Author: Gary Jackson

What Is Post-Acute Withdrawal Syndrome PAWS?

However, if a person already has alcohol use disorder, they can help prevent some of the withdrawal symptoms by speaking to a doctor about safe withdrawal. The most effective way to prevent alcohol withdrawal syndrome is to avoid drinking or drinking only in moderation. Doctors usually use a type of drug called benzodiazepines to reduce alcohol withdrawal symptoms. Alcohol withdrawal syndrome occurs when a person with alcohol use disorder stops or suddenly decreases their alcohol intake. Alcohol withdrawal syndrome is the group of symptoms that can develop when someone with alcohol use disorder suddenly stops drinking.

  • Doctors usually use a type of drug called benzodiazepines to reduce alcohol withdrawal symptoms.
  • Symptoms often include muscle ache, nausea, headache and increased heart rate.
  • However, CRF-like peptides also appear to maintain a negative-affective state, suggesting that they have a specific role in mediating the underlying PAWS stress response (Bruijnzeel & Gold, 2005).
  • A urine test can help doctors rule out withdrawal from specific drugs or combinations.
  • From these, we excluded 1,416 records during the title and abstract screening phase, leaving 592 full-text articles for review.
  • Several neurobiological and endocrinological features appear unique to PAWS, including enhanced glutamatergic activity in the nucleus accumbens, increased hypothalamic–pituitary–adrenal axis activity, decreased serotonin, and orexin availability, and contribute to the report of subjective symptoms.
  • For people in recovery from a substance misuse disorder, it may not be possible to prevent PAWS.

In addition, we supplemented the electronic database searches with manual searches of all eligible articles’ reference lists and previous reviews for additional studies. Treatment options for alcohol withdrawal syndrome typically involve supportive care to ease the effect of the symptoms. While some of the symptoms of alcohol withdrawal syndrome are similar to a hangover, they are not the same condition. People with alcohol withdrawal syndrome can have a wide variety of symptoms, depending on how much alcohol they drank, their body type, sex, age, and any underlying medical conditions. Post-acute withdrawal symptom (PAWS) is a condition where you experience withdrawal symptoms for an extended period of time — in other words, long after the typical acute stage is over. For example, benzodiazepines might be effective for helping people with alcohol withdrawal syndrome, but they won’t be appropriate for someone who has misused benzodiazepines in the past.

How Long Does Post-Acute Withdrawal Syndrome Last?

Keep reading to learn more about PAWS, the causes and risk factors, and how to cope in recovery. In addition, Dr. Bahji is a recipient of the 2020 Friends of Matt Newell Endowment from the University of Calgary Cumming School of Medicine. Dr. Bahji also received financial support from a 2020 Research Grant on the Impact of COVID-19 on Psychiatry by the American Psychiatric Association and the American Psychiatric Association Foundation.

Often, symptoms are triggered by stress or brought on by situations involving people, places or things that remind the individual of using. Many people in recovery describe the symptoms of PAWS as ebbing and flowing like a wave or having an “up and down” roller coaster effect. In the early phases of abstinence from substance use, symptoms can change by the minute. As individuals move into long-term recovery from alcohol or drug dependence, the symptoms occur less and less frequently. Moderate drinking is officially defined as 1 drink or less per day for women and 2 drinks or less per day for men.


These symptoms are common across substances — in other words, no matter which substance you used, you might experience one or more of the above. The available research suggests that some symptoms of opioid-related PAWS can last for weeks, and in some cases, 6 to 9 months after last use. According to the research, these symptoms can endure weeks or even months after discontinuing use. Sometimes, your symptoms after stopping antidepressant use are part of the “rebound symptoms” — in other words, the symptoms you were trying to treat with antidepressants start coming back. A 2020 study looked at experiences of PAWS after stopping antidepressants based on self-reported symptoms on an internet forum.

Alcohol and Post-Acute Withdrawal Syndrome

In a person with an addiction to benzodiazepines, for example, lasting withdrawal symptoms can stem from functional changes to the neuroreceptors in the central nervous system. Up to 15% of people who have taken benzodiazepines long term experience PAWS. Although our review found limited, mixed-quality evidence for different pharmacotherapeutic classes in managing specific PAWS symptoms (such as sleep disruption, mood, or anxiety symptoms), there remains a need to enhance the evidence base for PAWS and its treatment. Consequently, one strategy for improving PAWS research is to recognize it formally. We hope that the present review’s findings—by synthesizing literature across approximately four decades of research—may create a stronger argument for formalizing PAWS as a diagnostic entity. Furthermore, considering that PAWS symptoms are mainly related to the neuro-adaptive changes of GABA and NMDA systems, traditional treatments for AUD—such as naltrexone, nalmefene, and disulfiram—may not be able to suppress PAWS symptoms (Caputo et al., 2020).

Why do we experience post-acute withdrawal in recovering from substance abuse?

Consequently, the goal of this article was to summarize the extant literature examining the neurobiology and symptomatology of PAWS, paralleling findings from a complimentary review focusing on PAWS treatment. The duration can vary from person to person, and the substance involved may play a role. Often, there is no diagnostic test for withdrawal, as with opioid withdrawal. A urine test can help doctors rule out withdrawal from specific drugs or combinations. Dr. Bahji wrote the initial draft of the work and managed revision feedback from the other authors.

Alcohol and Post-Acute Withdrawal Syndrome

The most change occurred within 2 weeks of last substance use (Coffey et al., 2007). However, for negative affect and sleep symptoms, more evidence supports using gabapentinoids (gabapentin and pregabalin) and anticonvulsants (carbamazepine and oxcarbazepine). Although preliminary data support acamprosate, there were no controlled trials. Despite an older treatment trial showing some positive data for amitriptyline for mood, the clinical measures used were problematic, and side effects and safety profile limit its utility. Finally, there is no evidence that melatonin and other agents (homatropine, Proproten-100) show PAWS symptoms.