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What is PAWS (Post-Acute Withdrawal Syndrome)?

Oftentimes we focus most of our attention on the acute-withdrawal from opiates, but we fail to realize that there is a far milder form of withdrawal that can last up to 12 months after all the hardcore stuff is over. This “mild” withdrawal is called:  Post-Acute Withdrawal Syndrome or PAWS for short.

Some common PAWS symptoms are:

  • Depression
  • Impaired concentration
  • Lack of initiative
  • Stress sensitivity
  • Increased sensitivity to pain
  • Inability to think clearly
  • Drug cravings
  • and more…

In the past I had no idea what post-acute withdrawal syndrome was. I would just assume that everything was back to normal once the worst of it was over, but in looking back, I can vividly remember how out-of-touch I felt with life for the few months that followed. I say “out-of-touch” because that was the only way I could explain it at the time. I remember being very sensitive to stressful situations, I remember having a very hard time concentrating or thinking about a complex problem. But, what I remember most was the depression. It was just plain horrible, and had I known that it may have been a chemical issue (i.e. PAWS), then I probably would have had an easier time dealing with it.

It’s difficult to think that your life could be affected for so long after drug use has stopped, but the truth is that the mind-altering chemicals that we put into our bodies today, can have a very lasting effect on our brain’s once that use stops. There are a ton of ways that you can help yourself get through PAWS, like exercise, eating healthy, taking vitamins etc…, but I think the first step is to identify that PAWS is the real deal. I hope I’ve done that with this post.


1 How to Deal With Post-Withdrawal Depression | VicodinWithdrawal.org { 05.23.09 at 12:22 am }

[…] my previous post I write about PAWS and the symptoms associated with it, one of which being depression. I wanted to dedicate an entire […]

2 Depressed in PA { 02.10.11 at 3:03 pm }

This article saved my life. The information here never surfaced anywhere else in all of my research about the depression and suicidal thoughts I was having. I am going to see a doctor asap and see what we can do to get this under control I was on Vicodin from March thru December, first for pinched nerve, then disc replacement surgery, then a broken leg and although I had heard about addiction I never heard about this awful out of body depression experience. This week I started having chest pains and anxiety attacks and I had no idea how it could all be related. Now I do. Thank you.

3 Spsencer { 05.15.11 at 10:45 am }

Hi my name is Spencer, I was addicted to oxycodone on and off for about 2 and a half years now I was on saboxone for the past 7 months I recently detoxed off the saboxone and am clean now. The detoxing part was tarrable I did it by my self with 0 support I was in shock of how good i felt after detoxing. Now I have paws and its tarrable I have been 10 days clean how long will this depression last? I keep drinking caffine and it just make sthe physical withdrawls kick in more.

4 Vince { 07.09.11 at 1:54 pm }

I was taking subs for a year and a half about 1mg. per day i stoped in april and now its july after 5weeks i couldnt take the withdrawals any more so i started taking a half 7.5 vicodine twice a day i still have deppression and that burning feeling cant get well please help me.

5 brie { 07.26.11 at 8:14 am }

not sure why am writing this, i guess it is because i have no one to tell. my addiction to vicodin started over ten, yes ten years ago. i had a hit and run car accident which kept me out of work for months. the drugs helped me through the day but once i was physically ok, i kept taking the drugs because i liked how i felt and who i was. happier, more energy and i thought i had it under control. working in healthcare, there was always a way to get the vicodins. but the years passed and my tolerance grew. no longer did a half give me the same feeling, then a whole 7.5, didn’t do it either. the first thing when i woke up was take a vicodin. then it when to one and a half, then two just to get myself going. for the last 2 or 3 years it has been two in the morning and one and a half every three hours. getting scripts and using 3 to 4 different phamacys. then even that wasn’t enought. ah, here comes my new best friend, some one who dealt. i was buying 100 pills a week, in addition to my scripts. paying about 600.00 to 800.00 dollars every paycheck. how the hell did i get here! i had even gotten up to 3 tabs every 3 hours. and even 5 minutes late and i was an animal. i needed to get out of this hell hole. NO ONE except my dealer and my accommodating MD knew. i have a wonderful life, a fabulous husband and a amazing son. no one knew and i could never tell them. so what do i do? i had tried a few time, usually because i couldn’t get any but it never worked. cuz eventually i got them. till 10 days ago, i had enough. the money i was spending was disgaceful. so i just stopped. told my dealer, don’t give me any, even if i beg. told my MD i was going to try and get off this roller coaster. (haven’t seen him yet) it is the hardest thing i have ever done. the pain was so bad i though i would die and even looked in my secret hiding places for just one or two vicodins. thank god i couldn’t find any. yes i had many secret hiding places. but 10 days in and i’m OK, i think. i am suffering all the typical side effects. sleep, mood swings and general fatigue seem to effects me the most. i just keep telling myself “hey, you made it one more day”. i try and stay focused on a clean future and what i can provide my family with the money i’m not spending on drugs. well kids that is pretty much my story. i know i am not out of the woods yet but “one day at a time”. that’s all i can do. and if i can do it after an addiction that has spand over a decade. you can too. you just have to want it bad enough. oh, one more thing, i did take time off from work, had three weeks of vacation saved, because i could never do this while working. and here is another crazy thing, i told the job is was taking off to have elective surgery(tummy tuck), which i did! but as a true addict i took most of my post-op pain meds before surgery. so four days after the surgery i had nothing. well 15 valiums. which was like an aspirin to me. but i’m doing ok. and my husband and my son are my motivation. maybe someday i will tell my husband…maybe. good luck to anyone else ready to get off the ride. don’t give up. keep trying. it’s worth it. peace and love to all…i have walked in your shoes. there is no other way than to just STOP. it’s gonna suck, but the rewards are worth it. don’t let your addiction get as bad as mine. remember over a decade. it can happen easier than you think.

6 SD { 08.15.11 at 1:52 am }

@ Brie – Quitting is a small fraction of the battle. Staying clean is the war. If I were you, I would tell my spouse. You’ll need his support. If he is mature and understanding, he’ll be proud of you. I know I would. If you don’t tell him or others and create a support system it will be too easy to slip back into denial and addiction – which is a life threatening illness. Find a meeting as well. AA, NA, Al-Anon are all great resources where you’ll find someone who has or is going through the EXACT same thing. You are not alone. You don’t have to go it alone. Don’t listen to your ego, which is most likely telling you you have to do this by yourself. Your ego is wrong! Let go and let god. Be well.

7 brie { 11.21.11 at 7:48 pm }


8 brie { 11.21.11 at 7:54 pm }

SD, you are so right, i havn’t told him and i am falling back into my old habit. a little at a time ofcourse but i fear the worst. God help me but i feel i can’t share this with anyone. thank you for your words of support. i am not ready to give up on myself. just not sure what i am ready to to do or who i am ready to trust. God bless and again thank you

9 Kitty Mom { 11.22.11 at 6:38 am }

Hi Brie – You can absolutely trust the people on this site to listen and not be judgemental because we have all been through this as you have. Please keep posting and I pray that you make the decision to quit soon – and if not, we will be with you regardless. I have an email address that you can write to if you need any one on one. it is
Oh – and there is one more you can trust and without Him, I could not have made it almost 15 month.
God bless you Brie and stay in touch.

10 brie { 12.05.11 at 4:19 pm }

to all who have supported me, thank you. but i feel this is a battle i am losing. have hooked up with my friendly dealer, anything for a buck right? always accomodating. but i am still not ready to give up. i WILL try again. so…… so……. don’t know what to say at this point. i feel like shit cuz i did suffer and i tried so hard. but live got in the way. life is crazy and scary and hard. but i am sure you all know that. so again thanks for all the support. God bless

11 Alex Jacobs { 03.13.12 at 12:05 pm }

am hoping someone can give me some advice about the minor withdrawal I am going through…I haven’t taken any prescription medication for a while now, and could use some advice. Here is a brief timeline of what I’ve done as of late:

Today (Tuesday) – No medications other than vitamins and tylenol
Yesterday (Monday) – No medications other than vitamins and tylenol
Sunday – Very small amount (l~1/2 teaspoon) of codiene caugh syrup in the AM.
Saturday – 1/4 of a 5mg oxycodone hydrocholoride tablet in the AM; 1/2 codiene/tylenol tablet in afternoon; ~1/2 teaspoon of codiene caugh syrup in the evening
Friday – 1/4 5mg oxycodone hydrocholoride in the morning, afternoon, and early evening
Thursday – 1/2 5mg oxycodone hydrocholde in the morning and in the evening

Before Thursday, I was probably taking between 1-3 5mg oxycodone hydrochloride tablets a day since about Christmas (~2.5 months) with the occiasional day taking more. I had a back injury in early January whereby I was taking hydrocodone consistently for about a week as well. For the past year, or so, I have been taking both (oxycodone and hydrocodone) inconsistently, just here and there, and rarely more than one or 1/2 a tablet in a day.

I am a 30-year old male with a wife, child, and a demanding job. Can someone tell me how long I can expect myself to feel crummy? I don’t feel terrible – just a little anxous and tired/depressed at the same time. To be honest, at this point, I don’t want the drugs, I just want to feel better and be a good dad and husband to my family. I am extremely embarrassed for letting this happen to me…I should know better.

Thank you so much for any advice or thoughts you are able to share.

12 Maria { 04.30.13 at 5:42 pm }

Hello, everyone. I stumbled upon the site with just one simple search. I am/was (I say I “was” because my wonderful fiance’ put me through a 7 day detox in a medical facility (which cost him $7,000), where I was treated with suboxone and numerous other pills (including phenol barb, not to mention the 6-7 medications I would receive 3x per day…needless to say, I was completely wasted the whole time I was there.) I checked in because I was taking so much of the opiate pills for my chronic migraines it was leading to worsing headaches and the only option was to detox safely and under supervision (however, they never once mentioned the post affects…meaning HORRIBLE DEPRESSION! Backing up a bit…The day I ran out I started a really hard detox and the very next day I went into a full and VERY PAINFUL detox stage, with zero refills left. The reason I was first prescribed Norcos and Vicodin was to control the pain. Up until now I had been using for about 4 years. At first I only took as prescribed, but then it built to 10-12 /5-500’s per day. After leaving the detox facility I felt pretty good for a few days. Then, out of the blue, I began getting those horrible migraines back and I have fallen into a very deep depression. I don’t feel like myself, let alone anyone else in this universe at this point. It’s strange because I have decent days and really horrible depressive days where I feel hopeless. I have read on one post it can take 6-8 weeks to recover from the lack of energy, residual pain, fanthom pains in my legs and major insomnia. I have slept an average of 2-3 hours each night, since I have been back home. Sadly, for me… I see people in my condo community playing tennis, hanging out at the pool, going to the gym, but I can barely conjure the energy to think about walking out of my front door. I want that energy and happiness again. I have gone outside a few times, but it has been hard convincing myself to get up and get dressed. I suppose I thought (and my fiance’ too) that after the detox I would be my old self again (I had never been to a place like that in my life, and I was scared). I would agree with many of your posts…the depression and isolation is worse that the physical pain. Maybe because most of the physcial pain is gone now (still some residual aches and pains, which I suppose is normal after reading many of the posts). I have been to the Dr. and have been prescribed a mirad of medications (non-narcotic, of course). These medications, including Trazadone, did not work for me. My pain threshold is very low, so these meds do nothing to relax me. I sleep only about 2-3 hours per night. When will this madness end? On the flip side, opiate pain meds have been the only pain killer that had ever stopped my migraines. All of the other meds prescribed by my doctor have been worthless and have attributed to my depression. I have a benzo, but am afraid to take it. I am pretty lost and feeling hopeless at this point. I DO NOT want to relapse, and I hope I do not. However, I know that I am just one migraine from doing so. Thanks for reading. I will bookmark this page. Thanks.

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