All treatment providers we recommend are regulated by the Care Quality Commission (CQC) or Care Inspectorate.
Individuals coming out of substance use and detox will often experience what is called post-acute withdrawal syndrome, or ‘PAWS’.
The severity of the withdrawal can range from mild to severe, depending on the following factors:
There is a difference between physical dependence and psychological dependence. Physical dependence is when you have been taking a drug or drinking alcohol for so long, that your body has become accustomed to it.
The body is used to functioning whilst the substance is in the system, so you will experience withdrawals if the substance isn’t taken.
Psychological dependence is used to describe the emotional and mental effects and processes associated with addiction. These cognitive aspects are linked to mental withdrawal symptoms, whilst they may not be life-threatening like the physical symptoms, mental withdrawals can significantly limit your quality of life.
Decades ago, post-acute withdrawal syndrome referred to mild but persistent withdrawal symptoms that have continued after individuals have discontinued benzodiazepine therapy.
The phrase has now become generalised, referring to all protracted courses of withdrawal symptoms from substances.
To help understand post-acute withdrawal syndrome, we must discuss the stages of detox and withdrawals.
There are numerous stages of withdrawal and detox, each presenting with different symptoms and risks.
In the first few days and weeks following a limitation of substances, individuals may experience acute withdrawal symptoms.  
Acute withdrawal is the first stage of detox, presenting mostly physical symptoms. These symptoms are immediate and can last for up to two weeks.
Depending on the severity of withdrawals, the following are common symptoms of mild acute withdrawal:
Severe withdrawals may present the following:
Post-acute withdrawal syndrome (PAWS) is the second stage of detox. This happens because the brain is re-calibrating itself following active addiction. The first stage of detox is primarily physical symptoms, whereas PAWS symptoms are mainly emotional and mental withdrawal symptoms.
Depending on the severity and length of addiction, PAWS is known to last for months, even up to 2 years. However, the intensity and frequency of the symptoms will lessen as time goes by.
Symptoms can appear randomly and sporadically, acting as a leading factor for relapse.
Regardless of the substance in question, the symptoms of PAWS tend to be the same for all individuals recovering from substance use disorders and alcohol use disorders.
The following are common post-acute withdrawal symptoms (or ‘PAWS symptoms’):
Following the acute withdrawal stage, post-acute withdrawal syndrome is a natural response as the brain slowly returns to normal following addiction.
During addiction, the brain rewires its neurotransmitters. Once the substance is removed, the chemicals in the brain have to regulate themselves as they attempt to return to a healthy balance. PAWS is the brain correcting these imbalances.
Research has shown that there are certain substances that are associated with post-acute withdrawal syndrome, presenting with different symptoms:
These symptoms may persist for up to 2 years and can present themselves randomly. This is often a risk factor for relapse, defined as the return to substance use following a period of cutting down or cessation.
These symptoms are uncomfortable for everyone involved, so individuals should try different coping skills to help them recover and cope with them.
The start of PAWS may be confusing due to the emotional rollercoaster and mood swings. These dramatic mood swings may be totally overwhelming, but they will get further apart and less intense as time goes on.
You may go a period of time without symptoms, but they may randomly appear after a month or two without them.
This unpredictability causes anxiety, but you must try to be patient as time will help you recover from PAWS. Managing PAWS is the only way to overcome these mental symptoms.
Self-care is one of the most important aspects of managing PAWS that last for over a year. Take time to focus on yourself, including your mental and physical health. Self-care is not selfish, but it is taking care of yourself in order to be the best version of yourself that you can be.
The World Health Organisation defines self-care as “the ability of individuals, families, and communities to promote health, prevent disease, maintain health, and to cope with illness and disability with or without the support of a healthcare provider” .
Self-care involves steps to help individuals manage their stress levels and tension.
The following are commons steps involved in self-care:
During active addiction, self-care often becomes less of a priority. It is also important to educate yourself about PAWS, addiction, and detoxification. This can help prepare you for any unexpected symptoms.
For example, you may go months without symptoms, and one day you may suffer from insomnia followed by extreme irritability and anger.
Without preparation and self-care, the symptoms presented may put you at risk of relapse. Start a journal and keep a notepad to write down your experiences.
This will help you develop an insight into your symptoms, and document coping mechanisms that have or haven’t worked for you.
This will make it easier to remember things and keep track of important information and feelings. This can also help remind you of important dates, appointments, and your daily schedule or routine.
Make sure you talk to friends, family, and other loved ones. Be kind to yourself, addiction is a mental disease, and it is not your fault nor is it a moral failing.
The recovery process for PAWS is long compared to other detox timelines, as the psychological symptoms can last up to two years, outlasting the physical withdrawal symptoms of acute withdrawal.
The long-term recovery of PAWS follows the acute withdrawal phase, moving from physical symptoms of withdrawal to psychological symptoms such as cognitive impairment. This happens following a period of prolonged substance abuse, withdrawal from alcohol, or cessation of drugs.
PAWS is the reconfiguration of brain activity and brain chemistry after being rewired by drugs or alcohol. This will have affected brain function, and possibly cause or exacerbate mental health conditions.
This can be helped naturally by improving your practice of self-care such as exercise and good nutrition. It can also be helped by mental health professionals, through different treatment programmes and behavioural therapy.
Healthcare professionals are able to treat your symptoms at whatever stage of recovery you are in, whether that is the acute phase of withdrawal or post-acute withdrawal syndrome presenting with severe symptoms.
Addiction recovery is never easy or simple, but the sooner you start, the more likely you are to receive the help you desperately need.
 Loretta Butehorn.Post–Acute Withdrawal Syndrome, Relapse Prevention, and Homeopathy.Alternative and Complementary Therapies.Dec 2017.228-230.brain activity
 Gupta M, Gokarakonda SB, Attia FN. Withdrawal Syndromes. (2022). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.
 Substance Abuse and Mental Health Services Administration. (2010). Substance Abuse Treatment Advisory: Protracted Withdrawal.
 Saitz R. Introduction to alcohol withdrawal. Alcohol Health Res World. 1998;22(1):5-12. PMID: 15706727; PMCID: PMC6761824.
What is 5-HTP? 5-HTP stands for 5-hydroxytryptophan, which is a dietary supplement used to treat a wide range of mood disorders and other issues. Our bodies naturally make 5-HTP, but …