Note: This material was developed from Relapse Prevention seminars hosted by Terence Gorski. I recommend his excellent Staying Sober and its accompanying workbook for anyone interested in following the subject further. Most of these concepts are Dr. Gorski’s, adapted by me for a series of relapse prevention lectures.
Surprisingly, many of the problems associated with sobriety do not stem directly from drugs and alcohol. Instead, they are associated with physical and psychosocial changes that occur after the chemicals have left our bodies. These alterations in our nervous systems, physical condition, and psychosocial adjustments are known as post acute withdrawal syndrome (PAWS).
Post acute withdrawal results from: (1) the combination of damage to our bodies and nervous systems as a result of using addictive chemicals, and (2) from the psychosocial stresses of coping with lives without alcohol and drugs. PAWS is the cause of most relapse.
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.
All addicts and alcoholics suffer from damage to our bodies and nervous systems resulting from drug/alcohol use, accidents and malnutrition. We may also suffer from various chronic diseases, such as diabetes and hepatitis. 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…clear!”
Our ability to deal with these problems depends on our willingness to take care of ourselves, manage our stress, and maintain a healthy physical, emotional and spiritual lifestyle.
Symptoms of Post Acute Withdrawal Syndrome
The symptoms of PAWS reach a peak from three to six months after we get clean. Recovery from damage to our nervous systems usually requires from six months to two years with a healthy program of recovery. Any use of drugs or alcohol, even in small quantities or for a short time, will effectively eliminate any gains.
Inability to solve problems. There are six major symptoms that contribute to this:
· trouble thinking clearly.
· emotional overreaction
· memory problems
· sleep disturbances
· physical coordination problems
· difficulty in managing stress.
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 levels of stress, and the stress further exaggerates the other problems.
Inability to think clearly. Our brain seems to work properly only part of the time. Sometimes it works okay, sometimes not.
Inability to concentrate. Abstract reasoning suffers.
Rigid, repetitive thinking. Thoughts go around and around in our heads, and we are unable to put them into useful order.
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 short-term memory problems it may be hard to learn new skills and in formation. We learn by building on what we have already learned, and mem ory problems can make it very difficult—if not impossible—to do this.
Emotional over-reaction; numbness. People with emotional problems in 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.
Most of us experience sleep disturbances in recovery. They may last only a short time, or a lifetime. Often, this depends on what we consider 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—perhaps even in our occupations. Sleep problems stress the body, prevent our minds from working well, and generally exaggerate 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.
Problems managing stress are the most difficult parts of post acute withdrawal, and thus 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 time 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.)
Abstinence
Recovery from the damage caused by our addictions requires 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 of the reasons given above, 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 to!
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.
We need 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 episodes of PAWS, we need to bring them 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.
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. 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. This self-protective behavior will help us to be firm in accepting our own needs, and in not allowing other people, places and situations to 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.
Here are some things that will help…
Nutrition
The way we eat has a tremendous effect on the levels of stress we experience and our ability to manage the symptoms of post acute withdrawal.
Poor health contributes to stress, and malnutrition contributes to poor health. Practically all alcoholics and addicts suffer from malnutrition to one degree or another when we first get clean and sober, and we may continue to feel the effects for months after adopting a healthier lifestyle. Unless we consciously attempt to improve our diets and properly supply our nutritional needs, the poor eating habits that have carried over from our using days pretty-much guarantee that we will continue to do so.
Our bodies, damaged by alcohol and drugs, 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 in order to allow our bodies to repair themselves, reduce stress, and enjoy good health. We should take a multi-vitamin every day.
Hypoglycemia – the secret demon of relapse
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 the rest of the day. So, we have our candy bar. Forty-five minutes later, we are angry at our boss, arguing with our co-workers, suffering with tense muscles
and a nasty headache. We’re thinking that life sucks and maybe getting high isn’t such a terrible idea after all.
Has this ever happened to you? Then you already know something about hypoglycemia.
Our brains use glucose 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 sugars (several kinds), 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. Alcohol is easily converted, as well.
The problem arises when we are in need of food and our bodies get a big jolt of sugar. The sugar—whether it is from candy or fruit—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 jolt of sugar on an empty stomach causes the blood glucose to rise rapidly. A center in our brain detects the rise, and signals the pancreas to produce more insulin to deal with the sudden rise in blood sugar—too much insulin. The insulin causes us to burn the extra glucose rapidly, and our blood sugar comes down, but because there is so much insulin our blood glucose levels drop too far.
Now our bodies—and our brains—are low on glucose. The brain functions poorly. Waste products build up in our muscles and cause, along with inefficient signals from the brain, tightness and muscle tremors. Our heads begin to ache. Our thinking gets fuzzy. Some of us get downright MEAN. Our energy levels drop. We push people away—if we don’t scare them away. We are HUNGRY, ANGRY, LONELY and TIRED.
Most of us, in our addictions, knew all too well how to quell those nasty feelings by using. We taught ourselves to interpret the symptoms of hypoglycemia as wanting 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 well-balanced meals each dayThree nutritious snacks each day,between meals and at bedtime>>>>Avoid Sugar and Caffeine<<<< |
Planning meals
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—a donut, or bowl of cereal, and a cup of coffee, one “rectangular” meal—a sandwich and another cup of coffee at lunch, 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 our candy bars and some more coffee. Our poor pancreas! For, in addition to all that sugar in fits and spurts, caffeine (coffee) 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, especially by too much sugar and caffeine. Are we beginning to see a trend here?
Alcoholics and addicts in early recovery almost literally “take our lives in our hands” each time we plan our daily meals.
Our daily 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.
We should try to plan our eating 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. Instead we should carry raw vegetables, wheat crackers, a half sandwich, 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.
These eating habits are not inconsistent with meal planning for weight loss. Competent dieticians 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. In fact, 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.)
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, relieving pain, anxiety and tension, and 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, (mainly fruits and berries, with occasionally some meat). 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 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, and we should do it 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
Relaxation = stress reduction
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 in Microsoft Bookshelf 2000®, perhaps the one that best describes it is “participating in an activity for amusement.” If it isn’t fun—if we aren’t amused—if we have to work at it—it isn’t play.
Other ways of relaxing include bubble baths, a walk—by ourselves or with a friend, a massage, a swim, watching children and animals at play. Whatever we do, if we don’t feel better after doing it, it was the wrong choice.
One of the best relaxation exercises is also 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.
Belief in a higher power gives us a peace of mind and serenity that comes from awareness that there is a power that is not restricted by our 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.
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 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 communicating with that power.
Spiritual discipline is uncomfortable for many recovering people. We have lived lives of immediate gratification, and discipline is the reverse of that. Many of us have trouble with the concept of a higher power, as well. We may have been brought up as atheists or agnostics. Perhaps the god of our childhood was a vengeful god whom we cannot even begin to contemplate in the light of some of our past behavior. This is why we say that our higher power can be god, as we understand god.
Spiritual discipline includes prayer, meditation, spiritual fellowship, and regular inventory of spiritual growth. It is about our relationship with our higher power. It is not about someone else’s idea of that relationship. That is religion. While religion may be an important part of our recovery, it cannot take the place of spirituality.
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.
Balanced Living
Balanced living means that we are healthy physically and psychologically, and that we have healthy relationships. It means that we are spiritually whole. It means that we are no longer focused on just one aspect of our lives. 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.
With balanced living, immediate gratification as a lifestyle is given up in order to attain fulfilling and meaningful living.
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 newfound 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 proper health care. 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 always tell our health providers that we are in recovery, and always double-check their suggestions regarding drugs with a person knowledgeable about their effects on recovering people.
Freedom from physical distress allows psychological growth. When we feel good, it is easier to do the work we need to do, eliminate denial, guilt and anger, and move on to self-confidence, self-esteem and learning to feel good about ourselves.
Balanced living requires a strong social network that nurtures us and encourages a healthy, recovery-oriented lifestyle. This network provides a sense of belonging. It includes relationships in which we are a valuable part of a whole. It includes immediate family members, friends, relatives, co-workers, counselors, therapists, employers, 12-step group members, and sponsors.
Recovery is not about quitting alcohol and drugs. It is about living a life that does not require mood-altering chemicals to be worth living. Balanced living is the final goal of recovery.
WOW! Thank you so much for this enlightening article. I have almost 6 months off of alcohol, opiates, and benzos, and I related to everything you said. EVERYTHING.
The first few articles I read online about PAWS were very clinical and just stupid. But you “know your stuff”. Thank you for this service. Like you said, just knowing why I am feeling so crazy helps immensely.
-Kathryn
P.S. – I am going out at lunch to shop for healthy food because I see now how much my diet (mostly cereal, caffeine, and breakfast muffins) has contributed to my mood swings and just my general weirdness. I doubt I will never be un-weird, but I can try.
Absolutely awesome information! I was unaware that PAWS can last so long. I am nine months off of Suboxone, a horrible drug, and still feel lousy much of the time! I didn’t have any idea that how I feel currently had anything to do with PAWS as I didn’t know that it’s duration was so extensive. I suffer from almost every symptom you mentioned. I actually thought I had a health problem totally unrelated to recovery. Not knowing what you suffer from can be a horrible nightmare and just adds to stress levels. I am also in the middle of a bankruptcy and house foreclosure which, based upon your explanations, just adds to the problem. Thanks again for the extremely enlightening article as it alone has uplifted my spirits! It’s nice to know that there is a reason for the way I have been feeling!
Wow, what brilliant information! My sister is a recovering drug addict, I think is still using some Suboxone, and I know she is going through PAWS as she is almost 50 days clean. This helps explain why she is experiencing all of these symptoms around my family and I right now. I will make sure and pass this along to the rest of my family, and maybe even her! Thank you so much!!
If your sister is still on Suboxone, she isn’t going through PAWS, she is still addicted and is experiencing mild withdrawal. (Either that, or simply the frustration of an addict who can’t get high.)
Suboxone is an opioid, similar to heroin or any other opioid, except that it also includes nalxone HCL, a narcotic antagonist that prevents people who take it from getting (very) high. When it is used to reduce cravings for heroin or other opioid drugs, the user must be tapered off slowly — preferably in a clinical setting — and once clean can begin an active program of recovery. Until the drugs are completely out of the system, recovery (including PAWS, which is an unavoidable adjunct to recovery) cannot begin. The reason: the neural pathways that need to normalize in order to recover are being kept open by the Suboxone.
Your sister needs your support, and your encouragement to attend 12-step meetings. Perhaps you could be a good example by attending a few NarAnon or Al-Anon meetings yourself.
I am at ten months and am feeling paw symptoms. How long does this last at ten months?
Hi Rebecca,
Thanks for your comment. PAWS varies with every individual. It depends on individual brain chemistry, our physical condition, how much and what we used, the stress we’re under, whether we’re eating properly, going to meetings, making sincere attempts to get our lives back in order, improving our self-esteem, and so forth. Following the suggestions in the article will help, especially the blood sugar, exercise and vitamins.
A good sponsor and a good home group, along with working the steps will give us support through the hard times. We didn’t get addicted overnight, and we don’t get well overnight, but it does keep getting better. Not every day, but on average, if we stick with our program of recovery it gets better.
Hang in there.
–
Bill
Thank you for the much needed advice. I’ve been off of suboxone for four weeks now after being on for a year and a half. I could have stayed on it for life – my doctor was fine with it. I wanted off as soon as possible. Now I feel lousy. I’m so tired I can barely get up in the mornings, much less function throughout the day.
I found my way to addiction though doctor’s advice (pain pills for headaches), and now I fear I’m in for another rough ride through this “PAWS.” My doctor has prescribed adderal to get me through the work day. I work 70 hour weeks and am not sure how else to get through. I will certainly give some time and attention to what you’ve suggested.
It’s too bad suboxone is billed as such a “miracle.”
Thank you -
You are most welcome.
Suboxone, used properly in a clinical detox setting by specialists trained in its use is, indeed, a miracle drug. Like methadone, however, when used by unskilled practitioners or as a political tool instead of a clinical aid, it carries with it its own set of problems as serious, or nearly so, as the drugs it replaces.
Please know that Adderall, an amphetamine similar to methamphetamine, is not approved for giving people enough pep to get through the day when recovering from addiction to another drug. First of all, Adderall is indicated in cases of adult ADD and narcolepsy, not low energy. Second, it is a highly-addictive drug in its own right, when used improperly. Thirdly, it is a highly dangerous addition to an addict’s brain chemistry because — odd as it seems — it keeps activated many of the same neural pathways that are involved in addiction to depressants, including opiates and alcohol, thus increasing the length of time necessary for the neurological response to return to something like normal.
Most people newly off opiates or other pain medications find that reduced stress, exercise, support from others and treatment for the depression that often follows secondary withdrawal — by experts — is the most effective way to avoid the worst problems with PAWS. The 70-hour work week is a highly dangerous situation, but I’m sure that you see no way to reduce your efforts to human levels.
I suggest a physician whose specialty is treatment of recovering addicts; one with a strong background in psychopharmacology, combined with a 12-step support group and a program of nutrition and exercise.
However, I am not a medical doctor.
Thank you so much, icredibly well written. I am in recovery from alcohol – almost three months now. I was ready for the depression, that passed as I worked the steps in AA, but I’ve had alot of anger lately that has been threatening my sobriety. You’ve helped me understand much of what is happening – and made me think about ways to be a little more pro-active about stress levels at my job. Stress levels are going to remain high, I need to manage myself and my tasks better- I tend to procrastinate then its a stressball (I learned to do this from my boss, he’s the king of it). Cutting back the coffee would also be good.
Thank you! Makes it all worthwhile.
Good fortune in your sobriety. Remember that adage: “Anything I put ahead of my sobriety I will lose.” It’s too, too true.
bw
I was on Klonopin l.5 mg daily for 7 month. Was side stepped to valium for a 6 1/2 month taper (dr. assisted) I was also on cipralex l0 mg and was taken off that after the benzo withdrawal. Felt wonderful for four months during which time we moved but then BAM in January I felt like hell – all the symptoms of PAWS and have had very few days where I feel ok. I long for my life as it was several years ago before my breakdown. I am 56 years old and otherwise healthy. I don’t know why I am experiencing this now. The taper was realatively easy. My gp has put me on l0 mg of cipralex to help with the anxiety. I have been on for 6 weeks with little relief. Please help before I go crazy. I don’t drink or smoke and as I say, have been healthy except for the last year of benzo hell. Thank you so much. Lynn
Dear Lynn,
I am neither a physician nor a psychopharmacologist, but my guess is that the crux of your problem, in addition to your obvious physical and emotional turmoil, is the expression “gp.” The bare fact of the matter is that general practitioners are not trained to deal with emotional problems and psych meds. There is a great deal more to it than a few seminars, reading medical journals and package inserts.
I realize this is not the sort of help you believe you needed, but it is the best help that I can offer. Psych drugs are for psychological and psychiatric conditions, and general practitioners are not qualified to treat them. Bottom line.
Your county medical society should be able to put you in touch with a physician who is qualified to treat your condition. Please don’t wait too long to look for additional help.
As to why, who knows? Our neurochemistry changes as we age, and exposure to psych meds works its own changes.
Please see a specialist.
Best of luck,
Bill
Thanks so much. I have been sober for eight weeks and for the last week and a half (after going back to work) I have had pain and shakes and headaches and depression. I haven’t started working the program but am starting IOP today (I know I am late). I am so glad I came across this site because I was beginning to think was experiencing something out of the ordinary. Now I know that this is common and there are things I can do to ease my discomfort and help me stay sober.
Thanks alot
Hi, I am 4 weeks from my last dose of methadone. I was weaned off it in a detox centre. I am still in so much paws, and have abosolutely NO energy at all. I am wondering how much longer this no energy will last. I have to push myself to just get up and go to the bathroom. I am a 50 year old woman… I just want to feel somewhat normal again! Thanks.
Dear Kerry,
There are too many possible reasons for your malaise for me to be able to answer your question. In addition, everyone’s brain chemistry is slightly different, and that complicates diagnosis and treatment at a distance. It would not be ethical, nor to your benefit, for me to speculate.
Having said that, if you have no physical disabilities that prevent it, a good multivitamin morning and evening, combined with a good diet as outlined in the article and some light exercise, like walking, might help. It would also help to go to a few meetings, get a sponsor, and begin helping others. Finally, if all of those things seem impossibly difficult, there is a good chance that you are suffering from depression and you might consider seeing a doctor who is familiar with recovering people and their problems. No doubt the detox that you attended could supply information about that.
Congratulations on your success so far! Methadone is the devil’s drug, as you certainly know, and methadone maintenance is society’s way of saying “we don’t really give a …. about those addicts.” Stick with the people in your 12-step program, and with the suggestions of your physician (provided, as stated above, he understands addiction and psychopharmacology; most family physicians and many psychiatrists do not). If you don’t have a program, call NA and ask for help.
Keep on keepin’ on…you can do it. I did.
Bill
I will never understand why the phrase “insanity is…” (we all know the rest..doing something over and over and expecting different results) …..is used so often in MAINSTREAM addiction treatment…..and then it’s applied to EVERYTHING in our lives EXCEPT the “treatment” which is offered. How many is TOO MANY times at “treatment” before it’s insanity as well?
If PAWS seemed endless to us the FIRST time we tried the “traditional” treatments, why on EARTH would we expect it to be better the next time around? And the next…….
I am sure my posts seem argumentative. However, that is truly not the case. I just keep hoping that some DAY I will post something like this, and someone out there who works with addicts (or is one) will understand the point I am trying to make about what we offer as “treatment”. We tell addicts that they are sick and they have a problem with brain chemistry…they are JUST AS SICK as someone with epilepsy or cancer (as your posts prove by showing what happens PHYSICALLY to an addicted person who’s brain chemistry is now forever altered)–and then we prescribe a treatment we would NEVER consider “real” treatment for ANY other type of disease.
I worked for much of my adult life in a substance abuse counseling. While there I watched the revolving door of addicts who showed up time and time again begging for relief from their “affliction” (which was PAWS in the rawest of all forms) and time and time again I watched as the SAME thing was offered to them as “treatment”….”your sick, but your sick because your selfish, spirtually weak or just plain weak.” or “you have to WANT it more” or “your brain is changed forever, but all you have to do is come to this meeting and be as honest as you can be about what a bad person you are and you will be magically healed”…….
Time and time again I watched them become homeless, jailed or die…..because why stop using drugs if you feel just as miserable OFF them as you do ON them?
Thanks for listening.
I believe that you are absolutely right. What seems to have been misunderstood about my remarks, which may have been phrased unskillfully, is that I meant only to refer to the practice of using opiate maintenance as a substitute for impatient treatment, support, and psych meds if needed, thus prolonging the dependency and keeping patients in close association with people who are questionable supports. There are drugs far better suited for opiate detox in a clinical setting, which is how I believe the issue should be addressed.
It is also my contention that many physicians who position themselves as addiction specialists know virtually nothing about addiction, and about as much about mood-altering drugs and psychopharmacology. This is almost universally true of family physicians, and of many psychiatrists and psychotherapists as well. I have seen far too many patients and clients who took 96 hours to detox from their drugs of choice and weeks to do so from drugs prescribed by physicians who do not understand that the first step in stabilizing brain chemistry is to safely remove all chemicals, if possible, to create a baseline. The protocol of piling one drug on top of another is another of my pet peeves, and a practice all too common in the medical industry. This is an area where incompetent help may be worse than none at all, regardless of the source. Witness the current plethora of storefront “outpatient” detoxes using Suboxone.
That said, I am (as was Bill Wilson) 100% in favor of “outside help” when it is needed. In fact, I once made my living being outside help. I do not, however, believe medication and/or therapy are enough. That’s where the support and assistance in rebuilding a life and relationships that is found in the 12-step programs comes in, and support of that kind is absolutely essential, whether or not it is obtained in the 12-step rooms or elsewhere, in my less-than-humble opinion.
The point of my insistence on 12-step recovery is that after looking at a great many programs I have yet to find another platform that offers (a) support that is based on an inside understanding of addiction; (b) has worked for so many people; and (c) is non-religious. They may exist, but since the purpose of these pages is to direct people in directions that I know to work from my own personal and professional experience, it would be just as irresponsible for me to speak to those as it would be for me to be pontificating about addiction if I were not a recovering addict. (I am also a firm believer in the concept of addicts making the best counselors, although I have known brilliant exceptions to that rule.)
I am not anti-religion, either, although I am personally agnostic. My position on religious treatment programs is that most of the religions with drug and alcohol outreach are proselytizing faiths, and I don’t care for the ethics of pushing specific beliefs on people who are emotionally needy and vulnerable to subtle coercion. As a practicing Buddhist, I consider that sort of thing not only unethical, but to be distracting people from the reality that they need so desperately to embrace in lieu of the addictive dreamland. There is plenty of time after they have their feet firmly on the ground for them to seek out organized religion on their own.
Thus, I suspect that we are mostly on the same pages (except, perhaps, regarding the methadone). Thanks very much for your input.
Thank you so much for taking the time to read through my thoughts ….it seems like this subject tends to shut people down- the wall goes up before the first sentence is even spoke. We take a stance and try not to waver, but we never really HEAR someone else’s reality. I am as guilty as some of the people I have accused of this!
Thanks again.
(ps-I agree completely on your take of faith based treatment)
My husband is tappering off of subutex. He is very scared of the PAWS. I have read the article and stress will make the PAWS worse. Are there any vitamins other that the multi vit. to help with the PAWS. Can he get throught this? Have you heard of Low dose Naltrezone. I hear I helps with natural endophins production.
Please help. Thank for your article I know this will help.
lisa
PAWS occurs after detox. Acute withdrawal, when possible, should always be monitored by a skilled physician.
Withdrawal from buprenorphine, a synthetic opioid, is similar to that from any other opiate, except that (like methadone) its longer half-life tends to make withdrawal less severe unless it has been heavily abused. That doesn’t mean it is fun. Hopefully your husband is under the care of a physician who is competent to supervise detoxing patients.
Following the steps outlined in the article — even if it’s the last thing he feels like doing — and toughing out the several days after he takes his last dose is probably the safest course medically (although, I hasten to add, I am not a medical doctor and this is therefore a layman’s opinion that is worth exactly what you’re paying for it). This is one of those situations for which there is no magic elixer. The body is readjusting from a condition it has been in for a long time, and it takes quite a while for it to repair itself and get back to something like normal. He could double up on the multis, being always sure to take them with meals. Vitamins are food, and they are not absorbed properly unless taken with other food.
Addicts, of course (and I include myself), are people who, almost by definition, think it isn’t OK to feel bad. We have trouble getting the idea that everyone hurts, from time to time, and that we usually get over it. We want the answers NOW. Trouble is, apart from the above, I don’t have any. I realize this isn’t what you were looking for, but I do not bullshit about things I don’t understand, and I’ve told you all I know.
Good luck to you and your husband. I hope you’re hitting some NarAnon meetings and that he is attending NA. It helps.
Namasté
hi
i have every symptom you have listed above they all started about 3 weeks after i quit i had a withdrawl first that lasted about 2.5 weeks i then started to feel better , then all of sudden i just clicked into this weird state racing repetitive thinking thoughts going around and around no concentration i i could not focus on anything i thought i was going mad i had never exprienced anything remotely like this in my life before as i said i have had every listed symptom but it has got slightly better over time . the drug i was addicted to was cannabis ! have you ever heard of someone getting paws from cannabis addiction ? i have searched the net trying to find someone who has had paws from weed but i have found nothing . it makes me wounder if i have paws , but i tick every box in terms of symptoms and everthing else . also i am wondering if it will ever go away i have had it for 6 months now help!
Thanks for writing, Brian.
There is a lot of discussion over whether or not cannabis causes withdrawal per se. I think the entire discussion is beside the point.
Whenever we change our brain chemistry over prolonged periods there is going to be a period of adjustment after we stop, during which our emotional state will generally be the opposite of however the drug made us feel. Since THC leaves one relaxed and drowsy, we can expect a period of manic feelings and behavior for some time afterward. Generally, the period is longer the longer we have been using. You did not mention how long nor how much you were using, but I suspect quite a while and quite a bit. Sometimes this is simply our perception of the real world when we’re not “slowed down,” and sometimes it is an actual physical readjustment of brain chemistry, or a combination of both.
I cannot begin to diagnose your problem since, first of all, I am not a physician and, secondly, even a physician who is trained in chemical dependency could not make an accurate and ethical diagnosis without interviewing a patient and perhaps running some tests.
So understand that these are layman’s remarks. Having said that, two things come to mind: first of all, I wonder if your initial attraction to cannabis might have been related to self-medication of a condition undiagnosed — and perhaps unrecognized even by you. If there was a pre-existing condition, and if you were self-medicating, the condition may have worsened during your heavy use, and may now be manifesting more strongly.
The other thing is, how well are you taking care of yourself physically? Recovery from any addiction takes a big toll on the mind and body, creating stress which in turn takes an even greater toll.
I suggest that you follow as many of the guidelines in the article as your are able to. In addition to that, I suggest that if the symptoms do not begin to improve soon, you need to see a physician who has training in substance abuse, who can perhaps help you piece together your medical condition and see if there is something that needs attention.
With regard to the suggestions, pay particular attention to nutrition, exercise, and getting enough rest. I also strongly suggest a 12-step program like NA, if you are not already attending. These things are much easier to bear when you have the support of folks who have been there too.
Good luck, and remember that as uncomfortable as you are now, you have already gone through the worst of it. Keep on keepin’ on!
Bill
I would like to say that I used Suboxone very short term to come off opiates. First, I would like to say that I began taking opiates “innocently”. I have a Masters Degree, I am married to a very successful attorney, I don’t smoke or drink!! At the age of 30, I had a damaged nerve, began seeing a neurologist and was prescribed Oxycodone. From the very first time that I took opiates, I knew there was the possibility for trouble. I felt wonderful and euphoric. I had all the energy in the world. But as most of you know, things changed rapidly!!! I began abusing the pills, taking them when I wasn’t in pain. Taking much more than was prescribed, etc. The next thing I knew I was lying to my doctor to get my prescription filled early. Frequently visiting urgent care centers and faking injuries. Calling my dentist and claiming that I had tooth pain. Fortunately, I never ended up buying them on the streets from dealers but believe me I wasn’t far from trying!! I made several attempts at cold turkey and was so ill that I couldn’t even lift my head off my pillow. I too am a professional and can’t miss work. So to me, cold turkey wasn’t an option at the time. Fortunately, I have several friends in the medical field that introduced me to a Suboxone doctor. I went in and saw him, and on my first visit I had to be in full blown withdraw!! Man did that stink!! I had to run in the bathroom during my initial interview to have diarrhea, it was very embarrassing. The doctor reassured me and administered the first Suboxone pill and within 20 minutes, all withdrawal symptoms stopped. However, I did a very rapid detox from Suboxone. I was only on it for 2 weeks!! That is the key with Suboxone and I believe where people are going wrong with it!! I started with 4 mgs my first day and rapidly went from 2 to 1 to 0.5 to literally tiny pieces of the pill and came off completely!! Its been 16 months and Im clean and sober!! Yes, I have my bad days where I feel tired or depressed but I just think about the horrendous life that I had while I was using and understand that I would never go back there!! Ever!! I went from 200 mg a day of Oxycodone to Suboxone for 2 weeks and then off. The only withdrawal that I had when I completely stopped the Suboxone was a little diarrhea but I have IBS so that could have just been my condition. I strongly recommend Suboxone for SHORT TERM USE ONLY!!! It can be addicting like any other opiate and why trade one addiction for the next?? I am not a doctor and this is only my opinion, so please don’t be angry with me if you don’t feel the same!! I just wanted to tell my story with the hope that it would help somebody else that is suffering from this horrible addiction!!!
I agree with you absolutely. Thank you for sharing your experience and pointing out the benefits of Suboxone when used in a skilled manner by a conscientious physician. It is unfortunate that many of the physicians doing “office detox” do not fall into those categories. Those of use who have worked in detox settings have seen more and more instances of full-blown Suboxone addiction, due to the ministrations of storefront detox clinics (and a Suboxone detox is just as bad as a heroin detox, only it lasts longer).
It is even more unfortunate that this drug which, used properly, could end replacement therapy, is instead now being touted as a “better” replacement drug than Dolophine (Methadone).
is there such a thing as paws from SSRI’s?
Thanks.
Dear JAS,
SSRIs are usually prescribed for specific neurological disorders involving imbalances in brain chemistry. I would think there would be a rebound effect of some kind that would be detectable, but I have no specific knowledge about that. Since the effect of SSRIs is to increase the supply of serotonin, I wouldn’t be at all surprised if sudden cessation couldn’t lead to depression, among other things.
If someone you know has ceased taking medication, they should be under the care of a physician who is knowledgeable about these things. If they are doing it on their own, or under the supervision of only a family physician, I suggest they speak with a doctor who has received special training, such as a specialist in psychopharmacology, or at least with a pharmacist.
Good luck.
i have been feeling “foggy” and not myself, i have been 11 months sober… could this be related to PAWS?
It is certainly possible. I suggest discussing it with your sponsor and at a few meetings. Give your sponsor a copy of the article. Following the suggestions listed, even if it’s not PAWS, can never hurt. Finally, if you begin to feel depressed or otherwise unable to function normally, please see a physician who is trained in dealing with recovering people.
Finally, approaching anniveersaries are notoriously a time of relapse, and relapse occurs before we pick up. Redouble your efforts in the rooms. Get active. Help another drunk or addict. Do some service work. Start going to a new meeting to kick start some new aspects of recovery.
Good luck!
HELP!!!!!!! Eight years ago my husband injured his back… numerous docs prescribed pain meds (began with Ibuprofen 800 then escalated to Narcotics!). For years he had been taking Ultram (Tramadol) thinking it was “innocent”.. however was up to 20-30 50mg pills a day when the MAX dose was 300mg/day! He claimed docs said it was his “tolerance” he had developed to this drug – which made sense to me. He is also a 6′2″ 200lb man! Innocently, I went on accepting that his doctors said it was “ok” for him to get it on the internet because our insurance wouldn’t pay for the large prescription.
IDIOT ME!
After the amount of money he was spending to get this medicine really stressed our pocket book to the point of us not having $ to feed our four kids, I had to do something! I had let it go too far, by trusting he had this under control. I would question why he wasn’t getting it from his doctor etc… he always had a good reason why and I fell for it. Then I started to do research on this drug… found out how bad it was and that people were getting addicted. Tramadol is a non-narcotic and my husband had me convinced that it wasn’t hurting him. How could it? I would research and find things and present them to him and he wouldn’t listen. Finally got to the point of telling him I was going to start going to the doctor with him. He would say that was fine, but then when it came down to it, he would change the appointment or lie to me about going or say he couldn’t go etc… or even coming to me saying he was afraid that I would embarrass him in front of the doctor by bringing my concerns about the meds from the internet and that I would be “telling” the doctor how to do his job. After a while, I realized this was not right! I tried to get my husband to talk to me, but he just kept feeding me lies and I kept giving him the benefit of the doubt… I guess I was in a bubble thinking he would never lie to me or hurt me.
So one day, I was DONE! I marched myself and our 3 month old baby into the doctors office after leaving 20 messages trying to talk to the doc about this… first it was HIPPA, then my husband said he signed a release to talk to me, then they “lost it”, etc… excuse after excuse! That day changed my entire life…. that day I found out not only was my husband ordering excessive amounts of Tramadol from then internet (hiding it, lying, picking it up from fed ex, having it sent other places…) he was also taking NORCO!!!!!!!!!!!! In his chart he had informed the doctor that he had been taking Vicodin/Norco/etc… for the past 8 years!!!!!!!! Hmmm! So he told ME he was on Tramadol and told his docs he needed a narcotic! TAKING BOTH AT THE SAME TIME!!!! IN EXCESSIVE AMOUNTS! He would go see numerous docs to get Rx’s and get different types of drugs so that insurance would cover them… but I had NO IDEA!
Anyway… told him get help. We went round and round about this…. he kept saying he would, then I would find out he bought more drugs etc…. until it came down to me giving him an ultamatum (sp) —- get help either in-patient, out-patient, psychiatrist, or GET OUT! This was negativly affecting our four young children and I was not going to stand for the lying, manipulation, emotional mess any longer! I had to protect our children!!
He refused to go to detox — so we agreed on a compromise — Suboxone therapy. He seems to be doing “OK” on this.. as far as I know, he has been just on the Suboxone… but he gets wierd about it too… counting pills, hoarding pills…. I am reading posts and freaking out about this! Few reasons —–
He has been on Suboxone for 4 months now — 16-20mg/day. Scared about the “replace one drug for another thing”… but we were assured by the doc that it would not be the same thing….
Also — BIG ONE! He seems to have PAWS to the EXTREME CASE!!!!!!!! With 4 kids, me working part time from home and attending NURSING SCHOOL FULL TIME, he has pushed me over the edge! The moodyness, the emotions, the attitude, the overreaction etc… etc… I can NOT handle it! I was told when I started nursing school — if you can, move back home with your parents, but you all need to quit working if you want to be successful in this program! UM… yeah, I am 33, married with 4 kids… I am not moving back to my parents (are you insane!!!!!) and I can’t quit work!!! Unrealisitic! He has become worse than all 4 kids combined… the needyness, the drama — example — a few weeks ago, he had a very small cut above his lip… I would say maybe 2 MILLIMETERS if that! His face was smooth like he had just shaved that morning… I assumed he nicked himself shaving and didn’t mention it. He blew up, flew off the handle, told me I was completely insensitive, I didn’t care about anyone but myself, etc…. because I wasn’t concerned enough to ask what happened! First thing you should be able to tell by my personality… 4 children and I have wanted to be a nurse my whole life — those kinds of people are not insensitive! You can not be a nurse or a mom successfully and be insensitive! That is just ONE of MANY MANY instances!!!!
So my question — after the novel — is this…. anyone have any clue what I am supposed to do here?? I have let my husband trick me into believing that I am the one with the problem, I am the one who needs to get therapy and I have agreed!!!! Only issue is that I have no time to even pee, where will I find time to see a psychiatrist???? I guess I could spare one of my 3-4 hours of sleep I ONLY get each night, if I am lucky! Now I am concerned with the Suboxone … if my husband is having PAWS and STILL taking Suboxone… how much worse will it get when he is weaned from Suboxone???? If PAWS can last up to 18 months… will he have s/s of it while taking Suboxone and then even worse when he is weaned off???
Any advice… I am willing to listen/try!
Dear Karin,
It sounds like you find yourself caught between the proverbial rock and hard place — not unusual, in fact quite the contrary, for codependents.
The bottom line, once we sift through all the addict-speak and concerns is simple.
You need to take several steps:
Finally, ignore any promises, protestations, prostrations, pathetic pleas and all the other manipulative letters of the alphabet from your husband. He is terrified of getting off the drugs. He has no doubt already experienced the terror of withdrawal, and he cannot be blamed. He will do and say whatever he needs to avoid that, which is his greatest fear. Those of us who have been addicted understand and sympathize with him, but his instincts have been warped to the extent that he will do whatever he can to protect the status quo. Ignore his preferences. Find out what you need to do, and do it.
Bless you for being strong and faithful. Now it’s time for the hard part — the part that seems so unfaithful, but is so essential. It is his only hope — and yours — if you want to get back to normal.
Namasté
I enjoyed this article immensely…. I do have a few questions though. Most of the information that I have been reading about PAWS, says that “long term users,” or, “heavy users,” will be affected. I am curious as to what is classified as a “heavy user” or long term user.”
I have been drinking for several years. I sobered up a 2 times for over a year each time. The last year or so I have been drinking, until extremely intoxicated, about 2 or 3 times a week, give or take. I was sober for about three weeks. I fell off the wagon a couple of days ago.
Do you think I culd be a good candidate for this syndrome. I have all of the symptoms. (but then again I have all the symptoms of half of the diseases on the net!) HE HE!
Dear Diane,
This definitely qualifies as both heavy and long term, especially since I imagine you have been maintenance drinking in between the frequent binges. That most likely means that your system has seldom if ever been free of alcohol for the last year “or so” — and possibly more.
Obviously, the longer we drink the more we damage our bodies and the longer it takes them to recover, if they ever do recover completely. However, the issue is not how long we have been drinking, nor for that matter even how much we drank. Rather it is whether or not our bodies had the opportunity to change in the ways that cause us to require alcohol in order to feel normal. Once we have reached that point, we are fully addicted.
It is not up to me to call you an addict or alcoholic, especially since I do not know you. But you described a series of events that conform to the pattern of a person who is addicted to alcohol, including the attempt to quit and the failure to remain abstinent.
You have shown that you were able to go “cold turkey” at least once without severe withdrawal symptoms. That does not mean that it will happen the next time. I suggest a medically-supervised detox, but that is entirely up to you. Be aware that alcohol detox, sans medication, can lead to severe seizures and/or blood pressure spikes that can be fatal. Ethically, I must mention that.
I also suggest inpatient treatment, but that may not be an option in your case. If it is, I would take advantage of it.
By whatever means, get to some AA meetings. We need the support of people who have been there and done that. Open up to them if you can. There are probably women’s meetings someplace in your area if you would feel more comfortable, but if you live in rural Canada you may have to settle for what you can get. When it comes to recovery, any AA is 100% better than none. If you will go to meetings and do as they suggest, and also follow the outline in the article, you will have an excellent chance of success in your search for sobriety.
Namasté
I have been off tramadol for 60 days I was taking 400mg for two years for abdo pain drs pxn before I realisd the tramadol was actually causing the abdo pain. I detoxed on a programme where I tapered methadone for 5 days then they sent me home–after I got home it was hell but I persevered. However 60 days later I still only sleep 3 nights ot of 4 have stomach cramps regularly feel tingly all over often and have restless legs most nights. It is consderably better than it was but I would really like to go back to feeling normal. Do you have any idea how long it will take? I have never taken any other drugs and take only buscopan occasionally for stomach cramps now. If I have a glass of wine or a coffee it seems to make it worse–is this possible? Your advice or experience would be much appreciated. Thank you.
Sixty days seems long to be having even sub-acute withdrawal from tramadol. Although several of the symptoms you have described are part of the normal withdrawal syndrome, they can also be indicators of other conditions, including diabetes.
I would suggest a complete workup and physical from a competent physician — not the one who kept you on an addictive drug that failed for two years to alleviate the symptoms it was prescribed for. If for some reason you cannot afford a full workup, at least get a good blood panel including a fasting blood sugar.
You’ve come a long way. Hang in there.
THANK YOU SO MUCH FOR TAKING THE TIME TO WRITE THIS ARTICLE AND THROW IT OUT TO THE PUBLIC! I will always rememeber reading this and you will be in my prayers of meditation and in the far future when I look back on how absurd drug addiction (not caring about it and just doing “sh@t”) truely is.
Many mandalas to you sir!
-Tim
And good luck and life to you, sir!
Namasté
I am an alcoholic and have been in recovery for 5 months (serious drinking for 20 years – 40yr old Female). I went to a 30 day inpatient facility and just finished my intensive outpatient therapy.
There are good days and bad days, then there are good weeks and bad weeks. I have an AA sponsor and attend 3 – 4 meetings a week.
I have been on the relapse threshold for the past few days. I know the mental part of relapse is as bad as the physical. I have not picked up but have been tempted to so I could escape. Escapism, one of the many ism’s in an addicts life.
Even with the education, treatment and the support system I have there are still many occasions where I feel like I am going crazy. Asking when will this obcession, craving STOP.
When I get like this I research, I read and get as much information as I can. I do not have the strength to start over if I relapsed, so relapse is not an option.
My point to this post is I am very well versed with PAWS and normally when I start having the symptoms I recognize it. I did not this time and was probably the closest to relapse I have been YET. I found this article, read it and was able to take a deep breath and sigh of relief. I am with the writer above where I did not get sober to be miserable. As long as I know or can some what can explain what is happening I can continue. I know with PAWS my brain chemistry is trying to restore itself from all of the years of abuse. This I can live with because I know that it is progress.
I thank you for this article as you have restored my sanilty for the moment. I can now use the old AA adage’s of this too will past and one day at a time.
This article is like the one sentence at a meeting that you hear out of all the words spoken that can get you through to another day. Thanks very much for this and the hope
and guidance you are sharing with those in need.
- Tammy
“The Power of the Mind can Defeat anything there is.”
I can’t tell you how much it pleases me to get this sort of comment. My wife, who is a detox therapist, also teaches PAWS and gets the same kinds of responses. Clearly, the insistence of some folks in the rooms that all you need is the Steps is misguided. Information is what scares away the bogyman, not some crochety old-timer like me.
Your note humbles me, and it is good for me to feel humble. It’s rare enough.
I’m an alcoholic/addict with 2 years sobriety, from a long line of alcoholics. I wish I had known about PAWS while I was going through it. My sponsor thought I had ADD and need medication. I just stayed close to my program worked my step etc. and made it through
. My question is about my oldest sister, age 62. While she is not an alcoholic addict in the classic sense, she does have all of the “isms” 20 years ago following a devastating divorce went on prozac, then an ever widening array of psych “meds” , getting farther and farther off the deep end. Last year her medicine cabinet was an addicts jackpot Long story short she decided to, medically supervised , wean off of all her prescriptions. Now at 9 months clean, she can’t sleep, can’t think, has anxiety attacks and now fears that she is bipolar. She is not mentally ill and 20 years ago as this nightmare began she had damn good reasons to be depressed. She had no tools to deal with her pain other than her doctor. The saddest thing about her story is that she is muddling through all of this virtually alone because she doesn’t see herself as an addict. So I guess what I want to ask is can prozac detox cause PAWS?
thanks
Terri K.
You have said that your sister’s medicine cabinet was an “addict’s jackpot,” and that she had to “wean herself” off all the prescriptions. To me, that indicates that she may be an addict experiencing PAWS. I don’t know that the Prozac even has to be considered in the mix, although there can certainly be a rebound from that, as well.
Her physical and neurolochemical balance has clearly been scrambled, and after 20 years of it, it is hard to say what her condition might be. One does not recover from 20 years of immersing their brain in drugs without some long-term problems, regardless of the source of the drugs and whether or not they were “legal.” If this were a member of my family, I would encourage her to see a doctor who is truly expert in addiction and psychopharmacology. They are not, unfortunately, thick on the ground. You might ask a few of your friends in the program if they know of anyone — just collect recommendations, and ignore the advice — and do a bit of research. Then all you can do is suggest a visit, and hope for the best.
It sounds as though she is ready for some help, but it is extremely important that she get the right kind. If she finds some doctor who is willing to accept her self-diagnoses, she could end up back on the same bandwagon.
I am 90 days sober, attend meetings twice a week, am 64 yrs old. I am using 2 – 1.5 mgs clonazipan daily to help my withdrawal. Am I substituting one drug for another? Or as my physician claims can I back off the clonaz easily by reducing dosage gradually. Thank You
First of all, Rod, let me say that there is no such thing as “backing off the clonaz easily.” Clonazepam is a powerful anticonvulsant, and the withdrawal syndrome can include life-threatening seizures, along with other less-serious issues. It is not recommended for use beyond nine weeks even as a seizure or panic disorder treatment without close monitoring, and is normally prescribed for alcohol detox for only a few days to get past the danger of seizures (and that is “off label” use).
You are far beyond the therapeutic use of the drug in alcohol detox.
Detox should be monitored by a physician with experience in detoxification from anticonvulsants. Try to find a doctor or nurse practitioner who is associated with a treatment center and familiar with the detox protocol for Klonopin.
As to your underlying question, that is not for me to say. My personal feeling is that at 90 days the exercise, fellowship, good diet, vitamins, blood sugar control and working the 12 steps should deal with the withdrawal. We can’t argue with success — you are 90 days sober. However, if I were your sponsor I would suggest getting off the tranquilizers cautiously but expeditiously. If for no other reason, should you have a medical emergency the Klonopin could complicate your other treatment.
Finally, congratulations! I too am 64, and enjoying wonderful health and a great life because of my 12-step program and the benefits it has given me. I spent my 45th birthday in treatment, so I’ve been sober for a while and I can tell you that it does keep getting better if you work a good program and let life happen.
Namasté
I received a response on my personal e mail today. It was helpful and I appreciate it. It’s perfectly OK to respond to me via the site here. It may help someone else.
Very nice information. Thanks for this.its great to see someone with a like mind.
I just found your blog on the google search engine and saw a few of your other posts that you had done . I just added you to my Google News Reader. Keep up the great work. i will Look forward to reading more from you again.
I have been off suboxone now for 45 days with no clinical observation and have believe I am going through PAWS for sure. I am 26 years old and come off other drugs, some like Klonipin were monitored while others like oxycontin were not. However none of these have caused the same long term withdrawl period or PAWS which I am experiencing now. I read the whole article and believe I need to change my diet. The part of hypoglycemia is especially intriging to me as I have noticed I feel far worse after eating to much sugar or drinking coffee (even worse when using both together, IE a white chocolate mocha from Starbucks).
What worried me is when you wrote, “We really need to get this thing under control! Hunger produces stress. Blood sugar swings produce stress. Stress aggravates PAWS and, as we have seen, is deadly when combined with hypoglycemia—which is caused by poor eating habits, especially by too much sugar and caffeine. Are we beginning to see a trend here?”
Exactly what do you mean by deadly here? I constantly worry about my health because of PAWS and when I read this my anxiety shot through the roof. Is it deadly because it could cause us to relapse or because the combination itself is deadly in some way?
Dear Chris,
The “deadly” remark was meant to be figurative (unless a person is diabetic, in which case it could be literal over time). And of course relapse can be deadly as well.
You are the first person to bring the possible confusion to my attention, and I thank you for that. I will change it forthwith. If you misinterpreted it — or found it ambiguous — then others could as well. Thank you.
I hope you’re going to meetings and getting some support. It makes it much easier. However, if you are having emotional swings related to sugar and stimulants, I can almost guarantee that following the protocol I outlined will also alleviate a lot of your stress.
Remember two things: relapse=stress=relapse, and that stress is not always from unpleasant things. One of the most stressful things, for example, is getting married. When things get exciting, we need to be especially on our guard. New relationships are another pitfall, because they are not only stressful, they tend to make us defocus from our recovery priorities.
Thanks so much for writing. I will change that wording instantly.
I’m a physician, 25 months into recovery from alcohol addiction. I would like to pass on my congratulations to you for a well written, understandable, explanation of post acute withdrawal syndrome, and your well thought out responses to the questions or comments made by people visiting the site.
This has been one of the most useful site I’ve come across in my web searching of sites on addictions.
Dear Dr. Karen,
Thank you so much for your kind remarks.
I journal, and have done so for many years. Thus I have not only my own memories and those of my close supports, but my jottings to jog my memory. When I was writing PAWS as a handout for a lecture series (and, again, I must give Terry Gorski credit for much of the basics), I tried to address the things that had puzzled me and caused me trouble in my own recovery — as well as the issues I had seen confronted by people in the treatment centers where I worked. It seems to be useful to some folks, and is by far the most-read bit of material on this and my other sites.
Congratulations on your own recovery. I’m sure it is difficult for a physician to face her own infirmities, and it takes a lot of guts to admit a problem and address it as you have done. I hope that you allow it to illuminate your practice, when you return to it, and that you will become one of those rare creatures that I refer to so often in the comments above: a physician who understands both the reality and the most effective protocols for treating addiction.
Regards,
Bill
Great artical, I am going to show this to my Dr. I am currently on Subutex and xanax, I want off, but find it almost impossible to get off of the subutex. I was dependent on pain meds for a short time, under 6months and now have been on subutex for over 2 years. Was put on the xanax the last time, I tried to free myself from subutex. Its an awful drug to get off of.
Thanks for the great info,
C
Dear Clever,
Please assure your doctor that, despite my frequent comments about most doctors not knowing enough about addiction and detox, I emphatically do not have it in for GP’s and other family physicians. My own dear personal GP doesn’t know squat about it, admits it, and listens to me when I explain to him why certain courses of treatment are not options for me.
Addiction is as complex a field as any of the other neurosciences. No one can be expected to understand everything about medicine, and much of the confusion with family practitioners is the fault of pharmaceutical companies that are more interested in leading them down the garden path than in providing them with good, solid information about the medications they are being peddled. A physician who is seeing twenty or more patients a day cannot be expected to deal with all their aches, pains and misconceptions and at the same time stay up-to-the-minute about every area in the field of medicine.
Physicians receive, for practical purposes, no training in addiction while in medical school. Even psychiatric residencies are way behind the curve in treatment theory and protocols. The fact is, no one who is not devoting the lion’s share of her practice to addiction study and treatment is able to stay on top of the field. In a way, it is amazing that so many do as well as they do.
Best wishes to you, and to your doctor, and the best possible luck (and skill) in your recovery…
Bill
I was prescribed Vicodin and then Morphine sulfate. When that no longer worked for my degenerative knee. I became allergic to the Morphine late August of this year. My doctor who had been treating me reduced the Morphine from 30 mil a day to 15 without telling me I would go into withdrawal. I ended up in the hospital emergency twice within a few days and they treated me like a leper.
Finally I was put on Methadone after Fentanyl caused an allergic reaction as well.
I think my doctor intended me to stay on Methadone, but I looked it up and decided to taper off . I went from 30 mil of Methadone to 2.5 mil by December 26. From November to December 26 I could not taper any lower. That was my last day on Methadone. As others have mentioned I felt better shortly after I stopped taking it. Here I am 4 months and two weeks later and I am so much worse. I don’t know how much of what I am experiencing is
chemical damage or covered up arthritis pain. So much of my pain seems to be linked somehow to my gut,
I no longer have insurance. My doctor all most killed me and they are all so protective of each other at the HMO I had, This has been a eye opener about our medical system.
Right now I am going to a medical clinic to have my blood pressure checked as I have HBP. The doctor there prescribed Doxepin for my chronic pain. Are you saying I should not be taking this? This is the problem people with chronic pain face, What do we do about our very real conditions ?
Thanks,
Mary
Dear Mary,
Doxepin is a weak analgesic when taken internally. In this country it is FDA approved only as an antidepressant, although in many countries it is used for a variety of purposes, including local analgesia when in cream form. I am a bit surprised that it is being prescribed for chronic pain. It could, however, help with depression associated with the pain.
I am not a medical doctor, and I try not to say that people “should” or “shouldn’t” do particular things. (We call that “shoulding all over someone”…or ourselves. I try to share my own experience, which includes a fairly broad background both in personal recovery and in the recovery field.
Pain management is a tricky issue. There is no question that pain can so degrade quality of life that you might was well be on drugs. I would never suggest that any person’s therapy should be discontinued, although I might — and often do — suggest that they consider changing it. As you have seen for yourself, drugs carry with them their own quality of life and health issues.
Happily, yours is neither an uncommon issue nor an irresolvable one. There are a broad variety of pain relievers available that are highly effective and non-narcotic. Most doctors, unfortunately, are not familiar with them.
Check arouond your area for the names of physicians who work with drug detox and rehab organizations. These are the guys who are likely to know their non-narcotic stuff. Speak with a couple of pharmacists, and see if they will inform you a bit about prescription non-narcotic pain relievers that have little or no potential for addiction.
Check the forums and internet sites for further leads, as you are obviously doing alread. However, beware of people with The Answer. Honest people will not claim that they know what is right for someone they haven’t met.
I wish I could be of more help, but it would be unethical of me to make suggestions, as I know practically nothing about you.
Regarding money issues, believe me when I say that I feel that pain! There may be local or county assistance available through the health department or your local mental health services. Try checking with any publicly-operated programs to see if they can provide any assistance or direction.
Finally, although I know this may run against the grain, hit a couple of AA and NA meetings and talk about your problems. They will be sympathetic — which is nice — and your local recovering community can be both a powerful support and source of information.
You are doing the right thing. Keep on keepin’ on.
Bill
I succumbed to the Madison-Avenue hyperbole spewed by a storefront Suboxone-peddling physician. This doc assured me that my years of opiate abuse/dependency would dissipate in a mere two weeks with this wonder drug. Granted, while on Suboxone I felt wonderfully well; afterwards, however, my spirits crumbled as I began to feel worse than I had during the peak of cold-turkey withdrawal. Of course, he dutifully advised me that I was experiencing PAWS – and for an additional $800 in cash I could enjoy another two to four weeks of Subox. I gallantly and charmingly declined.
My relapse was all but inevitable. Eights months later (after a literal drive-by intervention) I entered a medical detox facility and then was assigned to an intensive outpatient program three times per week, three hours per day for 24 sessions – attached thereafter to a one-year aftercare program. This process has been life-changing for me. And right now we are “working” on the skills and strategies to understand and soberly cope with PAWS. Who woulda thunk? The group’s facilitator is an LADC who focuses a huge amount of therapy time on helping her clients understand PAWS and its propensity for leading to relapse. Not only does she make us dig deeply to uncover our original motives for “using,” she guides us and prompts us to do the work necessary to cope during recovery.
There is hope out there. To all who now suffer, understand the pain – instead of trying to cover it. In so doing, you improve greatly the chances that your tomorrows will be improvements upon your “today.” Indeed, this, too, shall pass.
My Most Positive Thoughts to All –
Dan
Dear Dan,
Thanks so much for your well-written and pointed comment. The Suboxone racket is the biggest scam to hit the recovery world since Methadone, or worse, because just any licensed physician can prescribe it, with no expertise at all. Both can produce nearly miraculous results when used properly — Suboxone the better choice — but as they are being purveyed (I almost used another word beginning with “p”) they do the vast majority of their recipients a gross disservice. Put simply, there is no…NO…substitute for education and skilled therapy, or at least a support group.
With your permission I would love to post this on the front page. Please get back to me if that’s OK, with caveats, if any.
And congratulations on both your good sense and your recovery.
Bill
Bill -
You most certainly may use my comments – excerpted or in their entirety. Your message is vital to those of us who have encountered speed bumps on the Recovery Highway!
All The Best -
Dan in Las Vegas
[...] on the Post Acute Withdrawal Syndrome article I wrote some time ago. You can read the article here. I so liked the way he expressed himself on the issue of store-front detox docs, that I asked if I [...]
[...] [...]