What Is Post Acute Withdrawal Syndrome Paws
This page explains post-acute withdrawal syndrome (paws), and what a practical next step can look like in Reno. Post-Acute Withdrawal Syndrome (PAWS) refers to a set of persistent impairments that can linger for weeks, months, or even years after someone stops using substances.
Carlos stared at the coffee mug, hands trembling slightly. It had been six weeks since her last drink, and while the intense cravings had subsided, a persistent unease lingered. She felt…off. Not sick, exactly, but emotionally raw, easily frustrated, and struggling to focus. She’d started snapping at her kids, something she hadn’t done before, and the simplest tasks felt overwhelming. She wondered if she was doing something wrong, if she was destined to feel this way forever.
COUNSELOR NOTE — RENO TREATMENT & RECOVERY
I’m Chad Kirkland, a Licensed CADC serving Reno, Nevada. I’ve spent 5+ years working with individuals and families affected by substance use and co-occurring concerns. Certified Alcohol and Drug Counselor Supervisor (CADC-S), Nevada License #06847-C Supervisor of Alcohol and Drug Counselor Interns, Nevada License #08159-S Nevada State Board of Examiners for Alcohol, Drug and Gambling Counselors.
Reno Treatment & Recovery provides outpatient counseling and substance use–related services for adults seeking support, assessment, and practical recovery guidance. Care is grounded in clinical ethics, evidence-informed counseling approaches, and privacy protections that respect the dignity of each person seeking help.
This is general information; specific needs and safety concerns should be discussed with a qualified professional.
What is Post-Acute Withdrawal Syndrome (PAWS)?
Post-Acute Withdrawal Syndrome (PAWS) refers to a set of persistent impairments that can linger for weeks, months, or even years after someone stops using substances. It’s important to understand that PAWS isn’t a relapse; it’s a natural part of the brain’s recovery process. During active substance use, the brain adapts to the presence of the drug, and it takes time to re-establish normal functioning once the substance is removed. PAWS symptoms can fluctuate in intensity and often appear unexpectedly, making it feel like recovery isn’t progressing linearly.
Why this matters during recovery
PAWS can be incredibly discouraging, as it can mimic early relapse symptoms. Many people experience emotional swings, difficulty with sleep, problems with concentration, and increased stress reactivity. These symptoms can lead to frustration, self-doubt, and a higher risk of returning to substance use as a way to cope. Recognizing PAWS for what it is – a temporary, though challenging, phase of recovery – is crucial for developing effective coping strategies and maintaining long-term sobriety. It’s a reminder that the brain is healing, and patience and self-compassion are essential.
What this looks like in real life
Imagine someone who has recently completed a detox program for alcohol. They’ve stopped drinking and are attending support meetings. Initially, they feel relief. However, after a few weeks, they start experiencing intense anxiety in social situations, even though they haven’t used alcohol. They find it difficult to focus at work, and their sleep is disrupted. They may misinterpret these symptoms as a desire to drink, leading to feelings of guilt and shame. This is a common presentation of PAWS, where the brain is still adjusting to life without alcohol, causing emotional and cognitive difficulties.
How counseling or support can help
Counseling can provide a safe space to process PAWS symptoms and develop coping mechanisms. We can explain options and coordinate referrals, and we’ll recommend medical evaluation when withdrawal or medical risk may be present. Techniques like Cognitive Behavioral Therapy (CBT) can help identify and challenge negative thought patterns associated with PAWS. Motivational Interviewing can strengthen intrinsic motivation and build confidence. Support groups offer peer support and validation, reminding individuals they are not alone in their experience. Learning mindfulness and relaxation techniques can also help manage stress and anxiety.
What are some common PAWS symptoms?
Common PAWS symptoms include: emotional swings, anxiety, irritability, difficulty concentrating, sleep disturbances, decreased libido, physical fatigue, and increased cravings. These symptoms can come and go, often triggered by stress or environmental cues. It’s important to track symptoms to identify patterns and develop personalized coping strategies.
How long does PAWS typically last?
The duration of PAWS varies greatly from person to person. For some, symptoms may subside within a few weeks, while others may experience them for months or even years. There’s no set timeline. Factors like the severity of the addiction, overall health, and coping skills can influence the length of PAWS.
Can medication help with PAWS symptoms?
Medication can sometimes help manage specific PAWS symptoms, such as anxiety or depression. However, it’s important to work closely with a medical professional to determine if medication is appropriate and to monitor for potential side effects. Medication is often used in conjunction with counseling and other support services.
What is the connection between PAWS and relapse?
PAWS can significantly increase the risk of relapse. The uncomfortable symptoms can lead to cravings and a desire to self-medicate with substances. It’s crucial to recognize PAWS as a potential trigger and to develop a relapse prevention plan. This plan should include coping strategies for managing symptoms, identifying support resources, and avoiding high-risk situations.
Where can I find more information about PAWS?
Resources like the Substance Abuse and Mental Health Services Administration (SAMHSA) website and the National Institute on Drug Abuse (NIDA) website offer valuable information about PAWS. Additionally, many addiction treatment centers, including Reno Treatment & Recovery, provide educational materials and support groups for individuals experiencing PAWS. Do not include sensitive medical or legal details in web forms.
Clinical Disclosure & Scope of Practice
To ensure the highest level of ethical care in Reno, Nevada, please review the following professional guidelines regarding our services and your privacy.
1. Scope of Guidance
Information provided is for educational purposes. Clinical assessments are required to establish a doctor-patient relationship and personalized treatment plans.
2. Mandatory Reporting
Per Nevada law (NRS 432B), clinicians are mandatory reporters. Confidentiality is maintained except in cases of immediate harm to self, others, or vulnerable populations.
3. Medical Necessity
We provide behavioral health counseling. We do not provide medical detox; clients at risk of acute withdrawal will be referred to a medical facility for stabilization.
Licensure Note: All services are provided by providers licensed through the Nevada State Board of Examiners for Alcohol, Drug and Gambling Counselors.