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Often, medical or therapy related terms are shortened into acronyms.  You may have heard someone use the word PAWS; but, when talking about recovery, paws does not refer to an animal’s feet. In recovery, PAWS stands for Post-Acute Withdrawal Syndrome.  This is the second stage of withdrawal.  If you or a loved one is experiencing substance abuse or withdrawal, knowing PAWS symptoms can be helpful.

What is PAWS?

Withdrawal is the brain’s reaction to the sudden removal of a substance presence in the body. Withdrawal happens when a person stops taking something that their brain has grown used to or has become dependent on.  This can happen as a result of substance abuse.

Withdrawal has two stages. The first state of withdrawal is called the acute stage. It is during this stage that someone feels the physical symptoms associated with withdrawal. Although everyone’s experience with withdrawal is unique to them and depends on the drug, most people experience the acute stage of withdrawal for a few days to a couple of weeks.

PAWS, Post-Acute Withdrawal Syndrome, is the second stage of withdrawal. PAWS has some, but fewer, physical symptoms.  PAWS is known for its mental, emotional, and psychological withdrawal symptoms.  The length of someone’s PAWS experience depends upon how much alcohol was abused another other health factors. PAWS may last for weeks to months.

PAWS can happen as part of a withdrawal from almost any substance. However, benzodiazepine users seem to be at a greater risk for long term PAWS symptoms.

Pregnant mothers that repeatedly suffer from substance abuse can put their infants at risk for developing PAWS.

What are Symptoms of PAWS?

The intensity and duration of PAWS symptoms can vary. Sometimes, symptoms may stop for a period of time then reappear. Some doctors have observed that the intensity of PAWS symptoms increase when someone is triggered by stressful or emotional situations.  However, symptoms can occur without any obvious or known triggers.

Symptoms of PAWS can include:

  • Strong cravings for the abuses substances
  • Changes in typical emotional reactions
    • Increased of emotional outbursts
    • Unusual apathy or lack of emotion
    • Depression
    • Irritability or aggression
  • Obsessive compulsive behaviors
  • Anxiety or panic attacks
  • Difficulty with stress management
  • Lethargy or low energy
  • Changes in sleep patterns
  • Insomnia or difficulty sleeping
  • Unusual Dreams
  • Difficulty with problem solving
  • Difficult with cognitive tasks or learning
    • Lack of clarity when attempting to think or make decisions
  • Memory loss or difficulty with memory recall
  • Dizziness
  • Clumsiness or falling
  • Social difficulties or unusual problems when maintaining social relationships
    • Difficulty with social cues
    • This may be a result of the previously listed side effects


PAWS symptoms can be confusing or frustrating. PAWS, when treated properly, is not permanent and will ease over time. For questions about PAWS, please seek the advice of a medical professional. If you or a loved one are experiencing PAWS, remember to focus on patience, compassion, and support. Healing will take time. With the help of a rehabilitation or substance abuse specialist, a person can safely overcome PAWS and lead a healthy life.