Post Acute Withdrawal Syndrome: Symptoms, Recovery, And More

It typically lasts for several months or years, depending on the severity of addiction. These symptoms typically reach their peak between three to six months after the start of abstinence. You can control the symptoms with professional oversight and medical intervention at a treatment center. Working with a substance use specialist can provide methods and medications to combat PAWS symptoms.

Careers – Join Our Team

Another important aspect of PAWS is the variation in the symptoms occurring in the post-acute withdrawal period, degree of impairment, severity, frequency, duration, and association with the specific substance of use. To that end, it may be less clinically helpful to consider these symptoms as a single construct, particularly in the case of AUD. For instance, craving and negative affect during alcohol withdrawal may stem from underlying psychological and neurobiological changes, whereas sleep disruptions are more physiological and less likely to be relevant to relapse (Cheng et al., 2022). Furthermore, from a theoretical perspective, cravings for alcohol may be driven by the incentive value of the drug rather than be a feature necessarily related to withdrawal (Berridge & Robinson, 2016; Tiffany & Wray, 2012). Still, there is a need for a further study exploring the interrelatedness—or lack thereof—between symptoms considered to be part of PAWS.

What is alcohol withdrawal?

Accordingly, individuals experiencing acute and protracted AWS have higher reported basal serum cortisol levels (Heilig & Koob, 2007). However, CRF-like peptides also appear to maintain a negative-affective state, suggesting that they have a specific role in mediating the underlying PAWS stress response (Bruijnzeel & Gold, 2005). Animal models indicate that atrial natriuretic peptide (ANP) inhibits the effects of CRF, corticotrophin, addiction what it is, causes, symptoms, types and treatment and cortisol (Ibanez-Santos et al., 1990; Mutschler et al., 2010). However, chronic alcohol consumption and acute withdrawal suppress ANP (Kovács, 2000). Although ANP levels gradually improve over 2 weeks of sustained abstinence, they remain lower relative to healthy controls even after 12 weeks of abstinence. These persistent deficits may sustain the cravings, low mood, and anxiety characteristic of PAWS (Kiefer et al., 2002).


  1. They may include trouble with sleep and memory, mood swings, and other symptoms of mental health conditions.
  2. In fact, post-acute withdrawal symptoms that persist or pop up during the first months of recovery can become a risk factor for relapse.
  3. These programs involve working with a team of mental health professionals in a group and individual setting.
  4. Patients with prolonged altered sensorium or significant renal abnormalities should receive an evaluation for the potential ingestion of another toxic alcohol.
  5. Taking care of your basic needs is a good way to avoid worsening your mental and physical symptoms.

Having people with first-hand knowledge to talk to will help put things into perspective and motivate you to keep going. While physical symptoms tend to resolve in two or three weeks, the chemicals in the brain take much longer to rebalance themselves. This manifests 12 steps of aa what are the principles of aa in a series of psychological withdrawal symptoms that can be stressful to deal with. There are many resources available for anyone who is ready to stop drinking for good, or who wants to reduce the harm alcohol is causing in their life by cutting down.

In the Next Few Weeks

Furthermore, as most extant AWS studies are limited to acute withdrawal treatment, further research remains needed regarding the post-acute withdrawal abstinent period (Williams & Mc-Bride, 1998). However, for negative affect and sleep symptoms, more evidence supports using gabapentinoids (gabapentin and pregabalin) and anticonvulsants (carbamazepine and oxcarbazepine). Although preliminary data support acamprosate, there were no controlled trials.

In addition, there appears to be some credible evidence to support the concept of PAWS based on neurobiological findings, including differences measured in evoked potentials, orexins, cortisol, CRF, ANP, serotonin, pancreatic polypeptides, and neuronal excitability. Nevertheless, PAWS remains an important yet controversial topic, with a lack of consensus about whether it even exists and, if it does, its causes, manifestations, and effect on relapse. The protracted withdrawal period from alcohol appears to induce transient alterations in multiple cognitive domains, including concentration, initiative, pessimism, and even a sense of humor (Voltaire-Carlsson et al., 1996). Furthermore, persons experiencing PAWS have lower executive functioning measures, including selective attention, visual scanning ability, visual-motor scanning, and cognitive flexibility (Cordovil De Sousa Uva et al., 2010). Although these symptoms typically last a few weeks to months, some subtle residual effects often remain for up to a year of abstinence (Vik et al., 2004). Although the evidence of irreversible effects is less clear for alcohol, subtle lingering cognitive impairment is often undetected and unaddressed (Vik et al., 2004).

Others may prefer to rely on a strong self-care routine and support from loved ones and others in recovery. The duration can vary from person to person, and the substance involved may play a role. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. If a loved one is experiencing PAWS, you can show support by reminding them that you’re there for them and encouraging them to reach out to you for help. Although PAWS can make it difficult to carry out day-to-day tasks — sometimes including meeting these basic needs — doing what you can to accomplish even one of these things can go a long way toward feeling better.

Therapy and support groups can help you cope with the mental and physical stress of PAWS. After the acute withdrawal stage, some uncomfortable symptoms may linger. Although PAWS can be challenging, there are ways to manage the symptoms and successfully avoid using the substance again. Symptoms of alcohol withdrawal tend to peak 24 to 72 hours after your last drink. Some people experience prolonged withdrawal symptoms, like insomnia and mood changes, that can last for weeks or months.

Benzodiazepines like Librium (chlordiazepoxide) and Ativan (lorazepam) may also help to prevent minor withdrawal symptoms from becoming more severe. Other drugs a healthcare provider might prescribe include anxiolytics , vitamins, and suboxone. The first withdrawal stage typically lasts for a few days up to 2 weeks. After this period, you’ll start to feel acute withdrawal symptoms almost immediately.

More important, even though PAWS is a temporary condition, the symptoms can become a driving factor in relapse. This is true even for people who are fully committed to staying clean and sober. These symptoms—termed post-acute withdrawal syndrome (PAWS)—were first described more than six decades ago (Satel et al., 1993). Building on Wellman’s findings, Segal and colleagues (1970) were the first to coin the term “protracted withdrawal syndrome” in 1960, describing neurovegetative and emotional instability symptoms persisting long after acute withdrawal had subsided. Following Segal, Kissin (1979) described several protracted alcohol abstinence syndrome cases in 1979, emphasizing their importance to relapse prevention.

By Buddy TBuddy T is a writer and founding member of the Online Al-Anon Outreach Committee with decades of experience writing about alcoholism. Because he is a member of a support group that stresses the importance of anonymity methadone: medlineplus drug information at the public level, he does not use his photograph or his real name on this website. We’ve tried, tested, and written unbiased reviews of the best online therapy programs including Talkspace, Betterhelp, and Regain.

It’s recommended, however, that they have someone stay with them who can help during recovery. Alcohol withdrawal refers to the physical and mental effects a person experiences after stopping prolonged and heavy alcohol use. When you suddenly stop drinking, your body is deprived of the effects of alcohol and requires time to adjust to functioning without it.

A counselor can advise on ways to cope with the mental and emotional aspects of withdrawal. A healthcare provider may request daily visits during which they will likely run blood tests and monitor vital signs until symptoms stabilize. People who have severe withdrawal often need to go to the hospital. Your doctor can tell you what level of testing or treatment you need. People who drink daily or almost every day should not be left alone for the first few days after stopping alcohol. Withdrawal symptoms can quickly go from a bad hangover to a serious medical situation.

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