Post Acute withdrawal syndrome?

Symptoms of Post Acute Withdrawal Syndrome – P.A.W.S.

What is PAWS?

The long-term effects or withdrawal symptoms that occur after initial withdrawal symptoms.  The severity depends on two factors.  Firstly the amount and degree of brain dysfunction or disruption that has been caused by the length of use, and type of chemicals used, and any injuries that occurred associated with the use.  The second thing that can affect P.A.W.S. is the stress factors experienced early in the recovery process and the severity of the psychological and social stressors that may occur.

P.A.W.S.  can affect the thinking process:-

  • Having a hard time learning and remembering new information.
  • Both short-term and long-term memory can be affected.
  • Inability to handle stress or uncertain situations.
  • Fuzziness of thinking, an inability to think clearly or logically.
  • Difficulty with solving problems and abstract reasoning.
  • Difficulty concentrating for any length of time or blanking out.
  • All or nothing, black or white thinking.
  • Having a difficult time prioritizing goals and putting them into action.

P.A.W.S.  also has emotional symptoms:-

  • Having nightmares or dreams about using alcohol or drugs.
  • An inability to sleep soundly.
  • A frequent occurrence of radical mood swings.
  • Difficulty in relating to others.
  • Disproportionate emotions for a situation, for example flying into a rage over a small incident.
  • Having inappropriate emotions.

P.A.W.S can last three to six months and in severe cases anything up to eighteen months.

P.A.W.S is directly related to stress.  Stress intensifies P.A.W. and P.A.W. intensifies stress.


Solutions for you might include:-


  • Maintain healthy diet and sufficient rest.
  • Regular exercise – to help maintain good mental, emotional, and physical health.
  • Spend some time engaging in some spiritual activity, journaling, meditating, relaxation, reading, etc.
  • Set boundaries and know your limitations. If you are alcoholic, don’t go to bars, pubs etc
  • Set goals – realistic, attainable. Live one day at a time.
  • Use effective stress management techniques.
  • Go to meetings, get a sponsor and work the steps.



  • Share your feelings – remember – an addict alone is in bad company. Post-acute withdrawal feels like a rollercoaster of symptoms. In the beginning, your symptoms will change minute to minute and hour to hour. Later as you recover further they will disappear for a few weeks or months only to return again. As you continue to recover the good stretches will get longer and longer. But the bad periods of post-acute withdrawal can be just as intense and last just as long.


  • Each post-acute withdrawal episode usually last for a few days. Once you’ve been in recovery for a while, you will find that each post-acute withdrawal episode usually lasts for a few days. There is no obvious trigger for most episodes. You will wake up one day feeling irritable and have low energy. If you hang on for just a few days, it will lift just as quickly as it started. After a while you’ll develop confidence that you can get through post-acute withdrawal, because you’ll know that each episode is time limited.




  • Post-acute withdrawal usually lasts for 18 months. This is one of the most important things you need to remember. If you’re up for the challenge you can get through this. But if you think that post-acute withdrawal will only last for a few months, then you’ll get caught off guard, and when you’re disappointed you’re more likely to relapse.



  • How to Survive Post-Acute Withdrawal



  • Be patient. Eighteen months can feel like a long time if you’re in a rush to get through it. You can’t hurry recovery. But you can get through it one day at a time.
  • If you try to rush your recovery, or resent post-acute withdrawal, or try to bulldoze your way through, you’ll become exhausted. And when you’re exhausted you’ll think of using to escape.
  • Post-acute withdrawal symptoms are a sign that your brain is recovering. They are the result of your brain chemistry gradually going back to normal. Therefore don’t resent them. But remember, even after one year, you are still only just over half way there.
  • Go with the flow. Withdrawal symptoms are uncomfortable. But the more you resent them the worse they’ll seem. You’ll have lots of good days over the next eighteen months. Enjoy them. You’ll also have lots of bad days. On those days, don’t try to do too much. Take care of yourself, focus on your recovery, and you’ll get through this.
  • Practice self-care. Give yourself lots of little breaks over the next two years. Tell yourself “what I am doing is enough.” Be good to yourself. That is what most addicts can’t do, and that’s what you must learn in recovery. Recovery is the opposite of addiction.
  • Sometimes you’ll have little energy or enthusiasm for anything. Understand this and don’t over book your life. Give yourself permission to focus on your recovery.
  • Post-acute withdrawal can be a trigger for relapse. You’ll go for weeks without any withdrawal symptoms, and then one day you’ll wake up and your withdrawal will hit you like a ton of bricks. You’ll have slept badly. You’ll be in a bad mood. Your energy will be low. And if you’re not prepared for it, if you think that post-acute withdrawal only lasts for a few months, or if you think that you’ll be different and it won’t be as bad for you, then you’ll get caught off guard. But if you know what to expect you can do this.
  • Being able to relax will help you through post-acute withdrawal. When you’re tense you tend to dwell on your symptoms and make them worse. When you’re relaxed it’s easier to not get caught up in them. You aren’t as triggered by your symptoms which means you’re less likely to relapse.


  • Remember, every relapse, no matter how small undoes the gains your brain has made during recovery. Without abstinence everything will fall apart. With abstinence everything is possible.

Published by Dylan Kerr BA ACAT FDAP DipHE MBABCP

Mr Dylan Kerr Addictions Counselor Bachelors in Clinical Counseling (Hons) Advanced Certified Addictions Therapist Member of the British Association for Behaviour and Cognitive Psychotherapist Member of the Federation of Drug and Alcohol Practitioners HeDip Health-care HeDip Psychology of Addiction Dip Counselling Diploma in Arts Therapy Diploma in Transactional Analysis CSAT III Dylan Kerr is a Certified Substance Abuse Therapist who is qualified in Counseling, Psychology of addiction from Leeds University and Healthcare from Birmingham City University. Dylan Kerr has been a senior Therapist at the River Rehab, Lead Therapist at Lanna Rehab in Chiang Mai and Head Counselor of Hope Rehab in Siracha. As well as working in Thailand for 7 years, Dylan has also been the on-tour counsellor for the the Rock band ‘The Libertines’. Dylan is now resident counsellor at an Asian rehab. Dylan has experience of working within the music industry supporting acts in therapeutic needs. As well as working around the world Dylan has over 13 years experience delivering substance use disorder treatment at various agencies around the UK. He is skilled in motivational interviewing, CBT, RET and guidance around 12 step philosophies. Dylan has worked with a broad client base and establish the rapport needed to effect change and sustainable progression. Dylan wishes to start this blog to help educate people on his observations within this field and debate the nature of work in the addictions field.

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