What is PAWS? Causes, Timelines, and Tips for Symptom Relief

Post-acute withdrawal syndrome (PAWS) can be one of the most challenging parts of recovery from an alcohol use disorder. Even after making it through the difficult and dangerous first few weeks of recovery, you can find yourself experiencing a web of negative symptoms that seem to have no end in sight.

You may come to a frightening conclusion: that this is just what sobriety feels like. That even after all your hard work, the promises of recovery have been left unfulfilled. In reality, it’s just another consequence of your alcohol use – and you will start to feel better, if you stay the course and take the steps to overcome PAWS.

But what is PAWS? What causes it? And how can you overcome these negative symptoms?

What is Post-Acute Withdrawal Syndrome (PAWS)?

PAWS refers to a set of symptoms that happens after acute withdrawal – or the one-to-two-week period where people experience symptoms such as shakes, delusions, hallucinations, or seizures. 

While the symptoms of PAWs are less severe, they can stretch on for weeks, months, or years, leaving people feeling underwhelmed with their new lives in recovery.

Living with PAWS feels like depression. Like anxiety. Like the energy has been sapped out of you. 

Unlike acute withdrawal, PAWS won’t put your life in danger. But it will put your sobriety in danger if you don’t take steps to combat the symptoms and keep striving towards recovery.

While PAWS has been known to happen to people recovering from all types of substance use disorders, we’ll focus on alcohol related PAWS. 

The research on PAWS is still new, but some estimates suggest that 75% of people recovering from an alcohol use disorder will experience some degree of post-acute withdrawal. 

What Causes PAWS?

PAWS is primarily caused by lasting brain changes that happen because of alcohol misuse. By the time a person develops an alcohol use disorder, they’ve already experienced significant brain changes that will take months, if not years, to recover.

These brain changes are why alcohol addiction is often labeled a disease. Chronic alcohol use disrupts your brain’s ability to make reasonable decisions about alcohol. At a neurological level, these changes occur primarily in the brain’s dopamine reward network – which is responsible for motivation, the feeling of reward, learning, and several other essential functions.

This can cause a ripple effect in your mental and physical health. If these changes are left unacknowledged, it can quickly lead to relapse before you ever see the benefits that a life in recovery has to offer.

But other factors contribute to PAWS as well, including:

• Poor nutritional status after recovering from an alcohol use disorder
• Stress during early recovery
• Undiagnosed mental illness
• Lifestyle habits

Essentially, there is no one single cause of PAWS – but rather a constellation of common challenges in early recovery that contribute to the negative symptoms you experience.

Physical Symptoms of PAWS

The physical symptoms of PAWS are often subtle, but in some cases can cause severe disruption in everyday life. Some of the most common physical symptoms of PAWS include:

Chronic Fatigue

Chronic fatigue is, by far, the most common physical effects of PAWS. In early recovery, you can feel as though you don’t have the energy for your daily tasks, have trouble keeping up with your friends or family, and generally feeling exhausted by the middle of the day. 

Sleep Difficulties

Struggling with insomnia or poor sleep quality can amplify the effects of chronic fatigue and is exceptionally common. According to one recent study, 88% of people recovering from an alcohol use disorder experience some type of sleep disturbance.

Emotional and Psychological Symptoms of PAWS

Most people who experience PAWS will have substantially more psychological symptoms than physical. The potential list of symptoms is broad, but most people will only experience a small subset of these potential side effects.

Depression

Many of the symptoms of PAWS parallel the symptoms of depression. This isn’t necessarily a single symptom, but a set of closely related symptoms that are all hallmark signs of a depressive disorder, such as:

• Loss of motivation
• Lack of interest in hobbies or activities
• Feeling hopeless or sad
• Trouble focusing or remembering
• Boredom

What distinguishes the effects of PAWS from depression is that they are expected to get better over time. Left untreated, depressive disorders stay the same or get worse – while most people will recover from PAWS symptoms, provided they stay sober.

Anxiety and Panic Attacks

Anxiety is another common symptom. People can break through the initial withdrawal stage, only to find themselves suddenly experiencing panic attacks and a host of other signs of anxiety. Often, this anxiety can come without any apparent cause.

Alcohol Cravings

Cravings for alcohol are often the most dangerous symptom of PAWS. Cravings can strike at any time, without warning, and can be extremely difficult to overcome.

Social Challenges

While it’s well known that a robust support network is one of the best things you can have for your recovery, when you’re experiencing PAWS, it can be difficult to build and maintain healthy relationships. 

You might feel disinterested in spending time with other people, not have the motivation to reach out to others, or not have the emotional capacity to build meaningful and lasting relationships.

Anger and Irritability

While experiencing PAWS, every little thing can get on your nerves. This can result in lashing out at the people closest to you or spending your days fuming over minutia.  

Alcohol and PAWS Timeline: How Long Does It Last?

The greatest challenge with PAWS is that the symptoms can last for months or even years before fully resolving. 

For myself, this is what made PAWS the most difficult challenge of my recovery: the feeling that these symptoms would never go away, and that this was my new reality if I continued to stay sober.

In comparison, the initial physical withdrawal was severe, but there was always an end in sight. Just a few more days, and I would start to feel better. Unfortunately, that’s not always the case with PAWS.

For most people, the symptoms of PAWS begin to peak about 4 weeks after your last drink and can last between 6 months and 2 years. But the symptoms do improve over time – and there are steps you can take to lessen their impact on your daily life, and get you started enjoying your life in recovery.

Want to learn more about PAWS? This video also provides a solid overview:

What To Do If You’re Struggling with PAWS

PAWS may be inevitable for some – but you can take steps to reduce the impact it has on your life, and to help your brain recover from the damages of alcohol use. Significant research has shown that the brain changes thought to be the leading cause of PAWS will completely revert within 6 months to 2 years – the exact same timeline as PAWS for most people.

A few lifestyle changes can have a dramatic effect in reducing the severity of your symptoms. These include:

• Exercise
• Meditation
• Socialization

Exercise actually helps the brain restore itself to a pre-addicted state. Meditation can be a valuable tool to help conquer anxious thoughts and reduce intrusive alcohol cravings. And spending time with friends and loved ones not only helps you build support for your recovery but enjoy your new life in sobriety.

If you’ve already tried the lifestyle changes and found they haven’t been enough – consider reaching out to a licensed mental health therapist. Starting therapy can provide you actionable tools and skills to overcome your PAWS symptoms, and in some cases psychiatric medication can help as well.

But above all else, the best thing you can do if you’re struggling with PAWS is to keep moving forward. If the research makes one thing clear, it’s PAWS gets better over time – and I promise, the rewards of recovery are worth the effort.

Related Articles On Sobriety