Why we don't get better immediately: PAWS

Many of the problems associated with early sobriety do not stem  directly from drugs and alcohol. Instead, they are associated with physical and psychological changes that occur after the chemicals have left our bodies.  When we use addictive substances, our brains undergo physical changes to cope with the presence of the drug in our body.  When we remove the alcohol or drugs, our brains then demand more to satisfy the desire caused by the changes.  The extreme symptoms that we experience immediately after we stop using  are called “acute withdrawal.”

That initial stage passes fairly quickly.  Unfortunately, acute withdrawal is not where it ends.   The changes that have occurred in our brains need time to revert back to their original state (to the extent that they ever do).  During the period of time while this is occurring, they can cause a variety of symptoms known as Post-Acute Withdrawal Syndrome (PAWS).


All addicts and alcoholics suffer from damage to our bodies and nervous systems from drug/alcohol use, accidents, and malnutrition. We may also suffer from chronic diseases such as diabetes, cirrhosis, and hepatitis, and we usually bring to early recovery a broad array of other problems. We've done damage to ourselves and our lives, and our "Number One" coping mechanism is no longer available to us!  It's important to know what to expect.

Recovery causes a great deal of

stress. Many addicts and alcoholics never learn to manage stress without alcohol or drug use, or do so only after several attempts at sobriety.  Our ability to deal with it depends on our willingness to take care of ourselves and maintain a healthy physical, emotional and spiritual lifestyle.  Repairing the damage to our nervous systems usually requires from six months to two years with a healthy program of recovery. 

PAWS is the most common cause of relapse in early recovery


The Symptoms of Post-Acute Withdrawal


Symptoms occur in over 90% of people withdrawing from long-term opioid use (such as heroin or prescription pain medications), 75% of persons recovering from long-term use of alcohol, methamphetamine, or benzodiazepines (such as Xanax, Valium, Klonopin or Ativan), and to a lesser degree other psychotropic drugs.  Symptoms last longer in people who are withdrawing from alcohol or benzodiazepines.

The most common post-acute withdrawal symptoms are:

•           Anhedonia (the inability to experience pleasure from activities usually enjoyable)

•           Depression

•           Impaired interpersonal skills

•           Obsessive-compulsive behavior

•           Feelings of guilt

•           Pessimistic thoughts

•           Impaired concentration

•           Lack of initiative

•           Cravings

•           Inability to think clearly

•           Memory problems

•           Emotional overreactions or numbness

•           Physical coordination problems

•           Stress sensitivity

•           Increased sensitivity to pain

•           Anxiety

•           Sleep disturbance (vivid dreams, using dreams, insomnia, over-sleeping)


Post-acute withdrawal feels like a rollercoaster of symptoms. In the beginning, your symptoms will change minute to minute and hour to hour. Later as you recover further they will disappear for a few weeks or months only to return again. As you continue to recover, the good stretches will get longer and longer. But the bad periods of post-acute withdrawal can be just as intense and last just as long.

Each post-acute withdrawal episode usually last for a few days. There is no obvious trigger for most episodes. You will wake up one day feeling irritable and have low energy. If you hang on for just a few days, it will lift just as quickly as it started. After a while you'll develop confidence that you can get through post-acute withdrawal, because you'll know that each episode is time limited.

Post-acute withdrawal usually lasts for 2 years. This is one of the most important things you need to remember. If you're up for the challenge, you can get through this. But if you think that post-acute withdrawal will only last for a few months, then you'll get caught off guard, and when you're disappointed you're more likely to relapse.

For more information about substance use issues, PAWS,

or to learn how you can speed up the repair work that your brain is doing,

contact us to schedule an appointment

We are happy to help you design a plan for navigating your early recovery