Note: This material was developed from Relapse Prevention seminars hosted by Terence Gorski, MS. I recommend his excellent “Staying Sober” and its accompanying workbook for anyone interested in following the subject further. Most of these concepts are Mr. Gorski’s, adapted by me for a series of relapse prevention lectures.
Many of the problems associated with early sobriety do not stem directly from drugs and alcohol. Instead, they are associated with physical and psychological changes that occur after the chemicals have left our bodies. When we use, our brains actually undergo physical change to cope with the presence of the drug in our body. When we remove the drugs, our brains then demand more to satisfy the desire caused by the changes. The extreme symptoms that we experience immediately after we stop using are called “acute withdrawal.”
Acute withdrawal, unfortunately, is not the whole story. Our bodies make initial adjustments to the absence of the drug, and the major symptoms ease up. However, the changes that have occurred in our brains need time to revert back to their original state (to the extent that they ever do). During the period of time while this is occurring, they can cause a variety of problems known as Post Acute Withdrawal Syndrome (PAWS).
All we addicts and alcoholics suffer from damage to our bodies and nervous systems from drug/alcohol use, accidents, and malnutrition. We may also suffer from chronic diseases such as diabetes and hepatitis, and we usually bring to early recovery a broad array of other problems. As one alcoholic put it, “When I got sober, things didn’t get any easier, but they got real …ing clear!”
Recovery causes a great deal of stress. Many addicts and alcoholics never learn to manage stress without alcohol or drug use, or do so only after many attempts at sobriety. Our ability to deal with it depends on our willingness to take care of ourselves and maintain a healthy physical, emotional and spiritual lifestyle. Repairing the damage to our nervous systems usually requires from six months to two years with a healthy program of recovery. PAWS is the cause of most relapse in early recovery.
Symptoms
PAWS symptoms reach a peak from three to six months after we get clean. Any use of drugs or alcohol, even in small quantities or for a short time, will effectively eliminate any improvement gained over that time, as it will keep the brain from healing. There are a variety of symptoms. Not everyone will experience all of them. Here are some of the main ones.
Inability to solve problems
Inability to solve problems leads to lowered self-esteem. We feel embarrassed, incompetent, and “not okay.” Diminished self-esteem and fear of failure lead to living and working problems. These all add to our stress, and the stress further exaggerates the other problems. Six things contribute to this: trouble thinking clearly, emotional overreaction, memory problems, sleep disturbances, physical coordination problems and difficulty managing stress.
Inability to think clearly
Our brain seems to work properly only part of the time. Sometimes our head just feels fuzzy because of the changes that occurred in our brains while we were using. The changes take time to improve. It is also due to the simple fact that we are trying to process a lot more information than we did before. While using, we mainly thought about getting more, using, and turning off our brains. Now we are considering the myriad things necessary to truly live our lives. To begin with, it can be a bit much.
Inability to concentrate
Abstract reasoning suffers, and we find our minds, like a confused cowboy, jumping on its horse and riding off in all directions. Also related to the reasons above.
Rigid, repetitive thinking
Thoughts go around and around in our heads, and we are unable to put them into useful order. We have not yet developed the ability to channel our thoughts and concentrate on one thing at a time.
Memory problems
We may hear something, understand it, and 20 minutes later…it’s gone! This sort of thing complicates our lives in many ways. It upsets supervisors, annoys significant others, and makes us wonder if we’re losing our minds.
With memory problems it is hard to learn new skills and absorb new information. We learn by building on what we have already learned, and memory difficulties can make it very difficult (if not impossible) to do that. Again, these difficulties add to stress, especially if we do not understand what’s happening to us. We may think, “This sucks! I might as well be high.”
Emotional overreaction or numbness
People with emotional problems in early sobriety tend to over-react. When this overreaction puts more stress on our nervous systems than we can handle, we react by “shutting down” our emotions. We become emotionally numb, unable to feel anything. We may swing from one mood to another. These mood swings may baffle us, seeming to come without any reason, and may even be misdiagnosed as bipolar disorder. If we have developed insulin resistance or diabetes as a result of our drugs and drinking, this can become extreme. (See H.A.L.T. below)
Sleep disturbances
Disturbed sleep is common in recovery. It may last only a short time, or a lifetime. Often, this depends on what we consider to be a problem. If we are night owls who used alcohol or pills to get to sleep in the daytime, we may discover that the only solution is to make significant changes in our schedule, and perhaps even in our occupations. Sleep deprivation stresses the body, prevents our minds from working well, and generally exaggerates any other difficulties we may be experiencing.
We may experience changes in our sleep patterns, sleeping for long periods at a time, or getting sleepy at different times of the day. Although these may persist, we are usually able to adjust to them. The important thing is to be willing to adjust. We may not be able to keep to our old sleeping habits.
Stress
Difficulty managing stress is the most difficult part of post acute withdrawal, and of early recovery in general. Early on, we may not be able to distinguish between low and high stress situations, because for so many years we managed stress by using mood-altering substances.
Worst of all, the other PAWS symptoms become worse when we are under stress, and this causes the stress to increase! There is a direct relationship between elevated stress and the severity of PAWS. Each amplifies the other.
At times of low stress, the symptoms of post acute withdrawal may lessen or even go away completely. When we are well-rested, relaxed, eating properly and getting along well with others, we seem to be fine. It is easy to see how we can get careless at these times, and many a relapse has occurred when things seemed to be going just fine.
Abstinence
Recovery from the damage caused by our addictions requires total abstinence. Abstinence means avoiding drugs and alcohol completely, unless we are under the care of a physician who understands both addictive disease and pharmacology. This specifically includes herbal remedies which, in many cases, are just as powerful and dangerous as prescription drugs.
Understanding and recognizing PAWS symptoms
Because we are addicts and alcoholics, and because repeated relapses will eventually be fatal, we must realize that understanding PAWS is, literally, a matter of life and death. It is absolutely essential that we gain an understanding of post acute withdrawal, be able to recognize its symptoms when they appear, and know what to do about them. We must understand these things well enough that we are able to put them into effect even during periods when our addict instincts are telling us that we don’t want or need to!
We need also to learn about PAWS, and means of controlling it, when our stress levels are low, in order to be able to prevent the symptoms or be able to recognize and manage them if they occur.
Stabilizing our episodes of PAWS
When we begin to experience PAWS, we need to bring it under control as soon as possible. Here are five steps that can help.
Talk!
We need to talk about what’s happening, to people who will listen and not criticize us. In addition to badly needed support, it helps us to clarify our feelings, look at them more realistically, and helps us recognize our symptoms. When we are in our own heads, our thoughts just go around and around. When we force ourselves to tell someone else, we often find that it puts them into order and they begin to make sense.
Ventilate!
We need to express as much as we can about what we are feeling, even if we think it sounds dumb or irrational.
Get a reality check!
We need to ask someone if we are making sense — not just in what we’re saying, but also our behavior. We must be sure our perception of what is happening matches up with reality.
Set a goal
What can we do right now to improve our situation? Taking action and changing things is our choice.
Think back…
…over what has happened. How did the episode start? What triggered us? What could we have done to reverse it sooner? Were there other options that might have worked better?
Self Defense
We are responsible for protecting ourselves from anything that threatens our sobriety, including anything that triggers post acute withdrawal symptoms. No one else can do it, because no one else can feel the warning signals. Learning about addictive disease, working a program of recovery, finding out more about PAWS—all of these things reduce the guilt, confusion and stress that intensify the symptoms and lead us to relapse. If we learn to do these things, we will begin to accept our own needs, and learn to be firm about letting other people, places and situations push us into reactions that threaten our sobriety.
We must identify our own stress triggers. Then we must learn to change them, avoid them, change our reactions, or interrupt the process before our lives get out of control again. If our Aunt Frizzy is blaming us for all the family problems, and letting us know it every chance she gets, we may need to avoid her for a while (a few years, a life…who knows?) If we find ourselves walking past the beer cooler too often in the store, or past a certain street corner, we need to recognize that, and change our routes through the store and the neighborhood.
Tools
Here are some things that will help us avoid PAWS, or control it when it sneaks up (which it will). They may be the most important things we will learn in the first few months of our sobriety. They are so important that we encourage you to print out this article, and to share it with others who may need it too.
Nutrition
With our organ systems damaged by alcohol and drugs, we were not—and may still not be—able to absorb nutrients properly. This, combined with our inattention to diet, has created deficiencies that we must deal with. All active alcoholics (and most other addicts) suffer from malnutrition to one degree or another, and we may continue to feel the effects for months after adopting a healthier lifestyle. Malnutrition contributes to poor health, and poor health contributes to stress. Unless we consciously improve our diets and properly supply our nutritional needs, the poor eating habits that have carried over from our using days guarantee that we will continue to fail at getting the nutrients needed to recover. Our bodies are repairing themselves, and they need the proper materials to do so effectively.
It isn’t necessary to load up on stuff from the health food store. It is much better to spend all that money on good healthy food at the market (although they’ll never tell you that at the health food store). However, we should take a good multivitamin every morning with breakfast. Yes, you will be eating breakfast.
Hypoglycemia – the secret demon of relapse (H.A.L.T.)
We’re tired and hungry. It’s been a long day, and we won’t be able to have dinner for a couple of hours. A candy bar is just what we need to pick us up and get us through. Forty-five minutes after eating the candy we are angry at our boss, arguing with our co-workers, suffering with tense muscles and a nasty headache, and life sucks again. We’re thinking about using.
Has this ever happened to you? Then you already know something about hypoglycemia.
Our brains use glucose, a kind of sugar, for fuel. If our brains are completely deprived of glucose, we will die just as quickly as we would if our air were shut off. Fortunately, our blood carries glucose to our brain, and as long as our heart is beating we don’t usually have to worry about its fuel supply. Usually.
Glucose is manufactured by our bodies from the carbohydrates that we eat. Carbohydrates (carbs) are a class of nutrients that include several kinds of sugars, pasta, bread, potatoes, and similar starchy foods. Practically all foods contain some carbs, but the most concentrated sources of them are sugars and alcohol.
In addition to fueling our brains, glucose provides energy for every cell in our bodies. Without glucose in the right quantities, our bodies just don’t work right. The carbohydrates most easily converted into glucose are the sugars. This is why we like them so much. Our bodies recognize that they are a ready source of energy.
The problem arises when we are in need of food and our bodies get a big jolt of sugar. The sugar is quickly converted into glucose. The amount of glucose in our blood rises very quickly, and we feel a burst of energy. We may feel some mood alteration as our brains receive a huge jolt of fuel.
We just received a reward for eating some sugar.
The big dose of sugar on an empty stomach causes our blood glucose to rise rapidly. A center in our brain detects the rise, and signals the pancreas to produce more insulin to help our cells absorb the extra sugar, but it produces too much. The insulin causes us to burn the extra glucose rapidly, and our blood sugar comes down, but because there is too much insulin, our glucose levels drop too far. (In diabetics and people who are insulin-resistant the mechanism is different, but the effect is the same—or worse.)
Our bodies—and our brains—are now low on glucose. The brain is running out of fuel. Waste products build up in our muscles. Along with inefficient signals from the brain, this causes tightness and muscle tremors. Partial paralysis of facial muscles may make it difficult or impossible to smile. Our heads begin to ache. Thinking gets fuzzy. Energy levels drop. We push people away, if we don’t scare them away. We may feel sudden bursts of rage, that seem quite reasonable. We begin feeling sorry for ourselves. . We are HUNGRY, ANGRY, LONELY and TIRED.
The big catch? Most of us, in our addictions, knew all too well how to quell those nasty feelings–by using. Poor me…poor me…pour me a drink
Important Point: We taught ourselves to interpret the symptoms of low blood sugar–hunger–as needing to use.
So, how do we avoid the trap? Easy in principle, but it involves some attention, some learning, and some effort. Basically, we don’t let ourselves get hungry.
Diet for Recovery:
- Three nutritious snacks each day,
- between meals and at bedtime
- Avoid Sugar and Caffeine
Meal Planning
We are “trapped” in a culture that tells us Three Square Meals A Day is the way to eat. Many of us interpret that as one “round” meal at breakfast time—a doughnut, or bowl of cereal, and a cup of coffee—one “rectangular” meal for lunch—a sandwich and another cup of coffee—and one huge meal in the evening. Since these aren’t really spreading the fuel around too well, we fill in the low spots with candy bars and some more coffee. Our poor pancreas! For, in addition to all that sugar in fits and spurts, caffeine also causes blood sugar swings!
We really need to get this thing under control! Hunger produces stress. Blood sugar swings produce stress. Stress aggravates PAWS and, as we have seen, is extremely dangerous to our sobriety when combined with hypoglycemia—which is caused by poor eating habits, too much sugar, and caffeine. Are we beginning to see a trend here?
Alcoholics and addicts in early recovery literally “take our lives in our hands” each time we plan our daily meals.
A quick word about diet:
Our diets should consist of a balanced mix of vegetables, fruit, carbohydrates, (such as potatoes, whole-grain rice, and dark breads,) protein (not necessarily meat), fat, and dairy products. A nutritionist can be a great help in the beginning, and there are thousands of books on nutrition and meal-planning that may be consulted. If we don’t know how to shop and cook, now is a good time to learn.
The US Department of Agriculture’s Food and Nutrition page is a good place to begin: http://www.usda.gov/wps/portal/!ut/p/_s.7_0_A/7_0_1OB?navtype=SU&navid=FOOD_NUTRITION
Scheduling
We should try to plan our schedules so that we do not skip meals—ever—and so that we can have nutritious snacks between meals.
- We must not snack on candy, donuts, soft drinks, (incredibly high in sugar,) potato chips, or other high calorie, low nutrient foods.
- We should carry raw vegetables, wheat crackers, a half sandwich (peanut butter and jelly on whole wheat is excellent; easy on the jelly), nuts, or even a package of cheese and crackers.
- These, along with a glass of water or milk, will keep our blood sugar steady and our moods elevated until time for the next meal. Having a nutritious snack before we begin to feel hungry will prevent our craving for sweets, as well.
It’s a good idea to actually schedule our snacks, halfway between meals and about ½ hour before bedtime. We must not miss breakfast!
Losing Weight While Eating Six Times A Day
These eating habits are not inconsistent with meal planning for weight loss. Competent dietitians and honest diet doctors know that several smaller meals are more conducive to weight loss than three larger meals, since the body more easily uses the smaller quantities of food, and is less likely to store it as fat. Properly planned meals will contribute to our health, energy and feelings of well-being, and make it easier for us to engage in exercise, (the real secret to weight control.) Our hunter-gatherer ancestors ate fruits and berries during the day, and gorged on game when they could kill something. Metabolically, we aren’t very far from those folks. The big difference between us and them?
Exercise
Exercise helps our bodies to rebuild themselves and maintain proper functioning. It also helps control our metabolism and prevent unnecessary weight gain. (Weight gain due to increased muscle mass may precede any loss due to burning fat.) Exercise produces chemicals in our brains that act as natural tranquilizers and relieve pain, anxiety and tension. It greatly improves our chances of getting a good night’s sleep.
Our ancestors lived together in small tribes of no more than twenty or so adults and a few children. They walked from place to place, following the food supply, eating whatever they could find. They carried everything they owned with them.
This lifestyle, during the eons preceding the beginnings of agriculture, is the lifestyle for which our bodies are best suited. Humans—like the herds we have followed since the beginning of our history—walk.
So, how much should we walk? Simple. We should walk fast enough and far enough to work up a sweat, and continue walking for at least 20 minutes thereafter, followed by a slower cool-down of 5 to 10 minutes. We should do that at least three times a week—preferably every other day.
We can walk at the mall; walk to the store; walk to the park. We can walk with a friend. When we’re walking we can chat, unlike most other forms of exercise. All we need is decent shoes and, if we’re over 50 or under a doctor’s care, our physician’s permission. And while we do it, we’re continuing a tradition that goes back thousands of years. How about that, sports fans?
Relaxation = stress reduction
Playing and relaxation are absolutely essential to a successful recovery.
Playing is not so much what we do as how we do it. Playing is having fun, laughing, and being childlike and free. Playing is not working at preparing for a marathon, participating in competitive sports at which we “must” win, or taking chess lessons. Of the 37 definitions I quickly scanned, perhaps the one that best describes it is “participating in an activity for amusement.” If it isn’t fun—if we have to work at it—it isn’t play.
Other ways of relaxing include bubble baths, our walk (by ourselves or with a friend), a massage, a swim, and watching children and animals at play. Whatever we do, if we don’t feel better after doing it, it was the wrong choice.
Meditation
Meditation is part of the 11th Step: “Sought, through prayer and meditation, to improve our conscious contact with god, as we understood him, praying only for knowledge of his will for us and the power to carry that out.”
Regardless of how we feel about god, we need to meditate. We need to learn to calm our minds, and to allow our subconscious to help us solve problems by serving up whatever it may have processed during the rest of the day. The only way to do that is to meditate in one form or another.
Think that’s too hard to learn? You already do it. Daydreaming is meditation. All we need to do is apply the skills we already know, whenever we want to.
One of the best relaxation exercises is also one the simplest. We find a comfortable sitting position. We move our bodies until our weight is centered, so that we can nearly go limp without changing position. We begin counting our breaths in our mind. We count up to ten, and then start over. We think only about breathing. In comes the fresh air and we…relax…and breathe the tension out. If other thoughts come in, we don’t fight them, we just recognize that they are there, and go back to counting breaths, always silently.
This is one of the oldest and most-used relaxation techniques in the world. It goes back at least 3500 years. We can do it for five minutes, then ten, working up to thirty minutes or more. It might be a good idea to set an alarm, in case we fall asleep sitting up. It happens.
Spirituality
Spirituality is an active relationship with a power greater than us, which gives our lives meaning and purpose. When we work a spiritual program, we consciously try to become a part of something bigger, greater and more powerful than we are, whether that be a 12-step group, our family, other humans generally, or that “god as we understood him.”
Trust in a higher power gives us a peace of mind and serenity that comes from awareness that there is something that is not restricted by our own weaknesses and limitations. Through spiritual development, we develop new confidence in our own abilities and develop a sense of hope. Through a spiritual program we can reach toward the future with hope and a positive attitude.
Spiritual discipline is uncomfortable for many recovering people.
We have lived lives of immediate gratification, and discipline is the reverse of that. Many of us have trouble with the concept of a higher power, as well. We may have been brought up as atheists or agnostics. Perhaps the god of our childhood was a vengeful god whom we cannot even begin to contemplate in the light of some of our past behavior. This is why we say that our higher power can be god, as we understand god.
Spiritual discipline should always include meditation, spiritual fellowship, and regular inventory of spiritual growth. It is about our relationship with the human spirit. It is not about someone else’s idea of a relationship we should have with a god. That is religion. While religion may be an important part of our recovery, it cannot take the place of spirituality.
In working on our spirituality, it is important that we use the principles of our 12-step programs. They provide guidelines for “increasing our conscious contact with god” (as we understand god). We do not have to have any particular image of, or belief in, a god to increase our conscious contact. We have only to be willing to recognize the possibility of a “higher” power, be willing to experiment at letting it communicate with us.
Many people joke about having a tree as your higher power. The writer had that sort of relationship with a majestic Casurina tree for some time. He used it to remind himself that he was not nearly as good at taking care of himself—yet—as that beautiful tree. Did it work? Who knows? At the time of this writing, he is 20 years clean and sober. Something did.
Peace and Contemplation
It is important that we structure our lives in such a way as to spend time alone each day. We need to examine our values, and look within ourselves to determine whether our lives are in harmony with those values.
Journaling
We strongly recommend keeping a journal, and writing in it every day without fail—even if we only write the date. Forcing ourselves to organize our thoughts and put them on paper clears our minds. Reading what we wrote some years later can be highly instructive, and lets us see how we have grown in our recovery.
Balanced Living–the aim of recovery
Balanced living means that we are healthy physically and psychologically, and that we have healthy relationships with others and, more importantly, with ourselves. It means that we are spiritually whole. It means that we are no longer focused on just one aspect of our lives. That is no longer necessary. It means we are living responsibly, giving ourselves time for our jobs, our families, our friends, and time for our own growth and recovery. It means allowing a higher power to work in our lives, even it that is only the influence of people around us. With balanced living, we addicts and alcoholics give up immediate gratification as a lifestyle, in order to attain fulfilling and meaningful lives.
It means a balance between work and play, between fulfilling our responsibilities to other people and our own need for self-fulfillment. It means functioning at our optimum stress level: maintaining enough stress to keep us functioning in a healthy way, but not overloading ourselves so that it becomes a problem.
Stress, in and of itself, is not necessarily bad. It can be the tension that keeps life interesting. But stress is unsafe for us until our new found ways of dealing with it are second nature. Until then, when it arises we run the risk of returning to our old ways of stress management.
Balanced living requires loving ourselves and taking care of ourselves. Nutrition, rest and exercise all receive the proper focus in our lives to provide energy, manage stress, allow freedom from illness and pain, fight fatigue, and rebuild our damaged bodies.
If we are under a physician’s care, and have been told to take certain medications, we do so. We do not stop taking them without consulting the physician. We communicate with our physicians regarding the effects that we perceive, the ways that we feel, and function as partners with her/him in our own treatment. We do not take the advice of amateurs, in the rooms or out of them, in place of the counsel of doctors with twenty-plus years of education. That’s just plain dumb. However…
We always tell our health providers that we are in recovery, and always double-check their suggestions regarding drugs with a person knowledgeable about their effects on recovering people.
Summary
Freedom from physical distress allows psychological growth. When we feel good, it is easier to do the work we need to do, eliminate denial, guilt and anger, and move on to self-confidence, self-esteem and learning to feel good about ourselves.
Balanced living requires a strong social network that nurtures us and encourages a healthy, recovery-oriented lifestyle. This network provides a sense of belonging. It includes relationships in which we are a valuable part of a whole. It includes immediate family members, friends, relatives, co-workers, counselors, therapists, employers, 12-step group members, and sponsors.
Recovery is not about quitting alcohol and drugs. It is about living a life that does not require mood-altering chemicals to be worth living. Balanced living is the final goal of recovery.
WOW! Thank you so much for this enlightening article. I have almost 6 months off of alcohol, opiates, and benzos, and I related to everything you said. EVERYTHING.
The first few articles I read online about PAWS were very clinical and just stupid. But you “know your stuff”. Thank you for this service. Like you said, just knowing why I am feeling so crazy helps immensely.
-Kathryn
P.S. – I am going out at lunch to shop for healthy food because I see now how much my diet (mostly cereal, caffeine, and breakfast muffins) has contributed to my mood swings and just my general weirdness. I doubt I will never be un-weird, but I can try.
Absolutely awesome information! I was unaware that PAWS can last so long. I am nine months off of Suboxone, a horrible drug, and still feel lousy much of the time! I didn’t have any idea that how I feel currently had anything to do with PAWS as I didn’t know that it’s duration was so extensive. I suffer from almost every symptom you mentioned. I actually thought I had a health problem totally unrelated to recovery. Not knowing what you suffer from can be a horrible nightmare and just adds to stress levels. I am also in the middle of a bankruptcy and house foreclosure which, based upon your explanations, just adds to the problem. Thanks again for the extremely enlightening article as it alone has uplifted my spirits! It’s nice to know that there is a reason for the way I have been feeling!
Wow, what brilliant information! My sister is a recovering drug addict, I think is still using some Suboxone, and I know she is going through PAWS as she is almost 50 days clean. This helps explain why she is experiencing all of these symptoms around my family and I right now. I will make sure and pass this along to the rest of my family, and maybe even her! Thank you so much!!
If your sister is still on Suboxone, she isn’t going through PAWS, she is still addicted and is experiencing mild withdrawal. (Either that, or simply the frustration of an addict who can’t get high.)
Suboxone is an opioid, similar to heroin or any other opioid, except that it also includes nalxone HCL, a narcotic antagonist that prevents people who take it from getting (very) high. When it is used to reduce cravings for heroin or other opioid drugs, the user must be tapered off slowly — preferably in a clinical setting — and once clean can begin an active program of recovery. Until the drugs are completely out of the system, recovery (including PAWS, which is an unavoidable adjunct to recovery) cannot begin. The reason: the neural pathways that need to normalize in order to recover are being kept open by the Suboxone.
Your sister needs your support, and your encouragement to attend 12-step meetings. Perhaps you could be a good example by attending a few NarAnon or Al-Anon meetings yourself.
I am at ten months and am feeling paw symptoms. How long does this last at ten months?
Hi Rebecca,
Thanks for your comment. PAWS varies with every individual. It depends on individual brain chemistry, our physical condition, how much and what we used, the stress we’re under, whether we’re eating properly, going to meetings, making sincere attempts to get our lives back in order, improving our self-esteem, and so forth. Following the suggestions in the article will help, especially the blood sugar, exercise and vitamins.
A good sponsor and a good home group, along with working the steps will give us support through the hard times. We didn’t get addicted overnight, and we don’t get well overnight, but it does keep getting better. Not every day, but on average, if we stick with our program of recovery it gets better.
Hang in there.
–
Bill
Thank you for the much needed advice. I’ve been off of suboxone for four weeks now after being on for a year and a half. I could have stayed on it for life – my doctor was fine with it. I wanted off as soon as possible. Now I feel lousy. I’m so tired I can barely get up in the mornings, much less function throughout the day.
I found my way to addiction though doctor’s advice (pain pills for headaches), and now I fear I’m in for another rough ride through this “PAWS.” My doctor has prescribed adderal to get me through the work day. I work 70 hour weeks and am not sure how else to get through. I will certainly give some time and attention to what you’ve suggested.
It’s too bad suboxone is billed as such a “miracle.”
Thank you -
You are most welcome.
Suboxone, used properly in a clinical detox setting by specialists trained in its use is, indeed, a miracle drug. Like methadone, however, when used by unskilled practitioners or as a political tool instead of a clinical aid, it carries with it its own set of problems as serious, or nearly so, as the drugs it replaces.
Please know that Adderall, an amphetamine similar to methamphetamine, is not approved for giving people enough pep to get through the day when recovering from addiction to another drug. First of all, Adderall is indicated in cases of adult ADD and narcolepsy, not low energy. Second, it is a highly-addictive drug in its own right, when used improperly. Thirdly, it is a highly dangerous addition to an addict’s brain chemistry because — odd as it seems — it keeps activated many of the same neural pathways that are involved in addiction to depressants, including opiates and alcohol, thus increasing the length of time necessary for the neurological response to return to something like normal.
Most people newly off opiates or other pain medications find that reduced stress, exercise, support from others and treatment for the depression that often follows secondary withdrawal — by experts — is the most effective way to avoid the worst problems with PAWS. The 70-hour work week is a highly dangerous situation, but I’m sure that you see no way to reduce your efforts to human levels.
I suggest a physician whose specialty is treatment of recovering addicts; one with a strong background in psychopharmacology, combined with a 12-step support group and a program of nutrition and exercise.
However, I am not a medical doctor.
Thank you so much, icredibly well written. I am in recovery from alcohol – almost three months now. I was ready for the depression, that passed as I worked the steps in AA, but I’ve had alot of anger lately that has been threatening my sobriety. You’ve helped me understand much of what is happening – and made me think about ways to be a little more pro-active about stress levels at my job. Stress levels are going to remain high, I need to manage myself and my tasks better- I tend to procrastinate then its a stressball (I learned to do this from my boss, he’s the king of it). Cutting back the coffee would also be good.
Thank you! Makes it all worthwhile.
Good fortune in your sobriety. Remember that adage: “Anything I put ahead of my sobriety I will lose.” It’s too, too true.
bw
I was on Klonopin l.5 mg daily for 7 month. Was side stepped to valium for a 6 1/2 month taper (dr. assisted) I was also on cipralex l0 mg and was taken off that after the benzo withdrawal. Felt wonderful for four months during which time we moved but then BAM in January I felt like hell – all the symptoms of PAWS and have had very few days where I feel ok. I long for my life as it was several years ago before my breakdown. I am 56 years old and otherwise healthy. I don’t know why I am experiencing this now. The taper was realatively easy. My gp has put me on l0 mg of cipralex to help with the anxiety. I have been on for 6 weeks with little relief. Please help before I go crazy. I don’t drink or smoke and as I say, have been healthy except for the last year of benzo hell. Thank you so much. Lynn
Dear Lynn,
I am neither a physician nor a psychopharmacologist, but my guess is that the crux of your problem, in addition to your obvious physical and emotional turmoil, is the expression “gp.” The bare fact of the matter is that general practitioners are not trained to deal with emotional problems and psych meds. There is a great deal more to it than a few seminars, reading medical journals and package inserts.
I realize this is not the sort of help you believe you needed, but it is the best help that I can offer. Psych drugs are for psychological and psychiatric conditions, and general practitioners are not qualified to treat them. Bottom line.
Your county medical society should be able to put you in touch with a physician who is qualified to treat your condition. Please don’t wait too long to look for additional help.
As to why, who knows? Our neurochemistry changes as we age, and exposure to psych meds works its own changes.
Please see a specialist.
Best of luck,
Bill
Thanks so much. I have been sober for eight weeks and for the last week and a half (after going back to work) I have had pain and shakes and headaches and depression. I haven’t started working the program but am starting IOP today (I know I am late). I am so glad I came across this site because I was beginning to think was experiencing something out of the ordinary. Now I know that this is common and there are things I can do to ease my discomfort and help me stay sober.
Thanks alot
Hi, I am 4 weeks from my last dose of methadone. I was weaned off it in a detox centre. I am still in so much paws, and have abosolutely NO energy at all. I am wondering how much longer this no energy will last. I have to push myself to just get up and go to the bathroom. I am a 50 year old woman… I just want to feel somewhat normal again! Thanks.
Dear Kerry,
There are too many possible reasons for your malaise for me to be able to answer your question. In addition, everyone’s brain chemistry is slightly different, and that complicates diagnosis and treatment at a distance. It would not be ethical, nor to your benefit, for me to speculate.
Having said that, if you have no physical disabilities that prevent it, a good multivitamin morning and evening, combined with a good diet as outlined in the article and some light exercise, like walking, might help. It would also help to go to a few meetings, get a sponsor, and begin helping others. Finally, if all of those things seem impossibly difficult, there is a good chance that you are suffering from depression and you might consider seeing a doctor who is familiar with recovering people and their problems. No doubt the detox that you attended could supply information about that.
Congratulations on your success so far! Methadone is the devil’s drug, as you certainly know, and methadone maintenance is society’s way of saying “we don’t really give a …. about those addicts.” Stick with the people in your 12-step program, and with the suggestions of your physician (provided, as stated above, he understands addiction and psychopharmacology; most family physicians and many psychiatrists do not). If you don’t have a program, call NA and ask for help.
Keep on keepin’ on…you can do it. I did.
Bill
I will never understand why the phrase “insanity is…” (we all know the rest..doing something over and over and expecting different results) …..is used so often in MAINSTREAM addiction treatment…..and then it’s applied to EVERYTHING in our lives EXCEPT the “treatment” which is offered. How many is TOO MANY times at “treatment” before it’s insanity as well?
If PAWS seemed endless to us the FIRST time we tried the “traditional” treatments, why on EARTH would we expect it to be better the next time around? And the next…….
I am sure my posts seem argumentative. However, that is truly not the case. I just keep hoping that some DAY I will post something like this, and someone out there who works with addicts (or is one) will understand the point I am trying to make about what we offer as “treatment”. We tell addicts that they are sick and they have a problem with brain chemistry…they are JUST AS SICK as someone with epilepsy or cancer (as your posts prove by showing what happens PHYSICALLY to an addicted person who’s brain chemistry is now forever altered)–and then we prescribe a treatment we would NEVER consider “real” treatment for ANY other type of disease.
I worked for much of my adult life in a substance abuse counseling. While there I watched the revolving door of addicts who showed up time and time again begging for relief from their “affliction” (which was PAWS in the rawest of all forms) and time and time again I watched as the SAME thing was offered to them as “treatment”….”your sick, but your sick because your selfish, spirtually weak or just plain weak.” or “you have to WANT it more” or “your brain is changed forever, but all you have to do is come to this meeting and be as honest as you can be about what a bad person you are and you will be magically healed”…….
Time and time again I watched them become homeless, jailed or die…..because why stop using drugs if you feel just as miserable OFF them as you do ON them?
Thanks for listening.
I believe that you are absolutely right. What seems to have been misunderstood about my remarks, which may have been phrased unskillfully, is that I meant only to refer to the practice of using opiate maintenance as a substitute for impatient treatment, support, and psych meds if needed, thus prolonging the dependency and keeping patients in close association with people who are questionable supports. There are drugs far better suited for opiate detox in a clinical setting, which is how I believe the issue should be addressed.
It is also my contention that many physicians who position themselves as addiction specialists know virtually nothing about addiction, and about as much about mood-altering drugs and psychopharmacology. This is almost universally true of family physicians, and of many psychiatrists and psychotherapists as well. I have seen far too many patients and clients who took 96 hours to detox from their drugs of choice and weeks to do so from drugs prescribed by physicians who do not understand that the first step in stabilizing brain chemistry is to safely remove all chemicals, if possible, to create a baseline. The protocol of piling one drug on top of another is another of my pet peeves, and a practice all too common in the medical industry. This is an area where incompetent help may be worse than none at all, regardless of the source. Witness the current plethora of storefront “outpatient” detoxes using Suboxone.
That said, I am (as was Bill Wilson) 100% in favor of “outside help” when it is needed. In fact, I once made my living being outside help. I do not, however, believe medication and/or therapy are enough. That’s where the support and assistance in rebuilding a life and relationships that is found in the 12-step programs comes in, and support of that kind is absolutely essential, whether or not it is obtained in the 12-step rooms or elsewhere, in my less-than-humble opinion.
The point of my insistence on 12-step recovery is that after looking at a great many programs I have yet to find another platform that offers (a) support that is based on an inside understanding of addiction; (b) has worked for so many people; and (c) is non-religious. They may exist, but since the purpose of these pages is to direct people in directions that I know to work from my own personal and professional experience, it would be just as irresponsible for me to speak to those as it would be for me to be pontificating about addiction if I were not a recovering addict. (I am also a firm believer in the concept of addicts making the best counselors, although I have known brilliant exceptions to that rule.)
I am not anti-religion, either, although I am personally agnostic. My position on religious treatment programs is that most of the religions with drug and alcohol outreach are proselytizing faiths, and I don’t care for the ethics of pushing specific beliefs on people who are emotionally needy and vulnerable to subtle coercion. As a practicing Buddhist, I consider that sort of thing not only unethical, but to be distracting people from the reality that they need so desperately to embrace in lieu of the addictive dreamland. There is plenty of time after they have their feet firmly on the ground for them to seek out organized religion on their own.
Thus, I suspect that we are mostly on the same pages (except, perhaps, regarding the methadone). Thanks very much for your input.
Thank you so much for taking the time to read through my thoughts ….it seems like this subject tends to shut people down- the wall goes up before the first sentence is even spoke. We take a stance and try not to waver, but we never really HEAR someone else’s reality. I am as guilty as some of the people I have accused of this!
Thanks again.
(ps-I agree completely on your take of faith based treatment)
My husband is tappering off of subutex. He is very scared of the PAWS. I have read the article and stress will make the PAWS worse. Are there any vitamins other that the multi vit. to help with the PAWS. Can he get throught this? Have you heard of Low dose Naltrezone. I hear I helps with natural endophins production.
Please help. Thank for your article I know this will help.
lisa
PAWS occurs after detox. Acute withdrawal, when possible, should always be monitored by a skilled physician.
Withdrawal from buprenorphine, a synthetic opioid, is similar to that from any other opiate, except that (like methadone) its longer half-life tends to make withdrawal less severe unless it has been heavily abused. That doesn’t mean it is fun. Hopefully your husband is under the care of a physician who is competent to supervise detoxing patients.
Following the steps outlined in the article — even if it’s the last thing he feels like doing — and toughing out the several days after he takes his last dose is probably the safest course medically (although, I hasten to add, I am not a medical doctor and this is therefore a layman’s opinion that is worth exactly what you’re paying for it). This is one of those situations for which there is no magic elixer. The body is readjusting from a condition it has been in for a long time, and it takes quite a while for it to repair itself and get back to something like normal. He could double up on the multis, being always sure to take them with meals. Vitamins are food, and they are not absorbed properly unless taken with other food.
Addicts, of course (and I include myself), are people who, almost by definition, think it isn’t OK to feel bad. We have trouble getting the idea that everyone hurts, from time to time, and that we usually get over it. We want the answers NOW. Trouble is, apart from the above, I don’t have any. I realize this isn’t what you were looking for, but I do not bullshit about things I don’t understand, and I’ve told you all I know.
Good luck to you and your husband. I hope you’re hitting some NarAnon meetings and that he is attending NA. It helps.
Namasté
hi
i have every symptom you have listed above they all started about 3 weeks after i quit i had a withdrawl first that lasted about 2.5 weeks i then started to feel better , then all of sudden i just clicked into this weird state racing repetitive thinking thoughts going around and around no concentration i i could not focus on anything i thought i was going mad i had never exprienced anything remotely like this in my life before as i said i have had every listed symptom but it has got slightly better over time . the drug i was addicted to was cannabis ! have you ever heard of someone getting paws from cannabis addiction ? i have searched the net trying to find someone who has had paws from weed but i have found nothing . it makes me wounder if i have paws , but i tick every box in terms of symptoms and everthing else . also i am wondering if it will ever go away i have had it for 6 months now help!
Thanks for writing, Brian.
There is a lot of discussion over whether or not cannabis causes withdrawal per se. I think the entire discussion is beside the point.
Whenever we change our brain chemistry over prolonged periods there is going to be a period of adjustment after we stop, during which our emotional state will generally be the opposite of however the drug made us feel. Since THC leaves one relaxed and drowsy, we can expect a period of manic feelings and behavior for some time afterward. Generally, the period is longer the longer we have been using. You did not mention how long nor how much you were using, but I suspect quite a while and quite a bit. Sometimes this is simply our perception of the real world when we’re not “slowed down,” and sometimes it is an actual physical readjustment of brain chemistry, or a combination of both.
I cannot begin to diagnose your problem since, first of all, I am not a physician and, secondly, even a physician who is trained in chemical dependency could not make an accurate and ethical diagnosis without interviewing a patient and perhaps running some tests.
So understand that these are layman’s remarks. Having said that, two things come to mind: first of all, I wonder if your initial attraction to cannabis might have been related to self-medication of a condition undiagnosed — and perhaps unrecognized even by you. If there was a pre-existing condition, and if you were self-medicating, the condition may have worsened during your heavy use, and may now be manifesting more strongly.
The other thing is, how well are you taking care of yourself physically? Recovery from any addiction takes a big toll on the mind and body, creating stress which in turn takes an even greater toll.
I suggest that you follow as many of the guidelines in the article as your are able to. In addition to that, I suggest that if the symptoms do not begin to improve soon, you need to see a physician who has training in substance abuse, who can perhaps help you piece together your medical condition and see if there is something that needs attention.
With regard to the suggestions, pay particular attention to nutrition, exercise, and getting enough rest. I also strongly suggest a 12-step program like NA, if you are not already attending. These things are much easier to bear when you have the support of folks who have been there too.
Good luck, and remember that as uncomfortable as you are now, you have already gone through the worst of it. Keep on keepin’ on!
Bill
I would like to say that I used Suboxone very short term to come off opiates. First, I would like to say that I began taking opiates “innocently”. I have a Masters Degree, I am married to a very successful attorney, I don’t smoke or drink!! At the age of 30, I had a damaged nerve, began seeing a neurologist and was prescribed Oxycodone. From the very first time that I took opiates, I knew there was the possibility for trouble. I felt wonderful and euphoric. I had all the energy in the world. But as most of you know, things changed rapidly!!! I began abusing the pills, taking them when I wasn’t in pain. Taking much more than was prescribed, etc. The next thing I knew I was lying to my doctor to get my prescription filled early. Frequently visiting urgent care centers and faking injuries. Calling my dentist and claiming that I had tooth pain. Fortunately, I never ended up buying them on the streets from dealers but believe me I wasn’t far from trying!! I made several attempts at cold turkey and was so ill that I couldn’t even lift my head off my pillow. I too am a professional and can’t miss work. So to me, cold turkey wasn’t an option at the time. Fortunately, I have several friends in the medical field that introduced me to a Suboxone doctor. I went in and saw him, and on my first visit I had to be in full blown withdraw!! Man did that stink!! I had to run in the bathroom during my initial interview to have diarrhea, it was very embarrassing. The doctor reassured me and administered the first Suboxone pill and within 20 minutes, all withdrawal symptoms stopped. However, I did a very rapid detox from Suboxone. I was only on it for 2 weeks!! That is the key with Suboxone and I believe where people are going wrong with it!! I started with 4 mgs my first day and rapidly went from 2 to 1 to 0.5 to literally tiny pieces of the pill and came off completely!! Its been 16 months and Im clean and sober!! Yes, I have my bad days where I feel tired or depressed but I just think about the horrendous life that I had while I was using and understand that I would never go back there!! Ever!! I went from 200 mg a day of Oxycodone to Suboxone for 2 weeks and then off. The only withdrawal that I had when I completely stopped the Suboxone was a little diarrhea but I have IBS so that could have just been my condition. I strongly recommend Suboxone for SHORT TERM USE ONLY!!! It can be addicting like any other opiate and why trade one addiction for the next?? I am not a doctor and this is only my opinion, so please don’t be angry with me if you don’t feel the same!! I just wanted to tell my story with the hope that it would help somebody else that is suffering from this horrible addiction!!!
I agree with you absolutely. Thank you for sharing your experience and pointing out the benefits of Suboxone when used in a skilled manner by a conscientious physician. It is unfortunate that many of the physicians doing “office detox” do not fall into those categories. Those of use who have worked in detox settings have seen more and more instances of full-blown Suboxone addiction, due to the ministrations of storefront detox clinics (and a Suboxone detox is just as bad as a heroin detox, only it lasts longer).
It is even more unfortunate that this drug which, used properly, could end replacement therapy, is instead now being touted as a “better” replacement drug than Dolophine (Methadone).
is there such a thing as paws from SSRI’s?
Thanks.
Dear JAS,
SSRIs are usually prescribed for specific neurological disorders involving imbalances in brain chemistry. I would think there would be a rebound effect of some kind that would be detectable, but I have no specific knowledge about that. Since the effect of SSRIs is to increase the supply of serotonin, I wouldn’t be at all surprised if sudden cessation couldn’t lead to depression, among other things.
If someone you know has ceased taking medication, they should be under the care of a physician who is knowledgeable about these things. If they are doing it on their own, or under the supervision of only a family physician, I suggest they speak with a doctor who has received special training, such as a specialist in psychopharmacology, or at least with a pharmacist.
Good luck.
i have been feeling “foggy” and not myself, i have been 11 months sober… could this be related to PAWS?
It is certainly possible. I suggest discussing it with your sponsor and at a few meetings. Give your sponsor a copy of the article. Following the suggestions listed, even if it’s not PAWS, can never hurt. Finally, if you begin to feel depressed or otherwise unable to function normally, please see a physician who is trained in dealing with recovering people.
Finally, approaching anniveersaries are notoriously a time of relapse, and relapse occurs before we pick up. Redouble your efforts in the rooms. Get active. Help another drunk or addict. Do some service work. Start going to a new meeting to kick start some new aspects of recovery.
Good luck!
HELP!!!!!!! Eight years ago my husband injured his back… numerous docs prescribed pain meds (began with Ibuprofen 800 then escalated to Narcotics!). For years he had been taking Ultram (Tramadol) thinking it was “innocent”.. however was up to 20-30 50mg pills a day when the MAX dose was 300mg/day! He claimed docs said it was his “tolerance” he had developed to this drug – which made sense to me. He is also a 6′2″ 200lb man! Innocently, I went on accepting that his doctors said it was “ok” for him to get it on the internet because our insurance wouldn’t pay for the large prescription.
IDIOT ME!
After the amount of money he was spending to get this medicine really stressed our pocket book to the point of us not having $ to feed our four kids, I had to do something! I had let it go too far, by trusting he had this under control. I would question why he wasn’t getting it from his doctor etc… he always had a good reason why and I fell for it. Then I started to do research on this drug… found out how bad it was and that people were getting addicted. Tramadol is a non-narcotic and my husband had me convinced that it wasn’t hurting him. How could it? I would research and find things and present them to him and he wouldn’t listen. Finally got to the point of telling him I was going to start going to the doctor with him. He would say that was fine, but then when it came down to it, he would change the appointment or lie to me about going or say he couldn’t go etc… or even coming to me saying he was afraid that I would embarrass him in front of the doctor by bringing my concerns about the meds from the internet and that I would be “telling” the doctor how to do his job. After a while, I realized this was not right! I tried to get my husband to talk to me, but he just kept feeding me lies and I kept giving him the benefit of the doubt… I guess I was in a bubble thinking he would never lie to me or hurt me.
So one day, I was DONE! I marched myself and our 3 month old baby into the doctors office after leaving 20 messages trying to talk to the doc about this… first it was HIPPA, then my husband said he signed a release to talk to me, then they “lost it”, etc… excuse after excuse! That day changed my entire life…. that day I found out not only was my husband ordering excessive amounts of Tramadol from then internet (hiding it, lying, picking it up from fed ex, having it sent other places…) he was also taking NORCO!!!!!!!!!!!! In his chart he had informed the doctor that he had been taking Vicodin/Norco/etc… for the past 8 years!!!!!!!! Hmmm! So he told ME he was on Tramadol and told his docs he needed a narcotic! TAKING BOTH AT THE SAME TIME!!!! IN EXCESSIVE AMOUNTS! He would go see numerous docs to get Rx’s and get different types of drugs so that insurance would cover them… but I had NO IDEA!
Anyway… told him get help. We went round and round about this…. he kept saying he would, then I would find out he bought more drugs etc…. until it came down to me giving him an ultamatum (sp) —- get help either in-patient, out-patient, psychiatrist, or GET OUT! This was negativly affecting our four young children and I was not going to stand for the lying, manipulation, emotional mess any longer! I had to protect our children!!
He refused to go to detox — so we agreed on a compromise — Suboxone therapy. He seems to be doing “OK” on this.. as far as I know, he has been just on the Suboxone… but he gets wierd about it too… counting pills, hoarding pills…. I am reading posts and freaking out about this! Few reasons —–
He has been on Suboxone for 4 months now — 16-20mg/day. Scared about the “replace one drug for another thing”… but we were assured by the doc that it would not be the same thing….
Also — BIG ONE! He seems to have PAWS to the EXTREME CASE!!!!!!!! With 4 kids, me working part time from home and attending NURSING SCHOOL FULL TIME, he has pushed me over the edge! The moodyness, the emotions, the attitude, the overreaction etc… etc… I can NOT handle it! I was told when I started nursing school — if you can, move back home with your parents, but you all need to quit working if you want to be successful in this program! UM… yeah, I am 33, married with 4 kids… I am not moving back to my parents (are you insane!!!!!) and I can’t quit work!!! Unrealisitic! He has become worse than all 4 kids combined… the needyness, the drama — example — a few weeks ago, he had a very small cut above his lip… I would say maybe 2 MILLIMETERS if that! His face was smooth like he had just shaved that morning… I assumed he nicked himself shaving and didn’t mention it. He blew up, flew off the handle, told me I was completely insensitive, I didn’t care about anyone but myself, etc…. because I wasn’t concerned enough to ask what happened! First thing you should be able to tell by my personality… 4 children and I have wanted to be a nurse my whole life — those kinds of people are not insensitive! You can not be a nurse or a mom successfully and be insensitive! That is just ONE of MANY MANY instances!!!!
So my question — after the novel — is this…. anyone have any clue what I am supposed to do here?? I have let my husband trick me into believing that I am the one with the problem, I am the one who needs to get therapy and I have agreed!!!! Only issue is that I have no time to even pee, where will I find time to see a psychiatrist???? I guess I could spare one of my 3-4 hours of sleep I ONLY get each night, if I am lucky! Now I am concerned with the Suboxone … if my husband is having PAWS and STILL taking Suboxone… how much worse will it get when he is weaned from Suboxone???? If PAWS can last up to 18 months… will he have s/s of it while taking Suboxone and then even worse when he is weaned off???
Any advice… I am willing to listen/try!
Dear Karin,
It sounds like you find yourself caught between the proverbial rock and hard place — not unusual, in fact quite the contrary, for codependents.
The bottom line, once we sift through all the addict-speak and concerns is simple.
You need to take several steps:
Finally, ignore any promises, protestations, prostrations, pathetic pleas and all the other manipulative letters of the alphabet from your husband. He is terrified of getting off the drugs. He has no doubt already experienced the terror of withdrawal, and he cannot be blamed. He will do and say whatever he needs to avoid that, which is his greatest fear. Those of us who have been addicted understand and sympathize with him, but his instincts have been warped to the extent that he will do whatever he can to protect the status quo. Ignore his preferences. Find out what you need to do, and do it.
Bless you for being strong and faithful. Now it’s time for the hard part — the part that seems so unfaithful, but is so essential. It is his only hope — and yours — if you want to get back to normal.
Namasté
I enjoyed this article immensely…. I do have a few questions though. Most of the information that I have been reading about PAWS, says that “long term users,” or, “heavy users,” will be affected. I am curious as to what is classified as a “heavy user” or long term user.”
I have been drinking for several years. I sobered up a 2 times for over a year each time. The last year or so I have been drinking, until extremely intoxicated, about 2 or 3 times a week, give or take. I was sober for about three weeks. I fell off the wagon a couple of days ago.
Do you think I culd be a good candidate for this syndrome. I have all of the symptoms. (but then again I have all the symptoms of half of the diseases on the net!) HE HE!
Dear Diane,
This definitely qualifies as both heavy and long term, especially since I imagine you have been maintenance drinking in between the frequent binges. That most likely means that your system has seldom if ever been free of alcohol for the last year “or so” — and possibly more.
Obviously, the longer we drink the more we damage our bodies and the longer it takes them to recover, if they ever do recover completely. However, the issue is not how long we have been drinking, nor for that matter even how much we drank. Rather it is whether or not our bodies had the opportunity to change in the ways that cause us to require alcohol in order to feel normal. Once we have reached that point, we are fully addicted.
It is not up to me to call you an addict or alcoholic, especially since I do not know you. But you described a series of events that conform to the pattern of a person who is addicted to alcohol, including the attempt to quit and the failure to remain abstinent.
You have shown that you were able to go “cold turkey” at least once without severe withdrawal symptoms. That does not mean that it will happen the next time. I suggest a medically-supervised detox, but that is entirely up to you. Be aware that alcohol detox, sans medication, can lead to severe seizures and/or blood pressure spikes that can be fatal. Ethically, I must mention that.
I also suggest inpatient treatment, but that may not be an option in your case. If it is, I would take advantage of it.
By whatever means, get to some AA meetings. We need the support of people who have been there and done that. Open up to them if you can. There are probably women’s meetings someplace in your area if you would feel more comfortable, but if you live in rural Canada you may have to settle for what you can get. When it comes to recovery, any AA is 100% better than none. If you will go to meetings and do as they suggest, and also follow the outline in the article, you will have an excellent chance of success in your search for sobriety.
Namasté
I have been off tramadol for 60 days I was taking 400mg for two years for abdo pain drs pxn before I realisd the tramadol was actually causing the abdo pain. I detoxed on a programme where I tapered methadone for 5 days then they sent me home–after I got home it was hell but I persevered. However 60 days later I still only sleep 3 nights ot of 4 have stomach cramps regularly feel tingly all over often and have restless legs most nights. It is consderably better than it was but I would really like to go back to feeling normal. Do you have any idea how long it will take? I have never taken any other drugs and take only buscopan occasionally for stomach cramps now. If I have a glass of wine or a coffee it seems to make it worse–is this possible? Your advice or experience would be much appreciated. Thank you.
Sixty days seems long to be having even sub-acute withdrawal from tramadol. Although several of the symptoms you have described are part of the normal withdrawal syndrome, they can also be indicators of other conditions, including diabetes.
I would suggest a complete workup and physical from a competent physician — not the one who kept you on an addictive drug that failed for two years to alleviate the symptoms it was prescribed for. If for some reason you cannot afford a full workup, at least get a good blood panel including a fasting blood sugar.
You’ve come a long way. Hang in there.
THANK YOU SO MUCH FOR TAKING THE TIME TO WRITE THIS ARTICLE AND THROW IT OUT TO THE PUBLIC! I will always rememeber reading this and you will be in my prayers of meditation and in the far future when I look back on how absurd drug addiction (not caring about it and just doing “sh@t”) truely is.
Many mandalas to you sir!
-Tim
And good luck and life to you, sir!
Namasté
I am an alcoholic and have been in recovery for 5 months (serious drinking for 20 years – 40yr old Female). I went to a 30 day inpatient facility and just finished my intensive outpatient therapy.
There are good days and bad days, then there are good weeks and bad weeks. I have an AA sponsor and attend 3 – 4 meetings a week.
I have been on the relapse threshold for the past few days. I know the mental part of relapse is as bad as the physical. I have not picked up but have been tempted to so I could escape. Escapism, one of the many ism’s in an addicts life.
Even with the education, treatment and the support system I have there are still many occasions where I feel like I am going crazy. Asking when will this obcession, craving STOP.
When I get like this I research, I read and get as much information as I can. I do not have the strength to start over if I relapsed, so relapse is not an option.
My point to this post is I am very well versed with PAWS and normally when I start having the symptoms I recognize it. I did not this time and was probably the closest to relapse I have been YET. I found this article, read it and was able to take a deep breath and sigh of relief. I am with the writer above where I did not get sober to be miserable. As long as I know or can some what can explain what is happening I can continue. I know with PAWS my brain chemistry is trying to restore itself from all of the years of abuse. This I can live with because I know that it is progress.
I thank you for this article as you have restored my sanilty for the moment. I can now use the old AA adage’s of this too will past and one day at a time.
This article is like the one sentence at a meeting that you hear out of all the words spoken that can get you through to another day. Thanks very much for this and the hope
and guidance you are sharing with those in need.
- Tammy
“The Power of the Mind can Defeat anything there is.”
I can’t tell you how much it pleases me to get this sort of comment. My wife, who is a detox therapist, also teaches PAWS and gets the same kinds of responses. Clearly, the insistence of some folks in the rooms that all you need is the Steps is misguided. Information is what scares away the bogyman, not some crochety old-timer like me.
Your note humbles me, and it is good for me to feel humble. It’s rare enough.
I’m an alcoholic/addict with 2 years sobriety, from a long line of alcoholics. I wish I had known about PAWS while I was going through it. My sponsor thought I had ADD and need medication. I just stayed close to my program worked my step etc. and made it through
. My question is about my oldest sister, age 62. While she is not an alcoholic addict in the classic sense, she does have all of the “isms” 20 years ago following a devastating divorce went on prozac, then an ever widening array of psych “meds” , getting farther and farther off the deep end. Last year her medicine cabinet was an addicts jackpot Long story short she decided to, medically supervised , wean off of all her prescriptions. Now at 9 months clean, she can’t sleep, can’t think, has anxiety attacks and now fears that she is bipolar. She is not mentally ill and 20 years ago as this nightmare began she had damn good reasons to be depressed. She had no tools to deal with her pain other than her doctor. The saddest thing about her story is that she is muddling through all of this virtually alone because she doesn’t see herself as an addict. So I guess what I want to ask is can prozac detox cause PAWS?
thanks
Terri K.
You have said that your sister’s medicine cabinet was an “addict’s jackpot,” and that she had to “wean herself” off all the prescriptions. To me, that indicates that she may be an addict experiencing PAWS. I don’t know that the Prozac even has to be considered in the mix, although there can certainly be a rebound from that, as well.
Her physical and neurolochemical balance has clearly been scrambled, and after 20 years of it, it is hard to say what her condition might be. One does not recover from 20 years of immersing their brain in drugs without some long-term problems, regardless of the source of the drugs and whether or not they were “legal.” If this were a member of my family, I would encourage her to see a doctor who is truly expert in addiction and psychopharmacology. They are not, unfortunately, thick on the ground. You might ask a few of your friends in the program if they know of anyone — just collect recommendations, and ignore the advice — and do a bit of research. Then all you can do is suggest a visit, and hope for the best.
It sounds as though she is ready for some help, but it is extremely important that she get the right kind. If she finds some doctor who is willing to accept her self-diagnoses, she could end up back on the same bandwagon.
I am 90 days sober, attend meetings twice a week, am 64 yrs old. I am using 2 – 1.5 mgs clonazipan daily to help my withdrawal. Am I substituting one drug for another? Or as my physician claims can I back off the clonaz easily by reducing dosage gradually. Thank You
First of all, Rod, let me say that there is no such thing as “backing off the clonaz easily.” Clonazepam is a powerful anticonvulsant, and the withdrawal syndrome can include life-threatening seizures, along with other less-serious issues. It is not recommended for use beyond nine weeks even as a seizure or panic disorder treatment without close monitoring, and is normally prescribed for alcohol detox for only a few days to get past the danger of seizures (and that is “off label” use).
You are far beyond the therapeutic use of the drug in alcohol detox.
Detox should be monitored by a physician with experience in detoxification from anticonvulsants. Try to find a doctor or nurse practitioner who is associated with a treatment center and familiar with the detox protocol for Klonopin.
As to your underlying question, that is not for me to say. My personal feeling is that at 90 days the exercise, fellowship, good diet, vitamins, blood sugar control and working the 12 steps should deal with the withdrawal. We can’t argue with success — you are 90 days sober. However, if I were your sponsor I would suggest getting off the tranquilizers cautiously but expeditiously. If for no other reason, should you have a medical emergency the Klonopin could complicate your other treatment.
Finally, congratulations! I too am 64, and enjoying wonderful health and a great life because of my 12-step program and the benefits it has given me. I spent my 45th birthday in treatment, so I’ve been sober for a while and I can tell you that it does keep getting better if you work a good program and let life happen.
Namasté
I received a response on my personal e mail today. It was helpful and I appreciate it. It’s perfectly OK to respond to me via the site here. It may help someone else.
Very nice information. Thanks for this.its great to see someone with a like mind.
I just found your blog on the google search engine and saw a few of your other posts that you had done . I just added you to my Google News Reader. Keep up the great work. i will Look forward to reading more from you again.
I have been off suboxone now for 45 days with no clinical observation and have believe I am going through PAWS for sure. I am 26 years old and come off other drugs, some like Klonipin were monitored while others like oxycontin were not. However none of these have caused the same long term withdrawl period or PAWS which I am experiencing now. I read the whole article and believe I need to change my diet. The part of hypoglycemia is especially intriging to me as I have noticed I feel far worse after eating to much sugar or drinking coffee (even worse when using both together, IE a white chocolate mocha from Starbucks).
What worried me is when you wrote, “We really need to get this thing under control! Hunger produces stress. Blood sugar swings produce stress. Stress aggravates PAWS and, as we have seen, is deadly when combined with hypoglycemia—which is caused by poor eating habits, especially by too much sugar and caffeine. Are we beginning to see a trend here?”
Exactly what do you mean by deadly here? I constantly worry about my health because of PAWS and when I read this my anxiety shot through the roof. Is it deadly because it could cause us to relapse or because the combination itself is deadly in some way?
Dear Chris,
The “deadly” remark was meant to be figurative (unless a person is diabetic, in which case it could be literal over time). And of course relapse can be deadly as well.
You are the first person to bring the possible confusion to my attention, and I thank you for that. I will change it forthwith. If you misinterpreted it — or found it ambiguous — then others could as well. Thank you.
I hope you’re going to meetings and getting some support. It makes it much easier. However, if you are having emotional swings related to sugar and stimulants, I can almost guarantee that following the protocol I outlined will also alleviate a lot of your stress.
Remember two things: relapse=stress=relapse, and that stress is not always from unpleasant things. One of the most stressful things, for example, is getting married. When things get exciting, we need to be especially on our guard. New relationships are another pitfall, because they are not only stressful, they tend to make us defocus from our recovery priorities.
Thanks so much for writing. I will change that wording instantly.
I’m a physician, 25 months into recovery from alcohol addiction. I would like to pass on my congratulations to you for a well written, understandable, explanation of post acute withdrawal syndrome, and your well thought out responses to the questions or comments made by people visiting the site.
This has been one of the most useful site I’ve come across in my web searching of sites on addictions.
Dear Dr. Karen,
Thank you so much for your kind remarks.
I journal, and have done so for many years. Thus I have not only my own memories and those of my close supports, but my jottings to jog my memory. When I was writing PAWS as a handout for a lecture series (and, again, I must give Terry Gorski credit for much of the basics), I tried to address the things that had puzzled me and caused me trouble in my own recovery — as well as the issues I had seen confronted by people in the treatment centers where I worked. It seems to be useful to some folks, and is by far the most-read bit of material on this and my other sites.
Congratulations on your own recovery. I’m sure it is difficult for a physician to face her own infirmities, and it takes a lot of guts to admit a problem and address it as you have done. I hope that you allow it to illuminate your practice, when you return to it, and that you will become one of those rare creatures that I refer to so often in the comments above: a physician who understands both the reality and the most effective protocols for treating addiction.
Regards,
Bill
Great artical, I am going to show this to my Dr. I am currently on Subutex and xanax, I want off, but find it almost impossible to get off of the subutex. I was dependent on pain meds for a short time, under 6months and now have been on subutex for over 2 years. Was put on the xanax the last time, I tried to free myself from subutex. Its an awful drug to get off of.
Thanks for the great info,
C
Dear Clever,
Please assure your doctor that, despite my frequent comments about most doctors not knowing enough about addiction and detox, I emphatically do not have it in for GP’s and other family physicians. My own dear personal GP doesn’t know squat about it, admits it, and listens to me when I explain to him why certain courses of treatment are not options for me.
Addiction is as complex a field as any of the other neurosciences. No one can be expected to understand everything about medicine, and much of the confusion with family practitioners is the fault of pharmaceutical companies that are more interested in leading them down the garden path than in providing them with good, solid information about the medications they are being peddled. A physician who is seeing twenty or more patients a day cannot be expected to deal with all their aches, pains and misconceptions and at the same time stay up-to-the-minute about every area in the field of medicine.
Physicians receive, for practical purposes, no training in addiction while in medical school. Even psychiatric residencies are way behind the curve in treatment theory and protocols. The fact is, no one who is not devoting the lion’s share of her practice to addiction study and treatment is able to stay on top of the field. In a way, it is amazing that so many do as well as they do.
Best wishes to you, and to your doctor, and the best possible luck (and skill) in your recovery…
Bill
I succumbed to the Madison-Avenue hyperbole spewed by a storefront Suboxone-peddling physician. This doc assured me that my years of opiate abuse/dependency would dissipate in a mere two weeks with this wonder drug. Granted, while on Suboxone I felt wonderfully well; afterwards, however, my spirits crumbled as I began to feel worse than I had during the peak of cold-turkey withdrawal. Of course, he dutifully advised me that I was experiencing PAWS – and for an additional $800 in cash I could enjoy another two to four weeks of Subox. I gallantly and charmingly declined.
My relapse was all but inevitable. Eights months later (after a literal drive-by intervention) I entered a medical detox facility and then was assigned to an intensive outpatient program three times per week, three hours per day for 24 sessions – attached thereafter to a one-year aftercare program. This process has been life-changing for me. And right now we are “working” on the skills and strategies to understand and soberly cope with PAWS. Who woulda thunk? The group’s facilitator is an LADC who focuses a huge amount of therapy time on helping her clients understand PAWS and its propensity for leading to relapse. Not only does she make us dig deeply to uncover our original motives for “using,” she guides us and prompts us to do the work necessary to cope during recovery.
There is hope out there. To all who now suffer, understand the pain – instead of trying to cover it. In so doing, you improve greatly the chances that your tomorrows will be improvements upon your “today.” Indeed, this, too, shall pass.
My Most Positive Thoughts to All –
Dan
Dear Dan,
Thanks so much for your well-written and pointed comment. The Suboxone racket is the biggest scam to hit the recovery world since Methadone, or worse, because just any licensed physician can prescribe it, with no expertise at all. Both can produce nearly miraculous results when used properly — Suboxone the better choice — but as they are being purveyed (I almost used another word beginning with “p”) they do the vast majority of their recipients a gross disservice. Put simply, there is no…NO…substitute for education and skilled therapy, or at least a support group.
With your permission I would love to post this on the front page. Please get back to me if that’s OK, with caveats, if any.
And congratulations on both your good sense and your recovery.
Bill
Bill -
You most certainly may use my comments – excerpted or in their entirety. Your message is vital to those of us who have encountered speed bumps on the Recovery Highway!
All The Best -
Dan in Las Vegas
[...] on the Post Acute Withdrawal Syndrome article I wrote some time ago. You can read the article here. I so liked the way he expressed himself on the issue of store-front detox docs, that I asked if I [...]
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Thank you so much for providing this information. My therapist told me about P.A.W.S. just yesterday, and we started to discuss HALT and tactics for my life. However, in a one hour therapy session it’s a lot of information to process and try to figure out how to make viable. I am so grateful to have this website as a resource!
The past six months I really felt like I was losing it, and that was AFTER the sobriety. I thought I was permanently high or something, and that I had some serious brain damage! It’s good to know that there is a real syndrome I am experiencing and that so many others have experienced and been able to work through P.A.W.S. I’m sad to realize that I really have caused such siginificant damage to my central nervous system, but I am glad there is hope.
With a little hope and a little faith I think anyone can battle addiction and have a chance of making it alive. At least that’s the theory I’m running with — Thanks again for the insightful information.
Dear Courtney,
It’s good that you are seeing a therapist. We have many little twists in our thinking that need an opportunity for straightening. Talking to someone who will make sure we stay on track is the surest way to take care of that.
I hope that you are also taking advantage of what the 12-step programs have to offer. They are not the be-all and end-all of recovery, but we need the association with and understanding of those who have also been down our road, and the structure of the program is quite complementary to the help that you are getting in therapy.
Keep on keepin’ on. I, and many others, are living, happy proof of what can happen when we surrender and realize that we can’t live our lives alone in a bottle.
Best wishes,
Bill
WOW! And I just thought I had used so much that my punishment was to be crazy throughout my clean time.
Someone at my home group mentioned PAWS and I poo-poo’d it. Then I was sharing some of my feelings with my sponsor and he mentioned it. So I thought I would look it up and came across your website
I couldn’t believe how text book I am. Especially the muddled thoughts. I just cannot concentrate on anything for any length of time. Most days, I feel like I’m just able to put one foot in front of the other and try to finish what is in front of me and not think about what else there is to do.
I am holding on and know that “this too shall pass”. I cannot express how pivotal it is for me to be attending regular meetings and sharing openly about what crazy thoughts and dreams I’ve been experiencing.
If all goes well, through the grace of the universe, I will pick up a six months key tag on the 15th. That is the longest I have ever been clean in 21 years of using and, I believe, a testament to the power of surrendering to the moment.
Thank you for you site.
Namaste
You’re most welcome, Chas, and namasté right back atcha.
This article has gotten more comments, here and elsewhere, than anything else I’ve written by a wide margin. Apparently there are a lot of folks in the same boat as yourself. Been there myself, in fact. Come the 14th, Bog willing, I’ll pick up a black tag, and a 20-year medallion from the “other” fellowship.
Keep on keepin’ on. As they say, it’s mostly a matter of don’t use and don’t die.
Bill
The following comment was presented for post today. In the process of doing so, I inadvertently lost it. I’m presenting the email notification version below, with all identifying data removed.
THANK YOU -THANK YOU_THANK YOU!
I am grateful that I went on the internet to search “recovering addict symptoms” tonight and found out about PAWS! I have been going through ALL the symptoms, extreme mood swings, emotional breakdowns, can’t deal with stress, anhedonia, etc. I’ve been sober 55 days and the last 4 have been “bad days” or a PAWS fit per say. I’ve read how the 30/60/90 6 month/ year -and incriments like that tend to be the worst for these symptoms. I WISH that councelors, psychologists, and people in recovery would spread the word! I know now that I am suffering from PAWS and that is NOT a reason to relapse! I’ve been to a number of professionals, treatments, meetings and never heard of this- but now I feel much better about my recovery. I need to cut the caffeine intake too!
I am writing about paws because the article is all over my condition like white on rice. I have been on heroin, methadone,and valiums every day for over 31 yrs. and drank whiskey every day for about 22 yrs. on top of all of those. I quit alcohol, methadone and heroin all at the same time and had very rude awaking for quite a while, but nothing compared to the valium withdrawal i’ve been going through for the last 16 months. I literally thought i was going to lose my mind, for almost a year it was like a bad acid trip. Non stop. My tension was so great it felt like my eyes were going to pop, like a band was strapped around my head, the muscles in my face were very tight and most of the time I was breathing very heavy and my heart about to jump out of my chest. I was having trouble distinguishing between fantasy and reality. I thought that everybody could see the way I felt by only looking at me. This started to go away for minutes at a time, then hours, then days and weeks at a time. I know it would get very overwhelming and feel like lightening ran up my spine when something stressfull came up. I stayed at home for a year after being in the rehab for three months. I didn’t know how to walk,talk, took an hour to get dressed and so on. I went to an AA meeting about seven months and had to get up and leave after about 5 minutes. Enough rambling, it still gets pretty scary sometimes and I went back to work and and on my 9th step with my sponser in AA. I figure that therapy and time will heal as much as possible but I may deal with episodes off and on the rest of my life ,the problem is you never know when they are coming. I am blessed to be alive, in descent physical condition and have a good family who quit enabling me long ago but still care about me. thanks for having a place that i could vent. Mark
Sounds like a tough trip, Mark. Perhaps some of the tools here will be of help. Sure hope so. You deserve some success after all that.
[...] time to heal. I have found recovery meetings (I use AA) absolutely essential in staying sane, lol! Post-Acute Withdrawal Syndrome (PAWS) — Why we don’t get better immediately) Digital Dha… __________________ The camel each day goes twice to his knees. He picks up his load with the [...]
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Great information and probably the best i have found in recent search for help with info on withdrawl.I,m a alcoholic and feel like my life has been a 30yr hangover.I work on cars at a Chrysler dealer and the hangovers really hurt now at 53yrs of age.Sometimes i think i will just fall over and die and have to go hide in the Men’s room or go lay down in my car with air on for awhile.I am having some success for the past few months in slowing down ( Going 4 or 5 days in the work week without a drink but hit it hard on the weekend and end up lying on the couch most of the weekend recovering)Smart i know in my heart i have to move to the next step of total recovery as i have found out that my daughter is a Herion addict and she is coming to stay with me a try to become clean. She was in NY (i,m in FL)with her mother going to college and started dancing in a strip club and got started on pain pills and then herion.Today she went to a Suboxone doctor and got a script for the drug up in NY.I have set it up for her to see another Suboxone doctor locally who is also a supposed “Addiction Guru” that comes highly recomended from various people in the Drug recovery field.I don’t know what she is going to recommend for treatment as we are to meet when my daughter shows up. Reading the advice here it looks like Suboxone is not the best treatment option.I’m scared as hell and have my hands full and feel a life change coming.
Dear Dave,
Suboxone works well for short-term relief of withdrawal symptoms, but is not the answer long-term. Total abstinence is needed to allow the brain’s receptor cells to return to normal. As long as they are being stimulated, either by opiates or opiate antagonists, no changes will occur.
The same is true of your drinking. Recovery means that the brain has a chance to return to normal — or as close as it will ever get — and then we need to learn how to live without drinking. Both require total abstinence and some help from folks who know what is needed.
I suggest inpatient detox for both you and your daughter if that is possible. If not, at least try to get it for yourself, since alcohol withdrawal is dangerous if not medically supervised. Then you both need support — ideally through treatment, but lacking that from AA and NA.
You did not say where you live in Florida, but fortunately there are a lot of treatment centers and meetings in most urban areas of the state. If you are fortunate enough to be in Palm Beach or Broward Counties, there are literally dozens of treatment facilities, including county-run free ones, and hundreds of meetings a week.
This is not a time for half measures for either of you. The only way to get clean is to do it wholeheartedly. Otherwise you’re just setting yourself up for another failure, and none of us drunks and addicts need to chalk up any more in that department.
Like the AA book says, “Rarely have we seen a person fail who has THOROUGHLY followed our path.” On the other hand, those of us who have been around for a while have seen thousands fall by the wayside because they just couldn’t let go of their own ideas and do as they were told by people who knew what they were talking about.
Good luck to you, and to your daughter. You have a long hard row to hoe, both of you, but there are plenty of folks willing to help if you will seek them out.
If I can be of further help, please feel free to contact me via the “Contact” tab at the top of the page. Be sure to include your email address, as I have deleted it from this posting of your comment.
Bill
hi bill
wow what great info , i am 3 yrs next month and have been told all about PAW for all of my recovery , but did not really take too mch notice , until now , due to lots of changes and stress i am currently suffering , but of course i have been doing all the wrong things i have been eating hocolate for braekfast , no exercise and not teling people how i feel , so now i know what i have to do , thanks natalie
Your letter, like most of the others, makes me feel privileged to have been able to help. Keep on keepin’ on!
Bill
hey mayb sumone here can help me out, iv read probably everything there is to read on paws and suboxone withdrawal..i used painkillers for about 4 years and been on suboxone for about 1 and half..im 23 years old..while on suboxone i turned my life around and began fighting mixed martial arts and just all together staying away from bad influences and dont even drink…i stopped my suboxone 18 days ago..i jumped off at 2mg a day..i kno i should have tapered alil more but i had the courage to stop that day and i wanted to take advantage..my sleep still isnt there i get about 4 hours a night..i cant focus..so i cant train because i will get hurt if im not on my game…my main questions is is smoking pot helping or hurting me…i find it has helped me eat, sleep ,and relax..i make myself lift weights and run everyday..i was curious if anyone knew anything about the effects of pot on a recovering brain .any help would be appriciated…”damaged people are the most dangerous becuz they know they can survive”
Dear Joey,
If you are using pot, you are not in recovery and neither is your brain. Recovery means abstinance from all mood altering drugs, to allow your body and brain to return to something like normal.
Sorry, but that’s the way it is.
Bill
PS: As a martial artist of 40 years’ standing, I can tell you that grass will seriously screw up your arts. Do the right thing.
Hi. I have been a narc addict for several years. I cannot tell you how many times I have done the 5 day cold turkey detox. Early spring of this year, I started taking Subs. I did not wean much and jumped off after just a couple of days of 8 mgs. I was not sick at all for the first 6 days, then hell. I was newly out of a 10 year relationship (still am) and that was my hook up for the subs and everything else. I used to deal with some wild abuse. Anyhow, I am not going back there. It’s been about 6 weeks without the subs and 3 and a half without anything at all. I took some vicodin thinking that would get me off the subs. Stupid, I know. Anyhow, I am not almost a month clean. I was about 6 months on the subs. I did go to a NA meeting. I did not really feel any better but I am still going. I am not experiencing all the symptoms, or I am minimizing them because they don’t compare the the clammy, sweaty, RLS ridden mess I was for a week. I sleep for 4 hours at a time and I am so tired all the time. My head messes with me. I have to talk myself into doing anything. I am trying to get out of the house everyday. This economy is killing my business and I need to get focussed but it is so damn hard. I am exhausted from it all and I just want to not feel lethargic. I am taking vitamins but it doesnt feel like its helping. I am trying here. I am trying. I need help.
Dear Tracy,
The article includes everything I know about PAWS, and all the tips I’ve picked up in 20 years of sobriety. It’s the best advice I can give you, and the best part of the best advice is to go to meetings, share where you’re at, and tell those folks you need help. You will get truckloads of it.
Don’t sell the people in the rooms short. They’ve been where you are now, and they’ve gotten through to the other side in one piece. Their advice is golden. Stay away from the guys and stick with the women.
Apart from that, hard as it is, keep taking the vitamins, eating as well as you can, and take a half-hour walk every day if at all possible. Your body is in the process of repairing itself, and you need to give it the materials and stimulation it needs to accomplish that.
You can’t expect to recover from years of chemically modifiying your nervous system overnight. It took years to mess it up. Things don’t work that way. But you’ve come a long way, and it’s much better than it was. Have faith that it will continue to get even better.
Keep on keepin’ on,
Bill
I have abused opiates on and off for four years. Went through detox two times when I had insurance, just from being so afraid of withdrawal. Went to counceling once. Of course my abuse continued to grow. I got to the point of being just sick of it. I quit and used a recipe I found online using vitamins an amino acids. I went to get change from my husbands “spare change cup” and found eight pills there (he takes them because he needs hip replacement). By the end of the night I had taken eight to ten pills out and took the pills over the next 24 hour period. This was on the 101st day of being clean. I am so disappointed in myself and feel miserable, but I am determined to pick up the pieces and move on. Had read a little about PAWS, but this article was very helpful to me. I realize I need to be in a program and will look in to it. I guess my question is, Have I lost the time of 100 days I put into sobriety, after a one day binge? Have I lost all recovery ? I so want to be rid of this deamon and your article has helped. Thanks, Deb
Dear Deb,
Quite the contrary: that 100 day investment may turn out to have been one of the most valuable experiences in your quest for sobriety. You now know that you cannot trust your disease. It is going to be with you — in spirit, as it were — for a long time. Recovery is about learning that, and learning to live without drugs.
Your picking up should have taught you three things:
*You must speak with your husband about keeping strict control of his medication so that you will not be tempted “accidentally” again;
*You need a support group that you trust enough to call and talk through urges to use, and that will help you learn to cope with life — comfortably — without using;
*Life goes on. Beating ourselves to death for being human and giving in to temptation is not productive. Learning from our mistakes is, however, imperative.
Relapse occurs long before we pick up; using simply makes it official. If we keep ourselves in a healthy state of mind and body, follow suggestions and generally live our lives as someone who is IN recovery, as opposed to someone who is thinking about being in recovery, we do not reach the state of mind that will cause us to pick up the random pill laying about the house.
As the song would have it, “Pick yourself up, dust yourself off, start all over again.” Except addicts have to be extremely careful about falling down to begin with. Sometimes we find ourselves unable to get up. The good news is, as long as we learn not to make the same mistake again (and, hopefully, none similar as well) we can profit from them.
I’m seeing some wishy-washy thinking here: “I realize I need to be in a program and will look in to it” needs to be “I will call and find the location of a meeting immediately.” PLEASE get to some meetings! You cannot do it alone. Your best thinking got you where you are, and you need some fresh input. The lifelong friends you will make in the process are a bonus.
Remember one other truism: Anything that you place ahead of your recovery, you will eventually lose.
Keep on keepin’ on,
Bill
Hey thanks for this awsome article.
I am 16 years old and I’ve been doing lots of drugs for the past couple years now.
I have been clean off of everything since 47 days ago and I’ve been having withdrawals for 38 days now. I can feel it’s getting better but I know it is a long horrible process that I must endure for my mistakes in the past.
Ive been eating mostly healthy and working out but now I am even more informed about what I should be doing from this article.
I wrote down alot of the steps and I’m making a scedual right after I’m done typing this..
Thank you for all the tips and advice. I will surely follow them until I am 110% normal again, and even so forth after.
Thank you again and I hope that everyone else going through the same kind of problems will recover and start feeling better soon.. =D
*While I was reading this I was already starting to feel better, how about that*
Hi Tyler,
Sometimes just knowing more about a problem can make it seem less daunting. I’m glad you found the article helpful. Of all the things I’ve written, I think I’ve gotten more comments and compliments about this one than any other (and I’ve written a lot over the past 50 years or so).
I am so pleased that you are feeling better. If you are not doing so already, hit some NA meetings. You’ll meet a lot of awesome people, and get even more useful information.
Keep on keepin’ on,
Bill
[...] that describes what PAWS can involve — and how important abstinence is in allowing it to pass. Post-Acute Withdrawal Syndrome (PAWS) — Why we don’t get better immediately) Digital Dha… __________________ When a resolute young fellow steps up to the great bully, the world, and takes [...]
ma husbanb is going through ttis paws how can i help her pls give me tips
I appreciate your fear and concern. All the tips I know are contained in the article.
A tip for you, though: hit some Al-Anon or Nar-Anon meetings. There is much there that you can learn about helping both your husband and yourself.
http://www.al-anon.alateen.org/meetings/meeting.html
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I have some advice for anyone on methadone treatment…methadone is extremely hard to get off of not only b/c of the medication but b/c of the idiotic rules of the clinics..for a long time i could not taper myself off since anyone with a high metabolism is going to experience the highs and lows of dosing once a day…my personal solution was to start slowly taking it throughout the day…simply doing that almost cut my dose in half right off the bat…after that i took 40mg poured it into a 100ml beaker and diluted it with water and then decreased the amount by 2ml a day until i needed a few days to stabilized and then i resumed the taper…once getting to a very low dose the taper needs to be slower (1ml) or diluted more…since they make you dose at the clinic you can easily screw up your entire taper…what i did was hold the dose in my mouth and just spit it out when i left, and when fearing i would have to talk i just casually spit the dose into my shirt while pretending to wipe my mouth with it…once your on 10mg a 40 mg dose is actually 4 doses and once u get down to a few milligrams you should have enough extra left over to taper without needing the clinic…of course I had my wife control the taper b/c when doing it myself i ended up tapering faster than what was comfortable and then falling backwards so it is much easier to have someone else control it by putting 10-20 ml of the diluted methadone into your drinks throughout the day that way you don’t have to think about it or see it….you must also be in the state of mind to want to get off.
Very impressive! Congratulations on your determination to become clean and sober. I hope you’re attending NA meetings to get some additional support.
The cooperation of government with the methadone detox industry is shameful. As you know very well, it is a longer and more difficult detox than heroin and the other opiates, and there are far more effective detox protocols. They call them “maintenance” programs for good reason. They maintain the addiction at full force.
If the government really cared about getting addicts clean, they’d open five-day inpatient detox clinics using buphrenorphine, followed by a month of intensive outpatient. That would save millions of dollars a year and actually get some folks on the road to sobriety. But that gets into discussions of the Drug War and Corrections Industries, which aren’t appropriate here.
[...] the link Ash: Post-Acute Withdrawal Syndrome (PAWS) — Why we don’t get better immediately) Digital Dha… and yeah Scotts right – I should have been less flippant – I never look back at what I used to do [...]
I can’t believe it! Someone actually figured out this is a real feeling. I have been clean from opiates (heroin, oxycontin) for 2 months and 19 days and I thought time heals all wounds, but it seems the cravings have been happening more often and stronger. My friends think I’m crazy or selfish because I can’t seem to stop thinking about it, but I really can’t help it. It almost feels like a natural instinct you can’t control. Even though “I” want to get clean, part of me does not want to let go. I can’t imagine life without having some sort of comfort zone, for me…opiates were it. Letting that go is the hardest thing I have ever had to do in my life! Please keep this knowledge going and spread hope to more people that struggle with this disease. Everyone, keep going….We can get our lives back.
Peace.