When the difficult decision has been made to get help for substance use disorder, many people are wondering how long is rehab? When can I be healthy and happy again and rebuild my life?
What they may not be ready for is post-acute withdrawal syndrome, or PAWS, also known as protracted withdrawal syndrome. This set of prolonged withdrawal symptoms can go on for months or years after acute withdrawal. PAWS can be so unexpected, and so difficult to endure without supports in place, that it becomes a risk factor for relapse even years after treatment for addiction has been completed.
Understanding PAWS and PAWS symptoms is vital for people seeking long-term recovery from drugs or alcohol. Once they know what to expect and how best to deal with it, they are prepared for any curveballs this syndrome may throw their way.
What Is PAWS?
Post-acute withdrawal syndrome is not yet a scientifically proven entity, but anecdotal evidence and the results of a rising number of studies have caused it to be taken seriously in the recovery community. It is a set of symptoms that arise after acute withdrawal from a substance that may last for years.
Many people know what to expect from drug detox or even the stages of alcohol detoxification but are unprepared for the symptoms that may follow this acute stage–and may linger for several years. Symptoms of post-acute withdrawal syndrome include:
- Inability to think clearly/brain fog
- Memory problems, particularly short-term memory
- Difficulty regulating emotions (numbness or overreaction)
- Sleep disturbances
- Physical coordination problems
- Sensitivity to stress
- Mood swings
- Fatigue
- Depression/lack of motivation
- Generalized anxiety
For those with a dual diagnosis, such as addiction and anxiety, it can be particularly difficult to parse out what is a symptom of the mental health condition and what is PAWS. And for anyone trying to rebuild their life after the devastation of addiction, experiencing these symptoms can cause immense amounts of self-doubt and despair, sometimes leading to relapse.
Symptoms may also present differently depending on the substance abused. PAWS alcohol symptoms include anxiety and depression, cravings, irritability, and fatigue. PAWS opioids can present as insomnia, difficulty concentrating, and mood swings, while PAWS benzodiazepines can include tremors and muscle pain.
Regarding how long does PAWS last, the answer varies, ranging from a few months to several years. Length of PAWS can depend on factors such as the amount of time a substance was misused or how abruptly use of the substance was ended.
What Causes PAWS?
Misusing alcohol and drugs affects the brain in many ways, from how it senses pleasure to sleep patterns. PAWS is a result of this–it arises from long-lasting neurobiological and psychological changes that occur after the chronic, heavy use of substances.
One major cause is neuroadaptation. Over time, the brain adjusts to the presence of a drug by altering neurotransmitter levels and receptor sensitivity. When the substance is removed, these systems cannot immediately return to baseline, leading to prolonged dysregulation. This imbalance contributes to symptoms such as anxiety, depression, and trouble concentrating.
Another cause is the disruption of the brain’s reward circuits. Chronic substance misuse trains the brain to depend on external chemical stimulation for pleasure and motivation. Recovery requires gradual rebuilding of natural reward pathways, and the slowness of this process can produce extended mood instability and low motivation.
Psychological conditioning also plays a role. Environmental cues, stressors, or emotions associated with past substance use can trigger lingering withdrawal-like reactions even after physical dependence has resolved.
Is There Hope for Healing from PAWS?
Part of the distress caused by post-acute withdrawal syndrome is that it can feel so unexpected–the acute physical symptoms of withdrawal have subsided, the rehab program has been completed, a strong peer support network is in place, so why do troubling symptoms persist?
Though PAWS may not yet be fully understood, it is identified, and post acute withdrawal treatment options exist at multiple facilities.
Treatment aims to mitigate symptoms and rebuild brain networks so that long-term recovery is possible. Talk therapy may be used to help retrain the mind, such as interrupting circular thinking with positive self-talk; practicing self-forgiveness; and learning to trust the process, knowing PAWS is finite and has an end.
At many holistic residential treatment centers, this treatment is combined with experiential therapies such as yoga, gardening, or acupuncture. Holistic treatment programs work to treat the whole person during recovery, whether that be understanding the importance of sleep in addiction recovery or incorporating spirituality and spiritual practices.
Continue Your Healing Journey at Sana at Stowe
If you feel that you may be in the midst of PAWS and are not sure where to turn, consider Sana at Stowe in picturesque rural Vermont. Surrounded by natural beauty, with your every need met in our luxury facility, you will encounter professionals who listen to your concerns and work hard to help you overcome the symptoms of PAWS.
Sana offers everything from detox and withdrawal management to holistic treatments meant to retrain the body and mind to thrive away from substances. We also take insurance from in-network providers, so our top-of-the-line services are accessible to all.
We specialize in co-occurring disorders, so whether you are seeking depression and addiction treatment, anxiety and addiction, or any other combination, we are equipped to help deal not only with the presenting substance misuse but also with the underlying mental health concerns.
If you are unsure whether or not you would benefit from our services, consider taking an alcohol screening test, or downloading our addiction treatment guide to learn more.
One thing is for sure: you will leave Sana a different person. Take it from a former patient: “Sana has created the perfect environment that helped me find the best version of myself during the most difficult struggle of my life.” Do not hesitate to reach out to us today. Call today at 866-575-9958, to speak with one of our caring team members. We are ready to help you on your journey to healing.
