Protracted withdrawal, also known as post-acute withdrawal syndrome (PAWS), is a prolonged and persisting set of symptoms that are experienced after the acute phase of withdrawal from substances such as drugs or alcohol.

Find out more about what protracted withdrawal is and how PAWS is treated here.


What is PAWS?

Acute withdrawal (also known as detox) typically involves intense physical symptoms that subside quickly after use of drugs or alcohol has ended, whereas protracted withdrawal involves more subtle and enduring symptoms of withdrawal that can last for weeks, months, or even years.

The symptoms of protracted withdrawal can vary widely depending on the type of addiction, the duration and intensity of substance abuse, individual factors such as genetics and overall health, and more. PAWS symptoms are different for everybody.

Common symptoms of protracted withdrawal include:

  • Mood changes, such as depression, anxiety, irritability, or mood swings.
  • Cognitive difficulties including problems with memory, concentration, and decision-making.
  • Insomnia or disrupted sleep patterns.
  • Physical withdrawal symptoms like fatigue, headaches, and stomach issues.
  • Cravings for drugs or alcohol which may come and go over time.

Protracted withdrawal can be challenging to manage, as it can significantly impact a person’s quality of life and increase the risk of relapse.

It’s essential for individuals experiencing protracted withdrawal to seek help and support from qualified professionals such as our team who can provide personalised treatment and guidance tailored to their specific needs.


What Causes PAWS?

Post-acute withdrawal syndrome (PAWS) can arise from various factors related to substance abuse and recovery. The exact causes of PAWS are not fully understood, but several factors are believed to contribute to its development, including:

Neurochemical Imbalance

Prolonged substance abuse can disrupt the balance of neurotransmitters in the brain, such as dopamine, serotonin, and gamma-aminobutyric acid (GABA).

When substance use stops abruptly during detox, the brain may struggle to readjust to normal levels of neurotransmitters, leading to mood disturbances, cognitive difficulties, and other symptoms associated with PAWS.


Chronic substance abuse can lead to neuroadaptation, which is where the brain adapts to the presence of the substance by altering its structure and function.

When substance use of drugs or alcohol ends, the brain may require time to reverse these changes and return to its natural balance, contributing to the prolonged PAWS symptoms.

Psychological Factors

Psychological factors, such as stress, trauma, co-occurring mental health disorders, or unresolved emotional issues, can exacerbate PAWS symptoms and prolong the recovery process.

Individuals with mental health disorders may be more susceptible to experiencing PAWS.

Withdrawal from Multiple Substances

PAWS can be more evident in individuals who have a history of varied abuse, as withdrawal from multiple substances simultaneously can complicate the recovery process and prolong the duration of withdrawal symptoms.


Each person’s experience of PAWS can vary based on factors such as genetics, overall health, and substance use history. Some individuals may experience more severe or prolonged PAWS symptoms than others without a known cause.


Acute Withdrawal Vs Protracted Withdrawal

Acute withdrawal and protracted withdrawal are two distinct phases in the process of recovering from substance abuse.

What Happens During Acute Withdrawal

Acute withdrawal occurs shortly after discontinuing or reducing substance use and typically involves intense physical and psychological withdrawal symptoms. These symptoms can include nausea, vomiting, sweating, tremors, anxiety, insomnia, and irritability, among others.

The acute withdrawal phase does not typically last a long time and can be experienced anything from a few days to a couple of weeks, depending on factors such as the substance used, the duration and the severity of drug or alcohol addiction.

What Happens During Protracted Withdrawal

Protracted withdrawal, on the other hand, refers to a more prolonged phase of withdrawal that occurs after the acute detox phase has subsided.

Also known as post-acute withdrawal syndrome (PAWS), this phase of addiction recovery is characterised by milder but persistent symptoms that can last for weeks, months, or even years after substance abuse has ended.

Symptoms of protracted withdrawal may include poor mental health, memory problems and trouble concentrating, sleep disturbances, physical symptoms like fatigue or headaches, and cravings for alcohol or drugs.

While acute withdrawal is typically intense and shorter in duration, protracted withdrawal involves more subtle and enduring symptoms that can significantly impact a person’s quality of life and increase the risk of relapse.

Treatment for both acute and protracted withdrawal may involve a combination of medical management, therapy, lifestyle changes, support groups, and ongoing monitoring and follow-up with healthcare professionals.

At Ocean Recovery we offer medically-assisted drug and alcohol detox to help people successfully complete withdrawal and begin the recovery journey.


Treatment for Protracted Withdrawal

Treatment for protracted withdrawal typically involves a combination of supportive therapies, medication, lifestyle changes, and ongoing support from healthcare professionals and support groups.

Healthcare professionals may prescribe medications to alleviate specific withdrawal symptoms such as mood disturbances, sleep disturbances, or cognitive difficulties.

Alongside medication, therapy can be crucial to help people in recovery avoid relapse. Some useful addiction therapies that are provided in rehab facilities include cognitive-behavioural therapy (CBT), individual counselling, group therapy, and family therapy which helps individuals address underlying issues contributing to withdrawal symptoms and develop coping strategies.

Lifestyle changes, including regular exercise, a balanced diet, stress-reduction techniques, and a consistent sleep routine, are also vital in managing symptoms and promoting overall well-being after detox has been completed.

It is also recommended to attend local outpatient services to continue the support that is received during medical detox.

Support groups such as Alcoholics Anonymous (AA), Narcotics Anonymous (NA), or SMART Recovery provide valuable peer support and encouragement during the protracted withdrawal phase.

Education about the nature of withdrawal and relapse prevention strategies is also essential to help individuals identify triggers, manage cravings, and create a relapse prevention plan to maintain long-term sobriety.

A comprehensive approach that is tailored to the individual’s needs and circumstances can significantly improve the chance of long-term recovery from substance abuse. Get in touch with our team at Ocean Recovery to find out more about the detox process and how we can help today.

You can also phone our team on 0800 880 7596 to learn more about the recovery process and your options.

John Gillen - Author - Last updated: March 18, 2024

John is one UK’s leading professionals in the addiction recovery industry. Pioneering new treatment techniques such as NAD+ and ongoing research into new therapy techniques such as systematic laser therapy, John is committed to providing the very best treatment for people throughout the UK and Europe. During his extremely busy schedule, John likes to regularly update our blog section with the latest news and trends in the industry to keep visitors to our site as well informed as possible on everything related to addiction treatment.