarvestNo More SilenceFuture of HealthPlanHealth ChallengesMindful EatingSugar SavvyMove Your BodyGut HealthMood FoodsAlign Your SpineFind CarePrimary CareMental HealthOB-GYNDermatologistsNeurologistsCardiologistsOrthopedistsLifestyle QuizzesWeight ManagementAm I Depressed? A Quiz for TeensAre You a Workaholic?How Well Do You Sleep?Tools & ResourcesHealth NewsFind a DietFind Healthy SnacksDrugs A-ZHealth A-ZConnectFind Your Bezzy CommunityBreast CancerInflammatory Bowel DiseasePsoriatic ArthritisMigraineMultiple SclerosisPsoriasisFollow us on social mediaShopProducts by ConditionInsomniaStress ReliefBack PainNeck PainSleep ApneaHot SleepersAllergiesPain ReliefProduct ReviewsVitamins & SupplementsSleepMental HealthNutritionAt-Home TestingCBDMen’s HealthWomen’s HealthHealth ConditionsDiscoverPlanConnectShopSubscribe
archivepp.com/article/post-acute-withdrawal-syndrome-the-major-cause-of-relapse-among-psychoactive-substances-addicted-us-3rjilapzgvd5ziaBahji A, et al. (2020). Prevalence of cannabis withdrawal symptoms among people with regular or dependent use of cannabinoids.
jamanetwork.com/journals/jamanetworkopen/article-abstract/2764234Bala A, et al. (2018). Post-SSRI sexual dysfunction: A literature review.
pubmed.ncbi.nlm.nih.gov/28778697/Cosci F, et al. (2020). Acute and persistent withdrawal syndromes following discontinuation of psychotropic medications.
karger.com/Article/FullText/506868Gates P, et al. (2014). Cannabis withdrawal and sleep: A systematic review of human studies.
tandfonline.com/doi/abs/10.1080/08897077.2015.1023484Hengartner MP, et al. (2020). Protracted withdrawal syndrome after stopping antidepressants: A descriptive quantitative analysis of consumer narratives from a large internet forum.
journals.sagepub.com/doi/full/10.1177/2045125320980573Lee JA, et al. (2018). Effect of early and focused benzodiazepine therapy on length of stay in severe alcohol withdrawal syndrome.
tandfonline.com/doi/abs/10.1080/15563650.2018.1542701Post-acute withdrawal syndrome. (2022).
americanaddictioncenters.org/withdrawal-timelines-treatments/post-acute-withdrawal-syndromePost-acute withdrawal syndrome. (2022).
drugabuse.com/treatment/withdrawal/post-acute-withdrawal-syndrome/Post-acute withdrawal syndrome. (2019).
addictioncenter.com/treatment/post-acute-withdrawal-syndrome-paws/Zhand N, et al. (2018). What do we know about the pharmacotheraputic management of insomnia in cannabis withdrawal: A systematic review.
onlinelibrary.wiley.com/doi/abs/10.1111/ajad.12783Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Current Version Oct 19, 2022 By Sian Ferguson Edited By Tess Catlett Medically Reviewed By Yalda Safai, MD, MPH Copy Edited By Megan McMorris Share this articleMedically reviewed by Yalda Safai, MD, MPH — By Sian Ferguson on October 19, 2022
How to Recognize and Manage the Symptoms of Post-Acute Withdrawal Syndrome
Medically reviewed by Yalda Safai, MD, MPH — By Sian Ferguson on October 19, 2022Share on PinterestEugenio Marongiu/Getty ImagesWhen 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.Post-acute withdrawal syndrome symptoms by substance
The symptoms of PAWS can vary from substance to substance. It’s important to remember that the symptoms can ebb and flow.Alcohol
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: anxietycravingsdepressiondifficulty focusing or thinkingfatigueunexplained chronic paininsomnia and other sleep problemsirritabilitylow libidonausea 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
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: anxietybrain zapsdepressiondiarrheadizzinessfatiguemuscle achesnausea sleep problemssuicidal ideationtremorsvisual changes Lastly, researchers have identified a condition called post-SSRI sexual dysfunction (PSSD), where someone experiences sexual side effects after they stop using SSRIs. Although it doesn’t occur in everyone, some people experience PSSD months after stopping long-term SSRI use. PSSD symptoms include:decreased libidoerectile dysfunctiongenital anesthesiapleasure-less or weak orgasmpremature 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.Benzodiazepines
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:anxiety cognitive impairmentchronic paindepression gastrointestinal disturbances insomnia muscle cramps and spasmspsychosisstrange 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.Cannabis
Whether used for medical or recreational reasons, stopping cannabis use might induce withdrawal symptoms, especially if you use it regularly and in high doses. Addiction Center notes that PAWS symptoms after long-term cannabis use can include:anxietychanges in appetiteheadachesinsomniairritability stomach pain Several reviews, including a 2018 review and a 2014 review, have noted that sleep disturbances are common during cannabis withdrawal. In some cases, these sleep disturbances — which may include strange, vivid dreams — persist for weeks or even months.Cocaine
According to Addiction Center, PAWS symptoms after cocaine use can include:depressionfatigue low motivationpoor impulse control 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.Methamphetamine
The 2021 study mentioned above noted the following PAWS symptoms after methamphetamine use:anxiety cravings depressionfatigue insomnia and other sleep problemsirritability poor impulse control According to the research, these symptoms can endure weeks or even months after discontinuing use.Opioids
The Addiction Center website notes that PAWS symptoms after opioid use can include:anxietydepressionexecutive dysfunctionfatigueinsomnia and sleep disruptionirritability 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.General PAWS symptoms
According to American Addiction Centers, the general PAWS symptoms include the following:anhedonia (the inability to feel pleasure)anxietycravings depressiondifficulty focusing or thinkingdifficulty with memoryexecutive dysfunctionfatigueincreased sensitivity to stressinexplicable chronic paininsomnia and other sleep problemsirritabilitylow 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.Symptom duration
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.Tips for symptom management and prevention
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:Eating regular, nutritious mealsSleeping enoughStaying hydratedMaintaining personal hygiene 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:exercisemeditationjournalingengaging in fun hobbiesrelaxing breathing techniquesspending 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 youattending a support grouptalking with a therapistmaking 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.Prescription medication and other clinical treatment options
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. A clinician might also recommend talk therapy or a rehabilitation program.Consult with a doctor or other healthcare professional
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 distressyour symptoms make it hard to function on a day-to-day basisyour work, relationships, or home chores are being affectedyou’re considering using the substance again (in the case of addiction)you’ve considered self-harm or suicide If you’re currently in crisis, please seek emergency mental healthcare. You can text HOME to the Crisis Textline at 741741 or call the National Suicide Prevention Lifeline at 800-273-8255. If you’re concerned about the safety of calling 911 for emergency help, consider the alternatives at Don’t Call the Police.Support groups and other resources
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: Al-AnonAlcoholics Anonymous (AA)Cocaine Anonymous (CA)Crystal Meth Anonymous (CMA)Marijuana Anonymous (MA)Narcotics Anonymous (NA)Faces and Voices of RecoveryNational Institute on Alcoholism and Alcohol AbuseNational Institute on Drug AbuseSMART RecoveryWomen for Sobriety You can find mental health support groups at the following links:Anxiety and Depression Association of AmericaAttention Deficit Disorder AssociationDepression and Bipolar Support AllianceInternational Obsessive Compulsive Disorder FoundationMental Health AmericaNational Alliance on Mental IllnessNational Eating Disorders AssociationPostpartum 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.Frequently asked questions
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 waytaking care of your basic needs by ensuring you get enough sleep, eat a healthy diet, and stay hydratedseeking 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 groupscelebrate their wins throughout recovery, in the case of addictionsuggest healthy ways to manage stress, like inviting them on a walk or doing a guided meditation togetherhold 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.The bottom line
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. Last medically reviewed on October 19, 2022How we vetted this article
SourcesHistoryHealthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.Alsheikh MY. (2021). Post-acute withdrawal syndrome: The major cause of relapse among psychoactive substances addicted users.archivepp.com/article/post-acute-withdrawal-syndrome-the-major-cause-of-relapse-among-psychoactive-substances-addicted-us-3rjilapzgvd5ziaBahji A, et al. (2020). Prevalence of cannabis withdrawal symptoms among people with regular or dependent use of cannabinoids.
jamanetwork.com/journals/jamanetworkopen/article-abstract/2764234Bala A, et al. (2018). Post-SSRI sexual dysfunction: A literature review.
pubmed.ncbi.nlm.nih.gov/28778697/Cosci F, et al. (2020). Acute and persistent withdrawal syndromes following discontinuation of psychotropic medications.
karger.com/Article/FullText/506868Gates P, et al. (2014). Cannabis withdrawal and sleep: A systematic review of human studies.
tandfonline.com/doi/abs/10.1080/08897077.2015.1023484Hengartner MP, et al. (2020). Protracted withdrawal syndrome after stopping antidepressants: A descriptive quantitative analysis of consumer narratives from a large internet forum.
journals.sagepub.com/doi/full/10.1177/2045125320980573Lee JA, et al. (2018). Effect of early and focused benzodiazepine therapy on length of stay in severe alcohol withdrawal syndrome.
tandfonline.com/doi/abs/10.1080/15563650.2018.1542701Post-acute withdrawal syndrome. (2022).
americanaddictioncenters.org/withdrawal-timelines-treatments/post-acute-withdrawal-syndromePost-acute withdrawal syndrome. (2022).
drugabuse.com/treatment/withdrawal/post-acute-withdrawal-syndrome/Post-acute withdrawal syndrome. (2019).
addictioncenter.com/treatment/post-acute-withdrawal-syndrome-paws/Zhand N, et al. (2018). What do we know about the pharmacotheraputic management of insomnia in cannabis withdrawal: A systematic review.
onlinelibrary.wiley.com/doi/abs/10.1111/ajad.12783Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Current Version Oct 19, 2022 By Sian Ferguson Edited By Tess Catlett Medically Reviewed By Yalda Safai, MD, MPH Copy Edited By Megan McMorris Share this articleMedically reviewed by Yalda Safai, MD, MPH — By Sian Ferguson on October 19, 2022