Post Acute Withdrawal Syndrome

What is Post Acute Withdrawal Syndrome (PAWS)?

Post Acute Withdrawal Syndrome (PAWS) can be defined as a condition which is associated with withdrawal of an addicted drug or alcohol after using a prolonged period. Certain drugs have a tendency to develop physical and psychological dependence and this property also present in alcohol. After prolonged using these drugs or alcohol withdrawing or discontinue to administer these drugs or alcohol causes discomforts to the affected individual. The discomfort rather symptoms are both related to physical as well as psychological1,2.

Phases of Withdrawal Syndrome

Depending upon the onset of symptoms and duration of stay Withdrawal Syndrome is divided into two phases:

  • Acute Withdrawal
  • Post Acute Withdrawal Syndrome

Acute Withdrawal

Acute withdrawal particularly does not denote PAWS. The symptoms of acute phase typically occur within first 2 weeks after discontinuing this drugs. The symptoms are frequently changed and not stabilize. In acute withdrawal, the symptoms are all related to physical and characterized as1,3:

  • Rapid heartbeat, palpitation, sweating, nausea. All these symptoms arise due to hyperactivity of ANS (autonomic nervous system)
  • Convulsion
  • Shivering
  • the extreme craving for the drug

Post Acute Withdrawal Syndrome

Post Acute Withdrawal Syndrome is the phase arise after acute withdrawal, which has other alternate names like post-withdrawal, prolonged withdrawal syndrome, protracted abstinence, and protracted withdrawal.

The name itself describe that the symptoms related to post-withdrawal occurs after acute phase and that can stay for prolonged period. The usual findings describe that Post Acute Withdrawal Syndrome symptoms arise two months or more after drug withdrawal.

The nature of the symptoms is psychological, which alter the mood of the affected person, pattern of sleep and stress response. The duration of these Post Acute Withdrawal Syndrome symptoms preceding for several months and the people even after recovering from the addiction. In some cases, these symptoms only stay for some weeks, whereas some can experience these even more than years2,3.


Post Acute Withdrawal Syndrome is associated with numerous symptoms. The PAWS symptoms are almost same for every addicted drugs and alcohol. But the severity of the symptoms, combination of symptoms and duration of persistence of symptoms are vary from individual to individual. The variation of symptoms occurs due to physiological including genetical difference of people, the composition of drugs, the quantity of each ingredient in drug and how frequently drugs are administered – all these factors interfere with the Post Acute Withdrawal Syndrome Symptoms.

Post Acute Withdrawal Syndrome symptoms

The included symptoms are1,2,3:

  • Anxiety
  • Bad temper
  • Mood swings
  • Drowsiness
  • Low interest
  • Sleep disturbance
  • the unstable energy level
  • Erratic concentration

Risk factors

  • disorganized home environment
  • Futile parenting
  • little or no mutual affection and fostering
  • Introvert, improper or destructive group behavior
  • Failure in academic
  • Illiteracy
  • Unsuccessful achievements in life
  • deprived of social acceptance
  • poor survival ability
  • companionship with deviant peers
  • Forceful pressure coming from fellow partner
  • Mental illness

Protective factors

  • Strong affection towards family
  • Potential Parenting which influences child life
  • Apparent parental trust and consequences
  • Successful life
  • Achievements in classroom and professional life
  • Strong spiritual connection
  • Strong connection with social life
  • Unadventurous convention about drugs and alcohol



Opioid addictions is a common addictive drug and individuals affected common in PAWS due to Opiates addiction. A variety of opiates is available in the pharma industry which represents illicit narcotics for addiction purpose. Though opiates are available in the market due to its strong analgesic action, but people used to continue to intake these due to its addictive action and even some brand is only available for an addictive purpose like heroin.

The included symptoms associated with PAWS due to opiates addictions are anxiety, low energy, and altering sleep pattern. The mechanism of action opiates arises due to binding with opiate receptors present in CNS. The opiates are usually prescribed to relieve severe pain, as it can assist in adapting apparent pain levels, persuade an emotion of well being, and at high doses generate a euphoric high.

The opiate addiction develops due to regular excessive activation of opioid receptors gradually become tolerated with the same dose, so do not create desire action. Therefore, more dose and frequent administration need to over-stimulate the opioid receptors present in the surface CNS.

The CNS regulates different physical and psychological activities and thus physical mental dependence occur. Sudden withdrawn of drugs missed opiate signaling and affects normal physical and psychological activities. In acute phase the physical symptoms are prominent, but gradually in PAWS psychological symptoms arise.

Usually, gradual dosing reduction is recommended to treat opiates addiction and also a low dose of opioid receptor antagonist drugs like naloxone is also prescribed4.


Another common addiction develops with chronic large dose alcohol consumption. The effect after drinking of large dose alcohol arises as sedation due to activation of γ-aminobutyric acid (GABA) receptors present in CNS. Activation of GABA receptor causes inhibition or reduction of overall brain related activities. In chronic using of alcohol even cause tolerance development in the brain tissues.

Individual experiencing over-activity or hyper-excitability in the nervous system after discontinuing the alcohol drinking and that can lead to tremors and seizures. Other mild symptoms are insomnia, anxiety, mood swings, lack of libido and these can persist for numerous months or even years. It is recommended that gradual dose reduction for over a long time or tapering can assist to the reduction of the intensity of the symptoms associated with acute phase, But this technique is less effective for the longer-lasting symptoms of PAWS5,6.


It is very important to detect symptoms arise due to PAWS and then prepare oneself to deal with the symptoms appear. Another important requirement before plan the symptoms are identified the time at which symptoms mainly occur. The Bellow the planning worksheet to handle the PAWS symptoms:

  • It is always suggested that strong support system hastens recovery. Here support system indicates family, relatives, friends, psychotherapist, clinician and other healthcare staffs.
  • Spiritual involvement or participate in the religious discussion. These can help to increase patience, controlling power towards desires, make you sober.
  • Love from close one, Support from family members provide strength to resist the symptoms
  • certain identified emotional states like rage, monotony, depression and aloneness trigger drug craving. Therefore, avoid the conditions, which influence these emotional state. A Strong support system can assist to avert the situations.
  • Regular meditation can provide you mental relaxation, which provides rest to the whole body.
  • Sufficient sleep is important to reduce fatigue and related drowsiness and that can be achieved through following regularize sleep pattern.
  • Frequent eating habit, rather intake of healthy snacking in short breaks can help you to avert drug craving
  • Incorporate multicolored fruits, green and leafy vegetables, and whole organic foods in your diet as much as possible
  • Regular sufficient exercise can increase physical stamina, which provides you tolerance of drugs withdrawal syndromes and also enhances energy level 2,3


  1. Post Acute Withdrawal Syndrome (PAWS); UW Health; Health Facts for You;
  2. Why Addicts/Alcoholics Don’t Get Better Immediately: Post-acute Withdrawal Syndrome (PAWS);
  3. Post-Acute Withdrawal (PAWS); ADDICTIONS and;
  4. Erik MacLaren,  Post-Acute Withdrawal Syndrome;
  5. Alcohol Withdrawal Syndrome | American Family Physician website
  6. Heilig M, Egli M, Crabbe JC, Becker HC. Acute withdrawal, protracted abstinence and negative affect in alcoholism: are they linked? Addict Biol. 2010 Apr;15(2):169-84.

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