Post Acute Withdrawal Syndrome is a collection of symptoms that can occur from time to time during the early stages of recovery from substance abuse. The symptoms can be fairly frustrating and can lead to relapse if they are not managed effectively. 


  • Difficulty concentrating, forgetfulness, brain fog
  • Cravings and urges to use
  • Irritable/angry
  • Trouble sleeping (insomnia, drug dreams)
  • Fatigue
  • Trouble with fine motor coordination and balance
  • Easily overwhelmed or “stressed out”
  • Anxiety/ panic
  • Depression
  • Lack of initiative
  • Mood swings

Why is this important?

The intensity and duration of PAWS symptoms tends to be related to the frequency and length of time spent using substances. As a general rule the symptoms last a few months, but can last over a year. PAWS symptoms can be especially frustrating because they occur off and on, but they frequently can be triggered if you are hungry, angry, lonely or tired, an acronym known as “HALT”. Therefore, it is important to take good care of yourself to decrease symptoms.  People can interpret the symptoms as the body needing the substance which can lead to relapse; therefore, it is important to understand the symptoms as part of the healing process and to manage the symptoms until they pass. 

Why do the symptoms happen?

The symptoms occur because the body and brain are trying to heal and readjust to life without substances. Specifically, the brain needs time to get the neurotransmitters and endorphins recalibrated to their natural levels. Neurotransmitters are responsible for allowing all of the cells in our body to communicate and when their levels are depleted or raised, serious problems in communication within the body can occur.  As mentioned, the symptoms of PAWS can sometimes trigger a person into wanting to use their substance, however, the reality is that your body is saying, “Hey! Just give me a minute, a lot has been going on and I just need a little time!” 

Bottom line

I hear people say, “I feel like I am going crazy!” They feel that they functioned better when they were using, or they are afraid they will never sleep again. However, the truth is you are not going crazy, you will function better and you will sleep again. You will. The most important thing you can do is refrain from using any substances and be patient while you get better. Your addiction did not evolve overnight and neither will your recovery. PAWS symptoms may be annoying and frustrating, but they are temporary. Take it easy, take care of yourself, and soon all the benefits of recovery will be yours. You earned it!