post-acute-withdrawal syndrome post-acute-withdrawal syndrome post-acute withdrawal syndrome (paws) is a hypothesized set of persistent impairments that occur after withdrawal from alcohol, opiates, benzodiazepines, antidepressants, and other substances. infants born to mothers who used substances of dependence during pregnancy may also experience a post-acute withdrawal syndrome. while post-acute withdrawal syndrome has been reported by those in the recovery community, there have been few scientific studies supporting its existence outside of protracted benzodiazepine withdrawal. because of this, the disorder is not recognized by the diagnostic and statistical manual of mental disorders or major medical associations. post-acute-withdrawal syndromeother namespost-withdrawal syndrome, protracted withdrawal syndrome, prolonged withdrawal syndromesspecialtypsychiatry, toxicology drug use, including alcohol and prescription drugs, can induce symptomatology which resembles mental illness. this can occur both in the intoxicated state and during the withdrawal state. in some cases these substance-induced psychiatric disorders can persist long after detoxification from amphetamine, cocaine, opioid, and alcohol use, causing prolonged psychosis, anxiety or depression. a protracted withdrawal syndrome can occur with symptoms persisting for months to years after cessation of substance use. benzodiazepines, opioids, alcohol, and any other drug may induce prolonged withdrawal and have similar effects, with symptoms sometimes persisting for years after cessation of use. psychosis including severe anxiety and depression are commonly induced by sustained alcohol, opioid, benzodiazepine, and other drug use which in most cases abates with prolonged abstinence. any continued use of drugs or alcohol may increase anxiety, psychosis, and depression levels in some individuals. in almost all cases drug-induced psychiatric disorders fade away with prolonged abstinence, although permanent damage to the brain and nervous system may be caused by continued substance use. signs and symptoms symptoms can sometimes come and go with wave-like re-occurrences or fluctuations in severity of symptoms. common symptoms include impaired cognition, irritability, depressed mood, and anxiety; all of which may reach severe levels which can lead to relapse. the protracted withdrawal syndrome from benzodiazepines, opioids, alcohol and other addictive substances can produce symptoms identical to generalized anxiety disorder as well as panic disorder. due to the sometimes prolonged nature and severity of benzodiazepine, opioid and alcohol withdrawal, abrupt cessation is not advised. hypothesized symptoms of post-acute withdrawal syndrome are: psychosocial dysfunction anhedonia depression impaired interpersonal skills obsessive-compulsive behaviour feelings of guilt autonomic disturbances pessimistic thoughts impaired attentional control lack of initiative craving inability to think clearly memory problems emotional overreactions or numbness sleep disturbances extreme fatigue physical coordination problems stress sensitivity increased sensitivity to pain panic disorder psychosis generalized anxiety disorder sleep disturbance (dreams of using, behaviors associated with the life style) mourning (the change in lifestyle) symptoms occur intermittently, but are not always present. they are made worse by stress or other triggers and may arise at unexpected times and for no apparent reason. they may last for a short while or longer. any of the following may trigger a temporary return or worsening of the symptoms of post-acute withdrawal syndrome: stressful and/or frustrating situations multitasking feelings of anxiety, fearfulness or anger social conflicts unrealistic expectations of oneself post-acute benzodiazepine withdrawal