Post-Acute Withdrawal Syndrome (PAWS) — Why we don’t get better immediately)
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.
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, or our recovery group, or the great outdoors — whatever. Recognizing a higher power is simply admitting that we aren’t perfect and don’t know everything. We let all those grandiose feelings go, substituting a bit of humility instead, and becoming willing to listen to the ideas and advice of others. In a sense, it is not so much recognizing the presence of a god as it is the realization that we aren’t one.
Spiritual discipline should always include meditation, 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 listening, and opening ourselves up to others and their ideas.
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. Perhaps we can combine this with our meditation, contemplating life issues and then meditating to let our subconscious come up with some answers.
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 if 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 of recovery 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 medications with a person knowledgeable about their effects on recovering people. Doctors are not pharmacists. They do not have time to study drugs and the details of their action. A good relationship with a pharmacist has saved the butt of many an addict/alcoholic.
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: 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 learning to live a life that does not require mood-altering chemicals to be worth living.
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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!!
Suboxone is a synthetic opioid, similar to heroin and other opioids, except that it also includes nalxone HCL, a narcotic antagonist that prevents people who take it intravenously from getting 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.
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
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.
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
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
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.
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.
Hi, I [self-detoxed successfully.] My question is now – I decided to go on Wellbutrin for the depression that I have from the opiate addiction. Should I stay on the Wellbutrin? Based on what Ive read from the P.A.W.S information – Im questioning whether I should stay on it. I have noticed that my ANXIETY – has subsided – it was pretty severe before I started which was about a month ago.
–Please advise Thanks very much
ps. This is the best post/blog Ive read online by far!!!!
Dear Chris,
Thanks for the nice compliment, and congratulations on your determination and your successful detox. It seems that you came up with a successful protocol that worked well for you. Please understand that I edited it out of your comment only because I do not feel comfortable publishing specific detox information here, since it amounts to giving medical advice that I am not professionally qualified to evaluate. I was actually quite impressed.
Again, on the matter of medical advice, I can only tell you what I would do, were I in your situation.
First of all, you did not say whether you are under a physician’s care. Your remark that you “decided” to go on Wellbutrin makes me wonder about that. If you are, I would ask for a reduced dose to taper you and minimize the chance for triggering depression. As you are probably aware, stopping any mood-altering drug that one has been on for a while risks symptoms that are the reverse of those produced by the medication — depression, in this case.
Short of that, I would consider the exercise/nutrition/support group route, and see how I feel. I might then try reducing the dose of Wellbutrin by half — not by breaking the tabs, but by cutting down the daily intake. Breaking tabs can be problematic, as many drugs are formulated to be absorbed at certain points in the digestive process, and breaking them can subject them to stomach acid (among other chemicals and enzymes) that could affect their behavior — and yours. If the reduction went well, then I would again reduce, then cut them out altogether.
During the entire period, I would closely monitor my mood by keeping a journal and referring back to it as a check on my own judgment. If I found myself becoming noticeably depressed I would seek professional help — IMMEDIATELY if I had any thoughts of self-harm.
Remember one thing: it takes months to recover physically from addiction, and you are already off your drug of choice. That’s the biggie. I applaud your desire to be off all drugs, but it is always better to err on the side of caution than to take chances that could put your head in a place where it again wants to use.
Keep on keepin’ on,
Bill
Bill, In response – I did actually see my primary physician prior before taking the prescribed wellbutrin. 150mg a day is what ive been taking. I would suspect the anxiety I had was solely from the addiction – not from clinic depression/anxiety – although they wellbutrin may have helped.
From my experience before – meaning my experience getting clean before – I had the same anxiety not as bad, but I had some that ultimately went away without Wellbutrin. I guess I may have just answered my question.
Bill, I really appreciated your response/comments. The SUPPORT is CRUCIAL everyone!
“Relapse occurs long before we pick up; using simply makes it official.” That is something I need to remember – thanks Bill
Hi,
Thank you for this article.
I never drank alcohol and never used street drugs. I was an accidental addict thanks to a doctor.
I was put on Zoloft for symptoms that turned out to be a severe undiagnosed ferritin deficiency ( iron stores in the cells ). Instead of iron, I was given this SSRI for my symptoms.
Then I found it nearly impossible to stop taking the SSRI without severe withdrawal symptoms…..problems I never had until I tried to get off this drug. So my doctor then gave me benzos for the SSRI withdrawal, and although I took less than the amount I was told to take daily, my body quickly became dependent on benzos! The withdrawal from that was even more brutal than the SSRI! I was in a very worse situation after being given these two prescription drugs than I was with just the undiagnosed iron deficiency. I truly felt like I was on deaths door.
I ended up in a detox hospital to get off 1 lousy milligram of Ativan that my doctor told me to take. I was forced to go to 12 step meetings and forced to say in front of a group of people that I was an addict. I cried, because I’d never touched a sip of alcohol or ever touched a street drug….and certainly never even got addicted to caffeine, gambling or whatever. Until I took these prescription drugs, I’d never been addicted to anything…..ever. But here I was, telling all these people my name and that I was an addict, and being told I had an addictive personality and this is why this happened to me. How the heck did I get in this situation?
Anyway, long story short…..I am now almost 4 years off any medication. But I still feel so physically lousy. Just plain awful all the time. And I know for a fact it’s because of what these two drugs did to me. I feel everything you described in the above article. Everything. A lot of neurological issues that can’t be diagnosed by doctors. Stuff I never had until I tried coming off this rotten stuff.
I was wondering if any of you have heard of this happening ( PAWS ) to people who became addicted to SSRI’s and/or benzos, and still had problems many years out. More importantly, is it possible to heal? I try to eat right ( I’m not perfect but better than I have been my whole life ), I refrain from any caffeine or medications of any kind. I try to exercise as much as I can, but I;ve become exercise intolerant because of this nightmare. It makes me feel worse and revs up all my symptoms.
I have turned to God and delved into my bible for spiritula guidance, but I’ve never felt more alone in my life. I truly feel God hates me for allowing this to happen
Dear Linda,
A tendency toward addiction has nothing to do with character, morals, or what one has or has not done in the way of drugs. It simply means that one’s brain is, for some reason, more prone to modification by chemicals than some other folks’. Some of us are just luckier than others.
PAWS after withdrawal from benzos is common, but it doesn’t last for four years. Benzos have been in use for over forty years, and I can find no record of symptoms such as you describe being associated with their low-dosage use. It is possible that the SSRI had a longer effect, but — again — after four years you should be in better shape.
You say that you have a lot of neurological issues that cannot be diagnosed by doctors, but you “know for a fact” that it is the drugs that cause your problems. Do you see the contradiction there? The drugs may have triggered a problem that was waiting in the wings, but they did not do this to you. I would find a competent neurologist who could help me sort out my problem. If there is a teaching hospital or large medical center near you, that is where I would look.
Blaming God is simply avoiding the big question: “What is the problem, and how hard am I going to have to work to overcome it?” The ball is most assuredly in your court.
Thanks so much for this very vital and helpful article! I have been drinking heavily for 30 years since my first binge session at 17 in college. Unfortunately, none of my family or friends really seemed to notice and while I had some bad things happen, I never really hit the proverbial bottom and have always been somewhat functional. Even now they are refusing to accept that I have a problem. Just maintained a low level of living and existing for all that time. I asked the universe for help and it just opened up and gave me the strength to start the long journey back to my true Self just one month ago. I now feel like Sleeping Beauty or Rip Van Winkle awakening from a long sleep. I look back on all the decisions made in my adult Life and realize that most of them were made in an alcoholic brain fog – from the men I dated and thought I loved to the career moves I did or didn’t make. It’s definitely a weird mental place to be in as so many years have passed and I would’ve done almost everything differently. Do not have insurance (am currently unemployed), so am detoxing at home by maintaining healthy diet and taking supplements. Main PAWS symptom are that I am sleeping a lot sometimes up to 13 hours a day and sweating (but that may be hot flashes
). I am somewhat concerned about more serious signs of PAWS popping up later as I really can’t afford to have long term withdrawal symptoms ’cause I need to get back to work. Does everyone who has long term addiction get PAWS later or just some folks? Also, having non-alcoholic beers and greatly crave sweets, so have chocolate daily! Is that ok? Feel like after all this time, those things are far better than alcohol so not beating myself up about that right now. Should I be?
Dear Cheryl,
Thanks for writing, and congratulations on your successful first month! The worst is behind you, both figuratively and literally, although there may be times in the future when it doesn’t exactly seem that way.
I’ll comment on several things, in the order you mention them. First of all, don’t worry too much about the sleeping, just don’t let it become a habit. If you are not incorporating exercise into your program at this time, you REALLY need to do so. That will help stabilize your body’s clock, help stave off any depression, and help your body do the rebuilding that is necessary. You don’t need to get carried away: a 40 minute walk every other day — more often, if you can fit it in — is all you need. Start slowly, and as you begin to get in shape you will naturally speed things up. The important thing is to pay attention to the time. Fifteen minutes of brisk exercise does not equal 40 minutes of continuous gentle exercise, for our purposes here. If the weather where you are does not allow outdoor walking, go to a mall. (Just make sure that you don’t do too much window-shopping; keep walking.)
Doing the things outlined in the article will do as much to prevent any more severe symptoms as can be done. You have beaten up your body’s systems for decades (as we all did), and it needs time to heal. When you feel able to go back to work, that’s fine. But don’t stop taking care of yourself. One of the odd things about us humans is that we’ll do what it takes to feel better…then we stop. Very human, but also pretty dumb.
Craving sweets is normal, but try to ration them so that you don’t binge and get too much sugar. Pay attention to the remarks on nutrition in the PAWS article. You should know that alcohol beats up the body’s ability to deal with sugar, and one of the first things you should do after you can afford it is see a doctor for a complete physical including a glucose test for diabetes. The good news is that the exercise, good diet and supplements are also the recipe for reducing glucose intolerance. Ration your sugar carefully. Chocolate is a treat, not a meal.
Not to put too fine a point on it, “non-alcoholic” beer is, at best, a mind-f**k. At worst, it can trigger a desire to drink. For one thing, beer can be listed as non-alcoholic with up to 1/2% alcohol content. That is not alcohol free, and people in recovery need to avoid all alcohol possible. But just as important is the fact that you are fooling yourself into thinking you can continue to do the things you used to do…you just can’t drink. That’s a recipe for disaster.
The fact of the matter is that you can now do all sorts of things that you couldn’t do before, now that you’re clean and getting sober, but there are a number of things you can’t continue. If you keep on doing what you used to do, you’ll keep on getting what you used to get.
Finally: you are not employed, and have plenty of time on your hands. You need to get to some AA meetings, whether you want to or not. It is nearly impossible to stay clean and sober without support, and you are obviously not going to get it from your family, who seem dead-set on feeding your denial. With the support of AA, your odds are between 25 and 50%. Without support, they are vanishingly small. Don’t bother writing about your excuses. We’re talking about saving your life, and there are no excuses. Here is a link to a site that lists practically all the meeting information in North America.
Again, thanks for writing and letting me be a small part of your recovery. Stay in touch. You know how to find me.
Bill
this is my 6th day of abstinence from opioids.This is my second time withdrawing and i withdrew cold turkey ….didnt take any medication except cetrizine for runny nose.I didnt eat fearing diarrhoea for 2 days and now all the acute symptoms have subsided and am eating 3 meals a day.Some how the acute withdrawl this time around wasnt as bad as the first time.i had abused for 18 months stopped for a month and felt terrible so went back to using it again after 30 days.Now I am dreading PAWS.I knew about PAWS but didnt think it would be that bad and i am so disheartned to learn that this will stay with me for 2 years.But this time I am quite determined to stay off it as my life has still some meaning and fortunately I havnt lost much .My family is intact and my wife as supportive as she can be.
All that youve written is very intresting especially about meals and exercise and I plan on keeping a routine based on what youve said .I hope to write to you again .Am very fragile and weak at the moment so i say i hope because i am not sure.But i pray ill be able to write to you again and be able to say thanx .it was great its working for me.
Dear Deja,
There is no guarantee that you will suffer from PAWS for two years. If you do what you need to do to take care of yourself — including support groups and a diet/exercise/sufficient sleep/multivitamin regimen, there is good reason to expect that you will avoid a lot of the problems. Just be sure not to get sloppy when you start feeling better, and be prepared for the fact that some days will be better than others. That’s how life works.
Remember that addicts who try to do it alone often end up doing the old stuff — alone. Get some support. And keep on keepin’ on. You can do it. A lot of us have.
Bill
Bill, This is Chris a couple articles above. Im now clean for couple months now. Question – I wake up at night with having to urinate on top of not sleeping great anyway from PAWS. I know from my opiate use it made me constipated and when I was using I was able to sleep all through the night without having to urinate.
Is this urination issue a PAWS problem? I dont think I have a prostate issue – Im 38, healthy, athletic, Ive been walking running literally 3 miles a day with a little weight training and great diet too.
Hi Chris,
Good to hear from you again. CONGRATULATIONS on your two months!
You’re way outside my area of expertise when you start discussing urology. That said, you are certainly rather young to be having prostate trouble. I am unaware of such problems being commonly associated with PAWS; however, everyone is a bit different. My GUESS is that there is some kind of infection involved.
I would discuss the matter with a urologist. You are certainly doing all lthe right things (assuming that you also have a support group), and it may simply be that the drugs were masking symptoms. Be sure to come clean with the doc regarding your past. It may help him make a diagnosis.
Let me know how this plays out,
Bill
Hello! I have been researching a number of different health ailments attributed to the abstinence of alcohol and have finally concluded that PAWS must be what I have. Although, I would like to ask you a few questions since you seem exponentially more educated on the subject then I. Is it possible to experience the symptoms of PAWS and have never been addicted to alcohol? I assume the answer is yes. I don’t say that I wasn’t addicted out of denial but the fact that I could quit and take lengthy brakes from it, without a problem, at any time. But I do suffer from anxiety and figure that even though I was never full-blown addicted to alcohol that it still had an impact and my already sensitive brain. I have been alcohol free now for 6 months and the symptoms (much the same as you described) are gradually improving. I am a 25 year old man, who eats a very healthy diet and works out constantly. Does it sound possible that something like PAWS could be the culprit behind what I am experiencing? My symptoms basically match those you described to a “T” save for the short-term memory loss. I did even experience coordination problems early in my abstinence but that has almost fully returned to normal. So then is it possible that PAWS is what I suffer from even though I am almost certain I wasn’t addicted to alchohol (though when I did drink I’d drink to the point of blackout)?
Thank you for your time,
Bill
Dear Bill,
According to the DSM-IV, an alcohol dependence diagnosis is:
My own definition of addiction in general is something that you keep on doing despite repeated and escalating problems.
It really doesn’t matter whether you were technically addicted or not. What is important is that you have decided you need to stop, and what has occurred since. Although I certainly cannot diagnose PAWS in your case, I would say that the duck theory applies: if it looks like a duck, quacks like a duck, etc…. Your description of your drinking, especially the part about drinking to blackout, indicates that you were drinking quite enough, on a regular basis, to set up the changes in your brain that lead to PAWS down the road.
I’m glad that your symptoms are beginning to abate, and that you are taking care of yourself. You are fortunate to have escaped primary withdrawal symptoms. I suggest that, if you get an urge to drink again, you remember that blackouts are one of the signs of developing dependence, and that if you choose to drink again there is an excellent chance that you will in fact become completely addicted.
You should also know that the neurological changes that take place in our brains when exposed to alcohol over time are not completely reversible, especially for those of us who got lucky and have the genetic predisposition for alcohol dependence. There is a lingering effect that makes rapid progression likely if we drink.
Good luck with your recovery. Keep in mind that there are other forms of addiction as well — such as exercise — and that we need to be careful that we don’t simply transfer our dependence. Endorphins are exceptionally powerful drugs.
Regards,
Bill
hello, i have only become aware of p.a.w.s after reading this webpage and like everyone else who has posted , have related completely with what has been mentioned within it. i have been a heavy binge drinker for 16 years and am currently counting days (20 today). this is not my first time quitting but it feels different to me this time. i feel ready to take the responsibility seriously. i also quit smoking last year and that experience is helping.
i am feeling all over the place right now. i keep dropping things, am easily angered (emotional over -reaction). my brain feels too big for my head and i am generally feeling like i’m going a little crazy, yet still feel a very strong resolve to win this time.
i am exercising some and taking vit c(1000mg) and a vit b complex. is that enough per day or should i double up for a while? i was also taking a st johns wort tincture but am going to stop upon reading your article, as you mention total abstinance from all drugs. i have also been taking 5-htp to help me sleep, though i don’t know how effective it really is?
i do worry about the long term damage i have done, i am so anxiety ridden especially when around others, i don’t see that ever going away. can you recommend anything that can help this, it is one of my biggest obstacles.
i am watching my diet now and related heavily to the part of your article about hyperglyciamia, this definately sounds (and feels) like me. i am a vegetarian, but get protein and amino acids from other sources (eggs nuts aloe vera juice etc). can being veggie be a concern during recovery, or a better question would be , do you know of any super foods i should be eating lots of?!
thankyou for your great blog, i will be checking back from time to time to read through it all.
thanks, matt
Hi Matt:
Congratulations on your good work. Twenty days is awesome!
I would add a multivitamin (drugstore variety will do) with breakfast and dinner for the next couple of months, then cut it down to one a day. Always take vitamins with a meal. Our bodies are designed to absorb them with food. The C and B Complex won’t hurt. You don’t have to worry about OD-ing on them, as they’re water-soluble, but take them with a meal and don’t get carried away. I’d say you’re taking enough.
Most important is to eat well-balanced meals. Supplements are great, but food provides nutrients that can’t be put in a pill, not just calories. You should pay particular attention to your carb intake. Sometimes a vegetarian diet is a bit short on complex carbs. Go heavy on beans. They are a good source of protein and antioxidants, especially black beans. Eat them with a little cumin to keep the flatulence under control until your intestinal fauna get adjusted. Beans are also the single best food to help normalize blood sugar.
Watch the sugar. Those outbursts of anger and clumsiness could be due to fluctuations. (They’re also pretty normal. Your body has been screwed up for 16 years. It won’t get better instantly.) After you’ve been clean for a bit longer, you should see a doc for a full blood workup including glucose, but don’t bother right now because your body is still adjusting to its new lease on life. In the meantime, just know that things will get better eventually. Us drunks get to thinking that it’s not OK to feel not OK. It’s fine. That’s how normal people live. Sometimes wonderful, sometimes it sucks, but the average is a whole bunch better than being loaded all the time. As a wise man once pointed out, “If we never have pain, how can we appreciate joy?”
St. John’s won’t hurt, if it seems to help. You can wean yourself off when you feel better. Don’t quit cold turkey. It can cause depression. Some people find that melatonin (sub-lingual) helps with sleep. Again, use it if you need it, but don’t become dependent. No one ever died from lack of sleep.
The anxiety is an issue that you will have to approach yourself. Social anxiety is treatable, but you may find that if you go to a few meetings and just sit without trying to interact too much to begin with that it will begin to fade. If not, I would try to get some therapy. Many of us started drinking because of social anxiety (yr. obdt. svt., for one) and it can be a trigger — besides preventing you from the joy of knowing others. There are drugs that help, too. We take them if we need them, but we always deal with doctors who know about addiction and recovery. Check with a few people at meetings for referrals.
The best exercise right now is walking. It’s low impact, gets you out in the fresh air and sunlight, and will do wonders for both your cardio and your mood. Minimum of 30 minutes every other day — 40 is ideal. Visit the mall if the weather won’t cooperate, but dress in layers so that you can add and subtract as needed, and any temp above zero is OK for walking if you cover your mouth and nose with a scarf.
Most importantly, don’t give up. You will improve. Things will get better. There WILL be bad days…those are the days you need to hit some meetings. Very few people manage to get sober and stay that way without support. AA is the best free deal on the planet for us drunks. DO IT!
Since you found Digital Dharma, I’ll pimp my recovery blog: http://whatmesober.com/
Keep on keepin’ on, take care, and stay in touch.
Bill
I posted in Jan of 2009 my experience with PAWS in the first 6 months of sobriety. I am still sober and am going on 18 months. I don’t feel the urge to drink very often now and my life personally and work wise are back to the usual. Meaning I have restored my image, good name and work now trusts me again. I have been traveling quite a lot lately for work and have been managing the stress pretty well.
I just spent a week at a customer site and have to say the trip went well – work wise anyway. During the day I was a true professional. But in the evenings all of the stress I managed during the day caught up with me and I my urge to drink was almost as strong as it was the first couple of months of sobriety.
I could not clear my head, felt like my heart was beating out of my chest and was visibly shaking. I did not drink and did manage to get through it but it was not fun.
I am a heatlhy woman and know think was all stress related. Maybe I took on too much, too soon – a whole week customer facing is a challenge.
Or can Paws really be this strong after 18 months of sobriety?
Hi Tammy,
I’m glad to hear that you’ve gotten a year and a half under your belt. Congratulations! That’s the big deal, not your recent experience. It proves that you are working a good program of recovery, and that you know how to do the right things for yourself.
All organisms will do whatever it takes to avoid stress. Humans are no exception, and us drunks, who know a quick and easy way to make it go away (temporarily), have to be careful. I suspect that what you experienced was less a matter of PAWS than of a simple stress reaction that you were unprepared for, and which simply kicked in the old instincts.
Important point: you didn’t drink. You recognized the problem, and you got through it. That doesn’t mean it wasn’t serious. I suggest meditation, and a daily inventory based on steps 10, 11 and 12. If you don’t know what I’m talking about, it’s time you learned. Hit a few AA meetings. You don’t have to keep going if you don’t like it, but pick up a copy of the book Alcoholics Anonymous and read it from cover to cover. There’s a lot of good information in there. Just remember that it WAS written 75 years ago, so it’s a bit stilted, and we know more about the nuts and bolts of alcoholism than we did then, by a long shot. Nonetheless, those folks worked out a program that has worked for millions of people, and you owe it to yourself to at least research it.
Example: If I were in that position, there are at least a couple of dozen people I could call who would understand where I was coming from, listen to my problem, and help me through it. A recovering alcoholic who lacks resources like that is treading on extremely thin ice.
If you don’t want to try AA, take some meditation classes. I suggest Yoga or Buddhist mediation, as they are proven over a couple of millennia to work wonders. Stay away from the New Age gurus. They’re not all bad, but they’re not necessarily the best at what they do. I’m not pushing Buddhism (although I practice), but I am pushing a proven method of getting in touch with inner problems and working through them in the light of reality and reason. You could also read the article on meditation under “Addiction” on the Digital Dharma links.
I wouldn’t worry too much about what happened. I would worry a great deal about the fact that it might happen again. You need tools to deal with situations like that. Go get some.
Please stay in touch and let me know how you’re doing.
Bill
hey bill,
thankyou for the speedy reply. well, i went to my first meeting today. i didn’t speak and was the first one out the door at the end, but it still feels like progress…. i left feeling glad i went and have already decided on the next one i will go to. pretty scary stuff though as i am not very sociable at the best of times. there was alot of love in the room though
i feel just listening is the best thing for now, as i read in one of the articles on your site…’take the cotton out yer ears and put it in your mouth!’
i hope eventually i will start opening up to people more…thanks again for replying, you’re doing a grand job sir
matt
Hi Matt,
Wonderful that you went to the meeting. Not speaking is OK. If you can feel the love, then you’re getting what you need right now. The time will come. If you can force yourself, speak to a couple of folks when you’re able. If not, at least keep going. You can get a lot by osmosis if you have an open mind.
Thanks for the compliment. I’m just trying to pass on what was given to me so freely. When you think of it, working with other addicts and alcoholics is one of the most important things we can do…and we can all do it. How often do “Earth People” get to help save lives? We do it every time we show up in the rooms.
What if they gave a meeting and nobody came?
Namasté
This article has helped me alot, and answered alot of questions I had. This is so very helpful for people in recovery to know, I can use this for now and for future use in my recovery lifestyle. I thank you so much for the uplifting and great ideas to keep sober life going and know what could be trigger’s in the future to look out for. From Debrinconcita in Portland Oregon USA.
Thanks for a tremendous article. My partner is now in an outpatient clinic (30 days)for alcoholism. She was asked to stay for an extra 2 weeks after her counselor and other professionals reviewed her case. They felt she was high risk for relapse. I had the opportunity to go to one of the family night meetings which happened to refer to PAWS briefly. I had come across some info on it, but I didn’t feel it really hit it right on. Having been an addict myself, I recognize some of the lasting affects of getting sober. I didn’t know it had a name at the time I was going through it. This article has alsobrought to my attention that my partner may very well be experiencing some of these symptoms. She is now at about 30 days sober after a 5 day inpatient detox. She called me this evening after going back to the facility after the weekend home, totally at a loss. She was feeling displaced and hopeless. She sounded really depressed and said she wanted to drink. I coached her through the best way I could, but encouraged her not to make any rash decisions and to talk it over with her counselor in the morning when she returned to her program.
Even after going through it myself, I have forgotten how heart-wrenching it is on both sides…the person going through it and the ones on the receiving end. I am working on my own recovery with the help of Al-anon, and want to be supportive but cautious that I don’t slip back into my codependency.
Do you have any suggestions for those of us who are the bystanders witnessing someone’s PAWS? I am happy to consider any suggestions, since I want to be supportive to my partner as well as aiding my own recovery.
Thanks so much,
Roxy
Hi Roxy,
Thanks for the compliment. This in haste:
You are doing the single best thing for yourself by attending Al-Anon meetings. Educating yourself is another good thing. Keep in mind that, regardless of the quality of your relationship, you cannot fix you loved ones or friends. There is too much emotional static. Be supportive, listen, but keep the advice to a minimum. You might print out the article and give it to her.
Finally, keep on keepin’ on. We didn’t ruin our lives in a few weeks, and we don’t put them back together that quickly — although, as addicts, we still tend to believe in the “quick fix.”
Good luck, and the same to your partner. Remember the 11th Step. It doesn’t have to involve religion. See the articles elsewhere in these pages for some information on that — under “Addiction” at the top of the page.
Best wishes,
Bill
Thank you so much for ALL of your postings. I am 7 months out of rehab for opiate, benzo and alcohol addiction. All of this started with emergency surgery a year ago this past January. My life turned upside down. I have lost my professional job, am bankrupt and 30 lbs over weight. My PAWS experience has been horrific. I have found it so helpful to remind myself that this is what I’m experiencing at any given moment. It’s true, there are days when I don’t believe for one second that living with this outcome is worth it. My addiction and withdrawl were so servere all I can do at this point is keep getting up one day at a time. I want to let others know, that perhaps, like me, in the beginning of recovery, I couldn’t take good care of myself. It was just too hard. I couldn’t leave the house, I couldn’t eat right and I couldn’t get anything together. Now, after some time, I am taking vitamins, eating several meals a day, walking my dog, even if I don’t feel like it, making my bed, taking a shower, keeping the kitchen clean and going to meetings. Sound’s simple? It’s not. It took many months to reach this place.
Wow! Opiates, booze and benzos — I’ll bet that was one hell of a detox!
Glad you’re going to meetings. Trying to get clean and stay that way without them is like rock-climbing without a rope — and without any rock-climbing experience. Keep up the good work and nothing will ever be that bad again.
I have just been studying PAWS at my recovery meetings. We are doing alot of recovery work started a month or so ago. I am so learning alot, I have been using most of my life. I started at the age of 15 yrs old. Now I am 47, this is the very first time I have tried to stop everything completely? I only relapsed 2 times. For 5 minute’s, but 5 minute’s is 5 minutes. I started my clean date over because of the relapses. But, I have not relapsed since Oct 6th of 2008. I am so happy and I don’t plan on going back to the other using lifestyle ever. I am so happy for you that you are doing so good and keep up the good work lady, Keep your eyez on the prize like I did. Debrinconcita in Portland Oregon USA.
Hello. I read your excellent article on PAWS about 4 months ago. I know that I am clearly an alcoholic and have been sober for 136 days today. In October, I was taking a drive to see my 2 sisters when I began having unbelievable anxiety attacks. I knew for certain that it was my use of alcohol and decided that alcohol consumption was over for me. (I had been through this about 12 years earlier and just did not want to do it again. I didn’t know that it was PAWS at that time.) About 2 weeks later, I started having virtually all the symptoms that are mentioned in your article. I couldn’t figure out what was going on but knew that it must be alcohol-related. That is when I found your article. I went to my family dr and, over the course of time, ended up taking 4 mg of prescribed clonazepam daily to help with the anxiety. Unfortunately, neither of us thought about the extreme depression benzos can cause. I ended up going to the ER in a suicidal state which got me into a mental health facility for 3 weeks. That was torture; however, they did get me an appointment with a psychiatrist and therapist after I left. I was also weaned off the clonazepam in that 3 weeks but had to begin taking 0.5 mg twice a day when I got home. The total withdrawal was too horrendous to bear. So, I am currently taking meds (prescribed by a psych) for anxiety. We are going to deal with the 0.5 mg clonazepam in the future when I am feeling less anxiety.
Through this entire ordeal, I had forgotten that this was all probably precipitated by PAWS. I thought that the effect of alcohol was probably long over. I was a relatively heavy drinker for many years. It just occurred to me today that 136 days is only 4 to 5 months. This may very possibly still be anxiety, sleep problems, etc. attributable to PAWS. I could have saved myself a lot of trouble if I had thought about it sooner. I just finished a couple weeks on the anti-depressant Cymbalta (for the anxiety and depression). The side effects were horrible, and I am having some withdrawal from only 2 weeks of use. I have read nightmares of people who are trying to get off Cymbalta but can’t get past the withdrawal. I suspect it will be on a lot of lawyers’ hit list very soon.
Anyway, does it seem likely to you that the anxiety, sleep problems, etc. are a result of PAWS and not me just cracking up? Thanks for your consideration.
Your supposition could well be the case. On the other hand, alcohol and drugs often mask other problems that then rear their ugly heads when the “self medication” is removed.
It would be not only stupid of me, but unethical as well, to comment more directly than that.
I will comment on a couple of other things, however:
Good luck, and don’t give up. The booze will cheerfully refund your misery.
Bill
Oh yes, one other question. My sleep problem is one where I fall asleep but almost immediately wake up in a “startle” or “terror.” This happens for multiple times before I finally am able to sleep for a few hours. It makes going to sleep a bit scary at times, but I keep hoping that it will pass in time. Does this sound like something caused by PAWS, and could it pass over time? Thanks again.
Sleep disturbances are common in early recovery. The subconscious has been repressed for a long time. Additionally, we tend to sleep more lightly, and thus remember more dreams since we generally recall best those that occur just before we awaken.
For goodness’ sake don’t get involved in sleep meds. As disturbing as this can be, no one has ever died from lack of sleep. Exercise and good nutrition are helpful here, and you might try some melatonin from the health food store, with the permission of your doctor. (It’s important to remember that health store preparations are drugs, too, regardless of how “natural” they are, and can interact with other OTC or prescription medications.)
I have been sober 25 days now. I experience PAWS mostly as it has to do with my blood sugar. If I don’t eat right I start feeling bad, and start feeling paranoid that I am losing my mind. I have only found a couple other articles that are written well about PAWS. Reading this while I am feeling like I am losing my mind helps to me to relax. Thanks for sharing your knowledge and experience.
You are most welcome. Having been and done there and that respectively, it’s a pleasure to share with others and sometimes help with a tough road.
Just keep in mind that the other road was a lot tougher.
Dear J.,
There is no way that anyone could ethically advise you via the Internet, especially given the variety of drugs to which you have been exposed. I will go so far as to suggest that your primary care physician doesn’t seem to be very knowledgeable when it comes to pharmacology. Few are, relying far too much on the detail men and ladies when they should be educating themselves via the literature. You should probably be completely detoxed medically, and then started on an experimental regimen from scratch.
I can only suggest that you contact a psychopharmacologist who specializes in detox, and perhaps get the necessary referrals after she has reviewed your case. Your local mental health association should be able to suggest a competent physician.
Thanks for writing. I wish I could be of more help.
Bill
This is an awesome article and I agree with all of the others that say “you really know your stuff.” I wish I had had this information 22 years ago when I quit drinking. I lived life as a dry drunk for 20 years before getting into a 12 step program and wow! I still have urges but still have the fear that comes along with the urges. If I would have had the knowledge that’s wrapped up in this one article I could have saved myself a lot of unnecessary suffering. I now have a 20 year old daughter that I brought home after she was beaten very badly while drunk….it scared her enough to ask for help….what scares me is that she says she doesn’t want to stay here forever..”I just want to get well enough to say no” is what she said to me. She has many of these symptoms and at one time or another has been diagnosed with bipolar, so this article really hits home with me and I want to share it with her so that she can understand how important it is to her recovery. She’s doing great, going to meetings, eating better, exercising with her sister, but she still keeps in touch with two guys that were in her life, both of which still drink and drug, and one that she had been doing crack with. So I thank you so much for your article. This has really been an eye opener for me and I know that, even if my daughter doesn’t stay sober this time, she will at least be armed with some really great information!!
I found this article because my fiance is a recovering alcoholic of 19 years and was a drug and alcohol counselor for a few years. He called me and told me to look up Post Acute Withdrawal Syndrome, and here I am, armed with terrific new information that will help me and my daughter….thank you!!
I have been sober for 23 years with three, one drink relapses, twice at weddings, and once watching a football game, and my daughter is almost two weeks sober. She looks wonderful, and it’s so good to see her smile and look healthy again. I’ve really missed her. I hope more of us find there way to this site……
Thanks for your kind remarks. It’s letters like this that make the whole thing worthwhile.
Good luck to you and your daughter. Tell her I said, “If you keep on doing what you used to do, you’ll keep on getting what you used to get” doesn’t just apply to drugs and personal behavior, but to people, places and things as well.
If those folks are still using, they do not have her best interest at heart. They want their using buddy back, regardless of what they say. She needs to understand that.
Bill
Namaste Bill
Thank you for this well-researched, well-written and comprehensively covered article. I have been sober just over two months and this article clearly explains to me why I have felt “spaced out,” headachy, tired, and reactive to small stressors since I stopped. My life of daily drinking for over 40 years has come to an end, and has largely been motivated by the invaluable assistance and support of people like you and the selfless research that has bought PAWS information to the doorstep of alcoholics like me. The observation in the article that, “PAWS symptoms reach a peak from three to six months after we get clean.” and that “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,” are words that will keep me going.
Thank you once again!
Ahhhhhh! Fell totally off the wagon tonight! It was a slow process that built up over a month as I went from 2 1/2 months completely sober to having non-alcoholic beers to enjoying one glass of red wine every few days at dinners out to one glass of red wine an evening and thinking I could do that occasionally to 3 glasses of champagne tonight! Feel simply awful! What do I do now??? Is PAWS gonna start all over again! So mad with myself as I didn’t get drunk, just very slightly buzzy but now 2 hours later feel headachey and know I am gonna be sick tomorrow! So hard because I am not drinking alone but am a Society Writer/Photographer so have to be out and around partying people every day for work! What would you advise to get back on track again?
Hi Cheryl,
I removed your image and email address.
Taking your issues in order:
1. Non-alcoholic beer is a mind-f**k. It’s like saying you buy Playboy to read the articles.
2. Alcoholics can’t drink at all, as you have discovered. I’ve been in similar situations. I just say, “Thanks, but I’m not drinking tonight,” or “No thanks, I finished my share.” After a bit people get the idea. Get a glass of soda with a twist, carry it around, and if you have to set it down watch it like a hawk to be sure someone doesn’t “do you a favor” and freshen it for you. People don’t really care whether you drink or not, as long as they think you’re taken care of.
3. If you don’t want to slip, stay away from slippery places. I understand about the job, but if it’s a problem you need to decide what’s most important to you. Attendance at AA and a good support group and sponsor will help. If you are finding excuses not to do that, then — again — you need to decide what’s really important to you. I was worried about who might see me at meetings, as I was a very high-profile public official. It was six months before I ran into anyone I knew, and he was one of the Councilmen.
4. It is a truism: anything you put ahead of your sobriety, you will lose anyway.
This is a disease of relapse. Don’t kick yourself too hard. Just learn from the experience. Remember, too, that alcoholism never “gets better,” and it is progressive — it gets worse. Women, unfortunately, have it worse than men because they produce less of the enzyme that metabolizes alcohol and so they get a double whammy: drunk faster because they’re smaller, and drunk longer because of the lack of the enzyme. The disease is 100% fatal if not arrested. It is arrested through abstinence, not “enjoying one glass of wine.”
You are probably in for a bit of more acute PAWS, since you opened up the neural pathways again. Again: learn from it.
Best wishes. Feel free to contact me privately using the Contact link if you wish. Gotta get to work.
Bill
I will be doing thr rapid detox next week wondering what are the chances of going
thru paws. have been using oxy for about six years. also has anyone else gone thru
rapid detxox.
The likelihood of your experiencing PAWS symptoms is about 100%. It is a normal consequence of getting rid of the drugs, and is not related to the manner of detox — if you survive detox.
Which brings me to the matter of “rapid detox.” I don’t know anyone who has had it, because most of the people I know have been treated by reputable treatment facilities. The fact of the matter is that rapid detox is a dangerous medical procedure that is marketed as a cure-all by people who should know better.
First of all, general anesthesia is dangerous under any circumstances. That is multiplied many times by the medical complexities of opiate detox. People have died from the procedure, my friend. I would never recommend it, nor would any professional I know.
In addition to the above, detox is only the first part of recovery. In a normal detox protocol (several days of buphrenorphine detox, in one form or another, accompanied by education, group therapy and both medical and peer support) you not only receive the beginnings of the grounding you need to continue, but can be referred to follow-up treatment, NA, etc. and given the information that you need to understand your disease and why the follow-up is needed. With rapid detox you are thrust out into the world with all your nerve endings bare and unprotected (almost literally) and no place to go.
I would add that the relapse rate after rapid detox is incredibly high, even for a form of addiction that has a high relapse rate under the best of conditions.
I suggest that you re-think this matter. Seriously. I have nothing to gain from this. You don’t know me, I don’t know you. Think about it carefully. Research it on some reputable websites, not just sites that are trying to sell you something. See what you come up with.
In any case, good luck. You’re moving in the right direction, if perhaps on the wrong horse.
I had my last drink back in October and began experiencing PAWS about 2 weeks later. In December, my doctor put me on 4 mg Klonopin to help with the PAWS. That made me very depressed over 6 weeks of use, and I was able to get off 3 mg of it in 3 weeks. (Still taking 1 mg which is what I had been taking while I was drinking. Plan to get off that once the PAWS improves.) It’s been nearly 200 days since my last drink and about 90 days since getting off the 3 mg Klonopin. This is probably a dumb question, but does the clock start over after the 3 mg of Klonopin, basically negating the 3 months of time I had prior to the Klonopin? Also, my PAWS is the stable kind (as Dr. Gorski describes it) and hasn’t really improved over these 6 months. Does it eventually improve as long as I abstain? Thanks.
Klonopin (clonazepam) is a benzodiazepine drug that has effects on the brain similar to alcohol. Until it is out of your system, I’m afraid that you won’t have much luck in overcoming PAWS.
This is the danger of dealing with physicians who do not really understand addiction and addiction pharmacology.
You have been operating under doctor’s orders, and I see no reason that you need to start “the clock” over again. However, I would get off the Klonopin the rest of the way so that I could really start my recovery.
Be aware that withdrawal from even small dosages of clonazepam raises the potential of seizures.
And congratulations on your six months!
the last time i smoked some weed was on april 20 2010 but i didnt like the way i was feeling so i stopped smoking weed, i told my self im gonna change i had thoughts going through my head on how im going to change, i was at work on april 30 2010 i think i experienced paws it was so scary i thought i was going crazy so i smoked some weed but the thoughts were still there, i cried to my mom told her what happend got depressed,now im on lexapro for depression and alprazolam for anxeity but i havent taken alprazolam since yesterday and im only 18 years between but i put alot of stress between those ten days didnt sleep right was that paws
Probably not. More likely it was acute psychological withdrawal. PAWS (Post-Acute Withdrawal) comes later. You didn’t mention how much you were using. If you were smoking large quantities daily, you could have been experiencing some physical withdrawal.
I am not qualified to diagnose your condition. You are probably on the right track. See how things go, and stick with your doctor’s advice for now — remembering that alprazolam is addictive and should not be used for longer than about a month. Believe me, you do not need a benzo addiction to add to your troubles. Been there, done that.
If the medications don’t help, consider seeing a mental health professional to help you sort things out. I’m not saying you’re nuts, but there may be an emotional component or a problem with a chemical imbalance. I assume your doctor gave you a good physical. If not, that should be done right away to eliminate any physical issues.
Finally, hit some NA meetings. You need to be able to talk to people who have been through similar stuff and who know where you’re coming from.
i use to smoke a lot of weed i smoked since i was 13 i did other drugs but i stood with weed
I returned to pain management after being off for over a year. I have a bone degeneration disease that has already taken all cartilage from my arm and is now taking my bone mass. I have had 6 surgeries so far to try and correct with no success. They are going to do a full arm and elbow replacement surgery soon. I was on methadone and percocet for only 4 months this time and I was tired of the symptoms. I went off the meds with no withdrawl symptoms and thought I was fine, now 6 weeks later I am sick, tired, my temper is rising, and rushes to the bathroom constantly. I am in horrific pain, but I Dont want to go back to the pain meds. How long can i expect this to last? I wasnt even on the meth and percs very long and now withdrawl symptoms immediately. I am afraid of the paw and how it will affect my job. Veyr scared right now
Your question is beyond my ability to help. I suggest that you contact a university medical center or teaching hospital near you for a second opinion. Unfortunately, when it comes to extreme pain management, there is sometimes no way to avoid the drugs. However, you should definitely get expert help with the management.
I wish I had more to offer, but I cannot ethically or morally advise you on this issue, as much as I would like to help.
Great article! I just came off a severe opaite addiction. It has been 22 days and I am feeling better every day. The worst symptoms I have are diaherea and a little fogginess. The insomnia after I got home from detox was horrible. I didn’t sleep for 9 nights. I see an addiction doctor who won’t prescribe ambien, klonapin, or any habit forming drug. He prescribed anti histamines but they did not work for sleep. Finally he put me on Seroquel for sleep. I had never been on it before, so I wondered if there are any withdrawl symptoms associated with it. They started me on 450 mg at night. I did that for about 7 nights. Last night I took 200 mg and I slept just fine. I have been on Seroquel for about 8 days now, so I just wonder how long (if at all) it takes to get off of the Seroquel.
Congratulations on your 23 days!
Your doctor is right on in refusing to prescribe habit-forming drugs. Addiction is a disease, not specifically related to any one drug, and we are prone to become rapidly addicted to other habit-forming drugs and behaviors. Since most psych meds are mood-altering, they can easily affect our judgment and lead to relapse back to our drug of choice. When we take drugs (as you know very well) we are not in our right minds.
Seroquel can cause withdrawal symptoms if we go off of it cold turkey. If you are now sleeping well, talk to your doctor about your concerns. Seroquel is available in doses as small as 25 mg, and tapering off is no big deal. Just make sure you do taper, or your insomnia (and some other unpleasant symptoms) could come back.
Here is a link to a fact sheet from the manufacturer in Canada. It will tell you what you need to know, but does not express a withdrawal protocol. That should be between you and your physician.
http://www.astrazeneca.ca/documents/ProductPortfolio/SEROQUEL_CIL_en.pdf
Hit those meetings, and good on yer! Keep on keepin’ on.
Bill
Great website! I am 152 days off Adderall. I took it for six years at a max dosage of 65-70 mg. I still feel fatigued.
What are your thoughts on this? I feel like I should start to feel better by now. I sometimes feel like this is as good as it gets.
Thanks.
Hi Lauren,
Thanks for writing. A lot of folks read these comments, and each question helps fill out the picture for everyone who comes after.
As a former speed freak, I can sympathize. You are feeling the normal depression that comes with removal of amphetamines. It does, however, seem to be lasting a bit long. If you are eating well, taking vitamin supplements, and walking a mile every other day (or more often), and getting out and associating with people at meetings and so forth, then there are two possibilities that come to mind: 1) that your serotonin production may have been suppressed more than we would expect, or 2) that you may in fact have an underlying condition that was being medicated by the Adderall. It is not uncommon for people to be drawn to drugs, especially stimulants, because they really do help them function better, initially.
I suggest that you speak with a doctor who is familiar with these issues. A local treatment center should be able to refer you, or if there is a university teaching hospital nearby you should be able to find someone who is well-versed. It may be that a selective serotonin reuptake inhibitor (SSRI) like Wellbutrin would be helpful. SSRIs increase natural serotonin levels, but do not get you high. The doctor could then help you get off the SSRI later, if indicated.
In any case, the admonition to get good nutrition, exercise, take a multivitamin morning and evening (with meals) and get out with people still stands. I realize this might be what you want to do least, at this point, but it is the best possible medicine for the post-amphetamine blues.
Keep on keepin’ on,
Bill
Hi Bill!
Thank you for this wonderful article. I wanted to share some information that has been helpful to many folks I know. Taking a relatively high dose of a fish oil supplement increases the “good fat” levels in the brain, making it a lot easier for the body’s natural fee-good chemicals to pass through cell membranes. This helps normalize brain functions and reverses problems like depression, mild forgetfulness, and lack of stamina. There have been numerous studies showing the effectiveness of fish oil supplements on clinical depression, and anecdotal evidence is growing that this supplement may also help with PAWS.
There are many good sources of Fish Oil, but you need to know what to look for. You want a highly concentrated fish oil (Omega 3) supplement with at least 50% fish oil. Make sure the supplement has been distilled to filter out mercury or other toxins. Most supplements contain two types of good fats: EPA and DHA. Only the EPA has been shown to improve mood, so look for a supplement that has higher levels of EPA. Avoid any supplement containing “cod” liver oil, to avoid too much vitamin A, which can be toxic.
Most depression studies have used relatively high doses. Folks will likely need to take a higher dose than indicated on the bottle to achieve a therapeutic level for depression and PAWS symptoms. Up to 3 grams a day of fish oil is considered “safe” by the FDA.
A word of caution: people with bleeding disorders, people who take aspirin every day, diabetics, or people who are pregnant should speak with their doctors before taking any fish oil supplements in any dose.
Anyone who does this should be aware that there might be a little bit of “leakage” because of the high levels of oil in the stool. Omega 3 is prescribed for the reasons above, and is also known to lower trigylcerides. All in all a good idea for folks whose fat metabolism is almost certainly skewed.
I’m a recovering heroin and well really every other drug in the book addict. I’ve been clean for almost two years, one of which I spent in jail, before that I drank and drugged for 11 yrs. I’ve been in a 12 step program since the day I’ve been out of jail. I think i’m losing my mind. The fear, social anxiety,rage and insecurity going on in my head is unreal, and that’s the thing it’s not real but I can’t grasp that. I pray and don’t really know what I’m praying to. I don’t want to use anymore but I’m miserable like this. Can these symptoms be PAWS?
Dear Joe,
Sorry I couldn’t answer right away. I know how hard those hard times can be.
At two years it’s unlikely that the issue would be PAWS per se, but it’s entirely possible that your issues are partly for physical reasons: nutrition, exercise, and watching your sugar intake would be a really good idea. Junk food and fast foods especially will screw you up. This is not the diet that our bodies evolved to eat, and they rebel if given too much of it. I know that eating well takes more time and costs more, but it will bring benefits if you are able to handle it.
Exercise — at least 1/2 hour a day of steady walking, bball or something similar is a must. That is what our bodies are designed to do. We neglect it and it costs us.
The sugar issue, as outlined in the section on hypoglycemia, is another issue. You might re-read it. If you have not had a physical and can arrange one, either through a private physician or the health department, it would be a good idea. Many addicts and alcoholics have blood sugar issues, and it can screw your head up more than you could possibly believe. I thought I was going nuts at about 18 years sober — then I found out I had diabetes. Controlling the sugar made a HUGE difference. Now it’s just other folks who think I’m nuts.
Last — but by no means least — WORK YOUR PROGRAM. Talk to your sponsor. Make the steps part of your life. If you haven’t done the 4th through 9th, it’s clearly time. You have to work on getting your past behind you, and that’s how it happens in AA. Also, if you can call your local mental health association, or an outreach program for ex-cons, you could probably find a group therapy session for little or nothing. That will help you work through some of the other issues.
No one can work your recovery for you. I don’t mean to imply that you haven’t been working, but I’m trying to point you in some productive directions. Remember, even Bill had to see “outside practitioners” in his sobriety. Sometimes the rooms aren’t the only things we need.
As far as prayer goes, check out the Third Step Prayer. It’s the way to pray. Asking for stuff doesn’t do much. Asking for help — and then listening for the answers — helps a lot. Meditation helps, too. If you can find a meditation group, join it. You don’t have to explain yourself to them, just be there. Otherwise, read this and go for it on your own.
Feel free to write. And keep on keepin’ on. You know what awaits you if you don’t.
Regards,
Bill
I have been clean from oxycontin for almost 3 months. I have gotten to a point in my sobriety where I’m extremely depressed. I mean, DEPRESSED. I can barely get myself up in the morning and taking care of my three kids is like hell. I don’t know what to do. I’m on prozac, after trying about 12 other antidepressants. I don’t know how to get out of this rut I’m in but I feel like I’m drowning.
Depression is a condition not necessarily related to recovery. I strongly suggest that you find a psychiatric teaching hospital in your area and get a good workup. Depression is frequently fatal. You cannot fool around with doctors who (clearly) depend only on drugs to treat it. Short of that, find a good therapist who is experienced in treating depression. Your local mental health association can advise you, and you may be able to qualify for free treatment, or treatment on a sliding scale.
You should also be aware that most antidepressants take up to two months to become effective. You have not been clean and sober long enough to get relief from even one, really. If your doctor is not aware of this, then he or she is obviously not qualified to treat depressives.
Please do not delay. Those kids need you in good shape. Here is some information that should help.
bill ur the man i have 3months clean i read this article when im stressed im 20 yrs old recovery from opiates n this info has helped me like a lot
thanks Rob, and congratulations on your two months!
Keep on keepin’ on.
Bill
Hi,
I have been off opiates for 9 months now, I quit cold turkey and recovered from physical withdrawals by giving myself much needed alone time and nurturing my body. I am having trouble dealing with the psychological aspect though…
Most of the time I feel numbness all around….After being hired for a new job, I am nor excited or pleased….just numb.
I am still having trouble connecting with people…I sometimes get stuck inside myself and have trouble conversing with people. I suppose it has gotten better over time, but I can’t tell.
I am wondering about the malnutrition….I became very bone-poking thin during my abuse and since I quit I have slowly gained back an appetite to food. I still have not gained any weight and my menstrual cycle has stopped for long periods (and I am not pregnant)……
Dear Zeldanne,
You are describing a classic case of chronic depression, perhaps aggravated by PAWS and even other physical issues — and certainly by your evident attempt to do this difficult job all by yourself. (At least you didn’t mention any support, either psychological, medical or in the 12-step rooms.)
You need to understand a couple of things about addiction.
Addiction occurs in the sub-cortical portion of the brain — the parts that evolved long before the relatively recent development of the cerebral cortex and its ability to reason. These parts of the brain are not amenable to coercion, logic, willpower, or thinking problems away. They are the parts that control the functions below the level of thought — in a sense, below even the subconscious.
These are where much of the recovery from addiction and the odd behaviors and impulses that it entails will take place. We recover by taking good care of ourselves, both psychologically and physically, and allowing the brain to recover slowly on its own.
Sometimes addiction can mask underlying conditions, such as depression, that then show up “in spades” when the drugs are withdrawn. Combined with the depression that is common — in fact, almost “normal” — in recovery, it can be devastating. Other physical and psychological issues that were also masked by the drug(s) ,may surface as well.
I suggest you see a physician who is affiliated with an accredited treatment facility, and who is skilled at dealing with addicts in recovery. You need a good physical workup, and someone in the medical field that you can trust. If you cannot afford a physician, check with your local mental health association to see if they can refer you to someone with the skills you need, perhaps on a sliding scale, or pro bono.
Needless to say, I also suggest a support group of your choice. My own preference would be Narcotics Anonymous. You need to be able to talk to people who have been where you’ve been, and who understand what you’re going through. (However, don’t let them give you medical advice.)
You have accomplished, on your own, a feat that few people manage with support. I congratulate you. Now it’s time to let someone help you to carry the remaining burden.
Please feel free to write.
Bill
Bill –
I have been on 1 mg clonazepam for 13 years (as prescribed by a doctor). The last 11 years of the 13 years, I was drinking a lot. I stopped drinking over 8 months ago and am slowly tapering off the clonazepam (with a doctor’s help). I have had pretty much the same level of PAWS for these 8 months. I was at a group therapy meeting last evening, and one of the other members thought that I may not recover given my age (56) and the mixing of benzos and alcohol for so long. Is there any reason to believe that recovery will not occur as long as I stay away from alcohol and get off the clonazepam? He seemed to think I may have destroyed my neural receptors. Thanks.
Unless your fellow group member is a neurobiologist, I would be careful about giving his assumptions regarding brain chemistry too much weight.
The most likely reasons for your still experiencing PAWS are (a.) that you are still on benzodiazepines and your receptors are unable to recover, keeping you in mild physical withdrawal as well, and (b.) the fact that PAWS can last for several months — even up to two years — in some cases.
Pay close attention to the section in the article regarding nutrition and physical exercise, continue with your group sessions, hit a few AA meetings to make some new sober friends, and get off the Klonopin so that your neurological recovery can begin. You should be able to taper in under two months with a doctor’s help.
Congratulations on your eight months! Please be assured that it does get better, just like they say.
Regards,
Bill
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Thanks for reading Digital Dharma,
Bill
HI. I am/was a chronic pain patient who was taking Opiates for almost 6 years. I wrote “am/was” because I decided to get off the opiates to see if I could manage the pain without. I went into detox on April 4th and am able to manage my pain without the opiates…an anitinflamatory is working very well. Yea!!! I was on a large dose of Fentanyl (150 mg every two days) and Percocet (30/10s 4 times a day) for most of the 6 years.
So, I am just about 3 months sober and I am experiencing PAWS BIG TIME!!! Today I feel like I just got out of the hospital again: creepy crawlies, tremors, sweating, fogginess, irritability and depression. I knew about these symptoms and knew that they come back to haunt me; but I have two children to care for and PAW is really getting in the way!!
Yesterday I got in to see a Therapist who deals with addictions. He thinks I should be put on Suboxone because of the length of time I was on the drugs. He is referring me to a psychiatrist who is certified in that area. The therapist suggested I go on it, and taper off of it slowly so as to avoid the current symptoms and to avoid any symptoms from the suboxone.
Please give me your opinion on this asap. I really am struggling to make it through the day right now. (And by the way, I go to Physical Therapy twice a week because I got SO weak during the detox and recovery. I am also taking the vitamins and eating pretty healthy. I will stay away from the sweets from now on though!)
Thank you for your help!!
Dear Linda,
Congratulations on your success in getting off the opiates, and on your three months (just about). Even with detox, it’s not easy; without it, it’s pretty close to impossible.
You are experiencing the reason that so few people successfully recover from addiction. PAWS is no joke, as you can testify, and simply telling folks to “get over it” is not the answer. PAWS is also cyclic. Three months is one of the “humps” in recovery where the symptoms become worse. Many opiate addicts report feeling withdrawal symptoms at the three month point. Fortunately, they pass after a time. In short, your condition is nothing unique.
You did not say if you are attending meetings. The support you get there is, in my opinion, absolutely necessary for optimum recovery. I encourage you to attend as many as possible. They are especially critical during periods of crisis like the one you are in now.
Suboxone therapy is problematic. It is not an easy drug to get off of, and many physicians do not understand its use. Just because it can be used in a certain way is no guarantee that it is really indicated for every patient. My wife, who is more versed in the details of detox than I, suggests that you check with your doctor to see if Neurontin and/or Lyrica might serve instead, to control the PAWS to a degree, and also perhaps to alleviate some of your pain. If he is unwilling even to consider these possibilities, that alone should tell you something. We need to remember that the business of psychiatrists is, largely, the prescribing of psych medications. In most cases, it is their primary tool. When you have a hammer in your hand, problems start looking like nails.
Therapists can also fall into the trap of suggesting easy ways out when they might apply other resources such as group therapy and individual counseling — and suggesting meetings.
Good luck, and please let me know how you’re doing.
Keep on keepin’ on,
Bill
It’s such a relief to read this article, i quitted Ecstacy 6 months ago after a year of frequently using it, from then i have felt all the symtons above, i’m in vietnam so very little that people know about this PAWS, i was desperate because i thought i’m going crazy, im working in a very stressful and competitive company that makes my PAWS even worse, im at the 6th month of abstinence and experiencing the very bad memory problems, and that is my biggest fear because it has a very bad effect on my job, is there any way i can get my memory recover quickly?
Dear Hyu,
Thanks for writing, and congratulations on having dumped the uppers! I was a speed freak myself (ecstasy — MDMA — is an amphetamine) and I know first hand how they can mess you up without your even realizing it until it’s almost too late.
The bad news first: PAWS takes its time. Just as they didn’t get screwed up overnight, i takes quite a while for our brains to get back to normal. The drugs make actual physical changes in our nervous system, and that has to be repaired.
The good news is, Paws is cyclic, and 6 months is one of the notorious hot spots. It is not surprising that you are having trouble now, and it will pass. The best advice I can give you is to return to the article and re-read it, with particular emphasis on the rest, nutrition, exercise and mental/spiritual aspects. If you can find a meeting of Narcotics Anonymous or AA where you live, that might help. All addictions are pretty-much the same. Try some meditation.
Remember two things: it takes time, and it does get better. Your stressful job certainly is a factor. I realize that there is probably little you can do about that, but to the extent that you can, I strongly suggest trying to alleviate some of the stress. That’s where exercise comes in — the BEST stress reliever! BTW: standing on your feet or working is not the kind of exercise I mean. I’m talking a long walk, a workout in the gym, a run, or something like that, where you go steady for at least half an hour.
Be mindful that if you use again, it will not get better — only worse — and that it will put you right back at square one for the PAWS.
Keep on keepin’ on, have faith that things will improve, and feel free to write.
Bill
I wanted to thank you for this blog. Yours is one of the best presented summaries of Gorsky’s thoughts. I point many people here when they post about how miserable they are even after they stop drinking.
Thank yuh. Thank yuh ver’ much.
Thanks a lot for the very quick reply, i took your advice and learn each tip by heart, there are 2 more questions: the article said i should avoid sugar in my diet, will it be ok with high-sugar tropical fruits or it just might as bad as a candy bar? And you mention the sugar-hunger effect, is it ok to take sweet dessert when you are already full? That will be all. Thank you very much!
Hi Hugh,
As a general rule, avoid sweets when you’re hungry. If you need a snack of fruit, that’s fine, but don’t overdo it. Stick to the Middle Path. Fruit has a different kind of sugar that doesn’t give your body the jolt that refined sugar does. Dessert is fine, just don’t overdo it.
You also need to know that you will have good days and bad. Eventually you end up with a lot more good than bad, but it can take a while.
Hang in there.
Bill
Thanks Bill, now i know the nature force behind those addiction that make ppl really hard to quit. It’s a tough process but i’ll hang in there, i cannot put my future at risk, i really need my mind and my brain back to normal the soonest it can.
Here’s a little more info:
Addiction occurs in the primitive brain” that evolved long before the relatively recent development of the cerebral cortex and its ability to reason. These parts of the brain are not amenable to coercion, logic, willpower, or thinking problems away. They are the parts that control the functions below the level of thought — in a sense, below even the subconscious.
These are the parts of the brain that control our breathing, heartbeat, and other bodily functions, the parts where we feel pleasure, pain, hunger, and basic emotions such as fear, anger and lust. They communicate with our cerebral cortex, where we carry out the activities that we call thinking, and we are then able to respond to them in complex ways. However, while our “thinking brain” is able to influence the primitive portions of the brain to a certain degree, it can’t tell it what to do. And, unfortunately for us addicts, it can’t control the messages sent to other parts of the body. We are able to ignore those messages, to a degree, but we can’t turn them off.
In the human body, survival issues speak with an extremely loud voice, and can, in most cases, easily overpower the wiser counsel of our cerebral cortex. People with normal reflexes can’t not jump when they hear a sudden loud noise, and that’s a good thing. Imagine a situation where, on hearing a noise in the jungle, we had to consider all the possibilities: wind in the trees, small animal I can eat, piece of fruit falling, another person, unknown cause, or maybe a big creature that wants to eat me. People who wasted time with all that thinking wouldn’t have many kids. Most wouldn’t even make it to adulthood, and so they wouldn’t pass that particular tendency along to their descendants.
So, our bodies heed the primitive brain in survival situations, and we run, jump to the side, or stand perfectly still until the cause of the noise has become more apparent. Then our thinking brain comes into play, and we decide whether to continue or to go back and display to our kid brother, the trickster, the anger that is a normal response to being scared out of our wits.
The powerful survival signals from our primitive brains have an important purpose, but they can cause problems. For example, when we use drugs, including alcohol, long-term changes take place in our brains. The primitive brain develops an actual need for the drugs, and interprets their absence as a survival issue like hunger, thirst, and our “fight or flight” reflexes. Because of the force of these urges, which can easily overpower our reason and common sense, we tend to ignore the messages of our thinking brain, and seek more drugs. The more used to the drugs we become, the more difficult to think our way out of the box we’ve built for ourselves. We are addicts.
Much of the recovery from addiction and the odd behaviors and impulses that it entails take place on the sub-cortical level. We recover by taking good care of ourselves, both psychologically and physically, and allowing the brain to recover slowly on its own. Until it does — until it recovers to the point that it stops sending us those signals that it needs the drugs for its survival — we have to watch our step. The bare fact of the matter is this: for an addict, using is more natural, more in keeping with the immediate needs of the survival brain, than not using. If we are not vigilant, in times of stress we may heed the primitive brain rather than the rational brain, and things go rapidly downhill from there.
I was a smoker for over 25 years with numerous failed attempts to quit. I quit smoking about 3 months ago, with the help of Chantix, and felt fine until just recently when most of the symptons you desribe above came crashing in on me. It was a shock to my system, hard to understand and even harder to desribe as I never suffered this kind of depression before… I thought I was going mad or in the middle of a mid-life crisis or something. I was totally at a loss to do anything about it or even tell anyone because I didn’t really believe it myself!
I had initially dismissed my cessation of smoking as a cause because it had been so long since I quit and my body was well clear of nicotine etc but the more I looked up my symptoms the more paranoid I got about it, and the Chantix I had taken to help me too. Sites had me diagnosed as bi-polar, manic depressive and in a permanent state of pyschosis, they were the first I came across and fed my paranoia to no end initially until I had a brief moment of reason and finally confessed all to my wife who brought me back to reality. My confession surprised her as much as it did me because I have always been a glass half full kind of person that can find the good in everything, including the bad and have never suffered from depression of any kind really. I was literally hanging on by a thread at the edge of reason before I confessed. What a relief it was, it didn’t change anything in the short term, in fact the symptoms got worse but at least I wasn’t alone and hiding my problem anymore. The more I looked in to the symptoms I was suffering the more reasoned websites, like this one, came in to view.
I do get and have had many of the symptoms described as PAWS and I’m still not entirely convinced I’m a sufferer of it but the explaination detailing the processes of what we go through struck a chord with me and make complete sense. At the very least for me this website (and others like it) has identified the problem I have and helped me realise I’m not alone in my madness. I think I can get on with the process of recovery now that I know my body is repairing itself and learning to cope without my lifelong addiction to nicotine.
Hi Duane,
Thanks so much for writing. You are the first nicotine addict who has written in a long time, and it’s important for your letter to be seen by others who are suffering with the same issues.
You are, indeed, suffering from Post Acute Withdrawal from nicotine, which is one of the most highly-addictive drugs known. The entire range of PAWS symptoms are common to ex-smokers, and they help to explain why it is also one of the most difficult addictions to kick. The depression is especially characteristic of nicotine withdrawal. Here’s why.
Serotonin is the neurotransmitter that gives us the “up” feeling. Its production is either stimulated or its actions mimicked by drugs such as amphetamines, methamphetamine, cocaine and, of course, nicotine (along with a number of others). For our purposes, the source of the serotonin doesn’t matter.
Heavy stimulation of the brain’s serotonin receptors makes us feel goooood. However, the brain compensates for the high levels of the chemical by creating more serotonin receptor sites. This causes us to need more stimulation to get the lift. Over time, we reach a point where if we are separated from the drugs that cause the stimulation of the receptor sites — or if the level even falls low enough for some of them to remain unstimulated — we begin to feel uncomfortable. We are addicted. We have created a situation where our brain needs the drug for us to function normally.
When we quit, our brain begins to protest vigorously. One of the major symptoms of withdrawal from stimulants, including nicotine, is the exact opposite feelings from those that the drug initially caused. The drugs took us up; the withdrawal takes us down. Here’s the kicker: until the brain normalizes the number of receptor sites, we will continue to feel the withdrawal. For some reason that we still don’t understand, these symptoms seem to peak at about three month intervals after stopping, especially if there is other stress occurring. Those are the classical times for relapse: three, six, nine months, and sometimes a year or more.
The treatment is the same as for any other PAWS situation. There is essentially no difference amongst nicotine and other drugs, except that the nicotine doesn’t get you very high when you’re using it. It’s sneaky.
You may assure your wife that your symptoms are very real, and that (while they are literally in your head) they are nothing over which you have control. These things are happening in a part of your brain that evolved long before the ability to reason, and you can’t talk yourself out of them. What you can do is take care of yourself, and force yourself to remain active.
The good news is: this, too, shall pass. And because you are no longer putting poison into your body you will have many more years to enjoy the peace that will eventually come.
Again, thanks for writing, and
Keep on keepin’ on.
Bill
ps: I smoked for 35 years. I know exactly what you’re going through. I’ve been clean since 1994, and it was the most difficult of all my addictions. But you can do it if I could.
Bill,
I am 65 days off Rx opiates. I am clean, no drugs, no nothing.
I have been through detox and primary care. I am a 61 year old male. BA. MA. ABD. I taught for 33 years at a small Community College. I was a damn good teacher, and a pretty good writer. I was also a good husband and father.
Now, just walking around is a hard thing to do. My family doesn’t understand. I was sent off to be fixed for 6 weeks..and I am still broken.
My education didn’t save me from addiction, nether did my wonderful family, nor my religion. RIGHT NOW I AM NOTHING MORE, OR LESS, THAN AN ADDICT.. a recovering one.
Until today I didn’t know what PAWS was. It is good to know that there is a name for what I am experiencing. I thought I might have had a stroke. I knew something was wrong. I have every symptom in the book. At least, I know now, ..there is a book.
I am attending NA meetings. Sometimes they are poorly led, and that bothers me. I am now unsure about everything I have ever believed. When things go wrong at NA, I get really upset. I have staked my life on NA.. I think that’s what set off my PAWS.
Anyway, thanks for the information on PAWS. It has made today a little easier. I’ll do what you suggested.I hope to be an ongoing disciple, of yours.
John W.
Hi, John,
First of all, congratulations on your (now) 67 days — and my apologies for not having replied sooner. My wife is in the process of setting up a new office for her psychotherapy practice, and we’ve been busy hanging pictures, arranging (and rearranging) furniture, shopping for same, and so forth. Yesterday and most of today was especially busy, and I just got to the mail.
Addiction takes place in the sub-cortical parts of the brain. Those portions evolved long before our cortex, where our monkey minds reside. Education, religion and so forth don’t impress the primitive brain much. It’s sort of like riding an elephant. We’re in control as long as our desires and those of the elephant don’t deviate too much.
Addiction causes actual physical changes in the parts of the brain that involve pleasure and reward. When we remove the drugs, or when they drop below the level at which the brain is comfortable, it sends signals to the rest of the body that it needs more…just as when we are hungry, thirsty or horny. This is a survival issue, as far as the brain is concerned, and the signals are strong and difficult to ignore at first. As the primitive brain adjusts to the reduced stimulation, the messages become less intense, and eventually pretty much go away. However, it takes time. It took a long time for our brains to become altered, and it takes quite a while for them to return to normal.
Your condition at two months is entirely predictable. Some folks (I was one, thank goodness) breeze through PAWS. I avoided most of the physical and emotional discomfort, but I was as crazy as a loon for the first year or so. I also watched people close to me from treatment and the rooms drop like flies. They were not so fortunate, and I’ve seem many folks fall by the wayside over the succeeding years. In practically all cases, they failed to take care of themselves by watching diet, rest, exercise, avoiding unnecessary stress and hanging out with other addicts who could relate to what they were going through.
As addicts, we trained ourselves to get more, NOW. Waiting and patience are not our nature. They are, however, intrinsic to recovery. It will get better. You will improve. And it will take time. I’m some years older than you, but I got sober at 45. It is harder for older people, but entirely doable. Just keep hanging in and doing what you’re doing. Re-read the article on PAWS and try to apply the suggestions to your program. You might also read through the comments. There is a lot of material there that has accumulated over the several years since I first published it.
Feel free to write and ask questions, or just bitch. That’s why I’m here. It’s what I do. And keep up the meetings. It’s exceedingly rare for people to make it without the fellowship.
Keep on keepin’ on…
Bill
What a kick butt article, I have been searching for weeks for some kind of clear and concise information on opiate PAWS and finally hit pay dirt. I call PAWS Post Traumatic Not Getting High Anymore Syndrome, but now I know there is more to it. I am 69 days clean from 13 years of severe opiate abuse culminating in a three year stint on Suboxone. I wish I had a doctor who understood the first thing about Suboxone…she had me on 16mg daily until I did some research on it and found out how irresponsible it was to keep someone on such a high dose for so long. I managed to wean myself down to just over 1mg per day and quit June 4/2010. The next 30 days consisted of me getting bitch slapped 24/7. It was borderline unbearable. It’s truly amazing what the human body and mind can tolerate. I had weaned down from 16mg to 1mg way, way too quickly and paid the price. The next few weeks consisted of much milder symptoms with sleep being the biggest issue, lack of anyway. A couple of weeks ago I began complaining to my wife more and more about how long is this crap going to last and she hit me with the two by four of truth…she said 13 years of abuse won’t go away in 60 days you dumb!@#. She was right. I am finally sleeping somewhat better, Central Nervous System is calming down bit by bit. My pissy attitude is improving slowly. I am getting better and very proud of myself for how far I have come. Lots of help made it possible, meetings, friends and my personal relationship with my God. Finding websites like this are also priceless. It always helps me to read about addiction, read what others have gone through and discovering how they made it out of the dark lonely cave of addiction.
I have book marked this site because the article on PAWS is something I will refer back to often, it is masterful, it is educational, it is powerful and it is comforting….thank you so much for taking the time to do it.
Ron
Hi Ron,
Congratulations on your 70 days! It sounds as if you are doing exactly what you need to be doing for yourself, and it’s working. Keep it up!
It’s horrible that so many physicians set themselves up as detox docs without knowing anything much about addiction (or, perhaps, just enough — but let’s not go there). To make things even worse, as you found out, Suboxone has the worst detox syndrome of any of the opioid drugs except methadone. Long-term maintenance is a crutch, not treatment. You should really have been detoxed in a medical facility, but you got through it, though, so good on ya.
Thanks for your kind words. Of the many things I have written, here and elsewhere, the PAWS article is the one that gets the most appreciation, by far. It’s linked to from a number of places, and lots of folks seem to find it useful.
I still get a thrill from letters like yours. After nearly 21 years in recovery myself, it is incredibly gratifying to know that something I have done is helping others. The first couple of years were the worst for me, as they are for most people, and I didn’t find out why until some years later when I was gathering material for lectures while working in addiction treatment. I’m sure knowing about PAWS would have helped me, and I’m glad to be able to pass that information along.
Please stay in touch, and let me know how you’re doing. Feel free to ask questions. If I don’t know the answer, I’m at least a helluva researcher, and folks’ questions help keep me up to date and on track in my own recovery. Working in the field you see a lot of old timers who’ve relapsed after 15, 20, 25 years, and it seems that they have the worst time of anyone getting back into recovery. Thanks for helping to “keep me green.”
Keep on keepin’ on,
Bill
About the medical detox, I probably should have done that, but a small part of my long term recovery plan was to experience a brutal withdrawal so the memory of that pain would never leave me…I over did it a bit I think! I will tell you that I went to see my GP before I quit using opiates to get a full physical. He gave me the works and after all my tests came back he said I was in excellent health for 42 years old, even my liver after that severe abuse from all the tylenol in hydrocodone and oxycodone was fine.
I hate to bring this up, but when you say “lack of sleep never killed anyone”, to someone who is in the throws of withdrawal and not able to sleep, it’s almost rude…besides the fact that they want to drop kick you through a window when they hear it. Have you ever heard of Fatal Familia? Lack of sleep most definitely does kill, it takes about 9 months though, and a complete lack of sleep.
P.S.—I read the entire article again this morning. I missed a few gems when I read it yesterday. I bet when I read again tomorrow I find another few gems. I think that whole article should be committed to memory. If you would include the stuff about how addiction takes place in the oldest part of the brain in the article, that would be great too. I found that discussion fascinating and very helpful. It helps us addicts to understand what is going on and why it’s going on. It gives us some sort of security that we’re not cracking up for no good reason.
Thanks again for the great work,
Ron
Hi Ron,
Vicodin and Percocet, eh? Nasty stuff. Having used for that long, you were indeed lucky to have avoided liver damage, especially if you combined it with alcohol at all. (Most of us do.)
I probably say and write a lot of things that make people want to “drop kick me through a window.” I believe in calling a spade a spade, and I would rather anger someone with a statement like “no one ever died from lack of sleep” than risk the effects of something like “oh, you poor baby…of course you can take something to help you sleep.” As far as Fatal Familia Insomnia goes, it’s an extremely rare, inherited, prion-related disease that damages the brain by causing a buildup of plaque in the thalamus. Profound insomnia is one of the major symptoms, but I believe the jury is out on what actually causes death. I mention that only because I am basically a smartass.
I’ll give some thought to your suggestion about addiction and the primitive brain. The article is already pretty long, and I have to consider the attention span of many people in recovery (which is often virtually nil). I’ve been thinking lately that a companion piece about addiction in general might be good, but on the other hand so much has been written about it that it seems rather like re-inventing the wheel somehow. I will definitely think about it, though. Thanks for the idea. Maybe I could synthesize some of the stuff from the comments. Hmmm…
Thanks again for your kind words, and
Keep on keepin’ on.
Bill
PS: You (and anyone else) can contact me privately, if you wish, using the link at the top of the page.
For everybody out there-it does get better. I decided to quit drinking after a pretty bad hangover, and what followed was hell. For over 3 months I lived a nightmare not knowing what’s wrong with me. I had a Cat Scan (thought I was having a brain tumor), an EKG (thought I was having a heart attack) and many doctor’s visits. It’s been almost 4 months now, and I still have bad moments, but most of the time I feel normal. In the beginning I felt like I had a tight band surrounding my brain-and the anxiety and fear that came with this feeling were surreal. Then I had episodes where my heart felt like it would explode-very scary. Add hot/cold flashes, extreme lack of energy, fear of death and you have an accurate description of what my life was since April. It got worse aroung 3 months and now it seems to be almost normal-except I still have days where I feel like I don’t want to do anything, and after a work day I am pretty exhausted.
I didn’t even realize that my problem was so big-but the withdrawal so so strong that I must have damaged my brain/body pretty severe.
All this information about PAWS is very helpful and I keep coming back to this website for support and to read about other people’s stories. I basically read all the comments and prayed for all these people. I wish everybody luck in their recovery-it’s so much worth it.
Thanks for writing, Al. Glad you’re feeling better. Three, six and nine months tend to be the worst spots for alcoholics. Feel free to write and share what’s going on with you.
Keep on keepin’ on,
Bill
First off I have been addicted to every opiate I know of in the past. I have detoxed “many” of times. Last time was a Cold Turkey detox from 120 mg of Methadone a day = 3 weeks of pure acute withdrawal hell, but I went 5 years clean. I relapsed “to get high” for about 2 months, and was fed up already. My Dr. put me on 20mg of Suboxone a day. At the time it was the “Miracle Drug”, which there is NO such thing.
I was on for about 6 months, and tapered down to 2mg a day then actually forgot to take it for about 3 days, since I only took it when I couldn’t stand it anymore. I stood off for about 3 weeks! Well, my Mother, which is all I have now, was worried, and wanted me back on subs. as a deterrent. You have to understand I know I shouldn’t have got back on, but we had just lost everything in Hurricane Katrina, and my Farther had 6 different types of Cancer since I was 13. He finally committed suicide, but I TOTALLY accepted why he did it, and I am an only child, so I will do ANYTHING for my Mother. I was fine, but I figured since it was so easy this time I would do it “for her”.
I got back on for a year, and I knew she was O.K. , so I started the taper again on my own, because my Dr. could care less. I got to the point where I was at before, but this time it was way worse, and I have a great job, so I wound up on it for 4 years total. I finally took all my added up vacation time, and weened down to 2mg a day, then every 2 days, then 3 days, then 4days (twice ea. time).
I am off! I can handle anything mentally that comes my way with GOD’s help. I KNOW this! I was also a drug counselor for 6 years, so I know what to do, and not to do. My problem right now is I’ve been off for 2 months, and my LEGS/RLS with that electricity feeling running through them is what is my problem STILL. Feels like I am endurance training all the time, but can’t stop. You know the saying, “Feel the burn”, well that is what it is like. I sleep well, thank GOD! When I am awake though my LEGS bother me so bad! Sometimes when I wake up, and I vomit in my trash can next to my bed just because of the intensity I feel in my LEGS and BODY right when I come out of sleep. I sometimes wish I could get my LEGS removed. Not really, but I feel that way!
Suboxone long term, for me, is the worst thing I ever did to myself. Is this a part of PAWS, and if so will it go away, and when? Is there “ANYTHING” I can do to help with this? This to ME is worse than the initial acute withdrawals, because it never goes away! I even fall asleep with it, but after work I’m so tired I just pass out. If you can help me in any way it would be much appreciated! Thank you so much, and GOD Bless!
Dear Bill,
Congratulations on making it through to the other side, and congratulations on your two months.
It is possible that your syndrome with your legs is PAWS-related, however I am not qualified to diagnose it — nor is anyone else via email. That said, your condition is probably not directly related to PAWS, but could have been masked by the action of the drugs. Those symptoms are not a joke, and need to be investigated immediately.
I strongly suggest that you find a good specialist in internal medicine, and have a complete workup. Be sure that it includes a glucose tolerance test. Do not go to the doctor you have been seeing. You need a specialist, and you need one that you can trust. This is no joke. I am unable to think of anything related to symptoms like those that could be good. Off the cuff, diabetes is a distinct possibility, and diabetes that has advanced to the stage of severe leg problems needs to be addressed right away, as it causes other problems that are less obvious.
Get the checkup, and take it from there. In the meantime, try to follow as many of the guidelines in the PAWS article as you can.
Good luck, and get on it right away, please.
Bill
I’ve been smoking pot for about 3 years now, and was smart enough never to get into anything hard because that would equal death. Around 16 yrs. of age I was put in a juvinile program “rehab” do to all my marijuana tickets. Things were alright for the first couple weeks without out my bud, but as they days went on things became very dysfunctional. I always felt stoned without out the euphoria. My reflexes were slow, I was socially impaired, i couldn’t concentrate, and had mad swings of emotions. I’ve never cryed as much as I did that year.I felt suicidal and very depressed. I’ve been going on what I call smoking binges for awhile now. I smoke literally all day. I couldn’t work or go to school, because by the time i smoked a few bowls i would be completely sober in a half hour. I had to be high. My tolerance became to high and the bud was not enough, no matter how much i smoked i couldn’t get high because i always felt fried, wihtout the euphoria. I was wondering if PAW could be the result of HEAVY MARIJUANA USE? I’ve been having these symptoms for over 3 years now, because everytime i sober up i make usually to 4 months and every thing is so dysfunctional and scary i relapse into another binge. THank you SO MUCH FOR THE SUPPORT
Josh, you are living proof of the bullshit in the claim that marijuana is not addictive. It most certainly can be, as you have so eloquently expressed. Thanks for your letter. With your permission, I would like to use it on a blog I write for a detox facility in Florida. Please let me know if that’s OK with you.
PAWS is not limited to so-called “hard” drugs. The brain has cannibinol receptors that are normally activated by cannibinols produced by the body. The active cannabinols in marijuana (mostly THC), attach to those receptors and cause the high. Over time, the brain grows more receptors in order to attempt to handle the increased levels of drugs. Eventually, as you have seen, if we use enough it becomes nearly impossible to get high and stay high for long.
At that point, if we quit or try to taper off, we leave a lot of the extra receptors empty. This is what causes the withdrawal symptoms that you have described, and the symptoms do not clear up entirely until we have been off the drug for a long time. The period between the time the THC is out of our system and when our brains finally “normalize” is the period of PAWS.
I suggest getting some medical help to get through the first few months. I don’t know what might be available in your area, but you could check the SAMHSA site for possible leads. http://findtreatment.samhsa.gov/ Please make the effort to get some help. You don’t have to do it alone, and you obviously want to be free of that awful burden.
Stay in touch, and let me know how things are going.
Bill
Go for it! I truly appericate the respone and support.
Bil,
It’s Al from few postings ago. I am a 33 woman who quit drinking over 4 months ago, and felt like hell on and off ever since. I just want to ask if the feelings i am having now are normal. I feel like there are electrical shocks going through my brain, and even though they are mild and not continuous, they worry me. I also feel like my heart is not acting normal, although I can’t figure out what it is. Is not pain, not flutering, just something different and uncomfortable. And of course, I am tired. Now it’s been over 4 months and I know that PAWS means psychological changes, but what I feel is physical, is this normal? (las day i drank was 4/22)
Just to clarify, I already had a CAT Scan which came back OK, all blood tests were OK and while I do seem to have a minor heart issue (mitral valve prolapse), I wonder if it’s PAWS related or not. I never felt bad until after i quit drinking. Sometimes I feel a little confused too, but not as bad as I used to right after I quit.
From your experience and stories you may have heard, is it normal to have this kind of feelings for so long? Again, they are on and off. I.E, I felt good all August long, but on or about August 27 I started to have this feeling of being extra tired-which doesnt go away. I truly feel like I opened Pandora’s box when i decided to quit drinking.
Thanks so much for doing this, it means a lot to many of us.
Hi Ali,
Good to hear that you’re hanging in there, and taking care of yourself as best you can.
PAWS can come up with some pretty unusual symptoms from time to time, and it does tend to come in waves. However, your symptoms sound more like anxiety than PAWS to me.
Since you seem to have good insurance, you might consider a consultation with a psychiatrist, if your internist has given you a clean bill of health. (I assume he did a fasting blood sugar test…some of those symptoms could be diabetes.) The shrink can evaluate your symptoms in terms of her specialty, and advise you further.
I wish I could be of more help, but there are too many variables to give you any useful information beyond that above.
Keep on keepin’ on,
Bill