Post-Acute Withdrawal Syndrome Timeline, Symptoms, Recovery Stages, and Treatment

While you’ve finished detox, it may take some time before your body adjusts completely. In fact, detox is only the beginning of your journey back to normalcy. This article provides information regarding post-acute withdrawal syndrome (PAWS).

We will provide you with explanations of the symptoms you’ll encounter during the PAWS process, the reasons behind those symptoms, and discuss the best methods to treat your symptoms as they appear. Setting realistic expectations is important to understand why symptoms persist beyond detox. Your continued symptoms don’t signify that something has happened incorrectly; rather, they represent an acknowledged aspect of the brain and body healing processes.

What Is Post-Acute Withdrawal Syndrome?

Post-acute withdrawal syndrome is a collection of symptoms that exist after the acute withdrawal phase has concluded.[1] Although withdrawal typically exists on a physical plane (nausea, tremors, etc.), PAWS often manifests itself as emotional, cognitive, and behavioral changes.

Common terms used to refer to PAWS are: protracted withdrawal, long-term withdrawal, or prolonged withdrawal symptoms. Although these terms are used interchangeably, they all generally refer to the same phenomenon.

How Long Does PAWS Typically Last?

As noted earlier, there is no definitive timeline that applies to each individual. For some individuals, their PAWS symptoms subside within a couple of weeks post-detox. Conversely, for other individuals, PAWS symptoms can persist for months. For some individuals, recovery times can extend beyond several months, and some factors that impact how long PAWS persists include:[2]

1. Substance type (opioids, benzodiazepines [Xanax, Klonopin, Ativan], amphetamines, methamphetamine, or cannabis).
2. Duration and intensity of use.
3. Degree of physical dependence developed.
4. Overall health status.
5. Stress levels.
6. Strength of support system.
7. Co-occurring mental health conditions.
8. Relapse prevention planning.

Avoid setting timelines for yourself based solely on your substance type. Rather than a perfectly linear progression, symptoms generally lessen in frequency and intensity as time passes.

The Stages of Recovery During PAWS

Although the PAWS process varies among individuals, recovery from PAWS often occurs in stages. Understanding this process can help alleviate feelings of uncertainty and unpredictability.

Early Adjustment After Acute Withdrawal

Immediately after the acute withdrawal phase concludes, the brain and body continue to adapt to being substance-free. Common challenges encountered during this initial stage of recovery include unstable moods, emotions, anxiety, disrupted sleep habits, lack of energy, fatigue, impaired concentration, distractibility, and strong cravings.[3] Frequent vivid dreams and headaches are common during this stage as well.

Emotional and Cognitive Stabilization

During this stage, symptoms may become less frequent and less intense.[4] However, symptoms may recur during stressful episodes. Individuals frequently report irritability, lack of motivation, feeling emotionally sensitive, sensitivity to stressors, brain fog, memory issues, disrupted sleep patterns, and decreased capacity for decision-making.

Although frustrating since recovery is expected to proceed rapidly, this stage represents a critical component of recovery.

Long-Term Recovery and Symptom Reduction

Generally speaking, symptoms have been significantly diminished and are much less frequent. Ongoing recovery involves regaining daily routines, improving coping mechanisms, learning to regulate emotions, and dealing with rare symptomatic flare-ups, most often resulting from significant stress.

What Types of Symptoms Will I Experience During Protracted Withdrawal?

Symptoms during protracted withdrawal commonly manifest themselves in three broad categories:[5]

• Emotional symptoms: anxiety, depression; irritability, mood swings; emotional sensitivity
• Cognitive symptoms: difficulty concentrating, focusing; memory issues, brain fog, impaired cognitive function, delays decision-making processes
• Behavioral, physiological symptoms: disrupted sleep patterns, insomnia, fatigue, low energy, heightened senses, stress response, cravings, low motivation; anhedonia (reduced capacity for feeling pleasure), poor impulse control, panic attacks, headaches

Additionally, some individuals experience heightened sensitivities to stressors, anxiety disorders, and head pain during this time frame. These symptoms commonly fluctuate and are not constant.

Why Do Symptoms Exist During Recovery?

Recovery is essentially an extended readjustment process after cessation of substance use. Chronic substance use can affect brain chemistry, endocrine function, stress response mechanisms, emotional regulation, and sleep patterns.[6] Additionally, these systems do not simply “reset” immediately once substance use ceases. Instead, they recalibrate over time, which contributes to the persistence of symptoms after acute withdrawal.

Specifically for substances such as opioids and benzodiazepines, the brain has made adaptations in anticipation of the existence of the substance. Once the substance is absent, however, neurotransmitter levels and stress hormone levels must reach a new equilibrium, baseline. This represents an inherently physiological process and not simply a matter of willpower. Recognizing this will assist in reducing frustration that accompanies slower-than-anticipated recovery timelines.

Treating Post-Acute Withdrawal Syndrome

The majority of the time, treating PAWS requires utilizing multiple elements of a comprehensive treatment program, including a structured daily routine, therapeutic support, and planning for potential relapse.

Structure Daily Routine

Establishing consistency in sleep patterns, regular eating schedules, exercise activities, and predictable daily routines can promote stability in mood and energy levels while the body continues to adjust to functioning without substances.

Manage Mental Health Symptoms

Cognitive behavioral therapy (CBT), a form of talk therapy that focuses on identifying and changing unhelpful behaviors, is commonly utilized for addressing anxiety, depression, and stressor-related triggers linked to PAWS. Antidepressant medications may also be prescribed as a portion of treatment planning for certain individuals (under medical supervision).[7]

Develop Relapse Prevention Strategies

Identifying personal triggers, developing a supportive community, and creating contingency plans for future cravings and emotional setbacks can contribute toward preventing relapse during this stage of recovery.[8] Support groups often serve as an excellent resource for developing relationships with peers who understand what early recovery entails.

Seek Medical Supervision if Necessary

Medical professionals can provide significant support when symptoms become persistent, severe, or interfere with daily functioning. Individualized treatment plans should be created with medical supervision (especially for those experiencing PAWS-related symptoms due to opioid, opiate, or benzodiazepine use, or stimulant use).

Recovery Does Not Have to Be Done Without Support

Working with a treatment team that is aware of protracted withdrawal can result in the difference between struggling through symptoms (without direction) vs. having a viable plan in place to address symptoms as they develop.

Factors That Can Impact Your Recovery Timeline From PAWS

Each person’s recovery timeline is unique. Factors that can influence your recovery timeline include:[9]

• Substance history
• Use frequency
• Length of time used
• Prior withdrawal experiences
• Your general health
• Presence of co-occurring mental health disorders
• Level of exposure to stress
• Environmental recovery setting

Comparing one person’s timeline to another’s timeline will create unrealistic expectations. Two people recovering from the same substance could have vastly different experiences regarding their brain chemistry, support systems, and overall health status.

A person with an extensive support system and consistent access to counseling may see symptoms diminish faster than another person experiencing recovery with fewer supports established around them, regardless of their substance history appearing comparable on paper.

When Should Someone Seek Help With Continued Withdrawal Symptoms?

You should contact a medical professional when symptoms interfere with your daily functioning, depression or anxiety appears excessive, increased risk of relapsing, or you cannot sustain previous momentum in recovery. Also seek assistance when you’re unsure if a symptom represents PAWS or an additional underlying issue vs. assume all symptoms are part of withdrawal. Contact New Waters to talk to an admissions specialist to see how we can help.

Frequently Asked Questions Regarding Post-Acute Withdrawal Syndrome