The initial 5–10 days of medically supervised in-home detox handle the dangerous part of alcohol or benzodiazepine withdrawal — the seizures, the autonomic instability, the delirium risk. Most concierge clients feel dramatically better by day seven. That’s when the second wave arrives: post-acute withdrawal syndrome, or PAWS.
PAWS is the constellation of protracted neurological, cognitive, and emotional symptoms that persist for weeks to months after the acute detox window closes. It is real, it is neurobiological, and for high-functioning executives, physicians, founders, and public figures who chose in-home care specifically to preserve continuity, it is the phase most likely to derail an otherwise successful detox if it is not managed with the same clinical intentionality as the acute phase.
This is how Concierge Home Detox structures the 90 days after acute withdrawal ends.
What PAWS Actually Is (and Isn’t)
PAWS is not a relapse in progress and it is not a personal failing. It is the predictable downstream consequence of the brain rebuilding its endogenous GABA, glutamate, dopamine, and serotonergic tone after months or years of chronic substance exposure that suppressed these systems.
Common PAWS symptoms our clients report between weeks 2 and 12:
- Fluctuating cognitive fog and difficulty sustaining focus for long meetings
- Sleep architecture disruption — especially early-morning awakening and reduced deep sleep
- Emotional dysregulation, irritability, tearfulness, or blunted affect
- Anhedonia — things that used to feel rewarding do not, yet
- Anxiety spikes without an obvious trigger
- Physical symptoms: low-grade tremor, tinnitus, temperature dysregulation, GI complaints
PAWS after benzodiazepine detox tends to be more prolonged than after alcohol alone. Clients who completed a long benzodiazepine taper often experience symptom waves for 6–18 months. Setting that expectation up front is central to preventing a discouraged mid-recovery relapse.
Our 90-Day Post-Detox Framework
Weeks 1–2: Physiological Stabilization
Immediately after the acute detox window, our nursing team continues in-home visits 3–5 times per week. We monitor vitals, sleep quality (via wearable data when the client consents), hydration and electrolytes, and any breakthrough symptoms. This is when we titrate off the last of the taper medications and lock in a supportive supplement protocol — typically continued thiamine, magnesium, B-complex, and (when indicated) a short course of hydroxyzine or gabapentin for anxiety and sleep support.
Weeks 3–6: Neurocognitive Reconditioning
By week three most clients can safely return to a reduced work schedule. Our physicians coordinate with the client’s executive assistant or chief of staff to structure a graded return — typically 4-hour work blocks the first week back, expanding as tolerated. We layer in structured aerobic exercise (20–30 minutes daily, low to moderate intensity), which has strong evidence for accelerating dopaminergic recovery, and cognitive behavioral therapy for insomnia (CBT-I) when sleep remains disrupted.
Weeks 7–12: Trigger Mapping and Relapse Prevention
The cognitive fog usually lifts enough by week six to do meaningful trigger and craving work. Our clinical psychologist runs weekly in-home or telehealth sessions focused on identifying high-risk situations specific to the client’s life — investor dinners, international travel, medical conferences, court appearances — and building concrete alternative response protocols. For clients with co-occurring anxiety or depression that predated the substance use, this is when we make final decisions about longer-term psychiatric medication.
Medication Management Through PAWS
A few clinical points that matter:
- Do not restart alcohol or benzodiazepines to relieve PAWS symptoms. This is the single most common cause of failed post-detox recovery. Even small doses re-suppress the compensatory neuroadaptations the brain is working to reverse.
- SSRIs and SNRIs are appropriate first-line for persistent depressive or anxious symptoms past week four, once acute withdrawal is fully resolved.
- Naltrexone or acamprosate for alcohol use disorder can be started once liver enzymes have normalized and the client is medically cleared.
- Gabapentin is often continued at a modest dose for 3–6 months post-detox for its documented benefit on protracted alcohol withdrawal anxiety and sleep.
Every one of these decisions is made in coordination with the client’s existing primary care physician and any specialists they see. We do not create parallel prescribing lanes.
The Family and Household Dimension
PAWS lives inside a household. Spouses and adult children who were relieved when the acute detox ended often expect their loved one to be “back to normal” by week two. When that does not happen, resentment builds — on both sides. We include a family psychoeducation session within the first 10 days post-detox that explicitly walks the household through the PAWS timeline, sets realistic expectations, and gives the family a small set of concrete behavioral supports: quiet mornings, protected sleep environment, no alcohol in the home for the first 90 days, and a clear no-questions-asked check-in cadence.
What Distinguishes Concierge Post-Detox Care
Traditional post-detox care hands the client off to an outpatient program the moment acute withdrawal ends. For our client base — high-earning executives, physicians, and public figures whose recovery depends on discretion and continuity — that handoff is often where things fall apart. The client is expected to attend group therapy at a facility they cannot risk being seen at, follow up with prescribers they have no relationship with, and self-manage symptoms they were not warned about.
Our model is the opposite: the same physician, the same nurse case manager, and the same therapist who ran the acute detox continue with the client through week 12. The intensity of contact tapers, but the relationships do not reset.
Related Reading
For context on how the acute detox window is structured before PAWS begins, see our clinical overview of how we manage long-term benzodiazepine tapers at home, our approach to delirium tremens risk management during in-home alcohol withdrawal, and the IV thiamine protocols we use to prevent Wernicke-Korsakoff syndrome.
Speak With Our Clinical Team
If you or a family member is considering in-home detox and want to understand what the full 90-day arc looks like — not just the first two weeks — call our clinical intake team at 866-896-3741. Conversations are confidential and there is no obligation to move forward.
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