Still Feeling Bad After Sobriety? A Guide To Acute and Post-Acute Withdrawal Syndrome

post-acute withdrawal syndrome | Just Believe Recovery PA

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Still Feeling Bad After Sobriety? A Guide To Acute and Post-Acute Withdrawal Syndrome

The vast majority of people who are undergoing substance abuse treatment or are in recovery from addiction do not bounce back immediately in a perfect mental and physical state. That is, symptoms related to past substance use may continue for weeks, months, or years.

Moreover, if you stopped using drugs or alcohol six months ago and are still feeling shaky, you are by far not alone. The duration and intensity of withdrawal symptoms during recovery are partially based on the substance used, the length of time used, and the frequency of use. However, everyone is different, and there’s no telling exactly how mild or intense mental and physical symptoms will be or how long they will last.

post-acute withdrawal syndrome | Just Believe Recovery PARecovering addicts of all types may be affected long-term by less intense versions of acute withdrawal symptoms, such as agitation and anxiety. However, other symptoms may also arise, including persistent insomnia, impaired impulse control, and emotional instability.

These symptoms may prompt people to return to substance abuse, trying to obtain some relief. If you are in this situation, please reach out to past, current, or new treatment providers to help you cope and manage symptoms and cravings.

Reaching out is especially important if you suffer from a co-occurring mental illness (as many people do.)

What is Acute Withdrawal?

Acute withdrawal syndrome is often referred to as just “withdrawals.” It is defined by the American Society of Addiction Medicine as “the onset of…predictable…signs and symptoms following the abrupt discontinuation of, or rapid decrease in dosage of a psychoactive substance.”

Symptoms are often the opposite of the effects of the substance being eliminated. For example, if you are a methamphetamine addict, rather than the intense energy and animation you feel while high, you will instead feel lethargic and down. Symptoms begin hours to days after the last substance use and will subside over time.

The following is a list of substances and the typical time frame for withdrawal:

  • Alcohol – 5–7 days
  • Benzodiazepines (Xanax, Valium) – 1–4 weeks; 3–5 weeks with tapering (gradual dosage reduction)
  • Cannabis – 5 days
  • Opioids – 4–10 days (methadone withdrawal may last 2-3 weeks)
  • Stimulants (amphetamines, methamphetamine, cocaine) – 1–2 weeks

What is Post-Acute Withdrawal Syndrome?

Post-acute withdrawal syndrome, also known as chronic or protracted withdrawal, is the presence of symptoms common to acute withdrawal that persist beyond the normal time frame (see above.)

Clinically, post-acute withdrawal syndrome exists, as withdrawal symptoms remaining past the initial withdrawal stage is a fairly common occurrence. However, there is no consensus on the defining factors or a time frame from a diagnostic perspective. The latter does make some sense quite simply because post-acute withdrawal syndrome can go on indefinitely.

How and Why Do Post-Acute Withdrawal Symptoms Manifest?

post-acute withdrawal syndrome | Just Believe Recovery PAChronic and severe substance use results in molecular, cellular, and neurological changes to the brain. These changes can affect emotions and behavior.

For example, chronic use of a substance causes the brain to respond to its rewarding effects, but as a trade-off, the brain will not receive the same reward from other activities that it once enjoyed.

This state is called anhedonia. In essence, the person’s ability to experience pleasure in ways that others do (and the recovering addict used to do) is impaired. Research has found that anhedonia is a symptom of post-acute withdrawal syndrome and need not be explained by other psychosocial factors during recovery.

Also, one study found that people in recovery from alcohol continued to suffer from withdrawal symptoms, including anhedonia, for at least a year.

Other Common Symptoms of Post-Acute Withdrawal Syndrome

  • Anxiety
  • Sleep disturbances/insomnia
  • Short-term memory loss
  • Chronic fatigue
  • Difficulty concentrating
  • Impaired decision-making abilities
  • Substance cravings
  • Impaired executive control, such as impulse control and problem-solving

How Do Post-Acute Withdrawal Symptoms Differ?

post-acute withdrawal syndrome | Just Believe Recovery PAEach psychoactive substance has different effects on the brain. Also, as noted, acute withdrawal symptoms do vary by substance and are often the opposite of that substance’s effects.

Moreover, post-acute withdrawal symptoms often mimic acute withdrawal symptoms, and then add whatever effects result from the brain changes for which that substance is responsible.

The following are potential long-term effects of withdrawal. Those listed are based on the existence of clinical evidence, so anecdotally, there are probably more. That is, these lists are by no means inclusive. Cocaine and methamphetamine (stimulants) have been among the least studied.


Hostility and irritability
Mood instability
Reduced interest in sex
Sleep abnormalities – difficulty falling asleep, decreased sleep time, and sleep apnea


Sleep disturbances that can last for weeks or months
Dysphoria (feeling down or apathetic)
Decreased ability to focus on tasks
Deficits in executive control, such as impulsivity and decision-making problems


Psychological symptoms tend to wax and wane, and may include:

Agitated depression
Panic disorder
Obsessive-compulsive disorders

Methamphetamine – Deficits in executive control, such as impulsivity and decision-making problems

Cocaine – Reduced impulse control, possibly impaired emotional regulation

Marijuana – Sleep difficulties and strange dreams


Please remember that if you in recovery and suffering from any of these symptoms, this is NOT a reason to return to substance use – but precisely the opposite. Please seek counsel from a substance abuse treatment specialist if you do not have one currently.

~ G. Nathalee Serrels, M.A., Psychology

Just Believe Recovery is a fully licensed, Joint Commission accredited, comprehensive drug and alcohol treatment center located in Carbondale, Pennsylvania

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