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Understanding Post-Acute Withdrawal Symptoms (PAWS) During Addiction Recovery

Understanding Post-Acute Withdrawal Symptoms (PAWS) During Addiction Recovery

Article At A Glance:

Alcohol recovery can be a challenging journey, and withdrawal symptoms are one of the biggest obstacles to overcome.

In this article, we will discuss the common symptoms that occur during extended abstinence, which can last for three months or more.

Diminished Intense Cravings

During the early stages of abstinence, intense cravings for alcohol are common. However, after three months, the cravings should start to diminish. This is a sign that your body is becoming less reliant on alcohol.

If you still experience cravings, N-Acetylcysteine (NAC) is a natural supplement that can help manage them. Read more about NAC and addiction here.

Impaired Stress Management

Extended abstinence can cause a rise in irritability, increased sensitivity, and difficulty managing stress. This is normal and may be related to zinc deficiency, which is common in alcohol addiction. Zinc absorption is impaired in long-term alcoholics, which may lead to irritability, dry skin, and poor immunity.

Read more about the importance of Zinc here.

Blunted Hypothalamic-Pituitary-Adrenal Axis (HPA)

Long-term alcohol addiction and protracted abstinence can disrupt the normal functioning of the hypothalamic-pituitary-adrenal (HPA) axis, which plays a crucial role in the body’s response to stress.

This disruption can lead to a blunted HPA axis, which impairs the body’s response to stress, increases sensitivity to stress, and makes it difficult to cope with stress, increasing vulnerability to relapse. Therefore, individuals in recovery should develop effective stress management techniques and seek support to help manage stress and reduce the risk of relapse.

Read more on Alcohol and Stress: The Impact on Early Sobriety.

Loss Of Interest Or Lowered Pleasure (Anhedonia)

Anhedonia, or the loss of interest or pleasure, is common in extended abstinence and is closely related to a hypo-functional dopamine pathway. This can make it difficult to find pleasure in daily activities and may increase vulnerability towards relapse.

It’s important to be patient during extended abstinence. Symptoms may persist for a year or more, as your body goes through a complete, whole-body recalibration. Remember, with time and support, sobriety and a fulfilling life in recovery are achievable.


Extended abstinence from alcohol can lead to a range of withdrawal symptoms that may persist for several months or more. These symptoms can include diminished intense cravings, impaired stress management, a blunted hypothalamic-pituitary-adrenal axis (HPA), and loss of interest or lowered pleasure (anhedonia).

While these symptoms can be challenging, it’s important to be patient and seek support during this time. With time, effort, and support, achieving sobriety and a fulfilling life in recovery is possible.

If you have any questions regarding this article or have any areas you’d like me to discuss, let me know, until next time.

All the best in health,
Stephen Brumwell.


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