Post-Acute Withdrawal Syndrome: The Major Cause of Relapse among Psychoactive Substances Addicted Users

The aim was to summarize post-acute withdrawal syndrome (PAWS) for the most common psychoactive substances, including alcohol, benzodiazepines, opioids, stimulants, and cannabis. A narrative review of relevant literature was identified through existing meta-analyses, systematic reviews, Google Scholar searches, and authoritative grey literature. PAWS associated with alcohol, benzodiazepines, opioids, stimulants, cannabis, and management and maintaining abstinence are discussed. PAWS is a relatively less known phenomenon of dependence and withdrawal; however, its severity and duration impact patients' capacity to stop using abused/addictive substances. PAWS may cause very slowly reversible or permanent physicochemical neuronal damage in the central nervous system (CNS). Managing PAWS symptoms are significant for preventing relapse during the first 12 months after cessation of abused/addictive substances, where the risk of relapse is highest. The longer abstinence is maintained, the lower the risk of relapse becomes. This review covers a knowledge gap in information that is generally not easily available and is almost non-existent in the literature.