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PAWS: What Families Need To Know


Protracted withdrawal, more commonly known as post-acute withdrawal syndrome or PAWS, refers to the rollercoaster of withdrawal symptoms that occur after acute withdrawal has taken place.

PAWS is not something we often learn about outside the walls of professional, clinical treatment. It is a frequent consequence of long-term addiction, and understanding PAWS’ role in the recovery process is vital to families and patients alike. The confusion created by the sudden onset of symptoms beyond the earliest stages of rehabilitation can be extremely confusing for the loved ones of a person in recovery. While many believe that the first year or two of recovery is a steady stream of progress, this is not always the case. Without understanding that the recurrence of withdrawal symptoms is normal, many newcomers fall victim to the delusion that they aren’t getting better, they’re never going to get better, or that their hard efforts toward recovery are moot.

Families need to understand that for up to the first 24 months of active recovery, symptoms of withdrawal can recur.

It can be discouraging to think that even into two years of sobriety the pain and struggle of the first 30-90 days can still be apparent. Treatment, therapy, 12-Step programming, and wellness plans can indeed make a lasting impact on a person’s life. However, the effects of long-term addiction are deep and severe. The mind, body, and spirit change tremendously during the first months and the first year of recovery. Comparatively, one to two years of sustained abstinence is a small amount of time against many years, if not decades, of sustained substance use. As the body, mind, and spirit work hard to filter out harmful chemicals and achieve a sense of connection, the resurgence of withdrawal symptoms can be crippling for loved ones as well as the sufferer. It takes time to lay down new pathways in the brain. As the body wrestles to recover, a person may find themselves feeling restless, irritable, and discontented even in the midst of sincere efforts to recover. The key is to understand that these occurrences are normal, timely, and most importantly, temporary.

Signs And Symptoms Of PAWS

The signs and symptoms of PAWS do not run on a set schedule. They vary from person to person, depending on the substance used and a person’s overall health.

The signs and symptoms of PAWS may include:

  • Sleep problems such as insomnia or nightmares
  • “Using dreams” about relapse
  • Depression
  • Anxiety
  • Panic
  • Physical discomfort
  • Obsessive thinking
  • Drop in immune function
  • Restlessness and irritability
  • Physical withdrawal symptoms such as nausea, sickness, and more

How To Handle PAWS

It is important to remember that the onset of “old” withdrawal symptoms is completely normal. Educate yourself, your family, and your loved one in recovery on PAWS and make sure that the recurrence of these symptoms is normalized so as not to stigmatize or shame a person. PAWS symptoms are not signs of regression. Rather, they are an indication that the body and brain are both working hard to recover.

Make sure that you and your loved one have a comprehensive understanding of what they need for self-care. Tools to use during the resurgence of withdrawal symptoms include:

  • Exercise
  • Maintaining balanced nutrition
  • Meditation or prayer
  • Cognitive behavioral therapy
  • Biofeedback
  • Holistic self-care modalities
  • Journaling
  • Service work to help “get you out of your head”

Lastly, it is of critical importance that your loved one stays close and communicative with their clinical, social, and spiritual support networks. Talking to a therapist or treatment team is of utmost importance as these clinical professionals can help track symptoms and adjust treatment accordingly. Socially and spiritually, it is important for your loved one not to isolate or distance themselves from their 12-Step Fellowship, including their sponsor, their sponsees, or their peers in recovery. Now, more than ever, they need the love, encouragement, and support of everyone around them.


Origins Behavioral Healthcare is a well-known care provider offering a range of treatment programs targeting the recovery from substance use disorders, mental health issues, and beyond. Our primary mission is to provide a clear path to a life of healing and restoration. We offer renowned clinical care for addiction and have the compassion and professional expertise to guide you toward lasting sobriety.

For information on our programs,

call us today:  561-841-1296.

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If you or someone you love has a substance use or mental health disorder, Origins Behavioral HealthCare can help. We will work alongside you to provide the most comprehensive treatment available.