Post-acute withdrawal syndrome (PAWS) explained
PAWS is a natural but often challenging part of recovery. Understanding what to expect can help you stay on track and feel more in control as your brain begins to heal.
Post-acute withdrawal syndrome, or PAWS, is the second stage of withdrawal that many people experience during addiction recovery.
The first stage is known as acute withdrawal. This usually happens in the early days or weeks after you last drank alcohol or took drugs, and involves mostly physical symptoms. PAWS comes after that and brings emotional and psychological symptoms instead.
PAWS is a completely normal part of the healing process and happens as your brain gradually re-balances after substance abuse. During this time, you might experience things like mood swings, anxiety, tiredness or difficulty concentrating. These symptoms can come and go, sometimes without warning, but they’re temporary and a sign that your brain is starting to recover.
In this article, we’ll explain what PAWS is, what symptoms to look out for, how long they might last, and practical ways to manage them on a day-to-day basis.
Common symptoms of PAWS
PAWS symptoms are the result of your brain slowly adjusting to life without drugs or alcohol. Below are some of the most common symptoms of PAWS, along with how they can affect daily life, work and relationships.
Foggy thinking and poor concentration
Also known as ‘brain fog’, this can make it hard to focus, stay organised or complete everyday tasks. It’s especially common after stopping substances like benzodiazepines, alcohol or opioids, which affect how the brain processes thoughts and emotions.
Anxiety, depression and mood swings
Emotional ups and downs are common during PAWS. You may feel anxious, low, tearful or irritable without a clear reason. These mood shifts can affect relationships and daily life, particularly for people recovering from alcohol dependency or stimulant use, (like cocaine).
Fatigue and sleep disturbances
You might feel tired all the time or struggle to sleep well. Poor sleep can affect your mood, energy and motivation. This is particularly common after using substances like alcohol, opioids or sedatives, which disrupt natural sleep patterns.
Stress sensitivity and cravings
Even minor stress can feel overwhelming during PAWS and may trigger cravings. This is the brain’s way of seeking balance, but it’s important to remember that these urges are part of the healing process and not a sign of failure. People recovering from alcohol and opiates often describe intense cravings, especially during stressful periods or moments of low mood.
How long do PAWS symptoms last?
PAWS is a temporary phenomenon. While it can feel frustrating or disheartening at times, these symptoms are part of your brain’s natural recovery process - and they do get better with time.
PAWS symptoms usually begin after the initial acute withdrawal stage ends. For most people, that’s within the first few weeks of stopping drugs or alcohol. From there, symptoms can continue for several months and sometimes up to 2 years.
It’s not always a straight line - symptoms can come and go, and you may have good days followed by more difficult ones. This doesn’t mean you’re going backwards - these ups and downs are a normal part of healing.
Here’s a general guide to what you might expect:
It’s important to remember that everyone’s recovery looks a little different. The type of substance you were using, how long you used it, and your own physical and mental health all play a role in how PAWS shows up for you.
How PAWS can affect recovery
PAWS can be one of the most challenging parts of recovery - not because it’s dangerous in itself, but because it can wear you down over time.
The emotional and psychological nature of PAWS means that symptoms can creep in when you least expect them, often just as things are beginning to feel more stable. Physical fatigue and brain fog can make it tough to focus at work, keep up with responsibilities at home, or stay engaged in relationships.
It’s not a lack of effort or motivation - it’s simply your brain working hard to repair itself. Without the right support and coping strategies in place, this stage of recovery can increase the risk of relapse.
6 practical tips to manage PAWS
Managing PAWS symptoms is all about taking small, consistent steps to support your recovery - especially when things feel tough. While PAWS can’t be rushed, there are ways to ease the symptoms and help yourself feel more in control.
- Prioritise good sleep - keep a regular bedtime routine, limit screens before bed, and avoid caffeine or big meals late in the day
- Eat in a way that supports your mood - try to eat balanced meals with protein, wholegrains and healthy fats. Avoid skipping meals, and limit sugar and highly processed foods, which can trigger energy crashes and mood swings
- Keep moving - light exercise like walking, stretching or yoga can boost mood and improve sleep. Start small and go at your own pace
- Don’t do it alone - getting mental health support or joining a recovery-focused support group can make a real difference. Professional therapy can help you manage low mood, anxiety or stress, while peer support offers connection and encouragement from people who understand what you’re going through. If you’ve been through addiction treatment, make sure you engage with the addiction treatment aftercare offered to you
- Calm your mind - use self-care strategies like deep breathing, mindfulness or grounding exercises to ease cravings and emotional ups and downs
- Be kind to yourself - recovery isn’t always linear. On difficult days, it’s OK to do less and take things slowly. Remind yourself that PAWS is temporary and part of your brain’s healing - not a sign of failure. Taking breaks, resting when needed and treating yourself with patience can help you maintain steady progress
- Make a relapse plan - a relapse prevention plan can support management of PAWS. List your early warning signs and coping strategies for riding it out. Include who to contact for support when you really need it
If you find that PAWS symptoms are making daily life feel unmanageable, reaching out for professional help can give you the tools and reassurance you need to keep going. You don’t have to face this alone - and with the right support, it does get easier.
Guidance for families
If someone you love is experiencing PAWS, your support can make a real difference. Here are some practical ways to help:
Offer emotional support
- Listen without judgement and reassure them that their symptoms are temporary
- Be patient and validate their experience, even if you don’t fully understand it
Recognise warning signs
- Look out for mood changes, withdrawal from others, strong cravings or talk of giving up
- Gently suggest professional help if symptoms seem to worsen or become overwhelming
Create a trigger-free environment
- Keep the home free of alcohol or other substances
- Reduce stress by keeping routines calm, supportive and predictable
Encourage healthy habits
- Support good sleep, regular meals and gentle activity
- Offer to join them in positive routines, like going for a walk or cooking a meal
Know that help is available
- If you're unsure how best to support them, reach out for professional guidance
- Remember, there are also support options available for families and carers
Recovery isn’t always easy, but you’re not alone. Each step forward brings you closer to a healthier, more stable future.