Post Acute Withdrawal Symptoms (PAWS)

Substance abuse has effects that last even when substance use has been stopped and acute withdrawal is over.

What are Post Acute withdrawal Symptoms?

Withdrawal symptoms that occur after the acute phase of withdrawal is over.

How long do they last?

It depends on how much stress a person experiences in early recovery and how much damage was done to the nervous system by alcohol or drug misuse.  Usually the symptoms last from six months to two years.

Why are they important?

Because PAWS can lead to relapse if not managed properly (e.g., “white knuckle sobriety”).

Types of PAW symptoms

  1. Difficulty in thinking clearly.
  2. Difficulty in managing feelings and emotions.
  3. Memory problems.
  4. Difficulty in recognizing and managing stress.
  5. Difficulty in sleeping restfully.
  6. Difficulty with physical coordination.

Managing PAWS

  1. Stabilization: talk honestly to people who will not accuse, criticize, or minimize about how you are feeling.
  2. Education: learning about all aspects of recovery from chemical dependency helps keep PAWS in perspective.
  3. Self protective behavior: you are responsible for protecting yourself from threats to your sobriety.
  4. Nutrition: three well-balanced meals a day, three nutritious snacks a day, no caffeine and sugar.
  5. Exercise: recommend that it be daily, to reduce tension.
  6. Relaxation: also daily, and includes having fun!
  7. Spirituality: means different things to different people.
  8. Balanced living: cannot afford to overdo some things and neglect others any more.

From Gorski T. and Miller M Staying sober — a guide for relapse prevention 1986

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