A man stands in a corner thinking about drugs

While the most extreme substance withdrawal symptoms tend to subside within two weeks, a variety of typically less severe general withdrawal symptoms can persist for months at a time.

Post-accute Withdrawal Symptom

These symptoms, collectively, are known as Post-Acute Withdrawal Syndrome, or PAWS for short. Understanding the PAWS syndrome produced by heroin, cocaine, alcohol, methamphetamine, and many other drugs is crucial to recovery.

While the severity is typically not as difficult as the initial withdrawal and may not require medical attention, PAWS withdrawal symptoms can be one of the most difficult aspects of early recovery. Therefore, recognizing the symptoms of PAWS and understanding that the symptoms are perfectly normal is crucial to achieving long-term sobriety.

So what are the symptoms of PAWS? Provided below is a list of the most common symptoms associated with PAWS.

PAWS Symptoms


Depression accounts for one of the most common and quite often the most severe symptom A man is in PAWS and is experiencing PAWS symptoms of PAWS. The cause of this depression in those newly sober is often both biological and psychological.

Heavy abuse of mind-altering substances that hijack the brain’s natural reward pathways often takes time to restore to a healthy balance.

This is often coupled with the psychological guilt of past bad actions that typically are associated with substance abuse.


Symptoms of lethargy include weakness, weariness, fatigue, the absence of energy, and an overall lack of motivation.

Lethargy can be a particularly difficult symptom of PAWS, in that it tends to potentiate many of the other symptoms such as depression, craving, etc.


Anhedonia refers to the inability to feel pleasure when one normally should. Like many symptoms of PAWS, anhedonia is the result of a chemical imbalance in the brain’s reward system caused by excessive substance abuse.

Anhedonia can often lead to a general withdrawal from social activities, hobbies, and personal relationships.

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Insomnia – The large majority of substances of abuse alter the sleeping patterns of the user. Thus, as a consequence, those newly sober will often face an extended period of time with sleeping difficulties while the body is restoring the biochemical balance in the brain.

Generalized Anxiety

Generalized anxiety is characterized by an excessive and exaggerated anxiety over typical everyday events one may encounter. Like other symptoms of PAWS, this has a biochemical component, coupled with adjusting to normal life situations without substances once again.

Mood Swings

Emotional instability leading to wild mood swings is often a hallmark sign of PAWS. Often these mood swings will occur for seemingly no legitimate reason or cause.

Intense Craving

A common symptom of PAWS (and consequence of the other symptoms of PAWS) is periods of intense craving for drugs and/or alcohol. These intense cravings are often cited as one of the most difficult aspects of early sobriety, and a frequent cause of relapse.

What causes post-acute withdrawal syndrome symptoms to form?

Chronic abuse of certain addictive drugs and alcohol is the main reason for post-acute withdrawal syndrome developing. Alcohol and many mind-altering substances can cause adaptive changes in the brain including molecular, cellular, and neurocircuitry changes.

The result of these changes often has profound affects on the individual’s emotions and behaviors. (1) (2) Drug and alcohol addiction, for example, causes changes in the brain’s reward pathway that may cause the brains own natural reward system to be affected. (3) These changes may last for weeks or months, and are the primary reason that post-acute withdrawal syndrome occurs.

So what can be done about post-acute withdrawal syndrome?

The reality is that post-acute withdrawal syndrome can often times be a difficult hurdle to overcome while achieving long-term sobriety. While not as severe as the initial withdrawal, the longevity of the symptoms can sometimes lead to feelings of hopelessness in early recovery.

To combat this, it is vitally important to realize that it is completely normal. Furthermore, there is no better time to remember the classic recovery slogan related to these feelings – this too shall pass.

Final Note

Post-Acute Withdrawal Symptoms are an unfortunate consequence of obtaining sobriety. Overcoming these symptoms thus is crucial to achieving sustained long-term sobriety. For more information on recovery and anyone seeking help with addiction and substance abuse problems, please call True Recovery at (844) 744-8783 or visit us online.


  1. https://web.archive.org/web/20180924130630/https://store.samhsa.gov/shin/content/SMA10-4554/SMA10-4554.pdf
  2. https://www.ncbi.nlm.nih.gov/pubmed/12359667
  3. https://www.annualreviews.org/doi/abs/10.1146/annurev.ne.19.030196.001535?journalCode=neuro