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



Non-Use – self explanatory. Either prior to onset of use, or a choice to not use substances for one reason or another.

Experimental Use – Usually done out of curiosity. The experience is evaluated and user may or may not continue to use. High level of choice involved at this stage.

Social (Occasional) Use – Use that occurs without incurring problems. High degree of choice involved whether or not to use.

Harmful Use – User may begin to experience occasional heavy intoxication that may cause harm to an aspect of self or another’s. life, or puts self or other at risk (i.e. driving while intoxicated or hungover). Regular use pattern (routine or binges) may start to emerge and/or amount may increase. Level of choice about whether and when to use is decreasing.

Dependence – Characterized by physical symptoms of craving, tolerance and withdrawal. Problems may be evident in many life areas, resulting from excessive use. Substance use is continued despite an increase in problems associated with use. A person’s life may be becoming more centered around acquiring and using drugs; other activities and involvements may become unimportant. There is little or no choice left about whether or not to use, and it is very difficult to stop using the substance. Dependence may be physiological or psychological or a combination of both.

Observable Effects of Drug Use
ALCOHOL Staggering gait, bloodshot eyes, flushing, slurred speech, vomiting,
impaired muscular coordination.

BARBITURATES & BENZODIAZEPINES Similar to alcohol plus: dilated pupils, weak and rapid pulse, drowsiness, shallow breathing, trembling hands, fainting, mood swings.

INHALANTS Chemical odor on body and clothes or in room, nosebleeds rash around nose and mouth, dilated pupils, runny nose, watery eyes, loss of coordination, slurred speech, stupor, vomiting, weight loss.

HEROIN Sleepy appearance, slurred speech, droopy eyelids, constricted pupils,
decreased respiration rate, slow gait.

COCAINE User shows decreased inhibitions, dilated pupils, runny nose, rapid
speech, tremors, sweating, severe weight loss, elevated respiration rate.

AMPHETAMINES Similar to cocaine plus acne that resembles a measles rash.

PCP Muscle rigidity, slurred speech, inability to speak coherently, loss of
coordination, blank stare, rapid and involuntary eye movements, exaggerated gait.

LSD Dilated pupils, confusion, disoriented sense of direction, distance and time.

PSILOCYBIN Dilated pupils, sweating, hyperventilation, rambling speech, hyperactivity, tremors, vomiting, impaired attention span, depression.

MARIJUANA Red or bloodshot eyes, increased appetite, meaningless giggly
conversations, impaired short-term memory, restlessness, dry mouth.