Signs and Symptoms of Post-Acute Withdrawal Syndrome (PAWS)

Recovery isn’t always a straight path. Even after the most intense withdrawal symptoms have passed, some people notice lingering challenges — like mood swings, trouble sleeping, or feeling foggy — for weeks or even months. 

These symptoms can understandably be discouraging, especially when they hit unexpectedly. This stage of recovery can feel confusing, and even make someone question their progress. 

Understanding why it happens and what you can do is a key step in staying on track. In this blog post, we’ll answer every question you have about post-acute withdrawal syndrome (PAWS) and discuss why medical detox is the best way to get through it.

What is PAWS?

Post-acute withdrawal syndrome (PAWS) is a set of withdrawal symptoms that can linger after the initial detox period. Unlike the early phase of withdrawal, PAWS tends to come and go over a longer stretch of time and may affect how a person feels and functions day to day.

Which Substances Trigger PAWS?

PAWS doesn’t happen with every substance, but it’s more common with those that cause changes in the brain’s reward system and stress response.

Here are some of the substances known to trigger PAWS:

• Alcohol
• Opioids (like heroin or prescription painkillers)
• Benzodiazepines (such as Xanax or Valium)
• Stimulants (like cocaine or methamphetamine)
• Marijuana
• Antidepressants (after long-term use)

What Are the Post-Acute Withdrawal Symptoms?

After the initial detox, recovery often feels like it should get easier—but for many people, that’s when PAWS symptoms creep in. These lingering challenges can make it harder to stay balanced and focused. Knowing how they show up day to day can help you spot the signs early and take steps to manage them before they derail your progress.

Mood Swings

One of the most common symptoms of PAWS is mood swings that feel intense and out of proportion. These shifts can take a toll on your emotions and sometimes leave you second-guessing your ability to stay in recovery.

You might notice this in everyday life through:

• Shifting from calm to angry over something minor, like a misplaced item
• Feeling deep sadness or hopelessness without a clear reason
• Unexpected bursts of energy followed by emotional crashes

Emotional Dysregulation

When mood swings are frequent, it becomes harder to control emotional reactions. Small stresses can suddenly feel overwhelming, and healthy coping skills may feel out of reach in the moment.

This can show up as:

• Getting easily upset by criticism or even casual comments
• Feeling emotionally “flooded” and unable to think clearly during conflict
• Reacting strongly to things that wouldn’t have bothered you before

Cravings

Addiction changes the brain’s reward system, teaching it to associate substances with relief or pleasure. This creates a cycle where certain triggers like stress can spark strong urges to use again.

In PAWS, cravings tend to come in waves. They’re not a sign or promise of failure but a sign that your brain is still healing from addiction. Recognizing them as part of recovery makes it easier to stay patient and use coping skills to get through.

You might notice this in everyday life through:

• Sudden, strong urges to use drugs or alcohol when feeling stressed or bored
• Romanticizing past substance use and forgetting the negative consequences
• Finding it hard to focus on anything else when a craving hits

Social Withdrawal

As the emotional weight of PAWS builds, many people pull back from social connections. While isolation may feel like a way to protect yourself, it often deepens feelings of loneliness and makes it harder to stay accountable in recovery.

In day-to-day life, this might look like:

• Ignoring calls or texts from close friends
• Turning down invitations to avoid awkward or stressful situations
• Spending most days alone, even when you crave connection deep down

Cognitive Impairment

PAWS can make it hard to think clearly, remember details, or make sound decisions. This mental fog can be frustrating and even shake your confidence in your ability to handle life’s demands.

Signs of this include:

• Struggling to follow a conversation or losing your train of thought
• Forgetting appointments, errands, or simple daily tasks
• Making snap decisions that you later regret

Sleep Disruption

Sleep problems are another hallmark of PAWS. Trouble falling asleep, staying asleep, or waking up unrefreshed can drain your energy and make emotional regulation even harder.

You might experience:

• Lying awake for hours despite feeling exhausted
• Waking up multiple times during the night or too early in the morning
• Feeling tired and irritable all day, even after a full night’s sleep

How Long Do PAWS Symptoms Last?

There’s no set timeline for how long post-acute withdrawal symptoms stick around. That said, PAWS symptoms often last anywhere from a few weeks to several months. 

Everyone’s recovery journey is unique, and several factors like the type of substance used, length of use, and overall health can influence how long it lasts.

In some cases, milder symptoms like mood swings or trouble sleeping may linger for a year or longer, coming and going in waves. Recognizing this as part of the healing process can make staying patient and committed to recovery easier.

Benefits of Medical Detox When Treating PAWS

Medical detox creates a safe starting point for recovery. It’s a place to get through withdrawal as well as a source of comfort and guidance that makes the path ahead feel less overwhelming. With the right support early on, you can stay steady as your mind and body begin to heal. Here’s how:

Stabilizes the Brain and Body Early On

Stopping substance use can leave the brain struggling to find its balance. Mood, sleep, and stress levels may feel unpredictable in these first days and weeks. In medical detox, professionals can provide targeted care to help ease these challenges.

This support helps by: 

• Allowing the nervous system to begin recalibrating in a controlled environment
• Reducing the intensity of early symptoms 
• Helping you feel physically and emotionally stronger as you prepare for the next phase of recovery

The steadier you feel during this stage, the more energy and focus you can bring to long-term healing and accomplishing your goals in recovery.

Monitors and Manages Symptoms Safely

Post-acute withdrawal symptoms can shift from mild to overwhelming with little warning. Medical detox provides around-the-clock monitoring so any changes in your health or mood are addressed quickly.

This proactive care helps by: 

• Minimizing the risk of medical complications, which keeps symptoms from escalating
• Reassuring you that help is always within reach, which can ease anxiety during a very vulnerable time
• Feeling supported in a way that makes it easier to stay committed to recovery 

Provides Emotional Support

The emotional ups and downs of withdrawal can take people by surprise. Feelings of frustration, sadness, or restlessness are common and can make it tempting to give up. Medical detox programs often include access to counselors or mental health professionals who understand what you’re going through.

These professionals offer guidance and coping tools to help you manage difficult emotions. Emotional support at this stage builds confidence and helps you develop healthier responses to stress. 

Over time, these skills can reduce the likelihood of relapse and support a more balanced recovery journey.

Reduces Relapse Risk Early

Many people relapse during the early weeks of recovery because of untreated withdrawal symptoms and overwhelming cravings. Medical detox lowers this risk by addressing both the physical and emotional aspects of withdrawal before they can derail your progress.

With cravings managed and symptoms under control, you’re better able to make clear-headed decisions about your next steps. This strong foundation gives you a greater chance of maintaining sobriety in the critical early months when the risk of relapse is highest.

Smooth Transition to Ongoing Care

Recovery doesn’t end when detox is over. A key benefit of medical detox is that it helps you transition into ongoing treatment with a clear plan in place. Whether it’s residential care, outpatient therapy, or support groups, this continuity of care keeps you connected to the resources you need.

Having a relapse prevention plan as a roadmap for the next stage of recovery reduces uncertainty and prevents gaps in support. It allows you to build on the progress made during detox and continue moving forward with confidence. This long-term support system is what makes lasting recovery possible.

Start Strong in Recovery With Medical Detox

Post-acute withdrawal symptoms can make recovery feel harder than you expected, but you don’t have to face them alone. A medical detox program gives you the support, care, and tools you need to get through withdrawal safely and prepare for what comes next.

With the right help, this chapter can be the one that lasts. You’ll have a team by your side to ease the challenges of PAWS and guide you toward lasting recovery.

A stronger, steadier recovery starts here. Contact us today to learn more about our personalized addiction treatment programs.