Are we actually totally sure that Post-Acute Withdrawal Syndrome is a real disease which is separable from pre-existing chronic depression and anxiety?
Its symptom set is just depression and anxiety, and it's described as functioning in the same way for a bunch of different drugs with different methods of action - alcohol, opiates, meth, benzodiazepines. What if it's just that people already suffering from chronic depression and anxiety are the ones most likely to overuse mind-altering substances, and those problems simply become more obvious by contrast during recovery?
I mean, that PAWS offers a convenient narrative for a culture fond of victim-blaming for psychiatric problems doesn't necessarily mean it's not a real phenomenon. But I do feel the need to be skeptical of convenient narratives.