What Is Protracted Withdrawal Syndrome?

Experiencing long-lasting symptoms despite avoiding drugs and alcohol is protracted withdrawal syndrome (PWS) or post-acute withdrawal syndrome (PAWS).

Most people understand that when you stop taking drugs or alcohol, even prescription drugs, there is an initial or acute withdrawal period. Withdrawal can last days to weeks and involve unpleasant, sometimes life-threatening physical and mental symptoms. However, the mental, physical, chemical, and biological changes from a drug dependency can take a long time to return to normal, leading to PWS.

People who have withdrawn from cocaine, heroin, Xanax, methamphetamines, alcohol, and even GHB have all experienced PWS or PAWS. Symptoms that continue regularly or re-appear randomly throughout recoveries, like PSW and PAWS, are disruptive and stressful and can be frustrating and threaten recovery.

Much like addiction, recovery is complicated. Although, with the right tools and strategies to help you manage the side effects and setbacks of addiction, your chances are better at recovery, preventing relapse, and achieving long-term success.

Ideally, healing can begin with help and determination once you are through that stage; but unfortunately, some people will struggle with withdrawal symptoms that can last for weeks to years. Learn more about protracted and post-acute withdrawal syndromes and how professional treatment programs can help you avoid or overcome them.

What Is Protracted Withdrawal Syndrome?

Protracted withdrawal syndrome (PWS) refers to withdrawal symptoms that last several years after the initial withdrawal period.

One of the reasons that PWS went undiagnosed for so long is that the symptoms are what doctors call “constellation symptoms,” meaning they appear independent and unrelated. Still, when viewed through the lens of drug and alcohol withdrawal, there is a connection.

Researchers initially diagnosed PWS in people who had gone through benzodiazepine withdrawal and called it benzodiazepine protracted withdrawal syndrome. However, as more studies regarding long-term recovery increased, it has become accepted that anyone overcoming substance abuse could be vulnerable to protracted withdrawal syndrome.

It is impossible to predict with absolute accuracy who will suffer from PWS, but some factors increase the chances, including:

  • Substance abuse over a long period of time
  • Being born addicted to drugs or alcohol
  • Physical condition
  • Past benzodiazepine use
  • Quitting cold turkey
  • Tapering off antidepressants too quickly or incorrectly
  • Previous traumatic or prolonged withdrawal experiences

Protracted Withdrawal Symptoms

Some common symptoms of protracted withdrawal syndrome (PWS) don’t manifest immediately; some lay dormant until outside factors trigger them, or the central nervous system doesn’t recover properly and causes them to emerge.

If you begin experiencing symptoms despite being in recovery, you need to inform your doctor of your past alcohol or drug abuse so that they can diagnose you properly.

Protracted withdrawal symptoms include:

  • Extreme cravings for drugs or alcohol
  • Mood swings
  • Insomnia
  • Unexplained physical discomfort and restlessness
  • Decreased attention span
  • Short-term memory loss
  • Cognitive impairment
  • Confusion
  • Anxiety
  • Decreased interest in sex
  • Inability to feel pleasure
  • Panic attacks
  • Depression
  • Chronic fatigue

Although all the causes of protracted withdrawal syndrome are unknown, doctors have successfully treated and managed them with education, behavioral therapy, medication-assisted treatment, and long-term care plans.

protracted withdrawal syndrome

What Is Post-Acute Withdrawal Syndrome (PAWS)?

Post-acute withdrawal syndrome (PAWS) refers to the lingering and recurring psychological and physical symptoms that can last weeks to months after the initial detox period.

Acute withdrawal symptoms are what most people associate with quitting drugs, primarily being physically ill and uncomfortable for days or weeks. When people take prescription medications for physical or mental illnesses or have been using drugs or alcohol to self-medicate, then stop, the initial symptoms will start to return; these are called rebound symptoms.

Rebound and acute withdrawal symptoms include substance-specific, common symptoms directly related to changes from the drugs or alcohol leaving the body and previously known conditions the substances suppressed.

PAWS symptoms differ from the rebound and acute withdrawal symptoms because they are new, previously not experienced, and often seem unrelated to substance abuse or withdrawal.

Withdrawal from drugs that interact with the central nervous system has the highest rates of PAWS. 90% of opioid users and 75% of alcohol and benzodiazepine users, and about 70% of stimulant users experience prolonged withdrawal symptoms, according to studies.

Rates for people who use psychoactive drugs and hallucinogens are still unknown because of limited research.

Post-Acute Withdrawal Symptoms

Post-acute withdrawal symptoms may not appear immediately after the initial withdrawal but a week or more after and will be new, previously unexperienced symptoms. Both acute and post-acute withdrawal symptoms will vary depending on the person and the substances.

Post-acute withdrawal symptoms, which can be physical and mental, include:

  • Lack of energy
  • Tremors
  • Numbness, burning, or tingling feelings in the limbs
  • Muscle weakness
  • Dizziness
  • Sexual dysfunction
  • Brain fog
  • Memory trouble
  • Vivid dreams
  • Sleep changes
  • Drastic changes in appetite
  • Intense mood swings
  • Increased sensitivity to stimuli
  • Lack of patience
  • Anxiety
  • Depression
  • Suicidal thoughts

Post-acute withdrawal syndrome side effects are not always present; they may sometimes come and go or seem mild. However, recognizing and treating PAWS can prevent it from escalating into permanent conditions and help stop relapse.

post acute withdrawal syndrome

Protracted Withdrawal vs. Post-Acute Withdrawal

The differences between protracted withdrawal syndrome (PWS) and post-acute withdrawal syndrome (PAWS) mostly come from their severity and the length of time they last. PWS entails longer-lasting (months to years) and more intense symptoms; PAWS is a shorter period of time (weeks to months) and generally more mild symptoms.

What experts classify as less severe can differ from how the person experiencing the symptoms would describe them; they can still be disruptive and challenging.

Many medical professionals, treatment programs, and addiction specialists interchange the terms protracted and post-acute withdrawal, primarily because they are similar and demand the same attention and urgency for improving quality of life and preventing relapse.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), other terms used to refer to persistent symptoms include:

  • Chronic withdrawal
  • Extended withdrawal
  • Prolonged withdrawal
  • Post withdrawal syndrome
  • Alcohol withdrawal syndrome (AWS)
  • Late withdrawal
  • Long-term withdrawal
  • Sobriety-based symptoms
  • Subacute withdrawal

Scientists are still researching the causes of prolonged withdrawal, but they have determined that symptoms flair up more when people in recovery experience stress.

There are many reasons to seek professional addiction treatment, including learning about and reducing the risk of withdrawal syndromes; and learning healthy coping skills if you experience unpleasant symptoms that challenge your recovery.

protracted withdrawal vs post acute withdrawal

Substance Abuse Treatment

At Northridge Addiction Treatment Center, we understand that seeking help for substance abuse involves many changes, including various questions and hesitations.

Our caring and compassionate team is here to put you at ease and ensure you understand every aspect of your journey to recovery, including what to expect and how you’ll benefit from your specialized treatment plan.

We provide onsite medical detox to keep you safe through withdrawal with 24-hour medical care and support. Our licensed addiction professionals use dual diagnosis and medication-assisted treatment to properly recognize and treat co-occurring disorders. We help educate you about your conditions and what it takes to manage them to maintain your long-term recovery.

Our evidence-based behavioral therapies work to reshape your thinking and empower you with confidence and skills to build a support network and overcome any challenges you face in the future.

Reach out to us today. We are eager to help you take your first steps toward lasting recovery.

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