What is Post Acute Withdrawal Syndrome (PAWS)?

Withdrawal and PAWS

Post-Acute Withdrawal Syndrome (PAWS) is a complex and often misunderstood condition that can occur after the acute phase of substance withdrawal has subsided. When individuals stop using drugs or alcohol, their bodies go through a detoxification process to remove the substances from their system. During this initial detox period, known as acute withdrawal, individuals may experience intense physical and psychological symptoms as their bodies adjust to functioning without the substances.

However, for some individuals, the challenges do not end with acute withdrawal. Post-Acute Withdrawal Syndrome (PAWS) refers to a set of lingering symptoms that can persist for weeks, months, or even years after the initial withdrawal period. PAWS can be a significant barrier to recovery, as the ongoing symptoms can be distressing and challenging to manage. In this article, we will explore what Post-Acute Withdrawal Syndrome (PAWS) is, its symptoms, causes, and potential treatment strategies.

Understanding Post-Acute Withdrawal Syndrome (PAWS)

PAWS is a phenomenon that primarily affects individuals recovering from substance use disorders, including alcohol, opioids, benzodiazepines, stimulants, and other drugs. It is important to note that not everyone who goes through withdrawal will experience PAWS, and the severity and duration of symptoms can vary widely between individuals.

The symptoms of PAWS are different from those experienced during the acute withdrawal phase. Acute withdrawal symptoms are typically intense and short-lived, occurring shortly after the last use of the substance and peaking within a few days to a week. On the other hand, PAWS symptoms are more subtle, persistent, and may fluctuate in intensity over time.

Common Symptoms of PAWS

The symptoms of PAWS can vary depending on the substance that an individual has been using and their unique physiology. Some common symptoms of PAWS include:

  1. Mood Swings: Individuals with PAWS may experience frequent and unpredictable shifts in mood, ranging from feelings of depression and anxiety to periods of euphoria.
  2. Anxiety: Persistent anxiety and nervousness are common symptoms of PAWS. Individuals may feel on edge or experience panic attacks.
  3. Depression: Lingering feelings of sadness, hopelessness, and lack of interest in activities can be present in PAWS.
  4. Sleep Disturbances: Insomnia or disrupted sleep patterns are prevalent during PAWS, with individuals having difficulty falling or staying asleep.
  5. Fatigue: Persistent fatigue and lack of energy are typical in PAWS, even after adequate rest.
  6. Difficulty Concentrating: Many individuals with PAWS struggle with focus, attention, and memory.
  7. Irritability: Individuals may be easily agitated or frustrated during PAWS.
  8. Physical Symptoms: Physical symptoms, such as headaches, dizziness, and gastrointestinal disturbances, can be present.

Causes of PAWS

The exact causes of PAWS are not fully understood, but it is believed to result from the impact of substance use on the brain’s neurochemistry. Prolonged drug or alcohol use can lead to changes in the brain’s reward system, neurotransmitter function, and overall neural circuitry.

When an individual stops using the substance, the brain needs time to readjust to its normal state. During this process, neurotransmitter levels may fluctuate, leading to the emotional and physical symptoms associated with PAWS. The brain’s ability to produce and regulate neurotransmitters, such as dopamine, serotonin, and GABA, may be disrupted, contributing to mood fluctuations and other symptoms.

Individual differences in brain chemistry, genetics, and the duration and intensity of substance use can also play a role in the development of PAWS. Some individuals may be more susceptible to PAWS due to their unique neurobiology and experiences with substances.

Substances Associated with PAWS

PAWS can occur with various substances, but it is commonly associated with:

  1. Alcohol: PAWS from alcohol withdrawal can include symptoms such as depression, anxiety, fatigue, and irritability.
  2. Opioids: Individuals recovering from opioid use may experience PAWS symptoms such as mood swings, cravings, and difficulty sleeping.
  3. Benzodiazepines: PAWS from benzodiazepine withdrawal can include anxiety, panic attacks, and cognitive difficulties.
  4. Stimulants: PAWS symptoms from stimulant withdrawal may include depression, fatigue, and difficulty concentrating.

Duration of PAWS

The duration of PAWS can vary significantly from one individual to another. In some cases, PAWS symptoms may persist for a few weeks to several months, while in others, they may last for years. The severity and frequency of symptoms may also fluctuate over time, with periods of relative stability interspersed with more challenging episodes.

Several factors can influence the duration of PAWS, including the type and duration of substance use, the individual’s overall health, and the presence of co-occurring mental health disorders.

Diagnosing PAWS

Diagnosing PAWS can be challenging, as there is no specific medical test to confirm its presence. Instead, healthcare professionals rely on a comprehensive assessment of the individual’s medical history, substance use, and the pattern and duration of their symptoms.

It is essential for individuals in recovery to communicate openly with their healthcare providers about their experiences during withdrawal and throughout their recovery journey. This information can help healthcare professionals make an accurate diagnosis and develop a tailored treatment plan to address the individual’s specific needs.

Treatment and Management of PAWS

While there is no specific cure for PAWS, several strategies can help manage its symptoms and support individuals in their recovery journey:

  1. Psychotherapy: Engaging in individual therapy or support groups can provide emotional support and coping strategies for managing PAWS symptoms.
  2. Medication: In some cases, medication may be prescribed to manage specific symptoms of PAWS, such as antidepressants for depression or anxiety.
  3. Nutrition and Exercise: Adopting a healthy lifestyle that includes a balanced diet and regular exercise can improve overall well-being and help manage PAWS symptoms.
  4. Mindfulness and Relaxation Techniques: Practicing mindfulness, meditation, or relaxation techniques can help reduce stress and promote emotional stability.
  5. Social Support: Building a strong support system of friends, family, and recovery peers can provide encouragement and understanding during challenging times.
  6. Avoiding Triggers: Identifying and avoiding triggers that may exacerbate PAWS symptoms, such as stress, certain social situations, or environmental cues associated with substance use.
  7. Routine and Structure: Establishing a daily routine and structure can provide stability and a sense of control during the recovery process.
  8. Therapeutic Outlets: Engaging in creative outlets or hobbies can provide a healthy distraction and a positive way to express emotions.

Post-Acute Withdrawal Syndrome (PAWS) is a complex and challenging condition that can impact individuals recovering from substance use disorders. It involves a set of lingering symptoms that persist beyond the acute withdrawal phase and can persist for weeks, months, or even years.

PAWS is believed to result from the impact of prolonged substance use on the brain’s neurochemistry. The brain’s readjust

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Samantha Kelly​

Director of National Business Development & Admissions Coordinator

I am a dedicated and passionate professional with extensive experience in business development Admissions and marketing. I have an incredible passion for showing others that there is a light at the end of this dark tunnel if someone truly wants it.
Being in recovery myself I understand the struggles of addiction and alcoholism. I Started this Career path in 2009. With multiple years of experience, I bring a multi-faceted approach and am always seeking new ways to make a difference in the lives of those I work with.

Kim L. Buckner


As a Substance Abuse Motivational Speaker, Pastor, Peer Advocate, and Facilitator. Kim helps clients avoid relapse by understanding their triggers. Those people, places and things that can cause craving, as well as internal triggers like feelings, thoughts, or emotions. Kim also clients with identifying and building healthy relationships now that they’re clean and sober.

Kim’s background includes extensive experience as a motivational speaker and work in faith-based organizations helping youth and adults alike. He says he is motivated by giving back to the community, understanding, and not judging who she comes into contact with. Kim’s favorite quote is by Dr. Raymond Johnson: “The respect given to others rebounds to the giver to deny the scared in the Other is to deny it in oneself.”

Caty Burns


Caty graduated from Indiana University Bloomington in 2015 with a Bachelor of Arts in Psychology and minors in Counseling and History. Throughout her undergrad, she worked at the local CASA program, supporting volunteers advocating for children who had experienced abuse and neglect. Caty worked for seven years at a community mental health center (CMHC), partnering with children, adults, and families.

During those seven years, she taught life and coping skills as well as behavior management, provided case management and peer recovery services, and facilitated treatment teams that included the client, family, providers, and community members. I have also worked at an IOP providing group therapy services. She is currently working towards my Master of Social Work.

In her free time, Caty enjoys reading, especially historical fiction, spending time outdoors and having movie nights with her family. Disney World is her happy place, and she dreams of living among the elephants.

Madison Knowles

Mental Health Therapist

My name is Madison Knowles, I am a Mental health therapist at NPAC. I am a single-mother of two and I have a daughter who is globally delayed and has been diagnosed with autism. I have been in this industry since I was 16 years old, as I was fascinated with human behavior. I obtained my masters in applied behavioral analysis and started off working with people with disabilities. I then found my love for counseling when I worked with juveniles who had mental health and substance use issues. I then decided to go back for my mental health therapy license after that and working in a forensic treatment center. I went on to obtain my therapy credentials and since 2017, I have also been working on my PhD in forensic psychology in which I am currently working on my dissertation. I am inspired by change and how resilient people can be. My favorite inspirational quote is “Some will, Some won’t, So what, NEXT!!!” This quote has inspired me to try, try, and try again no matter how hard life gets, someone will give you a chance eventually. As a therapist at NPAC, I have been given the opportunity to work with diverse populations such as in substance use and mental health and I am known for my work with people on the schizophrenic spectrum as well as with other clients with other severe conditions including personality disorders.

Megan Carmona, LMHC

Lead Therapist

Our Lead Therapist, Megan, is a bilingual Licensed Mental Health Counselor who specializes in working with adults who struggle with addiction, anxiety, depression, and trauma. As Lead Therapist, she provides individual, family, and group therapy sessions to our clients.  Megan says “I am very passionate about therapy, especially about supporting my clients in exploring their strengths and identity. My goal is to provide individuals with the tools that can help them achieve independence in coping with their challenges and facilitating personal development.” In her free time, Megan enjoys watching docu-series and playing video games with her family. Her dream is to own acres of land so she can care for vulnerable animals, especially old dogs, cats, and horses. 

Kristen Bensley

Primary Clinician

As Primary Clinician, Kristen works with all aspects of our clinical team, from case management to primary therapy.  She has broad experience working in the mental health field. Prior to joining our team at the Neuro Psychiatric Addiction Clinic, Kristen was part of the team awarded the Evernorth Behavioral Health Center of Excellence Designation by Cigna. She says her motivation is to help people rediscover who they are and become excited about the future and all the possibilities life offers. Kristen’s favorite quote is: “You can’t go back and change the beginning, but you can start where you are and change the ending.”

Ronn Daigle, MSW

Therapist, Utilization Review Clinician

Ronn Daigle services as a Therapist and Utilization Review Clinician at the Neuro Psychiatric Addiction Clinic. He has been working in the field of substance use disorder treatment since 2011, with experience in all facility-based levels of care. Ronn earned, both an Associate of Arts in Psychology (2013) and Bachelor of Science in Human Services, with an Addiction Studies Concentration (2015) from Indian River State College. 

Ronn additionally earned a Master of Social Work degree in 2021 and is a current Registered Clinical Social Work Intern working toward licensure (LCSW). He describes himself as detail oriented, and solution focused.

Ronn says: “There is nothing more fulfilling than working with someone who doesn’t believe in himself or herself, and being there in the moment with them when the belief begins. We work with individuals who come to us at a point and time in their respective lives where they do not believe that change for others is possible; let alone for themselves…throughout the process they eventually come to a point where they realize that change is not only possible, but achievable.”

Erika Melecio, LMHC, MCAP, CEI

Assistant Clinical Director

Erika Melecio, LMHC, MCAP, CEI is the Assistant Clinical Director at Neuropsychiatric Addiction Clinic who specializes in the treatment of LGBTQ, addiction, as well as mental health disorders ranging from depression and anxiety, to Bipolar Disorder, trauma, personality disorders, psychotic disorders, and eating disorders. Erika utilizes a number of modalities including Cognitive Behavioral Therapy, Solution Focused Therapy, Motivational Interviewing, Dialectical Behavioral Therapy, and Mindfulness amongst others. Erika has been in practice for close to a decade and has earned her license in Mental Health Counseling, as well as being a Master’s Certified Addiction Professional. Erika has worked with many individuals including couples counseling and family therapy, and is fluent in Spanish.
Throughout my years of practice, one of the things I enjoy helping people find is inner peace. Whether you are in the deepest parts of depression, overrun by your anxiety, controlled by your addiction, or there are certain issues in your life that are negatively impacting your ability to function, and have a happy, healthy life, maybe now is the time to talk about it. I am a big believer in empowerment, working hard in therapy, and utilizing different techniques to help you regain that inner peace that may have been lost along the way. I want to work with you as a team because with two people, absolutely everything is possible. I want to be there as a therapist, to help build you up, support you, but also help you be honest with yourself and accountable. At the end of the day, when all is said and done, my biggest goal for you is going to be simple….for you to no longer need my services. Why? Because if you no longer need my services, it means that you have regained your peace, you have regained your strength, you have regained your confidence. It means that you now have the tools to address any issues that try to derail you, and best of all, you will have the insight to overcome and thrive. So let’s begin this journey together, and get you to the place you want to be, emotionally, mentally, psychologically, and in your sobriety.

Aurelio Ayuso, MSW, LCSW, CAP, ICADC

Clinical Director

Aurelio has worked with those that suffer from the disease of addiction in adults and juveniles alike for over 10 years, beginning in the United States Navy where he proudly served for 20 years, working with those that were succumbed by addiction due to trauma and continuing his passion for helping those in need locally in Central Florida.

He specializes in both Addictions and Trauma, he has worked first as a therapist then as the clinical supervisor to both the Juvenile and Adult Drug Court programs in Brevard County. Aurelio has been instrumental in developing substance abuse treatment programs directly tailored to help those that also suffer from complex trauma due to their addiction. He has been recognized by several organizations for his forward thinking and ability to tailor treatment to individuals in the most restrictive environments.

Mr. Ayuso received his Graduate Degree in Clinical Social Work from the University of Central Florida in Orlando. He is a Licensed Clinical Social Worker as well as Certified Addictions Professional in the State of Florida, and Internationally Certified Alcohol & Drug Counselor. Aurelio specializes in the treatment of Addiction, Trauma, and Abandonment using strength based strategies deeply rooted in Solution Focused, and Mindfulness Therapies. At the Neuropsychiatric Addiction Clinic he passionately develops holistic curriculums that foster the belief that through addressing the mind, body, and spirit together, the Disease of Addiction can be addressed successfully.

Robert Lehmann, MHSA

Chief Operating Officer

Bob Lehmann is the Chief Operating Officer at the Neuro Psychiatric Addiction Clinic. He has a Master’s Degree in Human Services Administration with a concentration in Mental Health Administration and over twenty-five years of experience as a senior executive at addiction and mental health treatment facilities.

One of the reasons for his commitment to excellence in addiction treatment was his experience related to family members who suffered from the disease of addiction. Bob has been actively involved in community organizations throughout his career. Recently he was one of the founders of the Florida Addiction Treatment Coalition (FATC) and is its present Vice President. FATC was designed to bring together treatment executives in Florida to advocate on behalf of treatment facilities and the clients they serve adhering to a foundation of integrity and service excellence.

Jose R. Toledo, M.D.

Medical Director

A well-rounded and accomplished individual, Jose R. Toledo, M.D., is the Medical Director of Neuro Psychiatric Addiction Clinic.

Dr. Toledo is a neurologist with 25 years of experience and has been in private practice since 1991 on the Treasure Coast of Florida. He completed his neurology training at the State University of New York and his Fellowship training at the University of Pittsburgh in Epilepsy and Clinical Neurophysiology.

He also completed 24 months of acute inpatient psychiatry at the Western Missouri Mental Health Center, University of Missouri in Kansas City. In 2008, Dr. Toledo participated in and was certified in the continuing medical education activity entitled “Buprenorphine and Office-Based Treatment of Opioid Dependence” from The Medical University of South Carolina during which began his quest to found and head Neuropsychiatric Addiction Clinic.

Dr. Toledo is a brain specialist with particular competence in addiction medicine and out-patient detoxification treatment and integrates the fields seamlessly. He is certified to prescribe Buprenorphine (Suboxone). He incorporates his background in neurology into the addiction field. Dr. Toledo is member/fellow of The American Medical Association, The Florida Medical Association and The American Society of Addiction Medicine