Newly Sober? PAWS Still Has You In Its Claws!

We all know that most relapses occur in the first few months after we get clean and sober.  Many of them are related to Post-acute Withdrawal Syndrome.  We talked about PAWS in a previous post, but I wanted to go into it more specifically here.

Although there are differences in the way they act, all addictive drugs function by either stimulating or imitating the chemicals of the brain's reward system — giving us too much of a good thing.

In an attempt to return our brain chemistry to normal (homeostasis), the brain builds more receptor sites for those particular neurotransmitters.  This allows it to deal with the higher-than-normal levels, leading to tolerance: the need for more drugs to fill up the additional receptors so that we can continue to get high.

When we get clean and sober, those extra receptors clamoring to be filled up are what causes withdrawal: acute withdrawal while the drug is clearing out of our system, and post-acute withdrawal during the period when the brain is deactivating the extra receptor sites and returning to normal.  Some authorities believe that it never normalizes entirely, which may be why any use usually leads back to full-blown addiction.

There is a double-whammy effect, too. When the drug is removed, there is a “rebound.” We begin to experience many feelings and physical symptoms that are the opposite of the way the drugs made us feel.  Removal of the drugs' stimulation causes the production of the reward chemicals to drop to below normal, and they return to their pre-addiction levels slowly. During this period we may be antsy, anxious, depressed, manic, or combinations of those feelings. We may feel as though our recovery is hopeless, and that we might as well use.

That's PAWS.  The duration  varies depending on the drug(s) used and individual physical differences.  It can — but usually does not — last for up to two years.  Ordinarily it will peak and then slowly subside within the first few months.  During that period (and in most cases for the rest of our lives), use of addictive drugs can put us back on the merry-go-round quickly.  It will also prolong the period of PAWS.  It can even set us back completely, because it interferes with the brain's repairs.

So, in early recovery we need to be prepared for a prolonged period of slowly feeling better, with setbacks when our bodies need that additional bit of natural feel-good and don't get enough, usually when we are under stress.  Stress aggravates PAWS symptoms because the natural “drugs” that help us to cope aren't back to full strength yet.

The good news: it always gets better, slowly but surely.

The best medicine for Post-acute Withdrawal Syndrome is time, aided by mild exercise, good nutrition, rest, stress avoidance, and distractions.  We need to have some fun.  We need the support of people who know where we're coming from, and who know how to deal with people in early recovery.

That's why we recommend meetings, fellowship, halfway houses, long-term treatment, and some time away from the old grind and the old stresses.  They help us deal with PAWS, while we're getting into the habits that lead to long-term recovery.

As George Carlin used to say, “Just because the monkey is off your back, it doesn't mean the circus has left town.”

If you've had your own experiences with PAWS, how about sharing in the comments?  Questions?  Feel free!


  1. Kristin H. says:

    Thank you for this. It is an excellent source of information for several newcomers in my life and will be used as the ‘voice of reason’ considering they don’t want to listen to me 🙂

  2. Thank you Kristen. It’s good to hear from you.


  3. I was so thankful to find this website it has really helped me to understand ,why I feel the way I do. And what is going on with me in my recovery. Thank you so very much.!!!!!!!


  4. Hi Wendy,

    You’re most welcome. Please feel free to ask any questions you like. We’ll do what we can to answer them here, or privately.


  5. Hi,
    I stopped taking suboxone 15 days ago, most of the pain from wd are gone, but not all, I have been taking 16mg for two years, and quit cold turkey. I was just wondering what can help with paws such as vitamins, or is that a bad idea? I feel like I cant move, like I am in slow motion, and I cant think straight…help!

  6. Hi Nicole,

    Your feelings and symptoms are typical. You can expect good days and bad days for some time, but they will slowly get better. There is a comprehensive article about PAWS here. Please read it, especially the section on nutrition, to get an idea of what to expect. I will be happy to answer any questions you may come up with.

    Regarding vitamins: a multivitamin twice a day with meals and a good overall diet (see the article) should be all the nutritional support you need. Don’t be swayed by people who swear that this or that did wonders for them. Anecdotal testimony like that is pretty much useless, because we don’t know what would have happened if they hadn’t taken whatever it was. They might very easily have felt just as good. We are addicts, and we are always looking for the quick fix. Unfortunately, when it comes to PAWS, time is the cure, along with general good healthy lifestyle and support from others. When it comes to the health aspects, sticking to good science is best.

    Hang in there, and

    Keep on keepin’ on,


  7. Anonymous says:

    Paws will last at least 6 mths. Especially comin Off [metha]done or bup[prenorphine].

  8. Anonymous says:

    This was SO helpful and well written! THANKS.

  9. I’ve been away from alcohol for 11 months and still have a foggy brain. It’s encouraging to hear about PAWS. Thanks.

  10. I am at 3 1/2 months. I still have hot flashes mostly at night. They aren’t as intense but still uncomfortable. I also sneezed a lot in the beginning. I still sneeze a little every day but not like the beginning. I think the hardest part for me is the anxiety. I hope I see improvement soon. I haven’t yet had the cloudiness. I keep wondering if all this is normal at 3 1/2 months

  11. Thank you so much -this article was so helpful to me. I have been addicted to methadone for a very long time -I just got so sick of the life and weened myself offf,my dr. prescribed Clonidine patches which really helps with the initial withdrawas symptoms. I was really ready and so happy to be free then 3 weeks sober all the symptoms from PAWS starting setting in! I knew it wouldn”t be easy but never expected so much confusion! It is really good to know there is a reason for all the things I am feeling etc. This has been very insightful!

  12. russell says:

    just wanted to chime in. I’m a 2nd year medical student. you have the physiology of the receptors flipped. chronic drug use LOWERS receptor density (like D2 receptors) as a defense mechanism. Once you quit your drug of choice, it will take months for the receptor density to increase back to baseline.

  13. Ayearon says:

    I have been opiate free from using for 2- 2 1/2 years and first two months were hard I felt crazy like when sleeping if I was even alive and couldn’t tell what was real. I’m now at 5 months and the out of body experience has gone but now I feel like the withdrawals are back I can’t sleep again and I feel like everything is a dream please help us this normal I’m tired of this always feeling scared….

  14. SwitchMan says:

    Has now been 6.5 months sober now, Been drinking for 25 years, am now 60, Life went by in a sec, now every hour, every day seems like an eternity, Most days I feel like I don’t even know who I am any more, life is gone!!
    I will continue to be strong for my family and love ones and pray to GOD I can make through this black hole, no end in sight. But the other day I noticed something very different about myself and I just can’t quit put my finger on it, it was like a moment of clarity, I hope it comes back soon.

  15. Ive come off methadone and the WD was crazy…not the intensity but the length of it. After about 4 months I couldn’t take the lack of energy and weird feeling anymore so I went back, until I could get in with a Dr. for subox.
    I’m now at 2mg of subox strips and I’m going to do a super low taper, like down to 1/16mg lol! I’ve heard the difference between withdrawing from methadone and suboxone is like the flu compared to a cold. Can’t wait to be clean!!

  16. Just to be clear for those on subs and looking to come off.. not to put fear out there but as I am in my 9th month off subs and I have detoxed off methadone, I have to just put this out as I keep seeing people post about how coming off subs is nothing to methadone… if I could go back I’d go back on methadone at my highest before touching the outside of a sub strip package. methadone detox took me a full 18 month of what at the time I thought was HELL…
    then I kicked subs got subs PAWS. I’ve tried to kill myself 4 times ( yes real not cry 4 help} I’ve done everything according to all different help groups from Dr.’s to NA to these… time is the only thing I’m aware of that ends it if it ends as for the 2 years comment not sure where you got your info but PAWS is also not a catch all every type is different according to D.O.C. and as always the person. as of now I know of two people who have been dealing with Alcohol PAWS for over 15 years… I am good friends with a person who has been in subs PAWS going on 4… so there really isn’t an answer to how long it will last, and I think giving false hope is a good way to lead to relapse so to all of you throwing out times 1st you don’t know… so why do it? Second I feel while your comment section shows a general like, and thankfulness you should put up something on here stating the facts that none of this advice should be followed without talking to a doctor, that what is on here may be based on some studies but not all, and even the stuff that is supposed to be.. as you are human may be inaccurate
    as was already pointed out in a post. because the thing I’ve learned most researching this is that the more crap info you find out about that you took as truth to start the less you want to bother with sobriety at all… I know if I wasn’t married and had the responsibilities I have I would be High as I could get , probably hoping for a hotshot.

  17. Hi!

    I’ve been doing so much reading about PAWS the last few days. I took my last Tramadol July 30th. I’ve had a script since 2005 (two back surgeries). Worked in an office for years, started my own business which included very physical upholstery of restaurant booths and chairs. Ended up on 300 mg of Tramadol, 2 Etodolac, 3 Gabapentin and hydrocodone 5.0 up to three times daily. Partially retired in July and discovered that pain meds had me feeling “high” for the first time since I began taking them. Titrated off the Gabapentin, then Etodolac and finally hydrocodone with no issues. Still felt high so started on the Tramadol.

    Titrated from 300 to 200 mg and stayed at that dose for several weeks. Felt a little “sneezy” but otherwise ok. Then went from 200 to 100 mg and that’s when it hit the fan. Pretty much all of the physical withdrawal symptoms and very intense. After 4 days, I figured that I wouldn’t survive it again if I waited a few weeks titrate further so I quit taking.

    Have not had any desire to continue taking Tramadol, just a devil of a time working through the initial withdrawals and now the PAWS issues. Anger issues, don’t handle stress, lack of enthusiasm and energy basically.

    I guess my first question is should I prepare for the full 2 years since I was on Tramadol for so long. Never abused it nor took more than my PCP wrote the script for, if that makes a difference.

    Thanks for any answers you can provide.

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