Post acute withdrawal syndrome (PAWS) refers to a group of lingering psychological and mood-related symptoms that may continue for months—or even years—after the acute withdrawal phase ends. Although it’s not recognized as an official diagnosis in the DSM-5, PAWS is very real and can significantly affect your patients’ recovery from substance use disorders (SUDs).
In fact, failing to identify and manage PAWS is one of the major risk factors for relapse—especially in the early stages of recovery.
What NPs Need to Know About PAWS
While post acute withdrawal syndrome doesn’t appear as a standalone diagnosis in the DSM-5 (so you won’t code for it), it absolutely should be part of your clinical awareness as a psychiatric provider.
PAWS is also known by other names, including:
- Post-withdrawal syndrome
- Prolonged withdrawal syndrome
- Protracted withdrawal syndrome
Regardless of what you call it, PAWS includes a range of symptoms including:
- Anxiety or panic
- Depression or mood swings
- Sleep disturbances
- Cognitive difficulties (poor memory, concentration)
- Cravings or anhedonia
These symptoms may emerge weeks after detox and fluctuate in intensity over time.
How Long Does Post Acute Withdrawal Syndrome Last?
One of the biggest misconceptions about PAWS is that it resolves quickly. That’s unfortunately not true.
The duration of PAWS varies by substance:
- For alcohol and opioids, symptoms can persist for up to 8 months
- For methamphetamine, PAWS can continue for several years
- Benzodiazepines and other CNS depressants may also have prolonged symptom timelines
There is no “one-size-fits-all” time frame—making it essential for psychiatric nurse practitioners to individualize care and monitor patients closely over time.
PAWS and the Risk of Relapse
The presence of post acute withdrawal syndrome significantly increases the risk of relapse. Symptoms often linger when patients feel like they should be improving—leading to discouragement, reduced self-efficacy, and sometimes a return to substance use.
Intervening early, offering supportive psychotherapy, medication-assisted treatment (when appropriate), and validating the patient’s experience can go a long way toward preventing relapse and supporting long-term recovery. Often patients haven’t even heard of PAWS, so providing education surrounding what it is, and how to treat it, is incredibly important as well.
As psych NPs, recognizing PAWS can make a measurable difference in recovery outcomes.
Keep Growing Your Confidence in Treating PAWS
Learning about post acute withdrawal syndrome and its impact on relapse helps you become a more effective and empathetic provider.
If you treat patients with co-occurring mental health and substance use disorders (which is many of us!), this knowledge is essential—and it doesn’t have to be overwhelming.
If you want to get even closer to confident treatment, a little bit faster, check out the Mental Disorders Crash Course.
You can also explore more Psych NP practice support resources here to build your knowledge and clinical confidence.