Post-Acute Withdrawal Syndrome (PAWS) – How to Cope

How To Deal with Post-acute withdrawal syndrome (PAws)Post-Acute Withdrawal Syndrome also known as PAWS or P.A.W.S is the prolonged and persistent withdrawal symptoms that occurs after the initial “acute” withdrawal symptoms that’s typical from using heroin, opiates or other drugs such as benzodiazepines and even alcohol stops. PAWS can continue for months or even years after heroin use stops. So why does this occur and what can be done to stop it?

Almost everyone who has used heroin or opiates has experienced some kind of Post-acute withdrawal.

The length of time that Post-acute withdrawal syndrome occurs varies but typically lasts for 2 years from a recovering addict’s clean anniversary date.  It can be intense at times, but with patience and perseverance, symptoms can be overcome and recovery can conquer addiction.

Post-acute withdrawal can be compared to a roller coaster.  Post-acute withdrawal is an “on again, off again” experience full of hills and valleys, ups and downs.  The above referenced symptoms can come and go and can last anywhere from a couple of minutes to a couple of days.  There are no obvious triggers for each episode and not all of the symptoms listed above are felt.  And not all symptoms are always experienced at once.  The symptoms are sometimes intense and at other times, they are virtually non-existent.  But the feelings associated with PAWS can and often do return on and off for up to 2 years.

Some of these symptoms include:

  • Anxiety
  • Tiredness
  • Low levels of enthusiasm
  • Insomnia (trouble sleeping)
  • Concentration difficulties
  • Low levels of energy
  • Irritability
  • Mood swings

Thankfully, each episode pertaining to a particular set of symptoms is temporary and will go away as quickly as it comes.  But it can be a bit challenging to deal with in particular when coupled with urges and cravings associated with heroin and/or opiate use. post-acute-withdrawal-syndrome-paws-948x200

How to Cope with Post-acute Withdrawal Symptoms (PAWS)

Patience and Perseverance: The most crucial characteristics in not only surviving but conquering PAWS is patience and perseverance.  Symptoms can be intense at times, but they will always go away.  Pushing through and indulging in healthy activities that will help take your mind off of them when episodes occur can help reduce the desire to use heroin.

Take time to smell the roses: Taking time out from your day to experience and enjoy the moment and what you are currently doing is key to any healthy recovery.  It’s also key to enjoying and getting the most out of life.  So be sure to relax, take your time and go with the flow.  This will make PAWS easier to deal with.

Take Care of Yourself: Getting plenty of rest, exercising and healthy eating can help make recovery easier in general let alone dealing with post-acute withdrawal syndrome.  Indulging in drug use will only wake addiction up and allow it to take control.  Remember, recovery is the antithesis of addiction.

PAWS - Post-acute withdrawal syndromoeResisting Relapse: Post-acute withdrawal symptom can be a trigger and thus, cause the brain to consider drug use.  But those serious about recovery know the dangers of relapse.  Relapse is the awakening of the addiction that sleeps and resides within everyone who suffers from the disease of addiction.  Relapse is a state of mind first and an action second.   But it always results in drug use.  Relapse is a symptom of addiction and is not part of recovery.  Being prepared for P.A.W.S may just make resisting relapse a little easier.

Relax and Stay Positive: Don’t tense up when symptoms of PAWS arise.  Relax your body and try to concentrate on other things.  Think about something you are excited about or something that occurred during the day.  Most importantly, stay positive.  Don’t dwell on negative thoughts which addiction thrives on.  Positive thinking is the making of a successful recovery.


Heroin Recovery isn’t easy but it is possible.  Addiction will do whatever it can to stay alive and active.  But don’t think of post-acute withdrawal syndrome as a sign and characteristic of addiction.  Instead, think of it as your brain and body trying to heal and adjust to recovery and wellness.

Written and Published By,

William – Publisher and Founder of Kill the Heroin Epidemic Nationwide™

14 thoughts on “Post-Acute Withdrawal Syndrome (PAWS) – How to Cope

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    • Abbie,

      That’s a good question. It’s my understanding that Suboxone will reduce and even eliminate all withdrawal symptoms, including Post-Acute Withdrawal Syndrome. It also depends on how long you take Suboxone. For instance, if you’re only on it for a few months and PAWS could last up to 2 years I would think it’s possible that you can experience some Post-Acute Withdrawal Syndrome. But not everyone experiences this either. For more information, I suggest speaking with your doctor.

      Best wishes,

      William – Publisher of this Community

      • Suboxone withdrawals and PAWS symptoms are so much worse than any other drug, IMO. It’s a government made opiate, in it’s most basic form, and I can tell you now that choosing suboxone or methadone for PAWS is the worst choice you can make.
        My God, it is hell. Heroin can’t touch suboxone as far as messing you up for a long long time.
        Please don’t do that to yourself. I swear on everything if you get thru the basic dope sickness with heroin, the rest will be cake compared to suboxone.
        Just one “expert” opinion. ❤

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  8. my personal experience is that you can definitely recover from heroin addiction. takes a lot of will power and never looking back. i quit methadone on my own with the help of smuggled ibogaine. it was not perfect and took a lots of pain and despair but i had every intention to never set foot in the program again. as i went to see them with a monkey on my back and they gave me a gorilla instead. I had once quit heroin cold turkey before to fall back on the habit two years later and an overdose didn’t stop me. homeless by choice bouncing from crack to heroin i joined the methadone tyrants who want to keep you hooked for the rest of your life and treat you like children. that was 25 years ago and i have no regrets. to be clean is the hight of freedom.

    • Catherine,

      Thanks for sharing your story. Smuggled Ibogaine? That’s interesting. How did you know how much to take? Ibogaine is an intense psychedelic drug that paralyzes you and creates hallucinations. I’ve heard various reports by those who’ve experienced it. Some have had positive and others have had negative results. I’ve heard that one particular individual never fully came back from their Ibogaine “trip” and still sees and hears things to this day.

      That said, I’m glad everything worked out for you.

      Best wishes,

      William – Publisher of this Community

  9. I feel compelled to share my PAWS experiences with others who are trying to quit opiates and stay quit. A little background. I was not a drug user in anyway for most of my adult life and never considered addiction. At the age of 45, I had a bad injury due to an accident and was prescribed Roxycodone for the pain. 30mg 3X a day. This led to an addiction to Roxycodone and then IV Heroin that spanned 7 years.

    I went to detox for the first time at the age of 52 and after being discharged 6 days later, I only managed to stay clean for a total of 10 days. I felt pretty badly and the PAWS related fatigue was crippling and I went right back. I simply could not function. My addiction continued for another 8 months. I had a big habit again by then and was unable to taper down before quitting. 2 sometimes 3 buns a day of premium Newark diesel. By this time I didn’t even get high; I used to simply feel normal and chased the high. Eventually my addiction spiraled downward and I hit bottom. I simply could not use any longer mentally or financially. It was either quit or end my life.

    I obtained a prescription for Suboxone and decided to detox myself the second time. I don’t recommend this to anyone, it was excruiating. Go to detox and rehab if at all possible, its simply less painful. My addiction was pretty bad at this point and the Suboxone didn’t help much. After about 6 days of absolute hell, the detox was over. I managed to hide my first detox visit at rehab, but at this point the horror of my family figuring out that I had an opiate addiction became apparent. In my family its telegraph, telephone, tell everyone. Within 24 hours my entire, large, extended family now knew. I felt like running away to Guam or someplace.

    After detoxing, the PAWS once again kicked in, only worse this time. I am certain my age and somewhat lengthy history of using made things worse. Brain fog, fatigue, not sleeping, constant runny nose and just feeling AWFUL in a generalized sense. The best way to describe it was like having a bad hangover, which stayed with me everyday for the first 53 days. I dragged myself to work, came home and spent the rest of those 53 days dragging myself to NA meetings and lying in bed. It sucked. I thought it would never end. I was tempted to get relief many times by scoring but simply knew I could not use again or I would end up dead. Be warned, too many self detox failures left me feeling completely powerless and hopeless to my addiction. It got a lot harder after multiple failures. When you quit the FIRST time, stay quit. Yeah, easier said than done, I know. I simply did not have the emotional, physical or mental strength to fail one more time and come back from it. This was my absolute last run.

    I do work and took 2 weeks vacation off to go through withdrawal, knowing it would be bad but expecting that I could tough it out after 2 weeks. When I returned to work I was still very much feeling awful. I still don’t know how I managed to go to work everyday. I did it because I had too I guess. On a scale of 1 to 10, 1 being the worst I could feel and 10 being the best, I was a steady 1 or 2. On day 54, by some miracle, the generalized sense of feeling awful went away. I don’t know how or why, but it lessened greatly overnight. I still had fatigue, although less. I jumped up to feeling like a 5 or 6.

    I am now 115 days clean and I am determined to never go back. I have simply come too far to go through that pain and misery again and I know that death awaits if I do go back. Strong motivator. I still don’t feel completely normal. I don’t deal with stress easily, my motivation has not fully returned, I still get fatigue, but it’s mostly tolerable. I feel about a 7 most days and have occasional setbacks where I feel like a 6, but I get by. I continue to feel better in small increments. I don’t see the improvements each day, but over the weeks I can look back and realize another symptom is gone. I am confident in time I will return to feeling like a 10 everyday. It does get better.

    As a heads up, the monthly full moon made me feel worse for the first two months, not sure why. I would start to feel really badly the day before a full moon and it would last about 5 days before I improved. But by the third full moon, I felt no ill effects from it. Now I am switching mentally from focusing on how badly I felt, to dealing with all the life events I have ignored and screwed up over the past years and need to repair. Fun.

    Opiates are a lonely, every day addiction. You hide it from everyone and suffer in silence. Quitting becomes necessary for everyone eventually I think. If you don’t die first. Quitting was very hard, but in essence it’s the easy part. Staying quit due to PAWS was the hardest thing I have ever done in my life. But know that your PAWS will pass to a tolerable level in time. My experience is not meant to discourage anyone who is trying to get clean. Your experience might be different than mine and your PAWS less severe. I certainly hope that it is. Most other addicts I spoke with in NA did not have their PAWS symptoms last as long as mine. If you do find that your experiences are similar to mine, don’t give up hope. A few months of feeling badly are worth the freedom of being clean. Take a leave of absence from work to get clean if you have to. Go to rehab. Getting off this poison is your priority. If you’re new to NA or simply just don’t like meetings, I will strongly tell you to attend anyway. Just the social aspect keeps you from isolating and keeps your head in check. Hang in there. If I can do it you can too. See you in Guam.

  10. Thank you for writing this!!! So well done. Today is day 18 off subs for me, & I was on them for a LONG time. Tell ya what, tho, you’re right: quitting is absolutely the easiest part. We all get the flu, on or off dope, and we deal with it no problem. Same concept with detox. A week of straight hell, then a slow climb upward.
    My friend told me that it’s like I got the trophy, but now I gotta run the marathon. Funny how that works.
    My mind is better already, mostly because I f#^%ing did it, ya know? I get that I gotta keep running that marathon but the pride I have in simply choosing this impossible race to save my own life is just incredible. As rough as I still feel, I am feeling again. As batsh#* crazy as my poor brain becomes, I suddenly want to live. Like actually be alive. The shackles of dope are real as if they were made of iron. I’m so damn glad to be free of those, I might just make it.
    See ya on day 54!

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