Updated August 8th, 2025
When it comes to drug and alcohol withdrawal and detox, no two experiences are alike. There are several factors that will influence a person’s withdrawal experience, therefore, it’s impossible to predict exactly what symptoms a person will experience or how long the entire process will take.
In some cases, a person may experience what’s known as post-acute withdrawal syndrome or PAWS. This may result in more severe psychological or emotional effects that last much longer than the initial physical effects a person may experience while in detox.
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The Two Stages of Withdrawal
When a person suddenly reduces or stops the long-term abuse of a drug, he or she will experience certain physical symptoms. These symptoms are known as withdrawal. The symptoms of withdrawal can last for several days or weeks, depending on several different factors, but they can be treated with medication to reduce discomfort.
There are two main stages of drug and alcohol withdrawal: acute and post-acute.
- Acute: The acute stage of withdrawal is the first stage. It typically lasts several days to a few weeks. It’s impossible to say exactly how long this first stage will last or what types of symptoms a person will experience during this time, as every person and drug is different.
- Post-acute withdrawal: The post-acute stage of withdrawal is the second stage. During this time, a person won’t experience as many physical symptoms, but the psychological symptoms will increase as the brain gradually adjusts to changes.
The second stage of withdrawal, known as post-acute withdrawal, can last anywhere from several months to several years. This may increase a person’s risk of relapse, even after completing a detox program.
Factors that Influence Withdrawal Symptoms
There are many different factors that will influence a person’s withdrawal experience during drug and alcohol detox. Depending on the factors listed below, a person may experience a variety of different physical and psychological symptoms during withdrawal in varying levels of intensity.
- Drug abuse history
- Family history/genetics
- Physical and psychological health
- Tolerance
- Type of drug(s) abused
- Method of drug abuse
- Type of detox used (cold turkey, medicated, tapered, etc.)
Symptoms of Post-Acute Withdrawal Syndrome
As mentioned above, the physical symptoms during the acute phase of drug withdrawal will vary greatly from person to person. However, during the post-acute withdrawal stage, most people will experience the same types of psychological symptoms. These symptoms most often include:
- Mood swings
- Cognitive impairment
- Drug cravings
- Depression
- Fatigue
- Anxiety
- Low threshold for stress
- Insomnia/sleep disturbances
- Irritability
- Anhedonia (problems experiencing pleasure)
Not every person who completes a drug or alcohol detox program will experience PAWS, but some will. Due to a lack of scientific research, the syndrome is not recognized in the Diagnostic and Statistical Manual of Mental Disorders, but many people in recovery have reported experiencing these symptoms for months and years after completing detox and rehab programs.
The Dangers of Post-Acute Withdrawal Syndrome
The symptoms of post-acute withdrawal syndrome can be threatening for a person’s recovery for many reasons.
- A person may give up on their recovery because the symptoms of PAWS make a life of sobriety seem very unsatisfying.
- A person may view unpleasant PAWS symptoms as a justified reason to relapse.
- A person may begin substituting other addictive behaviors such as unhealthy amounts of exercise or shopping to cope with unpleasant PAWS symptoms.
- A person might continue with the same negative and harmful behaviors despite their ongoing abstinence from drugs and alcohol.
Prevalence of PAWS by Substance Type
While scientific literature on Post-Acute Withdrawal Syndrome (PAWS) remains limited, recovery community reports and clinical observations suggest it is a highly prevalent condition among individuals recovering from substance use disorders. Below is a breakdown of estimated prevalence by substance category.
Opioid Use and PAWS
Opioids—including heroin, prescription painkillers such as oxycodone and hydrocodone, and synthetic opioids like fentanyl—are strongly linked to prolonged withdrawal symptoms.
- Estimated Prevalence: Roughly 90% of individuals recovering from opioid dependence report experiencing PAWS.
- Why So Common: Opioids cause profound changes in the brain’s reward pathways and stress systems. Even after acute withdrawal resolves, these systems can remain dysregulated for months or years, leading to persistent symptoms such as insomnia, irritability, cravings, anxiety, and mood instability.
- Clinical Concern: Given the intense discomfort and prolonged cravings, PAWS is a major contributor to relapse risk in opioid recovery. This makes long-term support—such as medication-assisted treatment (MAT) and structured aftercare—critical.
Alcohol and PAWS
Alcohol is another substance frequently associated with lingering withdrawal symptoms after detox.
- Estimated Prevalence: About 75% of individuals recovering from alcohol dependence report PAWS symptoms.
- Typical Symptoms: Mood swings, depression, anxiety, sleep disturbances, low energy, and cognitive difficulties are common.
- Why It Happens: Chronic alcohol use alters neurotransmitters like GABA and glutamate, which play key roles in mood regulation and cognitive function. It can take a long time for the brain to re-balance these systems after cessation.
- Relapse Implications: Many people misinterpret PAWS symptoms as signs that recovery “isn’t working,” which can trigger a return to drinking without adequate support.
Psychotropic Substances and PAWS
Psychotropic substances—including benzodiazepines, prescription sedatives, and certain antidepressants—can also lead to PAWS after discontinuation.
- Estimated Prevalence: Around 75% of individuals recovering from psychotropic drug use experience some form of PAWS.
- Unique Challenges: Benzodiazepines in particular may cause prolonged anxiety, insomnia, and hypersensitivity to stress—sometimes lasting months or years. Antidepressant discontinuation can cause mood instability, cognitive fog, and sensory disturbances.
- Risk Factors: Longer duration of use, higher doses, and abrupt cessation increase the likelihood of developing PAWS.
Medically-Assisted Detox: A Safe and Comfortable Detox Experience
At Briarwood Detox, we provide safe medically-assisted detox programs for all types of addictive substances. Our professional team of medical and clinical experts is experienced in treating all kinds of symptoms and phases of drug and alcohol withdrawal.
If you complete a detox program at Briarwood, our medical team will ensure your safety and comfort throughout the acute stage of withdrawal. During detox, you will attend individual and group therapy sessions (as you are able) to help you cope with the psychological changes that accompany drug withdrawal.
If your psychological symptoms continue and worsen upon completion of your program, our staff can provide professional recommendations for ongoing treatment to help you cope with the mental stressors of detox and withdrawal.
Unpleasant PAWS symptoms don’t have to keep you from reaching your full potential in a life of recovery. Contact Briarwood Detox Center today to learn more about our medically-assisted detox programs and the services and assistance we can provide upon completion of your program.