Tree House Recovery Tennessee

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Post-Acute Withdrawal Syndrome (PAWS)

During the initial period following substance cessation, individuals often experience withdrawal syndrome, which manifests as a set of symptoms occurring after discontinuing chronic substance use. Both illicit and prescription drugs can induce withdrawal syndrome. This is typically what is called Post-Acute Withdrawal Syndrome.

The first phase of withdrawal syndrome is known as acute withdrawal, characterized by physical symptoms such as vomiting, shaking, sweating, diarrhea, and constipation. Typically, under medical supervision, these effects subside within a week.

However, individuals with a history of prolonged substance abuse and high dosage may encounter a longer-lasting phase referred to as post-acute withdrawal syndrome (PAWS). At Tree House Recovery in Nashville, TN, we provide unique and comprehensive treatment programs to aid those suffering from PAWS.

What is Post-Acute Withdrawal Syndrome? (PAWS)

Post-Acute Withdrawal Syndrome (PAWS) constitutes the second stage of withdrawal syndrome. Unlike acute withdrawal, PAWS primarily manifests as psychological symptoms like depression, anxiety, loss of balance, and anhedonia (inability to experience pleasure). These symptoms may compel individuals to relapse in an attempt to alleviate PAWS effects.

Withdrawal syndrome can be overwhelming or even hazardous. If you or someone you know is struggling with withdrawal syndrome, our team of experts can assist you in finding a detox facility in Nashville, TN. Contact us at (615) 314-8310, and we will help create a personalized treatment plan.

PAWS Symptoms:

PAWS symptoms often appear unexpectedly, resembling waves of emotions. These episodes can last for days and may persist for a year or longer after achieving sobriety.

PAWS symptoms vary among individuals and depend on the specific substance being quit. It is unlikely for a person to experience all the symptoms listed below.

Common PAWS Symptoms:

  • Depression
  • Mood swings
  • Hostility and irritability
  • Trouble sleeping
  • Lack of coordination
  • Exhaustion
  • Decreased interest in sex
  • Inability to experience pleasure (anhedonia)
  • Anxiety or panic
  • Heightened sensitivity to stress
  • Difficulty concentrating
  • Memory problems

Anyone in substance recovery can experience these symptoms. However, individuals with a history of the following substances are more prone to experiencing PAWS:

  • Benzodiazepines: Drugs such as Xanax and Klonopin, prescribed for panic attacks and anxiety disorders, can easily lead to physical dependence. Withdrawal symptoms often mirror the conditions benzodiazepines are intendedto treat, such as anxiety and panic attacks.
  • Opioids: Prescription painkillers and illicit substances like heroin and fentanyl can cause long-lasting PAWS symptoms, including exhaustion, anxiety, and cravings. Those who experience the full range of acute withdrawal symptoms from opioids are more likely to encounter post-acute withdrawal syndrome.
  • Stimulants: Substances like cocaine and methamphetamines elicit adverse effects like tremors, anxiety, and paranoia. After acute withdrawal, PAWS symptoms have contrasting effects, such as depression, anhedonia, and fatigue.
  • Marijuana: Individuals who cease marijuana use often experience PAWS symptoms. Marijuana induces calming effects, so PAWS symptoms present in the form of anxiety, insomnia, cravings, and stress.
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(615) 314-8310. Alternatively, you can fill out the form below, and we will reach out to you.

Factors That Aggravate PAWS:

The experience and duration of PAWS vary for each person. Some individuals may not encounter PAWS at all. However, certain factors can increase the intensity of PAWS symptoms:

  • Substance of choice
  • Duration and dosage of substance use
  • Co-occurring mental disorders
  • Seeking professional or medical support during detox and recovery

Table of Contents

What Causes PAWS?

The experience and duration of PAWS vary for each person. Some individuals may not encounter PAWS at all. However, certain factors can increase the intensity of PAWS symptoms:

  • Substance of choice
  • Duration and dosage of substance use
  • Co-occurring mental disorders
  • Seeking professional or medical support during detox and recovery

The exact causes of PAWS remain partially unclear. The timeline of PAWS poses a perplexing aspect for most individuals. Some people continue to experience symptoms for years into recovery, while others may experience fluctuating or intermittent symptoms over months.

Although the precise cause of PAWS is not fully understood, research suggests that changes in the brain during addiction and the stress of recovery contribute to its development.

  • Neurological readjustment: Substances alter dopamine levels, which are responsible for feelings of euphoria, satisfaction, and motivation. During active addiction, substances flood the brain with dopamine, leading to reduced natural production. Upon substance withdrawal, the brain faces a significant deficit, resulting in PAWS symptoms.
  • Stress: Prolonged substance use creates reliance on the substances for specific effects. However, withdrawal symptoms often produce effects contrary to those desired, leading to heightened stress during early recovery. High-stress periods are more likely to trigger PAWS symptoms.

Managing Post-Acute Withdrawal Syndrome:

PAWS symptoms are transient and fade over time. However, individuals may be tempted to relapse to alleviate these symptoms. The following strategies can help reduce the duration and severity of PAWS:

  1. Diet: Research suggests a strong connection between gut health and brain health. An unhealthy gut can exacerbate or trigger symptoms of depression, anxiety, and other psychological disorders. Conversely, improving gut health through a healthy diet can alleviate symptoms like depression, anxiety, and anhedonia, which are major components of PAWS.
  2. Daily Exercise: Exercise stimulates the release of endorphins, the brain’s natural feel-good chemicals that reduce mental and physical pain, enhance mood, and alleviate stress. Daily aerobic exercise has been extensively documented as effective in managing PAWS symptoms. Studies have shown that exercise can decrease opioid cravings, improve quality of life, aid in quitting smoking, and reduce cravings for stimulant addiction.
  3. Socialization: Isolation often exacerbates cravings and addiction. The journey of sobriety, especially in the early stages, becomes more challenging when faced alone. Social support not only provides invaluable assistance but also improves mood, reduces anxiety, and alleviates depression, a common symptom of PAWS. Meaningful interactions that foster dopamine and oxytocin release are particularly beneficial.
If you or a loved one is grappling with post-acute withdrawal syndrome, do not hesitate to seek help. Call Tree House Recovery at (615) 314-8310 to begin your recovery journey today.

Shorten PAWS w Lifestyle Recovery

There is a Better Way to Overcome Addiction and Combat PAWS – A Health-Centered Program.

  • MIND
  • BODY
  • SOCIAL
Learn More

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  2. DiSalvo, D. (2013, October 13). How Exercise Makes Your Brain Grow. Forbes. https://www.forbes.com/sites/daviddisalvo/2013/10/13/how-exercise-makes-your-brain-grow/?sh=6e5e8de3d1f9

  3. Zapletal, K. (2017, March 13). The Magic of Neurogenesis: How to Help Your Body Make New Brain Cells. Observer. https://observer.com/2017/03/the-magic-of-neurogenesis-help-your-body-brain-cells-development-entrepreneurship-health-neuroscience/

  4. ‌Taylor, A. H., Ussher, M. H., & Faulkner, G. (2007). The acute effects of exercise on cigarette cravings, withdrawal symptoms, affect and smoking behaviour: a systematic review. Addiction, 102(4), 534–543. https://doi.org/10.1111/j.1360-0443.2006.01739.x

  5. ‌Salem, B. A., Gonzales-Castaneda, R., Ang, A., Rawson, R. A., Dickerson, D., Chudzynski, J., Penate, J., Dolezal, B., Cooper, C. B., & Mooney, L. J. (2022). Craving among individuals with stimulant use disorder in residential social model-based treatment – Can exercise help? Drug and Alcohol Dependence, 231, 109247. https://doi.org/10.1016/j.drugalcdep.2021.109247