Post-acute withdrawal can bring lasting emotional and cognitive changes that affect mental health, motivation, and resilience. Understanding PAWS, including their signs and symptoms, and the importance of ongoing support can make a critical difference in long-term recovery.
At pH Wellness, our residential alcohol and drug treatment center in Riverside, CA, provides the structure, clinical care, and supportive environment patients need to navigate post-acute withdrawal and build a strong foundation for recovery. Learn more about all of our programs here.
What Is Post-Acute or Protracted Withdrawal Syndrome?
Post Acute Withdrawal Syndrome (PAWS), sometimes called protracted withdrawal, is a stage of recovery that often takes people by surprise. It develops after the initial detox period, once the body is free of alcohol, benzodiazepines, or other forms of substance use. However, the brain and nervous system are still working to find balance.
Unlike acute withdrawal, which usually lasts days to weeks and is marked by intense physical symptoms like nausea, sweating, or tremors, post-acute withdrawal is subtler and longer-lasting. Symptoms can stretch on for months, and in some cases, years, even after early recovery feels stable.
One of the most challenging aspects of PAWS is its unpredictable nature. Many people describe symptoms “coming in waves,” where stretches of calm are suddenly disrupted by anxiety, low mood, or cravings. This cycle can feel discouraging, but understanding it as a normal and temporary part of recovery is key. With the right support, individuals can learn to manage these ups and downs without losing sight of their progress.
Signs and Symptoms of PAWS After Alcohol Use
Because PAWS primarily affects mood, thinking, and emotional regulation, the symptoms often feel more psychological than physical. Still, they can be just as disruptive to daily life and long-term recovery if left unaddressed.
Common PAWS Symptoms Include:
- Mood Swings, Irritability, and Anxiety: These involve sudden shifts in emotion that make it hard to feel stable or calm.
- Depression and Low Mental Health Functioning: This may show up as persistent sadness, lack of interest, or emotional numbness.
- Sleep Disturbances: These can include vivid dreams, restless nights, or ongoing insomnia
- Strong Cravings for Alcohol or Drugs: Urges may resurface even after weeks or months of abstinence.
- Cognitive Difficulties: This often means problems with concentration, memory, or making decisions.
- Emotional Instability and Stress: You may feel easily overwhelmed or unable to cope with everyday challenges.
- Low Motivation: This includes struggles with energy, productivity, or maintaining routines.
These symptoms are closely tied to long-term changes in brain chemistry caused by substance use. While detox clears the body of the drug, the brain and nervous system need far more time to recalibrate. Neurotransmitters that regulate mood, sleep, and stress may remain imbalanced, which is why emotional and mental health challenges can linger well into recovery.
The good news is that PAWS does not mean a person is failing at recovery; it means the brain is healing. With patience, coping strategies, and structured treatment, individuals can learn to manage symptoms and continue building a healthier, substance-free life.
Acute Withdrawal vs. Post Acute Withdrawal
It’s important to distinguish between acute withdrawal syndrome and post acute withdrawal syndrome:
- Acute Withdrawal: Happens in the first weeks after stopping alcohol use or substance abuse, and includes intense physical symptoms like nausea, sweating, tremors, and seizures.
- Post-acute Withdrawal: Begins after initial detox, lasting months to years, with mostly psychological and emotional symptoms that affect mental health and overall stability.
While acute stages are often medically supervised, post acute recovery requires long-term therapeutic support, coping strategies, and relapse prevention planning.
Why Does Post-Acute Withdrawal Happen?
When a person enters abstinence and stops using alcohol or drugs, the body must adjust to life without the substances it once depended on. This period of adjustment may last for weeks, months, or even years. Clinical research and review articles note that post acute withdrawal syndrome (PAWS) protracted withdrawal symptoms can appear suddenly following a period of stability, often leading to frustration or risk of relapse if not addressed.
Key factors that contribute to alcohol protacted withdrawal, or post-acute withdrawal syndrome and related disorders include:
- Changes in Brain Chemistry: Alcohol, benzodiazepines, and other substances disrupt neurotransmitters such as dopamine, serotonin, and GABA, which regulate mood, cravings, and emotional balance.
- Nervous System Imbalance: The body becomes dependent on substances for stability; once they are removed, stress responses may be heightened, causing anxiety, irritability, or difficulty managing emotions.
- Emotional Memory Triggers: Past patterns of substance use can be tied to coping with stress. During abstinence, stressful life events or reminders may trigger cravings and destabilize recovery.
- Co-occurring Mental Health Disorders: Conditions like depression, anxiety, or trauma can surface more strongly after detox, making the experience of withdrawal more intense.
Ultimately, post-acute withdrawal syndrome is a biological and psychological healing process, not a personal flaw. With time, therapeutic care, and relapse prevention strategies, patients can learn to manage symptoms, reduce cravings, and rebuild resilience.
At pH Wellness, we remind individuals that recovery is a journey, and post-acute withdrawal is simply one step on the path to lasting health.
Managing PAWS: Treatment and Support
The treatment of alcohol and drug-related Post Acute Withdrawal Syndrome (PAWS) requires more than simply waiting for time to pass. While protracted withdrawal symptoms may last for months or even years following alcohol use or substance abuse, there are effective, evidence-based strategies that reduce distress, improve mental health, and lower the risk of relapse. Clinical reviews have noted that patients dependent on alcohol or drugs may experience irritability, lack of motivation, and stress during abstinence, making structured care essential.
At pH Wellness in Riverside, CA, we offer comprehensive treatment options designed to meet patients where they are in recovery and provide support every step of the way. Our approach includes:
Detox for Drug and Alcohol Misuse or Substance Abuse
Detox is often the first step toward healing, but it can feel overwhelming to take that leap. At pH Wellness, our medically guided detox services are designed to keep you safe, supported, and as comfortable as possible while your body clears away harmful substances. We combine compassionate care with clinical oversight so you don’t have to go through withdrawal alone.
Residential Treatment
For many, lasting recovery begins with time away from everyday triggers. Our residential program provides a calm, structured environment where you can focus entirely on healing. At pH Wellness, you’ll receive 24/7 support, therapeutic care, and a holistic approach that addresses your mind, body, and spirit. This safe space allows you to rebuild strength and gain the tools you need for a healthier future.
Partial Hospitalization
Also known as a day program, our partial hospitalization option is ideal for individuals who require structured support while still living at home. At pH Wellness, you’ll engage in full days of therapy, group sessions, and wellness-focused care without an overnight stay. It’s a powerful bridge between intensive treatment and independent living, helping you stay grounded in recovery.
Intensive Outpatient
Flexibility matters when balancing recovery with daily responsibilities. Our intensive outpatient Program (IOP) provides focused therapy and support several days a week, giving you the tools to manage cravings, stress, and emotional challenges while continuing with work, school, or family commitments. At pH Wellness, we ensure you’re never walking this journey alone.
Dual Diagnosis for Co-Occurring Mental Health Disorders
Addiction and mental health often go hand-in-hand, and healing both is key to lasting recovery. Our dual diagnosis services at pH Wellness are designed to treat substance use alongside conditions like anxiety, depression, or trauma. By addressing the whole picture with integrated care, we empower you to move forward with clarity, balance, and resilience.
Finding Strength Beyond PAWS
Post Acute Withdrawal Syndrome (PAWS) is often overlooked, yet it plays a crucial role in lasting recovery. While the intense symptoms of acute withdrawal usually fade within weeks, post-acute withdrawal syndrome (PAWS) may continue for months, sometimes disrupting daily life if left unsupported.
At pH Wellness, we want patients and families to know that these challenges are not permanent and are not a sign of failure. With the right blend of evidence-based treatment, therapeutic support, and patience, individuals can manage post-acute withdrawal symptoms, strengthen their mental health, and continue building a stable, substance-free life.
If you or someone you love is navigating drug or alcohol recovery, our residential programs in Riverside, CA, provide the structure, care, and compassion needed for healing. Contact us today to take the next step toward lasting recovery.
Sources
Bahji, A., Crockford, D., & El-Guebaly, N. (2022). Neurobiology and symptomatology of post-acute alcohol withdrawal: A mixed-studies systematic review. Journal of Studies on Alcohol and Drugs, 83(4), 461–469.
Bahji, A., Crockford, D., & El-Guebaly, N. (2022). Management of post-acute alcohol withdrawal: A mixed-studies scoping review. Journal of Studies on Alcohol and Drugs, 83(4), 470–479.
Volkow, N. D., Michaelides, M., & Baler, R. (2019). The neuroscience of drug reward and addiction. Physiological Reviews, 99(4), 2115–2140.
