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Post-Acute Withdrawal Syndrome

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.


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.


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.


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.


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.


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.


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.


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 Choose My Plate page is a good place to begin.


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 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 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 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.


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.


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.

711 thoughts on “PAWS

  1. I just passed 6 months of alcohol sobriety. I used to drink 600-750ml of vodka every day. I’m depressed alot. Anxiety is high off and on. I feel like a zombie with no real emotions. I’m tired of feeling this way…thought I’d start a conversation here and/or get feedback. Thank you!

    • Hi Jeff,

      Depression and anxiety are definitely on the menu for a lot of folks in early recovery, and are a normal symptom of PAWS. They suck, but they do go away eventually. You can enhance the speed in several ways. First of all, I’d suggest paying close attention to the steps in the article. Nutrition, exercise and rest are vital components of our bodies’ work to recover. Second would come meetings and fellowship — lots of phone numbers and reaching out to others in recovery. Third, if these things don’t help noticeably, would be to ask your physician to put you on an antidepressant temporarily. ADs do not affect your recovery (in a negative way), and there is no sense in being miserable unnecessarily. You may find that you want to remain on them, or cease them after you have a year or so under your belt.

      REMEMBER two things about antidepressants: They should NEVER be stopped cold turkey, but tapered with the advice of a physician; and they often take several weeks to have a noticeable effect. I don’t know how many people I’ve talked to over the years who have taken antidepressants for a couple of weeks — even days — and then hopped on to a different one (or stopped altogether) because they “don’t work for me.” Well, duh! Of course not.

      As addicts and alcoholics we are accustomed to “fast, fast, fast relief,” as the old Alka-Seltzer commercials used to say. It doesn’t work that way for us, any more than for others who suffer from chronic diseases. Do your best, hang in there, and

      Keep on keepin’ on!


  2. Hi,

    I think I am going through this since I quit drinking after 7 years. For some reason i cannot stop looking things up and it sometimes makes me feel alot better and sometimes it doesn’t

    My doctor prescribed citalopram for what I am going through and I did my first dose last night. Im on 20 mg and I feel anxious and weird, slightly panicky.

    My brain keeps wanting to tell me its something far worse than this. Its been 3 weeks since I quit drinking, I relapsed last saturday with a couple beers so I guess its been 5 days since I quit drinking altogether. I thought I was making progress and felt like I hate the feeling of this and decided I would just drink moderately. What happened to me was worse than I ever thought possible. Deep anxiety that caused depression and panic attacks.

    For some reason I feel better as nightfall hits but I feel the worse during the day (right now). I’m just hoping this clears up

    Oh and I’ve been exercising, trying to eat when I can and going to church and talking to lots of people including a pastor, therapist and recovery from alcohol counselor,

    It does not seem to be working, I’m tired of feeling like this but I know this will take time, I wish I could just fall asleep for months and be okay.

    Any suggestions?

    • Hi Conroy,

      I’d like to tell you things are going to get better, so I will. Things will get better.

      Unfortunately, although improvement is guaranteed, rapid improvement isn’t. Everyone’s body chemistry is a bit different, but early post-acute withdrawal stinks for everyone — and the fact is, you’re barely into PAWS because you’re hardly over your acute withdrawal.

      As alcoholics, we spent years training our brains to need alcohol and whatever other “help” in order to feel normal. We simply don’t get over those effects that quickly — which makes perfect sense when you think about it that way. But, being addicts, we’re used to rapid relief. If we felt withdrawal coming on, we used. If we were uncomfortable, we had a drink or a drug. We drank because the dog ran away, and we drank to celebrate his return. In every case, the results were felt within a few minutes. Now, however, we aren’t medicating the discomfort, yet our brains are telling us that we ought to be doing something to make ourselves comfortable. Obviously we can do that, but…

      The citalopram (Celexa) is a selective serotonin reuptake inhibitor (SSRI) that will not harm your recovery. It should be of considerable help, but it can take quite some time (up to several weeks) to reach its full effect, so

        don’t give up on it

      . You can learn more about it here: As with all antidepressants, it SHOULD NOT BE DISCONTINUED WITHOUT MEDICAL SUPERVISION, even if you have only been taking it for a short time.

      Meetings, lots of phone numbers to call for support, and an organized routine including some FUN will be of help, as well. We are natural emotional hermits, even if we were the life of the party, so make yourself go to meetings and find some supports, even if you don’t want to. Remember that your decision-making got you to where you are today. It’s time to consider suggestions verrry carefully!

      Please stay in touch, and

      Keep on keepin’ on!


      • Thanks for the reply,

        Tried the Celexa for 2 doses and wow it made things so bad I ended up in the ER. Everyone is telling me that I can get over this without medication and that I’m strong enough to, the only thing is that I don’t feel like that at all especially when I feel like it.

        Well needless to say they took me off the citalopram and put me on a low dose sedative Hydroxyzine and gave me 1mg Attivan incase I get a severe panic attack. I refuse to take the Attivan because I feel like its just going to make things worse and its a benzo. They tried to admit me to a hospital because of suicidal thoughts, but they are honestly intrusive thoughts and nothing more, which are horrible by the way.

        This all started from a bad marijuana trip, which then caused me to re-evaluate my life and caused me to quit alcohol. I’ve been losing a ton of weight as well and can hardly eat which I think is making things worse. I don’t know at times I feel fine then at times I feel like I’m going to lose it.

        I do have a wide support line and am trying to exercise and relax when I can but it seems so distant day to day, I guess I just want to wake up one day and breathe out and say,ahh I feel normal again.

        Thanks for all the advice.

  3. Hi

    I have had a heavy 8 – 9 year cannabis and tobacco habit with some moderate drinking thrown in. At the beginning of 2014 was starting to cause panic attacks and what I would seem to be symptoms of psychosis. The side effects were too much and I had to quit once and for all.

    Anyway I quit cannabis/tobacco (and tea/coffee btw) December 22nd 2014 so a little over 7.5 months. Still drink beer a bit but not much, and nothing compared to my friends ( I am in the UK )

    I have read some of your explanations below explaining the PAWS associated with Cannabis but I just wanted to get your opinion on what I am experiencing. It’s a quite a intense anxiety/depression which hit at the end of January and has not really lifted. It’s gotten a bit better since a couple of months ago when I started at the gym 3/4 times a week, but the strange thing is it feels like it’s part of me now. That and that I have foolishly stunted my emotional growth over the years.

    My main concern is that I used to be a sharp/quick person (many years ago of course I am coming up to my 29th Birthday in September) but the brain fog, fatigue, stress, anger, social anxiety, not being able to find words and keep up with conversations is really the worst part especially in a demanding job like mine. All this has just shattered my confidence.

    Would you have any advise on this? I think it could be a double whammy from the tobacco and cannabis? Does this increase recovery time or just make it worse?

    Any advice or help you can offer is much appreciated,



    • Hi JTAW,

      Most likely the issue is the cannabis, combined with the fact that you are still drinking. It is difficult to recover (if not impossible) when our brains are still being unnaturally stimulated, even if to a limited degree. It has been long enough that the smoking cessation is probably not a major problem, although it could be supporting the depression to a degree, since your brain was used to high levels of serotonin.

      The post-acute withdrawal from cannabis is most likely the major problem. THC withdrawal is a prolonged process that can take a couple of years. It will get better with good self-care, but you still have a pretty long row to hoe.

      I strongly suggest that you see a physician about getting on an antidepressant. She might consider buproprion, since it is a selective serotonin re-take inhibitor (SSRI) and should increase serotonin levels by reducing the speed at which it is re-absorbed in the brain.

      Antidepressants work in a different way from drugs of abuse, and will not affect your recovery. They can either be discontinued later (with a doctor’s assistance) or continued, depending on need. Never attempt to withdraw from an antidepressant of any kind without a doctor’s assistance, as rapid cessation can kick you into profound depression on the rebound. You also need to be aware that AD’s often take up to two months to “kick in,” so you need to get on them and then give them time to work. Sometimes you will get a partial effect more or less immediately, and sometimes not. Most of the “didn’t work for me” reports come from addicts who thing a pill or pint will immediately cure all discomfort. Brain recovery doesn’t work that way.

      Get off the beer, see a physician about the antidepressant, and please stay in touch. And remember to

      Keep on keepin’ on!


      • Needless to say, you need to be going to meetings and developing a support group. It is extremely difficult to recover and change our lives in a healthy direction without support from folk who have been there and know what it’s like and how we addicts think. BW

  4. And I forgot to mention I was smoking Probobly 3-10 times a day

  5. Hi I smoked marijuana everyday for 15 years from about 14-29 years old. A year and a half ago I had a panic attack one day while recalling a childhood mistake I made when I was 11. I smoked on and off for the next 6 months after that not knowing that weed was the issue or this memory. Anyways it’s been 8 months now not smoking. At first the anxiety and depression were stronger but really up and down, sometimes minute to minute. Seems now I’m good for 2 weeks and able to control my negative thoughts then the next 2 weeks I’m down again. The lows do seem to be a little bit better, hard to notice when you’re in the moment though. I’ve seen a few therapists and talked to them about my paws and this memory I was having (which I gathered the nerve to apologize for recently) everyone tells me it’s ok to forgive myself and ride out the withdrawal. Easier said then done. When I feel good I’m able to see the Finnish line and feel some hope that one day I’ll feel better. When I’m in the low period it is very hard To have any hope that I’ll ever feel like my old happy self again. I recently got married and have my first child on the way I a few months and it concerns me that I’m not going to be able to be the best person I can be for them. I know 8 months doesn’t seem like a long time considering I’ve smoked for 15 years. Also I didn’t realize that drinking brings you back to square one. I don’t excessively drink but socially I have a few beers with friends or family or a glass of wine with dinner. I’d hate to think I just through the last 8 months away. Not smoking for me is the easy part, dealing with the symptoms is tough.

    • Hi AJ, and congratulations on your 8 months off cannabis!

      The reasons we suggest abstinence from mood-altering substances are twofold. (1) The brain does need to recover and to normalize itself. (2) Everyone uses for a reason – most of the time to keep from feeling things. Even people who drink or smoke to “relax” are self-medicated by their own admission. It’s far better to remain abstinent, discover the discomfort, and then search out and correct the issues that cause it than to continue to turn off our feelings – in whatever way. That’s the real focus of recovery that makes it possible to improve our lives: not the using, but the reasons we use.

      Generally speaking, if we think we’ve got a problem, then we’re right. But just stopping the drug doesn’t change things. As an early sponsor of mine used to say, “When I got sober, things didn’t get better right away, but they sure got REAL!”

      As far as the PAWS goes, it’s unfortunately the case that THC has one of the longest post-acute withdrawals, sometimes even exceeding methadone and Suboxone. It sounds like you’re pretty typical in that regard. You can expect things to continue to improve – slowly – but it may take a couple of years to get things stabilized. In the meantime, I’d suggest abstinence from ALL potentially addictive substances, and I’d see my physician about getting on a mild antidepressant (NOT an anti-anxiety med) to help out over the next few months. AD’s won’t affect your recovery, and there’s no point in being more miserable than you have to.

      Remember these two things about antidepressants: (1) They usually take several weeks to have their effects, so give them a chance to work; and (2) Never go off an AD cold turkey. They must be tapered under a physician’s guidance in order to avoid a rebound into what can prove to be severe depression.

      Please stay in touch, and

      Keep on keepin’ on!


  6. Hi,
    Thank you for the advice. I think a part of me knew Rehab is where I need to go. There is one not far from my house, and I guess they have a fifteen day program and a twenty eight day—I’m thinking the twenty eight would be best. I’ve been taking the Percocet for four years, the Ritalin for about three.

    • Do some due diligence. All rehabs are not created equal. Google reviews and try to find some from off the site itself. There are many good treatment facilities, but unfortunately many are primarily interested in bringing in insurance revenue. is another resource for information.

      • Bill,
        Thank you! I have been looking and reading reviews, its like 50/50,some say the place saved their life and others say the place was horrible. So,yes I will do some in-depth research and I’ll go to the website you suggested.
        I have been feeling little better,I was able to shower today at least and I’ll be going to the grocery store and buying some whole foods. Again, I want to thank you for your help.

  7. I stopped using Percocet and Ritalin ten days ago. I feel like I haven’t any energy,and don’t want to see anyone or go anywhere. I read all the things you wrote about recovery, I just don’t know how to even get started when I don’t feel like moving, eating or seeing anyone. I also am crying a lot.

    • Hi Theresa,

      That must have been a miserable 10 days. Stopping cold turkey from both a stimulant and a depressant is a recipe for depression — with exactly the symptoms you describe.

      I strongly suggest that you see a physician who understands addiction and get on an antidepressant. Then start hitting meetings — or start the meetings before, if possible.

      I understand that you may be leery of taking any additional medications at this time. However, none of the antidepressants (as opposed to anti-anxiety drugs, which are usually benzodiazepines) will affect your recovery, and they can be slowly tapered off a few months down the road if necessary. Be aware that they can take up to 6 weeks to reach their full effect, so give them a chance. And never stop any AD cold turkey. It’s extremely dangerous.

      I should also note that some people in AA and NA will tell you that you shouldn’t take AD’s. Frankly, they’re full of crap, and shouldn’t pontificate about things they don’t understand.

      Congratulations on your 10 days and 100 nights, and

      Keep on keepin’ on!


      • Hi Bill,
        I’m already taking Cymbalta 60mg daily and wellbutrin 150mg 2x a day. And,I still find the way I’m feeling. Do I somehow force myself to get up and eat and exercise? I haven’t left the house since June 23rd,I don’t think I could go to any meeting right now.
        maybe I would be better off checking in to a rehab facility. What do you think?

        • I would always recommend someone going to treatment if circumstances permit. Not only is there the advantage of the experts to help diagnose the situation, but there is the companionship and fellowship of other addicts who also are trying to get well. Also, in my opinion, group therapy is always…or almost always…equal to, or better than, individual therapy. We are social animals, and as such our groups tend to be more than the sum of their parts.

          Whatever your choice, good luck, and

          Keep on keepin’on!


          • Hi There,

            Does it matter that I was taking the Percocet as prescribed for chronic pain due to injuries?  The Ritalin,however, even though prescribed I don’t think I have the legitimate reason for taking it outside of trying to counter act the Percocet making me tired. I’ve never bought either one of the substances on the street. I’m not sure that makes a difference or not. I could go to a rehab facility or to pain management doctor or both, perhaps…
            Hi There,

            Does it matter that I was taking the Percocet as prescribed for chronic pain due to injuries?  The Ritalin,however, even though prescribed I don’t think I have the legitimate reason for taking it outside of trying to counter act the Percocet making me tired. I’ve never bought either one of the substances on the street. I’m not sure that makes a difference or not. I could go to a rehab facility or to pain management doctor or both, perhaps…

            • Drugs are drugs, and withdrawal is withdrawal. Your body doesn’t care why you took them or where you got them. By all means, choose treatment. Pain management docs don’t have the knowledge to treat addicts. That’s fact, not opinion.

            • Rehab for sure. Pain management docs don’t have the knowledge to treat addicts.

  8. Pingback: Day 177 PAWS | Super Sober

  9. I’ve been fighting through alcohol-related PAWS for a while. I was astonished to learn that any amount of alcohol can cause a “reset” of the recovery period, since I had been successfully having a drink or two on holidays and special occassions without any urge to drink more. But it never failed that the PAWS symptoms (mood swings, memory loss, etc.) would ratchet up, big time, the very next day. So now I don’t touch alcohol at all. But I have a concern. I often drink Kombucha-style drinks for their gut health benefits. I was disheartened to see recently that they contain trace amounts of alcohol. Is that small amount enough to reset the PAWS clock?

    • It’s hard to say, Bob. Trace amounts (an ambiguous term) could be up to 0.5%, according to labeling guidelines, and that could vary depending on the means of manufacture, etc. Beyond that, a “trace amount” might be a problem for one person, but not another. Length of sobriety could be an issue as well. Personally, I avoid anything that I know contains alcohol — a little head game I play with myself to stay honest, but clearly I’m going to ingest some, since it’s common in many foods in small amounts — bread, for instance.

      Why not treat your gut with some of the many other means available, like lactobacillus acidophilus caps? And does your gut need treatment? How do you know? Just some things to consider. I have no definite answer, but my own instinct is always to err on the side of caution.

      Keep on keepin’ on!


  10. Hi Bill.
    I stopped smoking MJ after 20 years of thinking my once a night relaxant was doing me no harm.
    I also stopped smoking tobacco and drinking coffee
    For 6 weeks I was fine, then it all came crashing down.
    I certainly had suffered anxiety, jerks, twitches, a few headaches and the inability to find words but the most concerning thing is that even after 12 months my fingers shake when put in extended positions, they feel weak, sometimes they ache.
    some times I overshoot with the mouse. I went to see a neurologist and he said I shave some neurological symptoms, but I don’t have anything he can identify. so in other words he dosent know.
    Ive had some bloods and urine tests, I have very low iodine but thyroid is OK.
    I’ve recently ( 3 days ago) had a minor relapse and I have some tremor in my core.
    I was fine before I quit so I guess this is just paws. What I want to know is I hear people talking about twitches and shaking , but at 6 months ?
    Or could it be something else?

    • Hi Paul,

      First of all, you must understand that it’s impossible to diagnose someone from an email, and in any case I wouldn’t be qualified to do so. However…

      Cannabis is one of the longer post-acute syndromes, and symptoms at six months are not unusual. In extreme cases they can last for up to two years. If a complete neurological workup didn’t find anything, PAWS is an excellent bet. Read the section in the article about controlling symptoms and stick to it. Hopefully, things will get progressively better.

      And the next time you hear someone extolling the virtues of “harmless” pot, you have my permission to laugh at them and tell them they don’t know what they’re talking about. ;-)

      Keep on keepin’ on,


  11. Hey Bill,

    In 2009 I quit smoking cigarettes, weed and worst of all, kicked a 1-2 pill most days of the week pain meds habit that went on for years. It was hell. Having a solid bowel movement was impossible for months. Yet somehow, I prevailed and stayed sober aside from having a few beers the first few months once in a while. I can’t say I ever felt “normal again,” but I came close to it in 2012 for a while to where I could have a beer every now and then, and even though that was dumb of me, I was pretty much normal at that point.

    Then, in late 2012, my mother passed away. I stayed sober and dealt with it until one day in March 2013, I decided to smoke some pot again to relax. Bad idea.

    I got hooked weed again from March 2013 until August 2014, daily, and smoked almost all throughout the days and evening when I felt like it. Additionally, I chose to drink a few beers 3-4 times a week, or at times I decided to drink some premium 70 proof Vokda instead. I quit drinking cold turkey in early-mid October 2014, and as I said, quit smoking pot about 2 months earlier. I am here for reassurance, I guess. I’ve never taken a pill again or smoked cigs since 2009, but my relapse on weed and then alcohol for that 17 months I think is still giving me PAWS, even though I never got blackout drunk or overly excessive. I am 38 years old. The good news? I went to the doctor in Nov. 2014 and had routine bloodwork done which the docs said was normal. In early January, I went to the ER because I got the typical panic attack with a strong adrenaline rush, etc., and they admitted me overnight, took bloodwork again and X-Rays, and even gave me a stress test with an echocardiogram that I passed the next day.

    The panic attacks are the worst part. In January in the ER, they forced me (aside from shoving it down my throat) to take one Xanax pill, which was the smallest dose they had (0.25 mg). I was pretty upset they did, as I told them about my history, but since that night, I haven’t touched a Xanax even though they sent me home with nine of them. I have had several panic attacks since then, which I strongly, strongly believe happened because my body and mind are still in long-term recovery. I function fine in my job, but my nerves feel kind of jittery or off still a lot of times, my heart will occasionally race, but I’ve been through ALL the tests now several times other than perhaps a thyroid test from my doctor.

    So I have been clean from alcohol for 5 months now, and clean from pot for about 6 1/2 months. I’ve had moments where I worry I have MS because I get benign muscle twitches in my legs and arms sometimes that come and go, and have even resorted to seeing a holictic psychologist for 5 weeks now, which seems to have reduced my anxiety/panic symptoms some. I am very anti-meds, and would love reassurance this is all just still PAWS. I finally have some “normal” days where I feel like myself again, but the other half of the week can be pretty random. I am guessing it’s just the dopamine and serotonin levels evening out since I used smaller amounts of weed and alcohol daily over an extended period of time, especially given my prior bout with PAWS in 2009 after quitting pills.

    I’ve come to the conclusion I just depressed my nervous system too long and it is waking up, slowly but surely. Does this sound about right, even 5 or 6 months later? My symptoms seem so random, varied and odd this time. They are similar to what I went through in 2009, only they seem to be more neurological in nature, or psychological? I even get what feels like an occasional icy sensation in my arms. My blood pressure and height and weight are normal, I’m 5-9 and 160 pounds. I don’t get the urge to smoke pot again, but I have dreams about it a lot and occasionally feel like my mind wants to trick me into having a beer to calm my nerves again, which I won’t do because I know it can set me back. I still am livid at the ER docs for giving me that ONE Xanax pill 2- 2 1/2 months ago to calm me down in the ER too.

    Sorry for the rant, but any reassurance you can give me that this sounds like PAWS still would be great. I feel good so to speak, aside from the occasional neurological minor symptoms. The worry of anxiety attacks that are pretty strong are the only thing I feel are keeping me from fully being “healed” again, to be honest. The tips people give to stop them help, but how can I get past them without meds? There seems to be no specific trigger for why or when they occur. I even had one sitting on the couch totally out of the blue! Thanks Bill, I know I will probably be sitting here 6 months from now feeling great again, but geez, this sucks sometimes!

    • Hi Tim,

      Your symptoms are typical of post-acute withdrawal from THC and its metabolites. Contrary to popular legend, we do become addicted to cannabis, and the withdrawal — while mild — is real. The PAWS is a different matter. It’s usually prolonged, and pretty much as you’ve described it. The heavier the use over a prolonged period, the more severe the symptoms as a general rule.

      The good news is, you will continue to feel better as time passes. You might consider asking your physician to put you on an SSRI antidepressant temporarily. A/Ds DO NOT affect your recovery, and the gain in comfort usually even enhances it, as we’re able to function better both at work and in our program activities. While I applaud your desire to remain off meds, this may be a case of too much virtue. We used drugs to mess up our heads, and there’s nothing wrong with using carefully-chosen ones to help them get back on track.

      Two things to remember: Antidepressants can take up to 6 weeks to have a noticeable effect (although not always), and they should be tapered according to a doctor-approved protocol to avoid a rebound effect that could lead to major depressive episodes.

      Don’t worry about the Xanax. The single small dose didn’t hurt anything. If you’d taken that much daily for a bit, it would be a different matter.

      Hope things go well for you.

      Keep on keepin’ on!


  12. Hello! Loved reading the post and just beginning to learns about PAWS. I am 17, and have experimented with several different drugs, MDMA, amphetamines, hallucinogenics, but mainly heavy use (3-4x daily) of cannabis from June-December.
    Around the end of November, I took a tab of supposed acid and smoked a large amount that set off my first ever panic attack. Had no clue what it was, having no anxiety EVER before, which landed me up going to immediate care.
    Recovered from that, had some rebound anxiety, quit smoking for a couple of days after. Smoked couple of times after and I would have severe anxiety after so around mid December I quit smoking. I guess you could say I had depression/anxiety during, but not unbearable.
    Around mid-January, I slipped up and took 40mg Percocet and 1mg? Xanax at night, woke up next morning puking my brains out, railing migraine, etc. and I was physically sick a week before this. This set off about 5 days of pure psychosis, lost 10lbs, slept maybe 2hrs. each night, dissociation from life,
    it was by far the most difficult event that I ever went through. After recovering, now about a month after the event I am better, but face severe mood swings going from just okay, to that life crashing down on you feeling. Bouts of insomnia, and consistent nausea are pretty consistent.
    After going to pysch sessions I REFUSE to take any benzos or anti-anxiety meds. After going to counselling, recently starting spin and yoga class, the ‘good’ periods ARE getting better between the bad and now it’s all about recovery. I’m curious- I didn’t deal with the severe depression, anxiety, insomnia, nausea, lack of foucs etc.
    after my first month of quitting, but maybe the opiate/benzo mix set off something? Also, what are your guys thoughts on anti-depressants (which pysch wanted to give)? I just don’t know how I feel about more drugs in my system…any advice would be greatly appreciated.
    Good luck to everyone!

    • Hi Chris,

      Put simply, benzos bad, antidepressants good. Benzodiazepines effect changes in the brain similar to other abusable drugs, and the withdrawal and PAWS is brutal! They should NEVER be given for more than 6 weeks, but most doctors don’t know that or don’t believe it, preferring to believe the drug companies — who do not have our best interests at heart.

      A/Ds, on the other hand, work in different portions of the brain and do not affect recovery. Generally speaking they enhance it, by making it possible to function more effectively in everyday life and in our recovery programs. As I mentioned in the previous letter, there are two things to remember: Antidepressants can take up to 6 weeks to have a noticeable effect (although not always), and they should be tapered according to a doctor-approved protocol to avoid a rebound effect that could lead to major depressive episodes.

      Sounds as though you’re coming through this thing, slowly but surely. Follow the suggestions in the PAWS article, and

      Keep on keepin’ on!


    • I have been sober for 15 years now. I was wondering if anyone else is starting to have memory problems. Not short term mostly but remembering what I learned in collage, technical details of which at one time I was an expert, now I get confused. I don’t want to use again but I am getting worried and a bit scared. I also have been getting muscle cramps all over my body and they hurt. Anyone? I only take blood pressure meds and colesterol drugs. (misspelled) I still do the steps but I put jesus into most of my recovery

      • Hi Scott,

        You didn’t say how old you are, or what drugs you’re taking. It’s possible that your blood pressure meds are causing a mineral deficiency if they’re diuretics. Calcium and Potassium deficiencies, in particular, can cause cramps. There are also some anti-cholesterol drugs that can cause muscle weakness and fatigue. You should consult with your physician, and also research the possible side effects of your medications online. Mayo Clinic and Cleveland Clinic are good sources, as well as

        As far as the memory loss goes, I don’t know what to tell you. Your drinking shouldn’t be a factor with so many years off the sauce. If you are taking other drugs besides those you mentioned, it’s possible that it could be related. Also, keep in mind that our memories do tend to become less precise as we get older. Most people notice it in their 40’s, and by the time you get to 70, like me, you learn to say”Okay Google” a lot and laugh at it. Again, this is something to discuss with your physician. She might want you to consult with a neurologist to rule out any chronic condition.

        Congratulations on your fifteen years. That’s a real accomplishment! Stay in touch, and

        Keep on keepin’ on!


  13. Thanks for the article. I have a question about one part of your post. in the article you write: ” 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.” From a scientific standpoint, what it the process that wipes out all improvement? To be clear, this question is pure curiosity and does not consider what an actual return to drinking might entail for an addict. I have seen evidence that a brief return to alcoholic drinking will wipe out the gains as the alcohol binge once again marks brain cells to die while also preventing the generation of new cells. But I have not seen evidence that, for example, 2 beers every 60 days would wipe out the benefits.

    • Obviously there are lower limits to the statement, but I don’t know what they are and I rarely split hairs. Too many risks. For example: if one of those beers triggers a relapse, it’s guaranteed to reset not only your PAWS but your acute withdrawal as well.

    • After re-reading your letter, I see that I missed a point or two. 1) alcohol doesn’t mark brain cells to die, although acute alcoholism can damage the “white matter” in the brain and mess up the connections. 2) The mechanism is re-activation of the neural changes that lead to addiction in general, not just alcoholism, principally in the reward center.

      • Thanks for the reply. I agree in both practical and risk management terms, abstinence is the best plan.I was sloppy with my writing. In a return to alcoholic drinking, in research, chemicals used to identify/mark cell death will again show a pattern of cell death. From one article: “Neurodegeneration, particularly dark-cell degeneration, a necrotic form of cell death marked by shrinking of the cell body (i.e., soma) (Obernier et al. 2002a), occurs during intoxication. During alcohol intoxication, markers of neuronal death increase progressively, with multiple brain regions showing increasing damage the more time is spent intoxicated.”

        Anyway, there probably is a lower limit, but why risk it. Also, I have seen that those who return to moderate or interim drinking display poorer results in cognitive testing than those who remain abstinent.

  14. Again thank you for the reply, much appreciated.

    I think I should be clearer though. I believe I have been suffering from paws for so long because I kept relapsing on alcohol and codeine through those years and my brain never got the chance to recover. I have really been clean from drugs and alcohol since April 2014, so only 8 months in. The only drugs I take are antidepressants. Additionally I drink a lot of caffiene which I’ll stop very soon as am cutting down.

    Thank you again.


    • Hi Luke,

      AHA! The mystery is solved! Since you can’t have PAWS without being sober for a while, you can understand my confusion. Going on and off the wagon can definitely make you miserable for a long time. You are quite right: you kept setting yourself back to square one each time you relapsed. Congratulations on your 8 months clean and sober!

      How long have you been off the benzos and Ritalin? Post-acute detox from benzodiazepines can be prolonged and brutal, and coming off Ritalin can throw you into depression. I’d say the Wellbutrin is a good choice, unless it makes you jittery and/or activates the OCD too uncomfortably. Methylphenidate detox can also have a rebound effect, and increase the effects of ADHD which, as you know, is sometimes exhibited as OCD behavior.

      Your physician might consider sertraline (Zoloft) instead of the burproprion, since the latter seems to make you uncomfortable. However, DO NOT STOP TAKING THE WELLBUTRIN without starting another antidepressant. The rebound effect could throw you into deep depression.

      Finally, expect change. It is impossible to accurately diagnose psych disorders until a person has been clean and sober for several months. Until then, we can only treat the symptoms. As your body and brain recover from their over-exposure to mood-altering chemicals, many of your issues may either change for the better or disappear entirely. In the meantime, work your recovery program and be assured that the longer you stay clean the better things will get, although it make take some time. We altered our brains for years, and it takes quite a while for them to make the necessary repairs. We addicts want what we want, and we want it NOW! Life ain’t like that, nor is recovery.

      Good luck, and

      Keep on keepin’ on!


  15. Dear bill.

    Thank you so much for the earlier response. Much appreciated.

    My p doc doesn’t know anything about paws and in addition to the valporate has also put me on wellbutrin (zyban in the uk). I feel worse paws wise on this med ocd thoughts worse atm. My question is, do you think with all your experience that wellbutrin is either good or bad for paws in general.l? I was an alcoholic for a few years plus abused Ritalin and benzos. Thank you in advance. I have degenerative paws and it is constant.

    P.s. your website has helped me enormously as before I didn’t know what was wrong with me.

    • Dear Luke,

      Wellbutrin should not have a deleterious effect on your recovery. As I mentioned previously, PAWS does not last for “a number of” years, and there is no such thing as “degenerative PAWS.” Whatever your issues, if your symptoms are getting worse and you have had them for more than 18-24 months, you are not suffering from PAWS. If, however, you have been off the benzodiazepines for less than a year, you might be experiencing post-acute withdrawal from them — perhaps complicated by the Ritalin. (That’s merely a guess.) Benzo PAWS can be prolonged and is pretty nasty…but, again, should improve over time.

      I strongly encourage you to see a neurologist or psychiatrist. Something else is going on, and your personal physician is clearly in over his head.

      Keep on keepin’ on!


  16. Hello.

    I have been experiencing paws for a number of years. The cognitive issues poor memory and terrible depression and anxiety. My p doc finally gave me a mood stabalizer sodium valorate. I drank for about 3 years heavily mostly spirits. Do you think that a mood stabalizer might interfere with recovery from paws? Thank you

    • Dear Luke,

      PAWS rarely lasts more than 18 months to two years. Clearly there is more to your issue if you have experienced the symptoms for “a number of years.” I am not qualified to comment on the possible causes. However, if the medication you are on doesn’t help, I’d suggest seeing a specialist.

      Sodium valproate is a common mood stabilizer, and should not affect your recovery in any negative way.

      Keep on keepin’ on!


  17. Hi Bill, i’m new here i am 2 months into my paws, i have had it before many times but i never knew what it was before i came to this website so thank you for giving me my sanity back, i have cannabis related paws i am 25 and have smoked weed pretty much constantly day and night for 10 years on and off. I have been misdiagnosed with depression and anxiety in the past and have been put on citalopram for it, it made my life hell for the 2 months after the 3 week initial phase in more ways than i ever thought possible, so i stopped, i did stop completely without slowing down my doses which i didnt know not to do, but i think that made things worse. Like i have said i have had paws before and have been down this road before so i know its going to go on for a long time yet. I made a new friend recently and he was an alcoholic who had to be weaned off and hospitalised, put on a lot of drugs and by the sounds of it went through hell, i have been lucky enough to be able to talk to him about his recovery, he said to me that he had a very foggy head and the doctors gave him beta blockers and it has helped. My foggy head is the main problem in my life and it drives me to anger and a deep sense of disconnection with the world and everyone on it, would beta blockers help me? I eat properly and exercise regularly ( i am a gardener by trade). I realised this is the old substance abuse talking, wanting a quick fix, but it’s really driving me crazy, I have started reading like i have never done before, but i cant remember anything i’ve read, i cant really remember anything at all to be honest, i live day to day like this and its horrible, i have some patience however, will my memory come back to me one day? It seems i remember what year it is never the month and certainly not the day of the week, i was due for a full brain scan but i had to move so it didn’t happen in the end, i’m a bit lost and as hard as i try i cant explain this to anyone i’ve met apart from my new friend everyone just looks at me like i’m a hypochondriac or just plain lying. I have always hated to burden people with my problems, even in school i would never ask for help, so i am sorry for laying this at your door, you have helped your fair share already, i think i have read every single one of the posts and the website now so i have a fair idea of what i have yet to face, in the last 2 months i have stopped smoking tobacco, weed and stopped drinking alcohol could this be making the paws worse by stopping all drugs? I hope you can make sense of my scattered thoughts. But for now ill do what i can and just take each day at a time in this zombie like state :)

    Thanks George

    • Hi George,

      Sorry to take so long to get back to you. My wife broke her leg and her being unable to drive (we both work) plus my “real” job just ate up the past few days. This is the first chance I’ve had to get to the site.

      I’ve never heard of beta blockers having an effect on PAWS, either good or bad. I suspect your friend may be experiencing some placebo effect — but don’t tell him! If it’s helping, it’s helping. In any case, recommending a drug that is normally used for cardiovascular problems is so far outside my area of knowledge that I’d never suggest it. Beta blockers are exceedingly powerful drugs, with some complicating side effects. It’s best to stay away from them for “off-label” use.

      One thing you can do is try using electronic cigarettes to get some nicotine back into your system. The PAWS syndromes of both alcohol and (especially) cannabis involve serotonin depletion. Nicotine is a serotonin stimulant, and quitting at the same time as early stage PAWS is not generally a good idea. HOWEVER, if you have been successful in quitting, see your doctor about trying an SSRI (selective serotonin reuptake inhibitor) for a while. Bupropion might be a possibility. However, let your doctor be the judge.

      In any case, as you have surmised, PAWS will be a long, drawn-out process. Keep in mind that if you drink or use cannabis or any other mood-altering substance, you are looking at a near-100% chance of cross-addiction, and any appreciable use will set your PAWS back to day one. It took you years to get your brain accustomed to better living through chemistry, and it is going to take some time — thankfully, not as long — for it to get used to being back to normal. PAWS is the result of that process.

      Meetings, fellowship and trying to have some fun are essential to helping the process, as well.

      Please stay in touch, and let me know how things are going.

      Oh, and

      Keep on keepin’ on!


      • Hi Bill, it’s been a while and i’ve been clean of the cigarettes and cannabis since i last messaged. I recently went to the doctors again about my foggy head and memory etc and she has taken my bloods, it turns out i have a low thyroid so that might explain some of the symptoms, i’ve yet to be medicated for that, but ill let you all know what happens when i am. Thanks for your support and i hope your wife’s leg is better by now!

        • Hi George,

          Good to hear from you. Michele’s leg is all healed up and just fine. Thanks for asking.

          I can’t recall how long you’ve been clean, but keep in mind that the effects of cannabis can hang on for quite a while. Hopefully your physician will be able to help by treating your thyroid, but even if that doesn’t prove a cure-all, there is still hope. Time takes time.

          Keep on keepin’ on!


    • Make sure you are getting plenty of water. Stopping cramps are often as simple as cutting out some coffee and drinking more water

  18. Bill,

    Thank you so much for this. I have started and aborted treatment so many times until I learned about the nutritional aspect. My single biggest trigger was low blood sugar, either the crash after an insulin spike, or more often, the slow grind that occurs from not eating for 8 hours or more. Also of note is the cortisol response from sustained periods of not eating.

    I would encourage you to look at the amount of research done on epilepsy and ketogenic diets (not talking Atkins here, a lot more balanced and incorporating medium chain triglycerides). The brain seems to perform significantly better when utilizing ketones for energy. Exitotoxixity plays a huge part in PAWS as well as TBI’s and possibly Alzheimer’s and epilepsy. Without glucose you don’t have excitotoxicity.

    Going this route helped me tremendously, though if you do you have to be committed to abstinence (and thus treatment) as alcohol’s negative effects are magnified in ketosis.

  19. Thanks for your reply bill, correct that…drinking caused a massive reduction in my sexdrive, but getting sober it has completely disappeared?
    Only a few years ago when I was only a weekend drinker my sexdrive was typically high for someone my age, then the past 2 years I was drinking heavily everyday (8 to 10 drinks a day) and with that my libido lowered a lot, that I believe was because heavy drinking lowers testosterone levels in the body, (I lost body hair, no morning erections, got a beer belly, man boobs lol) but I kept on drinking thinking once I stop everything will get back to normal…but 5 and a half months sober there are no changes?
    If its unlikely to be related to PAWS then I might get my doctor to check for low testosterone levels, I hope the drinking hasn’t caused any permanent damage to my body! YIKES!
    Thanks again,

  20. Hi bill, I’m now 5 and a half months sober, I’m in my late twenties, feeling ok, other days I feel the effects of PAWS with the muddled up thinking, fatigue, anxiety but these days are getting fewer as the months go by, but I still have quite an embarrassing problem since getting sober….

    My sexdrive has simply disappeared!? It was OK when I was drinking but now it is always very low? Being only in my twenties I am worried this might be a permanent change, can the lack of libido be related to PAWS? If so how long should I expect to wait for it to return?

    Thanks in advance,

    • Hi Simon,

      Congratulations on your 5-1/2 months! The worst is over. Glad you’re feeling somewhat better. Based on your description, you’re right on schedule.

      Regarding sex drive: I don’t have any definite information for you. It’s possible that PAWS could be affecting it, but most unlikely unless you are pretty depressed. My guess would be that there are other issues. Could it be that sex was easy when you were drinking because of lowered inhibitions, etc., but that you are less stimulated now because you are no longer impaired? This sort of thing is often due to sexual trauma — or, in some cases, simple shyness. Did you have any trauma in your childhood or adolescence — not necessarily abuse, but perhaps something that could have made you excessively self-conscious about your sexuality? If you have a regular partner, is it possible that you find it difficult to relate now that you’re not drinking? Has ALL your sexual experience been when you were drinking? If so, you may need some practice relating to the attractive gender when you’re sober.

      I would talk to a therapist about this. It’s not necessarily a big deal overall, but it’s the kind of thing that feeds on itself, and your worrying about it could make it worse. A professional can help you sort out any issues you may have in a non-threatening environment, and can help you determine if there’s a psychological issue (fairly likely) or a medical one (less likely, but always possible of course).

      Hope things work out for you.

      Keep on keepin’ on,


    • Simon- What you’re going through is related to the dopamine levels in your brain rebalancing. My guess is that you feel kind of flat, not quite as energetic as normal, maybe some sleep problems, and your man has a “dead” feeling to it. This is all dopamine. The excessive addiction jacked your dopamine levels for years and now without artificial stimulus your feel kind of blah and have no sex drive. This will go away, although it does take time. Best things for recovery are low sugar diets, lots of exercise, and staying away from things that artificially raise dopamine levels like porn, video games, coffee, etc. This will take time to work, but it will, fear not. And by time I mean 3-9 months. Just an FYI. Stay strong and you’ll feel better than you ever have!

      • That is certainly a possibility, but most likely it is over-simplification of a more complex issue. It’s fairly unusual for people in early recovery not to be horny. Most people know intuitively that sex is one of the most powerful natural boosters of dopamine and other “feel good” neurotransmitters, and will seek it out when dopamine-deprived.

  21. Hi Bill, thank you so much for this article I really needed to read this. My name is Lloyd , and I’m a 30 year old Australian male. I am going through this big time. This is the umpteenth time of trying to get clean and sober (3 months so far) but I’m feeling anxious, irritable and tired all the time as well as going to univversity.Night time is the worst cos my head just won’t stop racing and my head feels bizarre like there are holes in my brain. The thought of drinking is appealing but the horror of what will happen to me if I do is greater than that desire. Still I feel like I’ve screwed my brain up big time. Thank you for this article thought.

    • Hi Lloyd,

      Sorry to take so long to get back to you. It sounds like typical PAWS to me, and it will get better if you don’t use. If you do, you’re right back to ground zero again. You know the drill. Don’t use, go to meetings, get a sponsor, get phone numbers, make at least three program calls a day, and get cracking on the steps. If you haven’t been doing those things, you can expect to relapse.

      What you’re going through is pretty typical of people in post-acute withdrawal. I’m not pooh-poohing it, by any means, but others have survived, and so can you. As I said, it will get better if you remain abstinent. It will also be worse the next time, and the time after that, if you don’t. Best to quit while you’re ahead (and while you still have one).

      Please stay in touch, and

      Keep on keepin’ on!


      • Hello Bill:  You couldn’t possible remember me…but I was on Xanax for 30 years and stopped cold turkey.  Three years out…I am still suffering.  And I am resigned that I will never recover.  I will always suffer from poor sleep, memory loss and chronic gnawing headaches.

        Anyway, my question is… can I use OTC melatonin as a sleep aid…or will this just trigger a set back…

        Thank you for your help with this and all of the great work you are doing.




        • Hi Brian,
          Melatonin has absolutely no effect on addiction and is frequently given to patients in rehab. Also, avoiding the light from electronic media – TV, computer, phone screens, etc. – should help. Recent research shows that all of them interfere with the Melatonin cycle if used within 2 hours of bedtime.

  22. Hi Bill,

    Just wanted to check in and say I am doing better. Been sober pretty much now since November and the sleeping has gotten better. I’ve learned a lot about doing social activities without drinking and home life has transformed from having to incorporate alcohol on a daily basis for both my wife and I to something we are now pretty much fine without. I’ve lost over 50lbs and running has become a big part of my life again, something I missed. Anyway I just wanted to say hi and let you know that since stumbling across your site in a pretty dark time for me I am doing better. Still more to work on, but doing better.

  23. Thanks for your reply bill, I don’t feel depressed, I walk my dog 2 times a day, I enjoy walking. Its not so much my mood but rather tiredness, i dont want to do anything because that takes effort, call it :) I once quit alcohol for 6 weeks last year and had the same symptoms, but as soon as I drank that night, rather than being hungover the next morning, I was full of energy! Ever symptom I had disappeared! Its like alcohol was my energy source,now I am sober I’ve had the wind knocked out of my sails, the slow muddled thinking, the general feeling of malaise etc?

    • Hi again, Mark,

      Just going by the symptoms you reported. Glad you’re not feeling down along with everything else. All I can tell you is that it will get better. Share about how you’re feeling at meetings, keep up the walking — at least a half hour of brisk walking every day or so — and hang in there.

      Have a great day, and … well, you know…


  24. Hi bill, I’m in my late twenties, almost 4 months sober from alcohol, I used to drink 6-8 beers 3 times week for 8 years, then the past 2 years it has been 8 beers everyday. I am yet to feel good sober, I’m tired a lot of the time, unmotivated, sleep a lot, dull headed, no interests in anything, sex drive has disappeared, feel like a zombie most of the time, foggy headed, I’m worried because I am yet to even have a good day sober, I feel like I did in the first month!

    Does this sound like PAWS? When should I expect to see improvements?


    • Hi Mark,

      It sounds like you’re rather depressed. This could be because of PAWS, or because of some condition that arose and was masked by the alcohol. In either case, an antidepressant might be helpful. Antidepressants are not addictive drugs — although they MUST be tapered when quitting — and they will not interfere with your recovery regardless of what anyone in AA tells you. They can only make you feel better, which should enhance your recovery. With regard to PAWS in general, the symptoms should begin to abate gradually, usually in periods of “better” followed by “not so good,” with the better days predominating as time goes by.

      Whether or not you choose to talk to a knowledgeable physician about your depression, the best antidote is exercise. Walking a couple of miles a day is invaluable in recovery. Avoid heavy exercise like bodybuilding, unless you are already in shape. Your brain and body are healing, and you don’t need to add further stress to your system.

      Please stay in touch, and

      Keep on keepin’ on!


  25. I am currently 7 days sober after a bout with alcohol that lasted almost 10 years. Prior to that, it was a marijuana addiction that lasted 8 years. I switched from weed to alcohol and became dependent on alcohol. I wasn’t a heavy daily drinker-Maybe about 1-3 beers or liquor drinks during the week and some weekends I would get a little heavy. I never realized how bad this was impacting me. I am fairly athletic and I run and bike almost daily. I see that you say to stay away from heavy exercise. Is this making my “brain fog” and severe panic attacks worse? I currently have a Dr.’s appt scheduled to make sure I am not going crazy, but my symptoms match this article to perfection! Is there anything that you can tell me about exercise? I just want to get better. THis brain fog, stress, anxiety, inability to solve problems, is making we worried and driving me insane. I am ready for it to go away for good!

    • Hi Chris,

      Congratulations on your week clean and sober. The fact is, you’re experiencing the tail-end of your acute withdrawal. PAWS hasn’t started yet. The symptoms will be similar, but not usually as bad, and they will get better over time.

      The amount you drank doesn’t really matter. The point is that your brain and body got accustomed to the stimulation of the alcohol, and it will take several months to repair and return to normal. Your chances of a relatively comfortable recovery will be much enhanced if you start going to AA meetings and get the support and guidance of people who have been where you are and who can support you.

      DO NOT let the doctor give you benzodiazepines! (Ativan, Xanax, Klonipin, and similar drugs) They will stop your recovery dead in its tracks, and are highly addictive in their own right. The symptoms you are feeling right now are fairly normal, but if you physician thinks you need medication, check it out with an addiction specialist. You might suggest gabapentin to him or her. It has some antianxiety effects, and might help with some of the nerve pain. However, if you start taking it, you must taper it when you decide to stop. Your doctor can help you with that, or there is information on the Web about how to go about it. Do not stop cold turkey. That said, it might be a good choice for a month or so.

      Regarding the exercise: if you are already in shape and accustomed to it, I’d continue — but reduce the intensity by about a third and keep things that way until your PAWS symptoms have mostly disappeared. Avoid anaerobic work and any other exercise that will break down muscle. Your body needs its resources to repair the damage from the drinking, and you don’t need to add muscle breakdown to the list of chores it has to perform. Lessened intensity will keep you in shape without slowing your recovery.

      Again, meetings and developing a support group are of extreme importance. The clinical term for people who try to recover on their own is “relapsed”.

      Please stay in touch, and

      Keep on keepin’ on!


  26. Hey M! Yes when I first quit I started going to meetings. I knew it would be ‘a good thing’ and being sober would suck at first. Of course I had no clue how Much it would suck these first several months or why! I also had no clue how Important meetings could be. Do it. You will even start to look forward to them. I promise.
    As far as ‘being found out’ I understand, but I’ll bet you’re a sh*t load more worried about it than anyone that you might tell. As far as exercising goes once you start it’s so much easier! I’d have no problem chatting as we move forward. Good Luck! (

  27. Bill,
    I am currently 7 months sober from alcohol and seem to be dealing with PAWS mainly brain fog and
    Anxiety which all started 9 days after quitting drinking….btw I was a 6-8 beer drinker every night and 10-12 on
    The weekends for 3 or 4 years straight…without knowing about PAWS I took Xanax for the anxiety but the last
    Time I took that was 4 months ago…it’s just frustrating as I have times of feeling great and then one day I’ll wake
    Up with brain fog and anxiety out of nowhere that’ll last a few days and then get better…I’ve been to doctors and
    Have had numerous blood tests, ekg, fasting blood sugar test, brain MRI, EEG all which were great. It just seems hard
    To believe alcohol causes this so much uncomfort for so long

    • Hi Robert,

      Believe it. You’re in the early to mid-stages of PAWS, and the Xanax is making it worse. However, the good days will become more prominent, with fewer bad ones. You can figure on this going on for another 12-18 months, but gradually lessening in intensity. Exercise, a good diet, some fun (and, of course, meetings) will make things go easier. Stay away from heavy exercise. Walking, bike riding and swimming are your best bets.

      Good luck, and

      Keep on keepin’ on!


    • Robert, I am suffering from withdrawal from benzodiazepines. The fact that you are taking xanax is the reason I am sharing this with you. I am almost 90 days clean and never realized what I would go through such a hard time with PAWS. Infact I never even knew what it was. I went to a rehab and they were baffled. I was only there for 30 days and came back home to get some support and more counseling. I feel completely broken. I have been on my prescription of benzo’s since I was 19 years old. I went to rehab because I finally got ill. I got paranoid from the meth, and other drugs. I would research getting off the xanax and what are the real problems that come with being on xanax. My story is awesome, and I will share more if you are curious.


  28. Hello Joel, I am wondering if you have gone to any meeting? I am complete fear of being found out! But on the other hand I keep wondering if I am acting like a dry drunk??? An I agree about being lazy I keep coming up with excuses of why I can’t get my ass moving. Biggest one i live in mass an snow is alway coming second I drive a car that can’t leave the driveway with even an inch of snow! I am going to say it to myself so you don’t have to!! Stop coming up with excuses!!!!
    Thanks for your help

  29. Hi Melyssa and well done!
    I have just gone past 100 days sober and can TOTALLY relate. I have worked out for many years, yet doing my weights every other day has never, ever been so difficult in my entire life. Shoot, getting out of Bed every day even seems to be a problem! I know for a fact that once i am up and active the lethargy wears off at some point. I also know for a fact that once i Start my exercise it is easy to keep on going, and that once i am done i feel sooo much better. I guess one reasoning that helps me out is the fact that if i could quit drinking and have stayed Sober (probably the hardest thing i have ever gone through) for this long…i sure as Hell can just exercise every other day. There’s no good reason not to other than me coming up with excuses…and that falls into the catagory of laziness :) Congratulations on Your sobriety – joel

  30. Hi Bill, I am 90days clean of methadone yesterday! I feel MUCH better than I did a month ago but I must admit the lack of energy has me a bit depressed. The idea of any kind of exercise has me crazy. When I here this could take up to a year or two to resolve makes me feel like 90 days is joke! I guess I need some support.
    Thanks for time

    • Hi Melyssa,

      Congrats on your 90 days and 360 nights!

      I’m getting ready to start a 30-day hiatus from the Internet, beginning with a trip out of town, so I haven’t much time to write. Methadone is a tough detox, and a tough PAWS. Obviously you can handle it. I hope you’re catching lots of NA meetings. That’s where you’ll get the support you need. If NA isn’t available, go to AA and say you have a desire to stop drinking. In any case, get some support from people who understand what you’re going through. It’s rough, but it does get better…and you never have to go through it again.

      Keep on keepin’ on!


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  32. Hello Bill! – Thank you very much for this forum and the time you have spent on here. I was struggling soon after deciding to become and STAY sober. It was only through googling that i discovered the PAWS phenomenon, and then i was actually somewhat relieved as things were making a little sense as far as what i was going through. The possible length of time is still daunting. So… I know for a fact that i started self medicating my loneliness with alcohol continuously (nightly, 8-10 beers/drinks) for several years. I remember being quite proud of myself when i became ‘just’ a weekend drinker. That was 9 years ago. Except for a couple weeks here and there it was Every weekend and sometimes spilling into the week if i had vacation days even. Since becoming single again a few years ago i realize it became a way of life for me. I knew on Mondays why my face was in the toilet and why i was wishing at times i were not alive…the poison. But it was not until the middle of this October that the weekly ‘day afters’ got bad enough for me to finally Accept that i needed to quit for good or else.
    That was 50 days ago. Went through the acute withdrawal phase, enjoyed my pink cloud even though i did not know that was just another phase, and WOW was i totally unprepared for this crap! Luckily when i decided to quit i had already::Talked to appropriate people at work, started going to AA, started seeing a therapist that deals in substance abuse. She was the first to explain PAWS to me. I eat a good diet, always have taken mutivitamins and work out plenty with weights. That’s been a stress reliever of mine forever, no way i’ll go from that to walking, although when it’s not too cold out i run twice a week. I have been on Lexapro for years (due to depression/anxiety, pretty much driven by my drinking of course) and started taking Campral a week ago. Was allowed Ambien before last weekend to use situationaly and that’s the only way i’ll use it. (Staying with family for XMas for instance). So…yesterday was the first day where i was aware anyways, of not either going through ups and downs (the downs always last longer and are real sucky. Anxiety, depression, dispair) or just being dowwwn. Seemed like a period of a couple hrs where there was nothing but anxiety…and that was a good thing! I’m aware everyone’s is different, i guess this is My PAWS and i’m looking for input. Thanks for doing what you do. Joel

    • Dear Joel,

      I’m SO sorry to have waited so long to answer. I made some changes in the site settings, and apparently turned off the comment notifications by accident. Mea maxima culpa!

      Congratulations on your (now) 73 days of abstinence from alcohol. The initial decision is the hardest, along with the first week. Then some are lucky to have the “pink cloud” as you did, and then the PAWS hits the fan. As you no doubt know by now, that’s the period when the brain normalizes from its exposure to alcohol and other drugs, and it can last for up to two years — although rarely that long. The good news: things do get better by fits and spurts, until the good days far outnumber the bad.

      Now for the bad news. Some medications can interfere with or prevent the brain from making those repairs, and Ambien (Zolpiden tartrate, a close relative of the benzodiazepines) is one of them. In addition to being highly addictive itself, it interferes with the repair of the GABA system, one of the prime factors in recovery from alcoholism. This is, unfortunately, true of all of the hypnotic (sleep-inducing) drugs that I know of. To put it simply, until those repairs have occurred, one is not out of the woods and, technically, not even recovering. I would also point out that using a drug “situationally” is problematic from a behavioral point of view. Your therapist should know these things, even if your doctor doesn’t.

      The best treatment for insomnia in recovery is a healthy, regular lifestyle, during which one goes to bed and arises at regular hours, avoids stimulants — especially caffeine — and puts up with the wakefulness until it finally goes away.

      I won’t be closely monitoring this site any more, so please check in over at if you have further questions.

      Hang in there, and

      Keep on keepin’ on!


  33. HI
    Heres my story
    Ive abused alcohol and drugs since I was 14 years old had a very rough childhood growing up in an alcoholic famlily. I have been clean off the drugs for 2 years because one night I did coke and was drinking alcohol and woke up had about 10 severe panic attacks thought I was going to die and was never the same since, I feel like im in a constant haze, easily irritated , vision is off , low energy, like im stuck in robotic mode and Im constipated ! . So then I ended up staying clean for a month from everything caused it scared me so bad and that didn’t solve anything so I resorted back to alcohol because I was so depressed and felt hopeless. Well now I have decided to totally quit everything have been 7 days sober of alcohol (and everything else still) . The last time I drank I had some weird symptoms the day after like smelling things that weren’t there , severe insomnia and just a weird scary feeling. I have seen neurologists have (had mri ct scan) , multiple doctors, general surgeon ( regarding my bowel incotence and am now going to see a cardiologist . My question is could this have something to do with PAWS even though I wasn’t sober at all before all this happened? I still have all those symptoms from the last night of cocaine use . No doctor can seem to tell me whats wrong. They say its all in my head.. :(

    • Hi Jessica,

      Congratulations on deciding to live the rest of your life, instead of just existing.

      I’d stay abstinent for more than a month, and see what happens. You are too close to your last consumption of alcohol for any accurate diagnoses of your symptoms. You need to give them at least a couple of more months, and then if they aren’t abating at all, continue with the medical investigations. In the meantime, an antidepressant wouldn’t be a bad idea. It won’t interfere with your recovery, and may help some of the other issues.

      The doctors are right…it is all in your head. That’s where addiction happens. Your brain is adjusting to many years of abnormal stimulation, and what you are feeling is a sort of rebound effect while your neurological system repairs itself and returns to normal. It takes time. Go to meetings, watch your intake of caffeine and sugar, get moderate exercise — a walk around a mall every couple of days is good, if the weather outside won’t permit it — follow the guidelines for nutrition as outlined in the PAWS article, and just wait it out. Time takes time.

      It will get better. Us addicts are used to quick fixes, but the body doesn’t work that way on its own. Hang in there, and

      Keep on keepin’ on!


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  35. I am 3 months sober and the insomnia is driving me nuts. I can usually get to sleep at my regular bed time but then I wake up exactly 2 hours later with major anxiety and restlessness. Then I lay awake until about 4am and usually go to sleep hard until the alarm goes off at 7. My doctors suggested sleeping aid medications and exercise. I elected to just exercise more to start. As an example I ran 6 miles today and lifted weights and here I am in the same boat -awake again after 2 hrs sleep. Any suggestions?

    • Hi New,

      Congrats on your three months clean! I can remember the insomnia thing. It’s common, but there are some things you can do.

      Try going to sleep an hour earlier if possible. If you waken, don’t lie in bed. Get up, have a snack, read something boring or write in your journal. As soon as you begin to feel drowsy (and you will, eventually) get back in bed and relax.

      It is quite likely that your exercising is interfering with your recovery. We recommend light aerobic exercise for people in the first year of sobriety. I know that you may be desirous of the “hit” that you get from exercising, but withdrawal from the burst of endorphins can create exactly the situation you are describing.

      Finally, be aware that things will settle down but that it is dependent on your developing a routine and sticking with it. Your brain is repairing itself from its over-stimulation from alcohol and/or other drugs. It takes up to two years for it to get completely back to normal.

      Don’t use, go to meetings, stay in touch, and

      Keep on keepin’ on!


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  37. Hello,

    It’s Welsey checking in. Still on the Lamictal 100mg.. feeling super depressed from it. Have a follow up soon. I’ve done a little more research on opiate withdraws and came across this.
    “The only relatively certain way to determine if permanent damage has been done to your brain – note, this may not be “damage” in the classical sense, such as that caused by glutamate excitotoxicity, but may instead be a situation where, always having been supplemented with exogenous mu-opioid agonist compounds, never began production of proper amounts of the endogenous opioid peptides, or, where in the same situation, the brain’s response to endogenous opioid compounds has been irreparably “dulled”, as is generally the case with people with a similar story to yours, or CCK* and BDNF** being overproduced – is to undergo a series of procedures including an accurate scan of the brain, such as a CPET scan. These will detect any physical abnormalities, which are positive indicators that something is not right, but will not detect neurochemical abnormalities or receptor abnormalities.”

    Read more:

    Should I get this scan done? I really do feel Opiates have fried my brain. I was perfectly normal before any of this. I’ve been off for 25 months now. I feel I am still going through some kind of PAWS, and I say this because I physically feel the brain changing in my head. I feel some kind of movement patterns and jolts. I feel like it is rewiring still. I feel the change in my head and I know when the worse is coming and then when the feeling of calm is coming… sort of hard to explain. I worked out 5 days a week and did not eat the best choices the first two years- I am wondering if this has delayed my recovery a bit, and I may need longer to recover. If you ask me if I am better now than I was two years ago, or even a year, I would say absolutely.. the hardest part is, when you started becoming more normal, you have that lingering effect of craziness still that does not mix will in your normal state. Feeling crazy in a crazy state makes more sense. As you get normal and something is lingering, you still question yourself.

    I am not sure if I agree with his approach to get on a maintenance plan. Is there something else that will jump start my dopamine a bit better? I don’t think serotonin is the problem

    • Hi Welsey,

      First of all, I am not a medical doctor. Even if I were, it would be unethical of me to contradict a physician’s suggestions in other than a general way without examining the patient. I have given you the best information that I’m able within my area of competence, and anything I might say from this point onward would simply confuse the issue, as it would involve guesswork. That is not what I do.

      It is quite possible that your recovery is taking longer than average. Each of us is different physiologically, and not only do we recover at different rates, we also perceive our recoveries in different ways.

      If you are physically feeling things occurring in your head, you need to speak with a neurologist. There are no pressure sensors in the interior of the brain, and it is possible that there is something occurring on the exterior. A neurologist can rule out anything threatening, and perhaps inform you further about these matters.

      I also suggest that you continue to work a good program of recovery, especially the steps and service work. It helps us to get out of ourselves, and becoming involved with others is one of the best ways to do that.

      Please be assured that I am not blowing you off. You are simply asking questions that I am not competent to answer, and it would be unethical of me to try.

      Regards, and

      Keep on keepin’ on!


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  39. Hello,

    I am still feeling terrible Bill. I was put on lamictal after 3 months of prozac that seemed to make me too wired. Nothing is working. This is my 3rd week on lamictal at 50mg. I never felt so worse in my life. i feel absolutely terrible. The worse depression I have ever felt in my life. When will I feel like me again? I never had any of this before I started using. I am doing what it takes to get well, but nothing is working. I wanna be put in a mental hospital to get well, but can’t afford it. I feel so bad.I hit my two year mark this week and still feel a lot of anxiety and depression. I worry and have racing thoughts. Nothing seems to help me.
    I feel the worse after a workout and after sex. I don’t feel relaxed after neither. I am not sure if I am bipolar, but I suppose trial and error will show that. My father is bipolar, but I feel I more so suffer from the anxiety portion of it all. I don’t get bad cyclings as I did a year ago, but I still don’t feel the old happy self again.

    • Wesley,

      It sounds to me like you need to settle on a medication that ameliorates your worst symptoms, stay away from steroids, since you seem to have reacted badly to them in the past, and tough it out until things get better. Every case of PAWS is different, and apart from that it is entirely possible that you have some other sort of issue that is either exaggerating PAWS or causing problems on its own.

      I’m not able to comment beyond generalities at a distance. It would be unethical. Generally speaking, PAWS lasts about two years or less. However, any number of things can produce similar symptoms, and possibly other things can prolong the syndrome itself. There is still a lot we don’t know. Find a knowledgeable physician that you trust, and follow suggestions. In the meantime, keep going to meetings, and

      Keep on keepin’ on!


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  42. Hi, I used oxycodone almost every day for about 3.5 years. The last year being the highest amounts used, around 300 mg a day. I am now 20 years old, and I got clean about 5 1/2 months ago. PAWS has been a real issue. and sometimes I question if it is really all PAWS or maybe something else wrong with me also. Over the months, On and off i’ll have extreme anxiety that will come and go throughout the day, and sometimes panic attacks. With this I’ve had a numb feeling in my head, like its filled up like a balloon. Well recently the past two weeks the stuffy head feeling has been going away, but I have extreme anxiety, and at least one panic attack a day. It was so bad that I had to stop working out for two weeks. Yes, I have worked out about 5 times a week these past 5 1/2 months. but had to stop. I just wonder if you know of panic attacks accompanied with a lack of cognitive function, really hard to think, being part of PAWS. Its been going on for about two weeks straight so I can only guess that I’m nearing the top of my PAWS. Hopefully that is. I would like to get back to the gym but can’t because it leads to a panic attack and it gets so hard to think I have to basically crawl out of the gym hoping I don’t die. Not fun.

    • Hi Steve,

      It sounds like your PAWS is proceeding according to schedule. Symptoms vary from person to person, but anxiety, cognitive issues, dysphoria and so on are not uncommon. Your dosage was plenty high enough to produce a full-blown course of PAWS.

      It seems like the main issue for you is anxiety and the panic attacks. It’s just as well that you’re not exercising heavily. Many opioid addicts take up working out as a substitute addiction. The endorphins work in the same receptor sites as the drugs did — or, more accurately, many opioids work on the endorphin sites. That’s why we normally suggest mild exercises like walking. It’s just as good for your health, and it doesn’t keep the endorphin cycle stirred up. Substitute addictions come in many forms.

      Regarding the anxiety and panic attacks, your best bet would be to talk to your physician about going on an antidepressant for a while. Antidepressants were developed to treat depression, but they also help people with anxiety disorders. Selective serotonin reuptake inhibitors such as fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), paroxetine (Paxil), and citalopram (Celexa) are commonly prescribed for panic disorder, OCD, PTSD, and social phobia. The serotonin-norephinephrine reuptake inhibitor venlafaxine (Effexor) is commonly used to treat Generalized Anxiety Disorder. The antidepressant bupropion (Wellbutrin) is also sometimes used. When treating anxiety disorders, antidepressants generally are started at low doses and increased over time.

      Antidepressants will not reactivate your addiction, and are not in themselves addictive, although they must be tapered when ceasing them to avoid a backlash of depression. They are one of the drugs that actually enhance your recovery.

      Please let me know how things are going, and lay off the heavy exercise for a while. As odd as it sounds, it really does complicate your recovery. A brisk one-hour walk is the way to go for the time being.

      Keep on keepin’ on,


      P.S. Don’t let them give you benzodiazepines (Ativan, Xanax, etc.) for the anxiety. Benzos will prevent your brain from recovering properly from the opioids, and there is a great danger of cross-addiction. If you think the PAWS associated with Oxycontin is unpleasant, you most assuredly don’t want to get addicted to benzodiazepines.

      • Bill,
        I am 3 weeks clean from addiction Norco 10mg dosed at 1 every 4 hours that was prescribed for knee issues for 9 years. Over the last year I was prescribed ambien and as tolerance increased I was taking 20mg a night to just sleep. I also prescribed celexa 20mg daily for shortness of breath/heavy chest.

        Anyhow, I went through a detox facility on Oct 18th to come off norco and ambien because I didn’t want to have to be medicated rest of my life. I had already almost tapered off celexa before date of detox. So essentually I would be med free once I left the facility. They weren’t very informative as I thought you go in for the 5 days and leave and just don’t use anymore. I found out that I was very wrong as I suffered the full brute of physical withdrawals for about 7 days after detox. During this time I visited my pain management Dr. who put me back on ambien at 10mg (half the dose of before) with a plan to slow taper over 6 months. She was concerned that the double withdrawal was too much to handle as I was having extreme PAWS. She also gave .01 chlonidine to take daily for as long as needed and advised that I start back the celexa 20mg for a while.

        I finally made it to 3 weeks after a 36 hour stay in ER where they gave me ativan to calm down the extreme panic attacks and suicidal thoughts of just wanting it to be over. That was about 6 days ago. Ever since then I have been falling asleep on my own around 10-11pm and waking up in mild panic attack around 12-12:30AM in which I take the 10mg of ambien and sleep until about 5AM in which I wake up in extreme panic attack, with racing thoughts that lasts until I get out of bed at 7AM to get my 4 year old ready for school. I am in a depressed mood swingthe rest of the day with occasional panic attacks up until the point of taking the chlonidine at around 10-11am which helps to slow me down but with it comes the dry mouth, chapped lips and lethargic feeling. I will deal with that at the expense of helping the panic attacks.
        Around 5PM I seem to become a different person. I am able to focus and calm my mind and actually relax. I feel my time with NA and reading (Bible, Book of AA), and spend a lot of time with my wife who is exceptionally supportive and has been managing our lives since I can’t function.

        My question is why do I seem to have such extreme cases of PAWS from 5AM-5PM and then it go away? I know the ambien will eventually be out of the picture with through slow taper to avoid another extreme withdrawal. I’m at my whits end and can really use some advice. I am to the point of going back to the Norco just to treat the PAWS but I can’t see that I’ve gone through all this hell for nothing. Will this ever get better?

        Thanks for your help.

  43. I’ve written a few post on this site over the past three years. my drug of choice is cannabis, lots of it. ive been smoking for 7 years now on and off. I typically binge for 3 months and stay clean for about 2-4 months.

    when I’m binging, i don’t have time to piss, i am taking smoke constantly straight to my face. my tolerane peaks at the tail end of my binges, and i can feel nothing but raw emotions. so i clean. what follows is a mess of a mind. i cant think very simple things through , my short-term memory is obliterated, i can’t follow a train of thought withforgetting what im thinking about getting confused. the list goes on. this is what causes me to relapse every individual time. i also deal with derealization every waking second of my exist

    i am terrified. i feel brain dead. to makingee matters worse, everybody believes there’s absolutely nothing wrong with me. i don’t exhibit blatant signs therefore my problems do not exist.

    this confines me to brutal mental
    isolation. the notion of perme

    • Hello Josh,

      You are a poster child for the Big Lie that cannabis is non-addictive and mostly harmless. I wish everyone who is preaching that line could read your letter.

      Unfortunately, you are also a perfect example of the devastation caused by PAWS. Your symptoms are typical for heavy cannabis users trying to get clean.

      Finally, you have explained clearly in your last paragraph why we addicts need NA or another program of recovery. “Earth People” simply do not understand what addiction is about. Even most of the pot smokers don’t. They have a couple of tokes once or twice a week, don’t think about it much the rest of the time, and can’t understand why some of us can’t do those things any more.

      Ideally, you need inpatient treatment. At the very least, you need to get with some people who have been where you are and understand the pressures you’re under. It takes an addict to understand another addict, and for those of us who are determined to get sober, it takes constant association with people who understand and who can give us tips on how they managed it. Practically no one gets sober without support. Some folks stop using, but there’s a big difference between that and living live in such a way, and learning the kinds of attitudes toward life that keep us from wanting to use.

      You can find an NA meeting at this website. Get involved. You’re going to have several months of PAWS to deal with, and you need people you can talk to about it. You will likely also find that you need to talk to a physician about some medical support to help you in the first few months. Check with a treatment center in your area for the names of some who specialize in addiction. Most general practitioners don’t know any more about it than the average layperson. It’s a different ballgame from prescribing pills for sore throats.

      Stay in touch, and

      Keep on keepin’on!


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  48. Thank you for getting back to me. Much appreciated. Over a year ago I left an abusive relationship. But as a result I suffered anxiety and severe panic attacks. My then doctor prescribed Citalopram, lyrica 600mg, diazipam and beta blockers. .plus I was taking the codeine and nytol. I managed to doc and came off everything but was put on sertraline. When I decided to stop the codeine I felt it only right to stop the sertraline otherwise I kinda felt I was cheating. Relapse is definitely not an option, therefore I need to find another way of coping. I think you might be rightand maymaybe I should go back on the sertraline. At least until the worst is over.

    • Hi again, Dawn,

      That doctor is clearly not acquainted with the proper use of drugs to treat anxiety. He was treating the symptoms, not the disease. Two things that came up after I posted this: (1) Zoloft is not an addictive drug, does not act on the brain in the same ways as addictive drugs, and is nothing to be concerned about as far as long-term use goes. ((2) My wife, who is clinical director of a large detox facility, suggests that the level of depression you are experiencing is probably in excess of what you should expect with PAWS, and that you should find a physician who can competently monitor your situation and medication on a long-term basis. Based on your statement in your last letter, I heartily concur.

      You should also get involved with a support group like NA or AA. Also, alcohol will have the same effects as any other drug, as discussed in my first response. If you want to recover, you need to be abstinent from it and all other mood-altering drugs. That’s why you need a competent physician who understands addiction.

      Please stay in touch, and

      Keep on keepin’ on!


  49. Hi there. .firstly thank you for the excellent write up! Very informative.
    I’ve been off codeine and stoppedsertraline cold turkey now 5 weeks. I’d been addicted for 6 years. I realise that I’ve come through the worst of the physical symptoms, however each day I find myself thinking” that’s another day down, maybe I’ll start feeling better tomorrow” The problem is I don’t. As each day passes I feel just as low, if not worse than the day before. The insomnia is terrible which isn’t helping as I’m so tired my days become unproductive, which in turn leads to guilt. Today is the worst so far. I feel emotionally void, tired, anxious and cravings are stronger than they ever were. I’m eating ok plus take vitamins including tyrosine ( think that’s what its called) I’ve tried staying active throughout this whole process. .in fact on day threei spent an hour on my hands n knees hoovering my room..normally a five minute job.

    My question is. .does p.a.w.s reach a peek..or as each day passes should I be feeling better? Today I even contemplated taking two co-codamol, just to ease things and help me relax and feel that feeling of contentment that I’ve not felt for a long time.

    • Hi Dawn,

      Your symptoms are typical for someone 5 weeks off an opioid drug. However, they are being exaggerated by having taken yourself off the sertraline. Depression is a normal part of post-acute withdrawal. It is also a normal part of coming off of an antidepressant, which is why they should be tapered off carefully over a long period if they are discontinued at all. Stopping any antidepressant “cold turkey” can cause life-threatening depression. You are getting an unnecessary double-whammy that threatens your mental health as well as your recovery from the drug.

      I would strongly suggest that you go back on the Zoloft, and stay there for at least the next few months. Your serotonin is so low at this point that the likelihood of your feeling better without it is low to nonexistent. We often suggest that people recovering from addiction use an antidepressant for a time until their brains have had a chance to recover somewhat. That can take up to a couple of years, and it’s a terribly long time to remain depressed. You have already been tempted to resume the use of your drug to get relief, which will put you right back in the same boat.

      PAWS normally reaches a peak at about two months sober, and tapers slowly after that as the body makes the necessary neurological repairs. It’s not possible to predict for an individual, as everyone’s brain chemistry is slightly different, as is their reaction to the drugs. The usual period for opioids is from one to two years, the bad days becoming interspersed with good days, fading in intensity and number with time. If you use, you reset the clock back to day one, and have to go through the misery again — if you get back into recovery at all, that is.

      Talk to your doctor about going back onto the sertraline (Zoloft), and check with an expert before deciding what medications you should be taking. You are fortunate that you didn’t fall into deep depression with suicidal thoughts. Keep in mind that it may take several weeks for any antidepressant to reach its full effect, so don’t give up on it before it has a chance to work.

      Feel free to ask any more questions. If you want to use the contact form at the top of the page, you can be a bit more frank if necessary, as those go direct to my email instead of this page.

      Good luck, and

      Keep on keepin’ on!


      Addendum: Two things that came up after I posted this: (1) Zoloft is not an addictive drug, does not act on the brain in the same ways as addictive drugs, and is nothing to be concerned about as far as long-term use goes. ((2) My wife, who is clinical director of a large detox facility, suggests that the level of depression you are experiencing is probably in excess of what you should expect with PAWS, and that you should find a physician who can competently monitor your situation and medication on a long-term basis.

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  51. I just have a question about PAWS. I have been clean for over 2 years and still have the urge to use when upset or certain times during the month. Everything in this article sounds like me. Is it possible that even years later I could have Paws? I’ve been diagnosed with other mental health issues. Maybe this is what is really wrong.

    • Hi Christine,

      As the immortal George Carlin was known to remark, “Just because the monkey is off your back, it doesn’t mean the circus has left town.” It is not unusual for recovering alcoholics and other addicts to have cravings farther into recovery than two years. That’s because there is a great deal more to recovery than simply staying clean.

      When we get right down to it, the major trigger for relapse is stress, because it activates some of the same biochemical systems that are involved in addiction. (That’s why some people become thrill junkies, or become addicted to chaos.) Recovery, in fact, is largely a matter of learning to live in ways that minimize stress, and when it is inevitable to deal with it in healthy ways, rather than turning it off with chemicals.

      There are other possible triggers: as you mentioned, pre-existing conditions — especially if we formerly self-medicated with alcohol or other drugs — can be an issue. Hormonal changes can have an effect, whether due to pregnancy, pre- or post-menopausal issues, or menstruation itself. Blood sugar fluctuations are a major issue for many people. Even today, almost 24 years sober from substances, getting too hungry can turn me into the same unreasonable bastard I was when I was boozed up; the difference being that I (a) am not rendered partially insane by the drugs and (b) know the signs and what to do about them. Conditions such as diabetes can exaggerate that problem, especially if a diabetic fails to follow the correct protocol for taking medication.

      I strongly suggest that you carefully read the section of the article on self-care, and follow all the suggestions. If you are doing that, working a good program of recovery in AA or NA, and continue to have periods of wanting to use, it would be a good idea to discuss it with whomever is helping you to deal with your mental health issues. I suspect, however, that if you will take good care of yourself you will find that the desire to use will be minimized. Remember that it is not our fault that we became addicted, but that we are very much responsible for our own recovery.

      As far as whether or not your problems are due to PAWS, it is really a moot point. The solution is the same. It is unusual for true post-acute withdrawal to last beyond two years, but it is not unheard of, especially in the case of benzodiazepines and opioid drugs — particularly methadone and suboxone if they were used for prolonged periods.

      I hope things go well for you. Please feel free to stay in touch via these comments or the contact link, and

      Keep on keepin’ on!


      • Thanks Bill for your respone,
        I did quit using methamphetamine on my own and never did the twelve steps. It wasn’t easy I just had to remove myself from the vicious circle of so called friends. I went through a lot of abuse and head games with the ex-boyfriend that used it to control me so i would think I was crazy, but I did outsmart him and realized I had to move forward. I got tired of living day to day using . I checked myself along with my daughter into a place for abused woman and families that i have to say that was the best choice i ever made for her and I. My therapist did diagnose me with bipolar, ADD and anxiety. when i get that urge to use I become very stressed cant think straight and rely on my Xanax for an escape. I would like a sponsor to vent to when i get like that instead of using another drug for my escape to replace the craving. I just dont understand why I still gets all the symptoms and why they would diagnose me with mental health issues after the fact. I forget everything half the time and dont comperhend the way I use to. Im also diabetic to top it off. I just want to feel normal again instead of always thinking poor me, poor me one minute and perfectly fine the next. i dont perfer to go to A/A nor N/A because of my anxiety, I think a sponser would benifit me alot, but dont know where to find one. Can you help

        • Hi Christy,

          The meth could be part of the problem. It really messes up your brain chemistry, and can take quite a long time to normalize.

          The bare fact of the matter is that you will not recover while you are on Xanax, which is a highly-addictive drug in its own right, and will keep your addiction going. Your symptoms are quite common for people addicted to benzodiazepines. You’ve switched drugs, but you’re not clean yet. If you were diagnosed less than four months off all drugs, the diagnosis is not accurate as to condition. It might correlate with the symptoms, but until the drugs are out of your system and your brain has begun recovery, there is no possible way for anyone to make an accurate diagnosis. I strongly suggest that you find a psychiatrist who works with a drug treatment center, is certified in addiction medicine, and who can prescribe an appropriate medication for your anxiety that will allow your recovery to begin.

          Ideally, you need an inpatient medical detox from the Xanax, as alprazolam withdrawal without support from medication can be problematic. At the very least you need to taper it slowly under medical supervision.

          At this point, you are not suffering from PAWS. You’re still on drugs, and your brain hasn’t begun the recovery process of which PAWS is a part. I understand that you don’t want to attend NA. I didn’t either. However, I know of no other place you can find a sponsor. I suggest you get clean, and then attend meetings even if they make you uncomfortable. As I stated before, the addiction is not your fault, but you — and only you — are responsible for your recovery.

          Hang in there, and get into some recovery!


          P.S. I know where you’re coming from on the Xanax. I detoxed from the alcohol in four days; the Xanax took nearly three weeks.

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  53. Hey Bill
    Thank you for responding. I have a question for you, I don’t have a lot of energy mentally or physically therefore I just want to stay home. Should I push myself ? Again I am 3 months off klonipin and ambien.

    • Yes. Try to spend some time having fun, even if you don’t feel like it. Walk a little. Take yourself to a movie, or better yet, go with a friend. The best way to get over PAWS is to live the way you’d like to live, not the way that the depression wants to live. Get plenty of rest too, but keep as active as you can without overdoing it.

  54. Is it normal after 3 months off klonipin and ambien to be experiencing paranoia and abnormal thoughts ? I try and focus my thoughts but it is difficult. I could really use some advise. When I read that it takes about 2 years to get back to normal it overwhelms me :(

    • Hi Lisa,

      Sorry to take so long to get back to you. Life happens.

      Yes, it’s perfectly normal. We spent years readjusting our brain chemistry with drugs, and it takes a while for it to repair itself. That’s the bad news.

      The good news is, it gets better slowly. You won’t have to put up with the same stuff forever. It takes a couple of years to get back to “normal,” (whatever that is), but the discomfort and other symptoms moderate gradually. I can’t tell you exactly how long it will take — it varies with individuals. However, I can absolutely guarantee that if you go back on drugs or drink, it will take one heckuva lot longer.

      Take care of yourself, and

      Keep on keepin’ on!


  55. Hi Bill
    Many thanks for your article on PAWS. I feel so much less insane after reading it.

    I am 51 days clean from a long history of intermittent but persistent marijuana addiction. I am now 45 years old. For last two years I got ridiculously hooked on the synthetic stuff and this is what I am cleaning up from today. Nasty nasty stuff and much like playing russian roulette but I don’t need to tell you that.

    I had been to the rooms about 3 years ago because I knew I was powerless over my addiction, but I didn’t (want to)understand the cunningness of my disease and knew nothing of PAWS and just strung days together, no steps, no sponsor, no intention of “becoming a groupie”. I hit ninety days I found the back door and ran…fast. More wasted time. Fast forward to present day, now I know what I am up against and I am grateful for this awareness and the program itself. That said, I feel impatient, frustrated and really quite annoyed that it will be such a long walk out of the woods. I stupidly still held the belief that I could stop…. and just move on. Yeah, right. Funny funny stuff.

    My belief in “this recovery” is that I used marijuana to self medicate (undiagnosed at the time) ADHD. Paradoxically self medicating, of course. I was the insecure kid with the brilliant mind (so they told me…not so brilliant now to be sure) and the utter inability to concentrate, plan, focus etc. Many of the PAWS symptoms are just who I am, before addiction, during addiction, and in recovery. I know I am not the lone ranger there, there would be many others who have been here before but I personally have not met them.

    My question to you is this: do you know anything about medicating ADHD in recovery, do you have experience or a view? I am not looking for a magic bullet, or an easy way out. All I know is that I am very confused. I had a four year holiday from drugs in my thirties while pregnant, breast-feeding and the like…. my focus and concentration did not improve even with extreme self care. The knock-on effect of this is of course anxiety, but the anxiety and poor self-esteem came from not being able to deliver. I understand the dragon, the question is now that I have named it, do I slay it? Or tame it. Or just jump in its back and enjoy the ride? Any insights are much much appreciated kind sir.

    Yours in recovery

    • Hi Carrie,

      Congratulations on finally deciding to call it quits. I had my 45th birthday in treatment, and a lot of other folks I know seem to have gotten clean (or begun to) at about the same age. I don’t know if that means anything except that I tend to hang out with older recovering people, but whatever… [Today’s word is non sequitur.]

      As it happens, my wife (with 23 years in recovery) also suffers from adult ADD. She has had good results from selective serotonin reuptake inhibitors (SSRI’s) for many years, most recently and longest from buproprion (Wellbutrin). What we need to avoid, as addicts, are drugs such as amphetamines and related compounds that give us instant results. The faster the discernible relief and “lift,” the greater the chance of abuse. The addict’s mantra, after all, is “Ommmmmmmmore, more, more!”

      That said, some people with ADHD find that they do not get high from theraputic doses of amphetamines such as Adderall and its kin. In them, they seem to have only a calming effect. The important thing is to find a physician who understands both addiction and psychopharmacology to guide you through selection and use of medication. Again, I would attempt to avoid the stimulants if possible. However, if SSRI’s don’t work, the alternative of stimulants is better (if properly monitored) than going back to cannabis in whatever form.

      Good luck with your ADHD, and with your recovery from your cannabis addiction. Be prepared for some temptation as your brain readjusts and makes repairs from long-term exposure, and beware of the danger of cross-addiction. All addictions work on the same sections of the brain, and completely unrelated drugs — including alcohol — are likely to both retard your physical and emotional recovery, and increase your chance of relapse.

      Keep on keepin’ on!


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  57. Hello Bill,

    I’m newly sober from alcohol at 100 days. I never experienced acute withdrawal symptoms when I stopped but plenty of PAWS. The irritation and anger was astounding. Now the sadness is almost unbearable at times. I did an 8 weeks 100% carb free diet. It was very hard and made me incredibly tired but I have a feeling it helped me but no carb is too hard and I found it didn’t benefit me. I do have intense sugar cravings at times, like I need to guzzle syrup or other intense sugar things, exactly like in my PMS. Since I’m not overdoing it, I allow myself the occasional sugar fix ,a tablespoon here, a piece of chocolate there and I found it has eased the alcohol and sugar cravings completely. I just hope I’m not needlessly staying stuck in PAWS longer than necessary. other than the intense sadness, I feel brilliant, grateful, and physically healthy.

    • Hi Dorothy,

      Welcome to recovery! I’m glad things are going as well as they are. The carb free diet was probably the worst thing you could have done, other than drink, and it’s no wonder that you’re suffering. You are recovering from a chronic disease that has affected every cell in your body. You need normal, balanced nutrition, not some regime that is guaranteed to screw up the very systems that are trying to repair themselves. The nutritional needs of people in early recovery are not complicated, and are covered pretty thoroughly in the PAWS article. Please believe that the closer you stick to those suggestions, the better off you’ll be.

      As for PAWS itself, the normal course runs from 8 months to two years, depending on individual factors, and there’s nothing you can do to speed it up, although there’s a great deal you can do to both help the healing and ameliorate some of the symptoms. Again, read the article thoroughly. This is not new stuff, and it is well-tested both clinically and in the practical experience of a lot of recovering people.

      Please read my article on depression in recovery here. Your brain is in the process of repairing itself, and while it is doing so — and perhaps afterward — low levels of dopamine are messing with your feelings. That can be normalized with medication. Many recovering people are reluctant to take meds, some sort of spiritual backlash from having practiced better living through chemistry for so long. Many also spend early recovery far more miserable than they need to be. Many more relapse. Some become so depressed that they kill themselves. Depression is nothing to fool with.

      I hope you’re attending AA. If not, you’re missing your best bet for recovery right there. Go to to find meetings near you.

      Please feel free to stay in touch, ask questions, and

      Keep on keepin’ on!


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  59. Hey its john, you probably dont remember me but Ive commented here in the past about my recovery from methadone addiction. Well the thing is I have about 2 and a half years completely clean and sober (with the exception of nicotine) and I still seam to be experiencing paws like symptoms. I just saw my doc and got some tests done and I checked out fine- no diabetes or anything like that. Is it possible to still experience paws after this long considering that methadone is such an intense drug to come off of or am I just brain damaged? Most days I still dont feel like my old self; im fatigued and irratable, my memory sucks and I have diffuculty verbalizing my thoughts. Will this ever get better?

    • Hi John,

      It’s theoretically possible to be experiencing PAWS symptoms from methadone at 36 months, but I doubt that’s the problem. Your symptoms sound like low-grade depression to me, which is far more likely.

      I’d speak to my doctor about trying an antidepressant. Keep in mind that practically all antidepressants take several weeks to have their full effect, and you need to give them a chance to work.

      Coincidentally, I just published about antidepressants in recovery on a different site. You can find it here. Keep up the meetings, too. You still need support. And make an effort to have some fun, even if you have to push yourself. It makes a difference.

      Keep on keepin’ on!


  60. You seem to know and understand. My question: can a recovering alcoholic, who has not used/been dependent on marijuana before, begin to use it recreationally for relaxation and enjoyment without a problem?

    • Hi Judy,

      Absolutely not. There are two good reasons.

      Most importantly, cannabis’ active ingredients, known as cannabinols (THC being one), work in the same portions of the brain as alcohol, except the effects tend to last longer. This will prevent the brain from repairing itself, and is also likely to promote relapse since marijuana, like alcohol, tends to encourage ill-considered bahavior.

      Second, recovery is about learning to live life without the “enhancement” of mood-altering drugs. If we are still interested in turning off our brains, we need to explore why, not how. Emotionally healthy people (the ideal of recovery) do not need drugs either to relax or enjoy themselves.

      Anyone who tells you otherwise knows next to nothing about addiction, or is deep denial about their own needs.

      Keep on keepin’ on!


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  62. thank you bill. i am so happy i am sleeping just great now. is it normal when im about to hit the 18 month mark in a couple weeks to start feeling emotional? i have not had the feeling i have right now in about 4 or 5 months. i can still think clearly and im past a lot of that rigid thinking. i really feel just weird and anxious in the head… hard to describe… i like feel normal but there is some emotion cloud over my head. just negative thinking, it drives me nuts! i was totally fine before i consumed drugs for recreational use. i swear, i will never touch a damn drug again in my life, even if i have too. i am surprised i am feeling like this still almost at 18 months. goooooo away paws!

    • Hi Wes,

      I was goofy from time to time for at least the first 18 months…probably longer. There’s a reason we hand out those chips and key tags at the intervals we do. For some reason, those “anniversaries” seem to be times of stress for many of us. Whether it’s totally psychological or not, doesn’t matter. What matters is that we sometimes need that little extra support and encouragement.

      Sit down and figure out what percentage of your using time your sobriety so far amounts to. I’ll wager that it’s still taking less time to get back to normal than you spent using. Fifty-fifty would be fair. You’re getting off with less than that, so grin and enjoy your anniversary. Don’t forget to pick up that key tag!

      And keep on keepin’ on!


  63. Hello,

    Just checking in. I am 17 months clean now. Everything is pretty good. My concentration has improved over these last few months. My sleeping is actually about 100 percent now. I can sleep straight through the night without any problems. Before, I could never ever sleep, and if I did, I would wake up in a daze, almost hallucinogen like feeling- lost of reality. The only thing that I am dealing with now that sort of drives me crazy is the negative thoughts that persist for a few weeks. I don’t have panic attacks like I did the first 13 months, but I still feel a little anxious and mind racing a tad bit- but nothing like before! I feel dizzy and blurred vision, and i know it is probably the PAWS kicking in. I feel like a cloud in my head for a few weeks, and I swear this always happens when I drink coffee or have caffeine, it makes thing so much worse. I am just wondering when this last part of PAWS will go away. I used opiates and weed for around 5 years straight, with increasing dosages. Xanex was in there a little, but nothing like those two. I know when paws is coming, I start feeling like almost a little under the weather, as if my head feels like a helium balloon. I guess it is hard to explain.. it just feels like it is re-registering back to the normal me and I can feel the process.. I am hoping at 17 months, that I am still on the right track and I have not gone crazy!! I am not EXTREMELY depressed like I hate myself, just I think about stuff negative sometimes, but not all the time… it just starting to annoy me!

    • Hi Wesley,

      Congratulations on your 17 months! A lot of hard work in there. Glad you’re sleeping at last. I remember those sleepless nights.

      I’d love to answer your question, but I really can’t. Cannabis, benzos and opiates have long PAW syndromes by themselves. I don’t know if the combination necessarily makes things worse, but it surely can’t help. Your symptoms have been steadily improving since you got clean, and are pretty typical for later-stage PAWS. The improvements should continue.

      Everyone’s brain chemistry is a bit different, and our bodies’ ability to make repairs varies as well, along with amounts of drugs used, etc. There are too many variables to be able to simply say, “You’ll be better at two years, three months and 17 days.” On the other hand, it’s probably safe to say that it won’t actually be that long. You spent five years with your brain in an abnormal state, during which it slowly adjusted to the conditions as best it could. It shouldn’t be too surprising that it could take a couple of years to get adjusted back to normal. Figure on continued progress.

      This may seem pretty obvious, but if caffeine seems to exacerbate the problems, you could always cut down or eliminate it. I’d taper, though. If it doesn’t seem to help, then don’t worry about it. Overall, it won’t hurt you.

      I felt pretty goofy sometimes until a bit over two years. Caffeine seemed to help me, but who knows? I didn’t use weed or opiates, although benzos and alcohol aren’t all that different in their over effects.

      Hang in there. It will keep getting better…at its own pace.

      Keep on keepin’ on!


  64. This is a great article. I have been using (and primarily abusing hydrocodone) for 2 1/2 years. In general, I would consume anywhere from 45mg to 60mg a day, each and every day. As a husband and father, I feel like I have lost that time and will never get it back. A thought that weighs very heavy on my heart. I have been clean now for 3 1/2 weeks from an abrupt cessation. Now I am experiencing what I read here as PAWS. I really thought I was loosing my mind, and I am not saying that lightly. I really thought my mind was gone. And depending on the day, my level of fatigue is also almost too much to bear. As I read this article I couldn’t help but feel tears welling up in my eyes (an emotion I haven’t felt in a long time), as I read that my brain may not be permenantly damaged…as I feel such unbelievable inadequacies every day in thought, memory, and reason. God help me.

    • Hi Jon,

      There is a story — that could have been written by O. Henry or de Maupassant, but almost certainly wasn’t — about the man who pined for his childhood sweetheart, happily wed to another for many years, for his entire life. Her loss made him miserable, and he never married. On his deathbed he was given to see what his life would have been like had she married him instead of the other guy. The wedding was beautiful. On their honeymoon journey, their carriage overturned. He was spared entirely, but she was killed on the spot.

      No, that wasn’t supposed to cheer you up. It was meant to point out that no matter how much we might want to change the past, we have no way of knowing how things would have turned out. It took everything in your life prior to this moment to make you the man you are today: a man who has made mistakes and regrets them; a man who loves and appreciates his family; a man who is lucky to have had their love for the past years, and who is likely to continue to have it for many more.

      Sure, you missed some things. So did I. I was drunk most of my kids’ childhood. But I am an incomparably better father than I would have been if I hadn’t had the insight and stimulus for personal growth that my addiction and recovery engendered. If you use the past few years as information to help you grow, you may well find that they were extremely well-spent after all.

      Because, as the parable expresses, we have no way of knowing how things would have turned out. But we do, as a result of sobriety, have a good deal of influence on how they may go in the future.

      Read the PAWS article carefully, follow the directions, and hit some NA meetings. If you take care of yourself, you’ll be fine in a few months and so will your family. If you spend too much time regretting the past, however, the uncomfortable feelings may well cause you to repeat it.

      Stay in touch, and

      Keep on keepin’ on!


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  71. I endured 18 months of benzo withdrawal – whereby every day I awoke feeling like I had the flu: aches, malaise, lethargy, and a debilitating foggy head. I exercised, read, attended support groups, and surrounded myself with family. It was very, very difficult.

    • Nasty stuff, isn’t it? It continues to amaze me that so many doctors remain ignorant of the danger of that class of drugs. It’s just one more reminder that they aren’t pharmacists, and that we have to self-advocate when it comes to medications. Benzodiazepines have their place: short-term use (less than six weeks) to treat specific symptoms. Prescribing them for longer periods is absolutely unacceptable, except in extremely unusual circumstances that are usually properly treated only by specialists.

      You did exactly the right things for yourself — but what a shame that it was even necessary.

  72. Hi Bill,
    I am sorry about posting that second message! The first one I submitted acted like it wasn’t going to go through, then I had noticed you responded to it ,after the fact! I appreciate all the advice you have given to me. I will definately look into NA and AA for that matter. I have already incorporated some of the tips in the article and feeling slightly better! Again, I am sorry if I sound like a whiney baby on here. I guess I got a little desperate for some help during this difficult time….. Thank you again soooo much, I truly do appreciate it!

  73. So I think I am suffering with PAWS right now! Been 3 months sober, I feel like I am in a constant daze and I cannot innitiate sleep. My question is, is how do people function like this? Leave their houses, work, even go out and about? I am 31, have no income and rely on my drug addicted boyfriend to fill my gas tank and do my errands! This website about PAWS is enlightening but I definately need to turn my life around!

    • Hi again Leslie,

      I’d say there’s no question about the PAWS, and it sounds like a rough trip. All I can tell you about that is that it gets better, and the suggestions about nutrition and exercise in the article are important. They do help.

      I’d attend some AA meetings, talk to some folks, and see if they can suggest some resources in your area that might enable you to make some changes. What changes you make are not mine to suggest. I think you see the potential stumbling blocks to your recovery yourself. Just keep in mind that if you can’t stay clean and sober, NOTHING else really matters.

      Best wishes, and

      Keep on keepin’ on!


  74. Dear Bill, I am so glad that I found this webpage through Soberrecovery! I do feel that I am currently suffering with PAWS. I am 3 months sober on two different substances that I abused for over 7 years. I can relate to all the mental symptoms that are talked about on this page! I guess my question is; when I am feeling so off, and have little to no support about the matter, how do I recover? I literally have no friends that I can talk to about this, and the only 2 people that know are my brother and dad who tell me to take care of it! I’ve tried NA and that wasn’t for me, I just feel plain awful and out of sorts! I am 31 years old and live with my parents, which isn’t a stress free environment by any means, my mother is unaware of my past history because everyone chooses to hide it from her because of her anxiety issues and how she would not be able to handle it (plus her mother is not doing well right now). I’m sorry that I am rambling on here but I can feel myself tearing up as I am writing this. I know that it will take time to get feeling better, but how do I support myself financially ,emotionally, and physically while I am feeling this way? I do see a counselor but the only thing she ever tells me is to go out and get a job. How can I work, when I can barely get out of my house and drive for that matter? Thank you for taking the time to read this!!!

    • Hi Leslie,

      How hard it must have been to get three months clean under such conditions! Congratulations on your determination to make it.

      It sounds like you are living in a pretty toxic environment. Big secrets and no support is not a good thing for anyone. I can’t speak to the advice you’re getting from your therapist, since all I know about it is the part that you are remembering. However, a therapist/client relationship is not a marriage, and you’re free to find another practitioner at any time if you feel you’re not getting what you need. Look for one who specializes in addiction — if at all possible, one who is herself in recovery. Therapists who are not in recovery are generally not the best choice for addicts, although I know a very few who seem to “get it.” Most don’t. In this respect, Google is your friend.

      You have got to get some outside support. Try different NA meetings. Try AA; you can’t drink alcohol, either, so you can truthfully say that you “have a desire to stop drinking,” even if you don’t say you’re an alcoholic. Google “12 step groups in (your town or area)” and see what other support is available.

      Stick with the chat rooms on, and with the forums. Look around for other online support. Both AA and NA have online meetings, along with many other fellowships.

      You have to remember that you don’t have to enjoy meetings, nor do you need to feel that they’re “for you.” You need to sit there and listen, and try to relate to what you’re hearing. You don’t have to talk until you feel like it, but you DO have to begin to learn that you’re not the only addict in the world, that others are making a go of their recovery, and that you can do it too. Possibly an AA women’s meeting would be helpful. They tend to be best for women with outside issues — more accepting.

      NA meetings:

      AA meetings:

      Thanks for writing. Problems, when shared, are a little bit easier to deal with — and your issues and solutions could be invaluable for someone else.

      Stay in touch, and

      Keep on keepin’ on!


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  78. Bill,
    I’m going to be 18 months sober (from alcohol) in a couple weeks, and this is the best I’ve felt in as long as I can remember. I had posted earlier about being put on Parkinsons meds to treat the physical PAWS symptoms (ataxia, balance issues, slowness, tremors etc.). Just wanted to post an update in case anyone is going through bad physical symptoms like I am. The meds have helped a lot, and as long as I take the recommended dose at the recommended time, I have great relief from the symptoms, and don’t have to use a cane 90% of the time. It was an overwhelming and tremendous feeling to ring in the New Year sober, for the second year. I want to thank you again for showing me a way out 18 months ago through your writings on this site. Thank for generously sharing your time, thoughts and wisdom with all of us.
    I still have a long way to go, and having come this far, there is absolutely NO turning back. Each day sober feels like a new beginning; today better than yesterday, and tomorrow to look forward to.
    Happy New Year.
    An ardent follower of your advice :-)

    • Hi Darcy,

      Congratulations on your (almost) 18 months. Must be great to know that the worst is behind you. I knew nothing about PAWS at 18 months, so I didn’t have that understanding. However, as I recall it was about that time when I decided I probably wasn’t going crazy.

      Glad to know that the meds are still working for you. What does your doc say about your condition. Eighteen months is a long time to keep having motor nerve issues from PAWS. Just curious.

      Take care, and thanks for checking in.

      Keep on…well, you know….


  79. Hey there everyone, this here is my first attempt to post on a blog related to this sort of thing, and even while the words may (or may not) seem cogent and organized I thought it would be a good thing for me to do. A little but about myself.. 24 years old living at home with my mom in Frederick Md, just about 7 months clean from an opiate/ later on opioid (suboxone) induced lifestyle. When it comes to my life, things are certainly seeming harder emotionally and psychologically as I add more days to my sobriety. No job, many contacts lost, assorted troubles day to day including lack of motivation, negative thoughts going in mad circles, making dumb mistakes, etc. ( i still cheat and drink beers, been through so many stages and phases on that front), smoke cigarettes (trying to cut back and eventually quit). I have also cut out marijuana, as I was a devout smoker (and still would like to, honestly) thinking that it would put me in a better position when looking for a job here soon. I have my first appointment with a mind-body focused therapist tomorrow morning and obviously have mixed feelings about it but I know it’s a good and necessary step for me. I guess what I’m doing here is trying to put my 2 cents in and connect with those who may understand me (I have been quite an isolated dude for a number of months now). Even now I’m trying to formulate thoughts and focus on what I want to share, but it seems tough to express what I would really like to at times. I guess if I get responded to I will go into more details about what I’m going through, as I’m new to actually posting on internet blogs. Let me just say that I’m having difficulties and a lot of the symptoms according to the description of paws as i understand it, and would be great to have a place to be able to discuss it.. this site gave me that good feeling. Anyways, blessings to all and I would look forward to opening a dialogue here…

    • Hi Michael,

      Congratulations on your desire to get clean and sober. Your symptoms do sound like you are experiencing the joys of PAWS. That will continue until you are also off the cannabis and alcohol. Until then, your brain cannot begin to repair itself. Simple biology, not a value judgment. You would do yourself a great favor to attend some NA or AA meetings and get totally clean. The initial discomfort is worth it for the increasing relief that follows. Unfortunately, there is no such thing as a little bit sober; you either are, or you aren’t.

      You are most welcome to comment here at any time. I answer all comments except those which are clearly not serious — although not usually right away. I look forward to hearing from you again.

      However, mine are only the opinions of one person. I would suggest that you copy your note above and paste it verbatim into an introductory post at Sober Recovery is an excellent venue for immediate feedback, and you can participate as deeply or as little as you like. Hang around for a while and check out the site and the posts before you jump in, then go for it.

      Please let me know how things go, and

      Keep on keepin’ on!


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  82. Hi Mr. Bill my name is Corey, im 20 years of age and I just wanted to comment on this blog just to let you know how awesome you are. I appreciate the fact that you really care about the lives of others b/c you were once in there shoes. I smoked pot for about, 5 months straight heavy and stopped cold turkey. That may not seem like a long time on pot, but anytime using is unacceptable truth be told. I just thank GOD I caught myself going down the wrong road to nowhere fast. I stopped December 26 2011, and all the way up to about mid march 2012 I smoked my very last blunt. I know that prolonged my PAWS but I am persistent in never touching that junk again. I have been sober for about 8 1/2 months now to this date Dec. 2012 and it feels good just to know that every step I take is drug free and to a better life. Every symptom you could think of related to PAWS I had, and still have those symptoms from time to time. I know I am not truly healed yet but far from where was at. I really appreciate you in all the good works you do and you inspire me to keep going and to inspire others going through this tough time in their life, b/c lord knows I needed the encouragement to keep going and still do so thank you. How long did it take you Mr. Bill to get through PAWS?

    • Hi Corey,

      Congratulations on getting clean, and at such an early age! I spent my 45th birthday in treatment. I wouldn’t say that the 25 years between that and 20 were wasted, but they could have been a damn sight more productive without the booze and drugs (including weed).

      Back in those days, cannabis was about 1/10th as potent as it is now. The increased kick from hybridization and improved growing methods has produced a drug that is quite different from the pot of the 60’s and 70’s. Back then it really was pretty benign. Not so today. The impairment from long-term use and the time needed to recover is an order of magnitude greater, just as is the strength.

      Marijuana is peculiar in the drug pantheon, in that it has little or no noticeable acute withdrawal, yet one of the longest post-acute syndromes. That’s partly due to the time necessary to completely clear the basic compounds and their metabolites out of the system. Cannabis has a couple of dozen active compounds (mostly cannabinoids of one kind or another), and many of them metabolize into compounds that are themselves psychoactive. Since all of them are fat soluble, they hang around for a long time. It seems, as well, that the brain’s cannabinoid receptors take longer to return to normal than some of the other receptor sites — although that’s a preliminary theory. Preliminary or not, it fits in with observations and anecdotal evidence.

      All of this is leading up to your question. When I was going through PAWS I didn’t really know what it was. I learned all this stuff several years later. But my life sober, even at its worst, was so much better than it had been toward the end of my drinking and drugging that it all looked and felt pretty good at the time. In retrospect, however, and having read some of the journaling I did back then, it’s apparent to me that I was pretty messed up for about 18 months, and nutty as a fruitcake for about the first year. Some days were better than others, and as I recall the crazy days were farther apart as time went on. I think it is safe to say that I was in fair shape at about 18 months, and pretty well back to normal (whatever that is) after the second year.

      All of these things are relative, though. If you weren’t all that messed up during your using career, the discomfort of PAWS may affect you entirely differently from the effect it had on me. Additionally, my main drugs toward the end were alcohol and benzodiazepines, not weed. This is all by way of saying that what applied in my case won’t necessarily apply in yours.

      Thank you for the kind words. I’m just doing what was done for me, using the talents I had and the knowledge I’ve acquired. You can do the same. All you have to do is work on your recovery, help others when you can, and most of all

      Keep on keepin’ on!


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  85. Hi Bill,

    I was a heavy drinker of wine and vodka for the last 6 years. I quit drinking July 7th and had terrible panic, anxiety, shaking, anorexia, and abdominal pain that lasted all day and night for about 4 days. I felt great for about a month and then began having the symptoms all over again after quitting caffeine and DHEA. These symptoms did not subside for weeks and just got worse. I ended up seen a doctor who gave me Xanax. This helped and I only take it when I absolutely need to. I will go for several days or weeks feeling find then BANG I wake up at 2 AM with a panic attach that doesn’t go away. I cant eat or concentrate. I lose 5 to 10 lbs every time I have these bouts. This is hell. Do you suppose this is PAWS? If so, what do you recommend?

    • Hi Chris,

      I replied to your comment over on

      • Dear Bill,

        Along with everyone else, thankyou for your dedication to helping people, it has really helped restore my faith in humanity.

        we may be of a similar age; I am 49. Ridiculous though it is, I used crack for the first time about 8 months ago and it has inevitably caught up with me. I reached a point recently of 1 or 2 grams at 2 day intervals, but am currently on day 10 without it. I work a stressful job in a third world country with almost zero support services for addicts (its not top of the list of of problems here). My questions are:

        Given that I have probably smoked 20 grams in 8 months, how far addicted am I compared to the other people on this blog.

        I beleive I have the mental resources to quit, but how likely is it that I can do it on my own?

        I feel for the ‘others’ who are much deeper in than me…….should we work on this together, or must I avoid them at all costs?

        I have writtten to NA, but no response. I have found a local psycologist who seems to have a fair idea, but does speak in rather general terms.

        thanks in advance,


        • Dear Laurie,

          Given your location and the kind of industry you’re in, I can see that it’s a high-pressure job. It’s also clear that drug use and addiction would not be a high priority in that part of the world; there are far more pressing problems that affect the entire population. (I removed your email address, BTW.)

          I’m familiar with the problems of stressful jobs and the temptation to reduce the pressure with chemical assistance. I got sober at about your age, also in a pretty high-pressure job. Alcohol and other drugs (including stimulants) masked the stress for a long time. However, stress is a form of energy, and it has to go somewhere. Suppressing it with drugs simply causes a buildup, and eventually things have to blow. In the case of drug use, it’s usually after we stop using. That’s one reason, along with the actual physical dependency, that it’s so difficult to quit. It’s like the man said, “Pay me now, or pay me later.” The problem with paying later is that the debt comes due all at once.

          So, you have two issues that should concern you, and the drugs are the minor one in a sense. You are not addicted. At ten days, you would have gone through at least three or four layers of hell if you were physically dependent on crack. That’s the good news. The bad news is that now you know how crack makes you feel, and that’s what keeps people coming back until the physical addiction takes over. There will always be the temptation to use “just this once,” and that is what you have to avoid at all costs.

          Underlying all of this is the stress. You MUST figure out a way to either reduce or discharge it — preferably both. Fun, relaxation, exercise and stimulating companionship are essential. I realize that those things may be difficult to find in East Africa, but you have to do something. In addition to reducing the effects of inevitable stress, those pursuits will make it easier for you to do your work.

          Essentially, you have to figure out a way to re-align your priorities to your advantage, rather then your employer’s. I’m sure the psychologist will agree with me here. A couple of possibilities that occur to me are church, Skyping with relatives or friends, and — here’s the biggie — getting in contact online with recovering people. There are no 12-step meetings in Malawi as far as I can determine. However, there are powerful NA and AA presences online, and there are meetings in East Africa, just not near you. Check here:

          I would also suggest searching for “online recovery” or “online AA” (or NA). I mention AA because there is more likely to be support available in your area if you can suss some folks out, and also because many folks of “a certain age” find themselves more comfortable there. There are myriad recovery sites and forums available. The people there will be happy to provide support and encouragement. Hit a couple of sites and chime in with your issues. They’ll fall all over themselves to be helpful and friendly. You can also write to me, of course.

          Stay in touch, and

          Keep on keepin’ on!


          • Hi Bill,

            thanks very much; that is extremely helpful and encouraging and I hope will really help turn this situation around.

            I am learning a great deal as I go though this. I ‘cracked’ as it were twice this week unfortunately, despite all the determination ( I thought) I had mustered. I took a larger than ever individual ‘hit’ in an attempt to say ‘once and for all’, but realise this is not how it works! I realise that no matter how much reason I apply, it is very hard to resist falling the wrong side of the knife-edge, even if you are conscious of making the wrong decision even as you are making it. I guess I just need a fool-proof mantra to use just at that moment ( I tried ‘ don’t forget, you will regret)…….but at that moment, it didn’t work!

            I fully take on board all your great advice , which by the way gives me more confidence in my local psychologist, who is saying very much the same things about stress. I will follow up the contacts you suggest.

            Although I realise everyone is different, I wonder if I am better off avoiding alcohol and weed as substitutes? (I haved never developed an addiction or even a regular habit of these, even with on and off use for many years)……….or could they help during this phase……..crack is a much scarier prospect!

            I reached you while looking for help from a Buddist perspective, as this is something I am increasingly interested in (although again, no-one else around here is!). Can I ask, have you had experience of people using meditation successfully for helping with drug problems? I have some practice under my belt, but not sure if it is the right path to take for this challenge.

            Thanks once again….your kamma is assured as far as I’m concerned.

            best regards,


            • Hi Laurie,

              When we use drugs such as opioids, amphetamines, alcohol and so forth, they stimulate the production — or in some cases prolong the action — of natural chemicals in our brains that are involved in the reward system. The reward system is there to cause us to enjoy things that are good for us, like eating, exercise, rest, sex and similar natural pursuits of healthy creatures. When we overstimulate the reward system (and some other parts of the brain as well) they become less sensitive to the natural levels of the “feel good” chemicals and require more stimulation. Over time, we reach a point where our brains can no longer produce the chemicals on their own in sufficient quantities to keep us feeling normal. We need the drugs in order to function, and we are now addicted.

              Although various drugs work in various ways, all drugs of abuse affect the reward system in one way or another. They make us feel good, or at least better, than we felt without them. Were that not the case, who’d bother to use drugs? (I include alcohol when I refer to drugs; it’s just another abusable chemical.) When we are addicted — when we need drugs to function normally — we have powerful physical, emotional and psychological incentives to continue taking them. Essentially, when we stop, we feel lousy. Over time we convince ourselves that taking them is okay, and we begin to protect our drugs with denial about their effects on us and the people around us. Only when their adverse effects exceed our tolerance do we become convinced that we need to do something about our addiction.

              Note that I stated that all drugs of abuse have the same general effects on the reward system, albeit by different means. That means that once we are addicted, the continued use of any drug will prolong the addiction. Our brains cannot repair themselves as long as they are subjected to abnormal stimulation. We have to remain abstinent so that, eventually, our brains’ ability to produce the necessary neurotransmitters will not be exceeded by our need for them. Only at that point will we feel normal again.

              The alcohol and cannabis are not substitutes. They are additional stimuli that are prolonging your addiction. Post-acute withdrawal, when it begins, can last for months. Any use of mood-altering chemicals during that period (and, for most people, afterward as well) will stop the repair process, prolonging the PAWS and most likely re-starting the addiction.

              As far as meditation goes, I recommend it highly. You also need the support of recovering people who know what you’re going through, and who can help you avoid the self-deception and other pitfalls that lead to relapse. They can also support you emotionally and help you work through the many problems that have been caused by your addiction. That’s why very few people who don’t attend self-help meetings regularly manage to stay clean and sober.

              If you doubt the accuracy of the above, print this out and run it by your therapist. I’m sure he will agree with me.

              You can do this, but it has to become the priority in your life. Sobriety isn’t for sissies. Please take care of yourself, stay in touch, and

              Keep on keepin’ on!


          • By the way Bill, thanks for thinking of removing my e-mail address….I goofed again by filling it in again…how do I get past the requirement to provide an address? ( i would make a useless spy!)

  86. Thanks, Bill, for your quick reply! I was mostly wondering which commonly used anesthesia (or peripherally related) drugs or classes of drugs would be likely to trigger PAWS symptoms. I have no problem with avoiding those altogether, opting for local anesthesia only, etc., but wanted to know what to watch out for specifically. I’ve noticed that caffeine still can exacerbate anxiety and other symptoms (and of course I’ve read your recommendations about caffeine), and I’m working on cutting that down significantly — I just seem pretty sensitive with the triggers of all kinds (stress, caffeine, lack of sleep, etc.) so am trying not to make life harder for myself by overlooking something that may set me back in my work to let my brain heal itself over time. Never really dealt with benzos and don’t intend to if they’re going to cause problems even in a dental/clinical setting, and I haven’t been on ADHD meds of any kind for over a year. Took them as prescribed for 6 years but decided they weren’t for me, and I would at times drink too much to combat the anxiety even clinical doses stirred up in me — hence my PAWS symptoms now, even though I don’t abuse alcohol after discontinuing the meds.


    • Hi again, Katherine,

      Sounds like you’re on the right track, and that your head is in the right place. Keep on as you are, and hit those meetings!

      Cheers, indeed.


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  88. I felt fine for months until these last few weeks. Each time I experience the depression, anxiety, fear, paranoia, it is no where near what it use to be in the past. I have tried Celexa a year ago, and i felt like a zombie hah! Taking care of my anxiety problem, I lost the natural drive to really care about anything else. I just felt really dumbed down as well. I was only on it for 2 months.

    • There are about two dozen effective antianxiety agents available. Not all work for all patients, but practically everyone can find one that gets the job done, although some trial and error may be necessary. As addicts, we want results now. Unfortunately, it doesn’t work that way.

      Good luck. It’s nearly 4:00 AM here, so I’m going to bed.


  89. You are saying I have depression, clinically? Or my PAWS is making me depressed? I have never had any problems prior with anxiety or depression before my drug use… I haven’t listened much with the lifting and work out goes. I lift and do heavy and do cardio for a combined 90 minutes 5 times a week. Probably why my PAWS is so terrible. Are you thinking I should not be experiencing symptoms like this still?

    • Wesley,

      I am not a psychiatrist, and even if I were I would never presume to diagnose anyone I hadn’t seen personally. What I said is that you have classic symptoms of depression: negative thinking, fatigue, poor concentration, just want to lay in bed all day, etc.

      Depression is often a part of PAWS, especially for people who have been addicted to opiates. The anxiety could be part of the depressive syndrome, or something else. However, depression is the more serious condition and should be treated first.

      You could try using a standardized extract of St. John’s Wort (not the root, the extract), from a health food store — about 1600 mg./day to start, and see if that helps. However, if you were my client you’d be seeing a doctor.

      As for the exercise, I won’t repeat myself.

      Take care,


  90. Hello,

    Its me again. I am coming up to my 14th month clean from opiates in a couple weeks… still feeling PAWS… especially in the last few days after thanksgiving.. wondering if all that food had something to do with it… Still feel terrible, negative thinking, and a lot of anxiety filled with fear. I feel fatigued as well… just want to lay in bed all day.. Everything else seems to improving.. my concentration is poor… Is it normal to be experiencing PAWS still at 14 months? I read it can last as long as two years… Comparing myself to last year or 6 months ago, I am a lot better… but man, this process seems slow… I just hope I am normal one day without anxiety… I seem to hate crowds more than ever and having a list of things to do seems to stress me out…

    • Hi Wes,

      Sounds like depression to me. Classic symptoms. Talk to your physician about the possibility of getting on an antidepressant. AD’s won’t trigger your addiction, and the right one could change your life much for the better. If that doesn’t help the anxiety, gabapentin (Neurontin) might be helpful. Stay away from all benzodiazepine-based anti-anxiety agents. Check with your pharmacist about any prescriptions. Don’t trust the doc to know everything about his drugs, or about addiction. They try, but it’s hard for them to keep up.

      Ref antidepressants: They take up to six weeks to show maximum benefits. Don’t give up just because it doesn’t happen overnight, although there could be some immediate effect. Also, don’t EVER stop taking them without monitoring by a doctor. The rebound effect can be acute. Trust me on that. I lost a close family member to suicide after she stopped her meds abruptly. That, however, is no reason not to take them. Tapering works just fine when the time comes.

      Glad you’re noticing improvement. That certainly helps in the hope department. Yes, the process is slow. We didn’t mess ourselves up in just a few weeks or months, most of us, but we’re often surprised at how long it takes for things to get right again. Go figure. Think addicts have a problem with long-term thinking?

      Keep on keepin’ on!


  91. Hi Bill — I’ve been reading this site for a while and am grateful to you for your insights and info. Quick q: Is PAWS activated by, say, general anesthesia for a dental procedure? (e.g., Valium or something like it?) I haven’t been addicted to that kind of drug but have experienced PAWS from drinking while taking (as prescribed) ADHD meds and find that PAWS can still be triggered by stress months down the line. I’m anticipating a couple substantial dental procedures in coming months and have the option of doing them under sedation but don’t want to re-trigger full-blown PAWS. I get that recreational drugs and prescription drugs that may be abusable are to be avoided, but what about surgeries, etc.? Is the issue more about knowing I have addictive tendencies that could be triggered or the physiological repercussions (PAWS symptoms) that could be triggered — or both? Thanks!


    • Hi Kate,

      General anaesthetics do not ordinarily activate PAWS, because they don’t operate as painkillers; they simply shut the cerebral cortex down for a short time. The prep agents (Valium being one) are another matter.

      PAWS symptoms have nothing to do with addictive tendencies. Addiction, PAWS, and reactivation of addictions are simply biochemical processes that affect the mind. They have nothing directly to do with psychology. They occur on the subcortical level, below the level of conscious or subconscious thought. That’s why we can’t think ourselves out of our addictions. They don’t listen; can’t hear a thing. They can talk to the conscious portions of the brain, but it’s only one-way communication.

      What you need to understand about addiction is that we are not addicted to drugs. We are addicted to the effects that they have on our brains. All drugs of abuse, including alcohol, work on the reward system, and tranquilizers such as Valium, Xanax and Ativan (benzodiazepines) work in similar ways. Any drugs that act similarly can trigger addiction, are potentially addictive, and can affect recovery from addiction (PAWS). Cross-addiction with alcohol and benzos is extremely common, and perhaps inevitable. ADHD meds can be problematic as well, and can also have an effect on local and general anaesthetics, so make sure your dentist knows about them if you are still taking them.

      I have had multiple extractions under local anaesthetic (Lidocaine) over the years, with no pain. My wife had eight extractions on the same day with local anaesthesia. If you tell your dentist that you are a recovering addict and likely have a high tolerance to the meds, she can load you up good and you’ll never feel a thing. Locals are far safer than general. Every general anaesthesia carries risks, albeit small.

      That’s the best information I can give you. I certainly can’t tell you how to proceed, but you can gather from the above what my preference would be (and was).

      Please let me know how things go, and

      Keep on keepin’ on!


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  97. Bill, thank you so much for your concern. I took your advice and went to the doctor. He prescribed me with Zoloft. I’ve been feeling better each day since I messaged you last and hopefully the Zoloft will ensure that I don’t fall back into severe depression. I probably wouldn’t have gone to the doctor had you not been so insistent that I needed to. Thank you for that.


    • You are entirely welcome, Eric. I’m pleased to hear that you were able to get some relief for your discomfort. I’m no stranger to depression myself, and I very much sympathize with your situation.

      Please stay in touch, and

      well,you know…


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  100. I am 15 months sober from alcohol and am still experiencing severe physical PAWS symptoms. My DR. put me on Parkinsons meds (specifically L-DOPA). I am hesitant to take them as I may go back to square one with PAWS/recovery. Any thoughts on using dopamine makers/agonists in helping with PAWS?
    I am following all your diet, nutrition, exercise etc. recommendations diligently, but sometimes get frustrated wondering if I am really healing.
    Thank you for continuing to be a font of support and inspiration through my recovery.

    • Hi Darcy,

      Good to hear from you again. The L-DOPA has no undesirable effects on addicts of which I am aware. I think you can safely try it, and I hope it helps your ataxia. When you are able, it would be helpful to find some T’ai Chi classes and join in. It’s a wonderful, gentle exercise to help retain balance and coordination, and would probably be good for rehabilitation as well. If you can’t find classes, there are good instructional videos. You should practice in front of a mirror if you use them, to insure that you are developing the movements properly. Once the moves become automatic, it’s a great form of moving meditation, as well.

      Discuss with your doctor the possibility of rebound when discontinuing the L-DOPA. (I assume that you’re not to be taking it permanently, given that your neurological problems should self-correct with time.) I would think that a slow taper over a couple of months would be effective when/if the time comes.

      Please stay in touch. It’s good to hear from you, and I learn a lot from folks’ comments. Yours illuminate a new area, and are especially valuable.

      Above all, Keep on keepin’ on!


  101. Bill, I am 22 years old and was addicted to weed for almost a year, and addicted to cigarettes for two years. I would stay high all day, sometimes smoking as soon as I got up (before eating or getting dressed even) and often all throughout the day, and almost always at night until I fell asleep. Then I quit both weed and cigarettes cold turkey. After about a month without smoking, I started having intrusive thoughts and irritability. The intrusive thoughts had me feeling like I must’ve been losing my mind. I felt a ton of stress, anxiety and depression as a result. I also had nightmares and trouble sleeping. These ills went away after a week and a half or so.

    Then, shortly after, I started smoking weed heavily again for three weeks. I smoked 10-15 cigarettes during this period as well. Then I quit again. Now it has been at least five weeks since I last smoked weed (or cigarettes). I felt great for the past five weeks clean, but for the last five days or so I have been severely depressed, am having suicidal thoughts, intense anxiety and am suffering from intrusive thoughts again. I’ll feel relief for an hour then depression will come swooping back in.

    Do you think my brain is recovering? That I’ll be happy again soon? The fear that the intrusive thoughts, depression, anxiety and stress will not go away, or will go away periodically but always come back and worse each time has me scared to death.

    Thank you very much for any thoughts, they will be helpful I am sure.

    • Hi Eric,

      I’m terrifically worried about your depression and suicidal thoughts. Please speak to a physician IMMEDIATELY. Depression is a killer, and the time to deal with it is in the beginning. Waiting will only make it worse, and the fact that you are already experiencing suicidal ideation means that you are already in trouble. I lost a granddaughter who thought she was OK and stopped taking her medication. You’re not even on any yet. See the doc, PLEASE!

      Antidepressant medications will not trigger your addiction. They are entirely different drugs, and could possibly help alleviate some of the other symptoms. However, don’t let the doc put you on benzodiazepine tranquilizers. Some doctors mistakenly believe they are good for depression. Not only is that not the case, but they are highly addictive.

      I can’t overemphasize the need for you to seek help NOW! Please stay in touch. You’re going to be OK, but right now you need some assistance getting through this.

      Post-acute withdrawal from cannabis is peculiar, in that it subsides, returns and subsides again. Not too much is known about it specifically, since the fiction that marijuana is non-addictive — or at most mildly so — has in effect put it on the back burner of research. Thankfully, more is being learned every day.

      I can assure you that your discomfort is not forever. Your brain is in the process of recovering right now, but it will take a while for it to become completely normal. So much depends on individual use, brain chemistry and overall health that it’s impossible to say how long. Anecdotal information indicates that the post-acute syndrome for grass lasts up to two years, but in steadily-diminishing form. You can expect more symptoms, but they will get gradually less severe, and you should have periods of relative ease from time to time.

      With great concern,


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  108. Hey Bill, Eric again.

    My psychiatrist/cognitive therapist said I have a duel diagnosis, being a major anxiety disorder and chemical dependency from when I was on suboxone for pain ( i guess i should mention i also have chronic pain, for which I was prescribed suboxone)
    Anyways, she said she understood that paws can be prolonged by klonopin, but since the other medicines I’ve tried (antidepressants and neurontin) aren’t working well, that its hard to say not to take the klonopin once in a while.

    Anyways, I had held off for 5 months from the klonopin since I was scared of prolonging PAWS (im 9 months off suboxone now), and today I finally took around .10 mg of klonopin. Mainly because I get so anxious at times that it’s literally torture and I just couldnt stand it today.

    Can you give it to me straight, am I going to start PAWS all over now since I took klonopin?

    I am in a recovery process, I do yoga and meditation for at least an hour a day, I have started AA meetings, and eat and exercise well. But I need to know if I just screwed everything up with the little bit of klonopin I took.

    Thanks for the advice.

    • Hey Eric,

      It’s not likely that you will be back to ground zero on the PAWS with only an occasional Klonopin. You’ll want to monitor your intake very carefully, and remember that the addict in us is always looking for a little more, and a reason to take it. Keep the fact that clonazepam is a highly addictive substance firmly in mind. Ideally, you’d be completely abstinent; however, your doctor seems aware of the issues, and you need to listen to her. As long as you can look in the mirror and tell yourself that you’re not making excuses, you should be OK.

      Remember that, for an addict, lying to others is simply rude; lying to ourselves is often fatal.

      Best of luck, and

      Keep on keepin’ on!


      P.S. I’d keep the matter to myself at AA meetings. When you get a sponsor, however, you should level with him. keep in mind, however, that sponsors are laymen — your shrink is the pro. You need to make it clear that you are following a doctor’s direction.

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  114. The last comment I left was kind of harsh. I’m not a doctor, so I shouldn’t have said that anything was nonsense, I’m sorry about that. I do hope you’ll reply to my other comment though.

    • Hi again, Eric,

      I try to answer all contacts that aren’t obviously trolls. As I mentioned earlier, I was out of touch, and I missed your first reply in the middle of a huge volume of mail. I apologize for not getting back to you sooner.

      I completely understand your frustration. Early recovery is a rough time, our nerves are frequently worn thin, and as addicts we are always searching for the “magic bullet.” My reasons for my earlier statement to you are twofold:

    • My advice is based on the collective advice of a number of experts that I consult in person, online, and through reference. As you will have noted from your browsing on the subject, there is little literature — far too little — about PAWS and the issues surrounding it. That does not mean that my advice is incorrect. What it may mean is that you were looking for something to contradict it, and couldn’t find anything. Lack of proof does not constitute proof.
    • Benzodiazepines are highly addictive drugs that operate in the same areas of the brain as most other “downers,” including alcohol, although their mechanism of action is somewhat different. You will find that few if any experts on addiction recommend treating with them, except for the purpose of alleviating the symptoms of acute withdrawal. I will not recommend them for extended use, ever. Having been addicted to them myself, I know first-hand what they can do. The withdrawal syndrome from benzodiazepine addiction can be more severe, and lasts up to three times as long, as that from alcohol — both during acute withdrawal and PAWS. As an example, I detoxed from alcohol in five days; the benzo detox took an additional two weeks, and I was pretty off-the-wall for over a year. That experience was what later got me interested in PAWS, and the lack of information is why I started lecturing on it, and eventually wrote this article.
    • There are other alternatives. I am not ordinarily a fan of herbals, but some people have had good results from valerian root, others from St. John’s Wort. You should always consult your physician before taking herbals because of possible interactions with other drugs. Just because you can buy them OTC does not mean that they are not powerful drugs. If aspirin were discovered today, it would be available by prescription only — and for good reason.

      Good luck in your continued recovery. Please stay in touch, let me know how things are going,

      And keep on keepin’ on…


  • you should probably be more careful about saying that any benzos will start PAWS over and other non-sense like that. I can’t find any evidence which suggests that, and honestly it’s kind of ruined my recovery. I really have needed to take it as needed for months and havnt because of the fear this website instilled in me.

  • Thanks for the reply Bill.

    No, i wasnt using benzos or klonopin during addiction other than here and there as needed (prescribed by a doctor) and at low doses. I have been totally clean of opioids for 8 months and still experience PAWS which can screw with me real good at times. I havnt taken klonopin at all in 4 months since reading this site. But at times I honestly do need it, and I think im doing more damage to my mind not taking a small .10 or .25 dose at times. How much prolonging of the PAWS symptoms do you think this would cause?

  • can you provide any evidence that proves taking klonopin during opioid withdrawal causes a person to start the PAWS process completely over? How much klonopin would one have to take? There are times when I feel like I’d like to take .25 mg when i’m desperate for sleep and nothing else is working or when i really need to make an appointment and i feel bad. Is taking that low of an amount really going to start PAWS over?

    • Hi Eric,

      I’m in the country for the weekend at my sister’s, trying to do this on an EVDO connection tethered from my phone. It took about two minutes to open this page, so I’m not going to be able to search for the evidence you asked for — depending, of course, on what you call “evidence.”

      How long have you been clean? If you are actually in withdrawal, then Klonopin might alleviate some of the symptoms, but should be discontinued as soon as possible. If you have been clean for longer than a couple of weeks, the symptom reduction would probably not be worth the prolongation of PAWS. If you continued to take the Klonopin, you could end up with a cross-addiction. Personally, I would not chance it unless I were under the supervision of a doctor who really understands addiction.

      You didn’t say if you were using benzodiazepines during your addiction. If you were, the danger is much higher.

      Please disregard the previous answer if you even saw it. I was in a rush, as I didn’t know when I’d lose the connection, and I didn’t proofread carefully. (Klonopin, of course, is not an opioid drug and I am all too human.) Thankfully, I got the connection back — actually got 3G this time! I may get to check the rest of my email.

      Keep on keepin’ on,


  • Hi Bill,

    I was tested by my doctor and a neurologist for the tingling I was having and came out clean. The neurologist said that he thought it was Elavil, which I was taking for insomnia. I quit taking the Elavil, but it actually turned out to be Generalized Anxiety Disorder that was causing the tingling and other unpleasant symptoms. My doctor put me on 10 mg Lexapro and I have been feeling like a brand new person. I think this explains why the PAWS has been so excruciating. I feel better than I have in years even though I am still having some sleep issues. Not that I am saying Lexapro is the cure for PAWS or anything. It just has worked out so far for my situation. I will also have a little therapy coming in the next several weeks. Pills don’t teach skills.

    Take care and thanks for listening,


    • Hi Garrett,
      Great that you found a solution! Lexapro is not addictive, and is a good choice for GAD. Keep in mind that you MUST NOT take yourself off of it without a doctor’s supervision. Even though it isn’t addictive, there can be some nasty rebound, including seizures, if withdrawn too rapidly.
      Sorry I have to cut this short, but I’m on my phone.
      Keep on keepin’ on!

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  • I will read this article. I still fall in the lines of normal but not by much. My doctor from school advises that i am normal and do not mess with trt from a doctor. Another doctor tells me my ranges are out of whack and wants me to come in and speak to me. I can’t really take a side. I wake up every two hours during sleep. I wonder if my hormones will eventually adjust back to normal as I continue into my sobriety. I always feel so foggy and low energy.

  • Hey bill,
    I am ten months now. Still not hundred percent, but better than when i first came off. The doctor ordered a testosterone and thyroid test, and my thyroid was a 4.49. The max amount is 4.50 on a test. My testosterone was 366 out of 1100. The doctor mentioned opiates causing problems with my hormones. My liver enzymes were elevated beyond normal ranges. I feel so foggy, anxiety, and depression all the time. I think it’s improving, but my symptoms persist daily.. and a few times during the month, get even worse. Racing thoughts still exhist, but my organization has improved. I appreciate your strong words of wisdom,keeping me going with great optimism. i will never mess with a substance again, nor do i ever think about them or crave them.

    • Hi Wes,

      Good to hear from you. Sorry you’re still having discomfort, but unfortunately time does take time, as they say. Hang in there.

      Low testosterone could have some bearing on the depression. Could also affect your willingness/ability to get out and do the other things that help stave it off. I can’t comment on the thyroid issue. There is a terrific amount of disagreement in the medical community, and all I can say is find a doctor who is willing to deal with symptoms on a trial basis, not just based on T.S.H. tests.

      This article from the NYT gives you an idea of how divided the docs are on this issue:

      In any case, it is getting better and there’s no reason to think that will change. Good luck, and

      Keep on keepin’ on!


  • Hi Bill,

    I am nearly 6 months sober and have been hit by PAWS that is sometimes mild and sometimes it feels like I never quit drinking. Most of these symtoms I am familiar with: anxiety, unable to handle stress, scatter brained, fatigue, etc. But in the last month I have been experiencing tingling and buzzing sensations in my fingers, feet and legs. I visited my doctor today who really doesn’t seem to have much experience with alcohol related issues. He put me on neurontin and ordered a blood test to check thyroid and potassium among other things. He will probably give me a referral for a neurologist if the tests don’t reveal anything. Have you ever heard of tingling in the extremties as being a symptom of PAWS?

    • Hi Garrett,

      Congratulations on your progress so far.

      Before your doctor gets too far afield, I would ask him to prescribe a blood sugar workup, including A1C. It’s not too likely that you are developing neurological symptoms at this late date. However, blood sugar issues, including diabetes, are common in alcoholics, and sometimes symptoms are masked by the high octane carbs and then the early PAWS symptoms. Tingling extremities is a common symptom. Even if that isn’t the case, ruling out the blood glucose issues is still a good idea.

      Let me know how things go, and

      Keep on keepin’ on!


  • Bill,
    I just completed 1 yr of sobriety from alcohol last week. Although I was spared the psychological/mental side effects of PAWS, I got hit really hard with the physical problems. The ataxia is so bad (and it seems to get worse) that I have had to use a cane to walk; not to mention the severe balance issues. Throughout this year of sobriety, the temptation to reach for the bottle to ease the physical and emotional pain was ever present. However, I was able to overcome those dark days because this website gave me the hope and willpower to ‘keep on keepin’ on’. I thank you profoundly for being an integral part part of my recovery, and I look forward to waking up to many more hangover-free, depression-free mornings. My life has just begun!

    • Hi Darcy,

      Congratulations on your year of trudging the road to happy destiny! Clearly, judging from your attitude, you are well on the way.

      Your note brought tears to my eyes. Thanks so much for writing! Your remarks humble me. My life in sobriety has been one of excellent health, despite some chronic issues that are controlled, and folks like you remind me of how fortunate I am. You are what recovery is about: accepting the things you can’t change, knowing the difference, and choosing to be happy rather than dwelling on the negative aspects of life that are there for us all in one form or another.

      On the extremely unlikely chance that you haven’t seen it, Mayo Clinic has an excellent overview of ataxia and its treatment. I include it here not only for you, but for anyone else who may be having the symptoms.

      Please keep in touch, and

      Keep on keepin’ on!


  • Are you in recovery?lol,not cause i think it’d be funny but cause you know addiction triggers relapse prevention meditation,spirituality,etc…just like someone who has found a “healthy way to live and how to get there to begin with you are awesome,Im for sure going to check out more of your stuff,you relate to us like you are one of us,whether you are or arent,doesnt matter,you are an inspiration and have a knack at making things that seem unattainable to some,very simple to grasp,I didnt say easy I said simple,big difference…I myself am 51/2 months clean and sober my last run was one of heroin and 12 years of the hell that brought so this was awesome to see again,not “new” to me but a good reminder of where I’d like to be headed you give us G-O-D…good orderly direction,thank-you,sir…

    • Hi Mary,
      Congrats on your 5-1/2 months!!
      I’m in recovery from alcohol, prescription drugs and codependency. My sobriety date is 9/14/89. My wife got clean with me, and is Clinical Directer at a treatment facility.
      I worked in the field for several years,and now I write about addiction and recovery professionally. This site, however, is part of my 12th step.

      Keep on keepin’ on!

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  • Hello Bill,
    This blog/article is amazing, I’ve spent the last hour or so reading your replies to many great questions. I wonder if you’d mind answering one for me. Could you share with me your concept of your higher power and how it has evolved over the sober years? I have almost 13 months sobriety now and have struggled with the spiritual aspect of the program. I am willing and eager to grow spiritually but until recently considered myself aggressively agnostic. This higher power thing has been tuff for me but I know it’s essential to my sobriety.

    • Hi Cade,

      Thanks so much for your kind words, and congratulations on your almost 13 months. The worst is behind you, although there will still be a bump in the road from time to time. We call that “life.” ;)

      The Spirituality Thing, as I call it, is one of the major stumbling blocks of the program for many people. Alcoholics and other addicts are black and white thinkers (to begin with, at least), and nothing galvanizes discussion like higher powers and spirituality. The controversy, and some people’s insistence that others agree with their world view, has driven many people from the rooms — or at least given them an excuse to reject the rest of the program as well as the proselytizers. The Bible-thumpers usually have no idea what damage they have done, and if they do recognize their influence, they tend to blow it off with “oh, she just wasn’t ready.” I have a problem with that.

      Personally, after many years of seeking and study both before and after I got sober, I have come to the conclusion that I am agnostic with a small “A”. I do not know if there is a god. I see no reason to think that there is, based on what I know of the world, but I’m perfectly willing to admit that I could be wrong. It’s simply that I don’t plan to put any effort into convincing myself of something that cannot be proven. Atheists, to me, are just as god-ridden as the most devout fundamentalist. As the therapist John Bradshaw used to say, “One hundred eighty degrees from wrong is still wrong.” That said, religion is a great comfort to billions of people. It has much to recommend it. The shamans are a different matter. But let’s not get me started…

      You will find an article that I wrote on the subject of spirituality versus religion here: My contention is that you can have spirituality without religion, but not the reverse (unless you’re just giving lip-service to the beliefs). Give it a read and let me know what you think.

      And keep on keepin’ on!


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  • Bill,

    Thank you so much for this. If this has already been answered, I apologize! I went 98 days with no smoking, no drinking and no drugs. Impeccable diet, everything. I slipped a few days ago (only cigarettes and booze – a massive amount) but am 100% back to being sober and eating right. Did this one slip undo all the healing my brain did in those 3 months?


    • Hi Stefan, and welcome back!

      Everyone’s brain chemistry is different, so I can’t answer your question definitively. I don’t know of any studies that have been done on people with short relapses. As you can imagine, the supply of volunteers is limited and the ethics of creating the condition intentionally are beyond the pale. Most of the data is anecdotal, and thus subject to a wide range of interpretation.

      Based on anecdotal experience from speaking to a number of people over time, I’d have to guess that a relapse of — say — 24 hours might not create a setback all the way to square one. What it would definitely do is greatly increase the likelihood of another slip. Unquestionably it got the attention of all those receptor sites. Be careful!

      I’d guess that you can expect some PAWS symptoms to worsen, at least for awhile. I would strongly recommend that you double up on meetings, get a sponsor if you haven’t already, and start working a program of recovery. In reality, there is no such thing as a “slip.” The relapse occurs prior to drinking, otherwise we wouldn’t drink. That would seem to indicate that something is wrong in your life or in your program. Think of this as a wake up call. Look carefully at the past few weeks, and ask yourself what you could have done differently. Again, going over this with an experienced recovering person can be extremely revealing if you have an open mind about it.

      Best wishes for continued recovery, and

      Keep on keepin’ on!


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  • Thanks for getting back to me. I was just curious cause today and last night I’ve felt really loopy and out of it. It could be the meds but I use to feel like this a while back. I guess I could just be going through an episode. I haven’t had one in about 3 months. But as I’ve read the longer I’m sober the longer the good stretches will be. I was caught of guard this time and went into panic mode. I then went back and read through my old journal and saw days like this. I’m rambling on, but it’s nice to get it out. Thanks for listening.

  • Hello Bill
    My name is Jerry we’ve talked a couple of times over the last year. I’m about to be one year sober from alcohol here on the 15th of this month. I been feeling better in the later part of this year. Around 10 months I started taking Fluoxetine (Prozac). I’ve just reached the end of the 6th week. I started on 10mg and upped it to 20mg last Thursday. It’s been making me calmer and more relaxed. Yesterday I started having a stomach ache and felt dizzy. I use to get that a lot, but haven’t had it in a while. I’m trying to figure out if it’s the upping of the meds or the P.A.W.S. stopping by to say hello once again? I haven’t felt like this in a good while. I feel like I have the spins and having trouble sleeping and thinking. Like my mind is rattled out of no where.

    • Hi Jerry,

      Good to hear from you again. Congratulations on your almost one year. Like they say, 365 days and 730 nights. The worst is over!

      I can’t say for sure what the problem is. My guess is the increased dosage. Nausea and insomnia are common side effects of Fluoxitine, and dizziness sometimes accompanies nausea. I’d sit tight for a couple of days, and if it doesn’t ameliorate I’d call my physician.

      BTW: Tomorrow is AA’s 77th birthday.

      Keep on keepin’ on!


  • Bill,

    I posted here at 5 1/2 months clean and sober from a serious oxy addiction (for 4 years) while still struggling badiy with paws. Had bad anxiety/depression and also some psychological trauma from all the emotional pain involved in early recovery. Since then, I’ve taken your advice and have been focusing on eating healthy, exercising, spirituality, all that good stuff.

    I’m now today almost 11 months and clean and sober, and paws has eased significantly. I no longer feel like a raw nerve, emotionally and physically I’m much much more stable. Life’s pretty good now a days, and don’t anticipate going back anytime soon. I know it depends on the person, but from your experience, at what point do improvements stop taking place? Can I expect to keep feeling even better with more time? I really do feel good now, and I can’t believe it because I never thought I would again, but I don’t remember really what I felt like before I started using. It was probably even better than this. I’m 25 years old by the way.


    • Hi Tom,

      Good to hear from you again. Congrats on the almost 11 months. Good job!

      You can expect improvement for a while yet. PAWS can drag out with opioid addictions, but generally you should be improving rapidly. Watch out for a bad spot at about one year. It’s partly physical, and partly psychological, but a lot of folks relapse then. You will continue to have occasional rougher periods for a few months yet, but you are definitely through the worst of it.

      Stick with your supports and continue to take care of yourself physically, and I’ll expect you back here at 18 months to tell us all what it’s like.

      Keep on keepin’ on!


  • Your information on PAWS helps a lot! I am going on 6 months clean and I continue to have physical symptoms like I just stopped 3 days ago. I will admit they aren’t near as bad as they were on day 3 or 10 for that matter but all the same still have them. I was a heavy opiate user for the past 6 years and to be honest kinda thought it should all be peachy by now. I go to meetings still most every day and I changed all my using friends to recovery friends, working on step 3 and just felt like all the things I’ve been doing to maintain recovery I should be mentally and spiritually better by now. Some days I will say are better than others but it’s those bad days that seem to stick out in my head the most. I’ve been trying to eat right, journal, pray often, do service work like chair meetings, clean up the meeting place, help others……and I still feel empty inside. Emotionally I’m a wreck. I want to cry more than I want to smile. I don’t though, I act as if everything is okay with the hope that one day it will be. You shed a lot of light on some things. What sucks the most is feeling all crappy but not knowing why I feel that way. I don’t want to give up. 6 months may not sound that long to you but it’s the longest clean time I’ve had outside of a controlled environment since I was 15, I’m 40 now. Before opiates it was coke, before that it was banging K4’s. During it all was alcohol. For some reason I just can’t seem to find any happiness inside of me. It has always come in a form of liquid, pill, or powder.

    The only thing you said that I am not ready to let go of is the caffeine. Geeze I have gave up everything else please can’t I have one guilty pleasure! :)

    • Hi Christy,

      Congratulations on your 180 days and 365 nights! You may not think that us old-timers remember what it was like, and maybe some of us don’t, but when you’ve worked closely with people in early recovery for years, it does “keep you green” with respect to the reality of early sobriety, if not necessarily other things. And I remember those first six months — hell, I remember the first 18! I was crazy as a loon. Somehow I missed most of the physical effects of PAWS, but I paid extra into the nuts account. I do empathize.

      If you’re sleeping OK, don’t sweat the caffeine. If you’re having trouble with insomnia, at least cut back some. Sleep is essential to stress reduction, and we can’t take pills, so since most people have a major problem in that regard early on, I discourage coffee. Oddly, we’re finding that coffee has some health benefits beyond just being a pick-me-up, so…

      The only thing you didn’t mention that might be lacking in your program is exercise. Be careful in that regard. Us addicts have a tendency to overdo everything, especially anything that produces endorphins (the body’s natural opioids). I recommend (specifically) a half hour of walking at a reasonably good pace, at least 4 times a week. Moderate exercise increases our resistance to stress, which is a major factor in PAWS. It also helps our metabolism and sleep. If you’re not doing something like that — or if you’re unable to for some reason — at least stand up and move around for an hour or so a day. Avoid sitting for too long, too. If you work at a desk or workstation, get up and walk a few feet every 20 minutes. These are small things, but vitally important in dealing with PAWS — and good health in general.

      Let me know how things go,and

      keep on keepin’ on,


  • Bill,

    Quite drinking about 6 months ago and experience the whole gambit of PAWS. Things are most certainly getting better but I was wondering what effects if any have you seen in regards to non-alcoholic beer? Also regarding the PAWS – I noticed high levels of twitching especially in my legs, is this a common side effect you have see? I checked with my doctor and he said it was just stress but it lasted around 5 months and drove me up the wall. Seems to have subsided recently but I just thought it was worth mentioning.

    Thanks for all you do.


    • Hi Chad,

      Have you had a glucose tolerance test since you got sober? The “happy legs” thing can be an indication of blood sugar issues. Might be a good idea to have that checked out. Hypoglycemia and/or diabetes sometimes become noticeable when the alcohol is gone. Don’t want to alarm you, but you don’t know until you have it checked.

      I am 1000% against “non-alcoholic” beer. First of all, it contains up to .5% alcohol. That’s not much, but we don’t know how much it takes to keep the brain from recovering as it should. Second, it’s a mind fuck.* I’m telling myself that I can’t drink, but I can keep on pretending I can. That shows reservations, regardless of what excuses we hang on it. Some people may disagree on that, but I know people who have relapsed after thinking they could drink the stuff. I can’t say whether or not that was the cause, or just an expression of the “easier, softer way,” but I certainly wouldn’t take the chance myself, even after 22 years.

      I’m glad things are improving for you. You’re right where you’re supposed to be, on course and on glide path (except for the O’Doul’s). Please stay in touch, and

      Keep on keepin’ on,


      *I don’t normally use crude language here, but that’s the only phrase I can think of that really describes the way I feel about it.

  • I am 2 and a half years into my recovery from 5 years of heavy opiate based prescription drugs. I am still experiencing regular PAWS episodes. My general experience of life is difficult and suffer with a lot of anxiety which tends to manifest in the body in the form of abdominal pain and digestive issues.
    I keep thinking this is going to end soon, but time keeps ticking by and I am still not even close to being back to my normal self again. I tried to return to work at one stage but had to stop again because of the nature of my work which involved dealing with numbers and very busy environment.
    My most recent ‘episode’ which I am experiencing right now is including physical anxiety symptoms akin to acute withdrawal. Writhing and kicking, not sleeping and no appetite. Completely out of control of my emotions, filled with fear.
    What am I to do about any of it. When I’m good, it lasts for a couple of weeks if I’m lucky. I feel really frustrated and exhausted by the whole process.

    • Hi Ellie,

      I’m afraid you are not experiencing PAWS from opiate addiction at two and a half years clean, unless you have been taking mood altering drugs or alcohol since you stopped the pills. Some possibilities would be benzodiazepine based anti-anxiety meds such as Ativan, even occasional drinking, or opioid analgesics that are not obviously mood-altering. Unfortunately, many physicians don’t understand that those are not consistent with good medicine when treating addicts.

      If any of those are the case, they could have prolonged the PAWS. In whatever event, given the severity of your symptoms, I would suggest a complete physical, along with a blood workup including thyroid and glucose tolerance tests. It is possible that a medical condition that was masked by the drugs is now rearing its head. Try to find a doctor who is affiliated with a treatment center, or certified in addiction as a specialty.

      Please stay in touch, as well. I’m interested in finding out those results.

      Keep on keepin’ on,


  • well its been almost a year sense i last posted on your forum and im back for round 2 of withdrawell.
    i would have never started back to taking the lortab if winter hadn’t never came calling and the aches and pains got worse sense i couldn’t get outside daily and exercise. i didnt abuse them i took them like the doctor prescribed. here lately i have gotten the feeling that the pills are holding me back on doing my summer yard work. today is day 1 of getting clean AGAIN im tired, hot 1 minute cold the next , not near as bad as last year this go-round i weaned myself down to 2 a day before going cold turkey.. eating is not much of a option today even though i know i need 2 to keep my energy up. my appetite is gone i figure for at least another 2 days. it sux ..the mood swings will possibly set in tomorrow like a run away roller coaster along with the constant runs to the bathroom every 5 minutes. .i hate to say this buy im glad i have went through this before but wish i didnt get back on the pills to get a refresher course on how miserable withdrawell was and is going to be for the next few days when i have reliefe in a bottle in the next room. will post updates on my stages of withdrawell for others to read in preparation to what the body and mind goes through during recovery.

    • Hi Larry,

      When an addict takes drugs, it’s abuse. Doctor’s prescriptions mean nothing. Half the addicts in the country — probably a lot more than half — have prescriptions. If you hadn’t wanted to take them, you would have refused the prescription. Be honest with yourself. You chose to use drugs. Now you can choose not to. But don’t make excuses. I’m sorry you felt the need to do some more research, and even sorrier that you’re going to have to go through all the misery again — but that’s what addiction is: a disease of relapse. We don’t always pick up, but we do relapse. Relapse comes before we start the drugs, otherwise we wouldn’t take them, would we? I hope you make it for good this time.

      Do yourself a favor. If you’re really serious about this, dump the “relief in a bottle in the next room” down the toilet. It will relieve you of the constant torment of knowing they’re there. Hanging onto them is what we call a “reservation.” (I’m going to do this, but just in case….)

      Stay in touch. Rant, scream and rave if you like. It’s OK for the next four days. I strongly suggest you get to some meetings — but you knew I was going to say that, didn’t you?

      In any case, keep on keepin’ on. It’s about all you can do for now.


  • Thanks Bill. I’ll post again next month to let you know how I am feeling. Your last part reminded me of Charlie Sheen. It is what it is. I will never touch anything again. Wise mans last words!

    • “It is what it is” is just New Age claptrap, until we learn acceptance. How many folks have you heard say that, and then immediately rush on, trying to change things that they lack the ability to change. Or keep things from changing — same thing.

      Reminds me of a friend I knew back in my folksinging days. He’d sit tuning his 12-string, and mutter into the mike, “I’m gonna get this damn thing tuned and have it welded.” That’s us addicts, through and through. The one thing that’s constant is change. When we resist change, we create unhappiness, and that leads in directions we can’t afford to go. Charlie had no intention of changing, he just wasn’t going to use. It doesn’t work that way.

      And that IS how it is.

  • I go out very often, almost every day. I never let it get the best of me. I just feel so out of it. From the readings, I thought it only hit you for a few days. It hits me for 2-3 weeks and then I am fine again for the next month or so. I know I am improving. I wake up some days, and remember things as a child that I couldn’t remember on drugs. My memory is improving. Although I have trouble doing math still, and can’t put numbers together well- this was my biggest issue. I worked for the top computer company in the world, and I had to retrieve confirmation numbers via phone when I clocked in for work. I had to replay that sucker over and over again to understand the numbers. This started happening before I hit rock bottom with pills. I couldn’t understand simple numbers. I would look into it too much. Is it usual to have PAWS symptoms before quitting? I would get PAWS if I didn’t get my pills. When I actually did quit, the PAWS increasingly was worse. I can’t wait to be normal again. I finished my Bachelors a few weeks ago, and I have no idea how I did it because it was so difficult to understand or concentrate more than a minute. I know it is improving, but I think I am over analyzing it.

    • Sounds like you’re doing about all you can.

      PAWS can and often does last for months after the last drug has left the system. You are in PAWS the entire time; you’re just asymptomatic for varying periods. Stress is the big trigger, but sometimes the symptoms just come on. Your brain chemistry is getting all mixed up as various portions of your brain improve. They’re not all in sequence, and that throws your neurotransmitters off and makes you feel strange.

      No, you do not get PAWS while you’re using. Those are the effects of the drugs and of acute withdrawal. PAWS stands for post-acute withdrawal syndrome. It comes after acute withdrawal, which is the period during and just after the drugs leave your system. PAWS symptoms are usually more or less the reverse of how the drug made you feel. Nervousness, anxiety and confusion are the norm for people who used opiates and tranquilizers. It will go away on its own. You have no control over it, except for taking care of yourself physically and emotionally. Worrying about it is like trying to think a broken leg well. It just ain’t gonna happen, but if you don’t take care of yourself, you can certainly slow the healing of the leg — and the brain.

      Yes. You’re over-analyzing the heck out of it. Just be in the moment. It is what it is.


  • Hey bill,
    I had an epidural nerve block with cortisone steroid. My first injection i felt a little anxiety after, and a month later, i recieved a second injection into my lower lumbar. After the second one, my paws have been terrible for two weeks now… like really bad.. i been clean from everything else since october. Any reasoning? I wish it would all go away.

    • Hi Wes,

      I don’t want to seem simplistic here, but the answer is simple. You’ve been stressed. PAWS is aggravated by stress. In your case, where anxiety is also an issue, the stress is greater. End of story.

      Entertain yourself. Read a book, have some fun, take a walk, talk to someone, go to a movie (not at home, go out, and go with someone else). The PAWS will go away, but worrying about it will only make things worse.

      Hang in there,


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  • Dearest Bill,

    I am Cheryl who first wrote you on January 25, 2010. Been meaning to write you again to say “thank you” for the longest. I credit you with saving my Life and tell everyone about you. Fell off the wagon on April 9th of that year. But have now been sober since April 10th, 2010, after you made the comment about a hangover being withdrawal just like withdrawing from cocaine or heroin. I use that quote to try to get other people, who are getting drunk every night to see the Light and it always jars them. No one sees alcohol as the drug it is.

    Unfortunately, the only good thing about my Life right now IS my sobriety. My Mom, who was my best friend and only real ally died of a heart attack after being misdiagnosed at the hospital. And with no work available, I started my own business but it has yet to turn a profit. Thus, I have been evicted from my apartment and am waiting for the marshalls to come any day now. Will be living on the streets, since all my friends were people I met in bars, who abandoned me once I quit drinking. On top of that, after I quit drinking and because of the grief that my Mom’s death brought, I gained weight and was diagnosed pre-diabetic. Then my only real support, a beautiful little cat that has been with me for 15 years just developed a lump. So I hit rock AFTER becoming sober. I was recently put on Lorazepam for a month just to deal with all this. Not happy about that, but it was really all too much. Sometimes feel like checking out. Hope that this is not going to be something else to kick but I made sure they gave me the lowest dose.

    Sorry for all the bad news mixed with the one good. But then, had I still been drinking with all this strife and grief, I would have drank myself to death.

    • Hi Cheryl,

      Thanks for the good words. They’re what make this effort worthwhile.

      So sorry to hear about your troubles. Life is hard for a lot of folks these days. I’m thankful every day that my wife and I have the skills to continue to make a living at our ages, since our retirement fund went down the drain during our addictions. At that, having to make do on Social Security would beat being in your situation.

      Have you talked about these things at meetings? You never know what might crop up. AA people are pretty good at stepping up with ideas, and sometimes with help. Also, you might look for a sober house that would be willing to help out.

      I’m extremely concerned about the “Sometimes feel like checking out.” Depression, in addition to its obviously fatal possibilities, can also hinder you in solving your current problems. There are a variety of effective anti-anxiety/antidepressant drugs available that are not addictive. Tetracyclic antidepressants such as Remeron (mirtazapine) are also effective against anxiety, as are most of the selective serotonin reuptake inhibitors (SSRIs). The herb St. John’s Wort is also effective in some cases of depression.

      All antidepressant agents, regardless of their structure, have a slow onset of action, typically three to five weeks. Significant therapeutic improvement is always delayed, so don’t just stop taking them if they don’t seem to work immediately. Also, be aware that sudden withdrawal from antidepressants can lead to severe depressive episodes that can be life-threatening.

      No one in recovery should be taking any benzodiazepine. Lorazepam is one of the worst choices, because it is highly addictive, the detox syndrome is potentially dangerous, and it can trigger a relapse onto alcohol. Also, while it is an effective anti-anxiety drug, Ativan is not an antidepressant and actually has depressive side effects in many cases. DO NOT, however, stop taking it without supervision by a physician. I wasn’t kidding about the withdrawal, which can lead to seizures and blood pressure spikes.

      This is not medical advice. I am not a medical doctor. If you will do some research on your own, however, you will discover that this is good information. And ALWAYS talk over your medications with a pharmacist. They are far more aware of the effects of drugs than most doctors — most assuredly including yours.

      Get to some meetings. You need all the support you can get, and you need to get out and about, even if you don’t feel like it. Trust me on this. I’ve been there.

      Please stay in touch and let me know how you’re doing. Feel free to ask any further questions, and

      Keep on keepin’ on!


      P.S. So sorry about your kitty. I’m a cat lover too, and I still grieve for my best buddy Mr. Slim, who’s been gone for nearly six years. I do know.

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  • Hi Bill,

    I wanted to thank you for your site you really are doing something awesome here. It has been a great shoulder for me to lean on during these times. I am 33yr old Australian who relocated to Sweden with my family last year and being in a new country is trying at times especially the last 5 months copping with withdrawal and so on. As I do not speak Swedish I haven’t been able to reach out for the support like I would have done by now had I been in Australia. This is why i am posting today. I just have come to the point where I need some advice on my personal situation. I will try and be as brief as I can.
    I experimented with most recreational drugs in my teens and early twenties but my drugs of choice became alcohol and weed, with weed playing a more dominant role. I have probably been either stoned or drunk or both almost every day for close to ten years although I have stopped for periods lasting up to around a month on numerous occasions during that time, Without ever noticing withdrawal.
    I stopped smoking weed when I moved to Sweden but my drinking significantly increased to compensate. The catalyst to me stopping drinking was a panic attack which I had after a big night out. I have no history of panic attacks or anxiety. Subsequently I went 78 days sober experiencing a whole range of symptoms which seemed to be slowly lifting. Even though I knew it wasn’t the best thing for me I had a pre scheduled 3 day holiday booked in with my mates from Australia and I drank and smoked weed again for two of those days. I came back feeling remorse and felt I had taken a step back with my symptoms but I soon bounced back and a few weeks later I drank again I have done this twice since then each of these times I averaged about 5-6 beers.
    The last few weeks I have been poor with my diet and drinking a lot of coke and eating junk food i felt myself slipping into old bad habits, a week ago I had 5-6 beers on Friday night then on Sunday for the first time since seeing my mates I smoked weed. I really didn’t enjoy the high and just wanted it to end. The next day I woke up with a cold/flue and went the week feeling terrible as the cold/flue started to lift I became very anxious which has built up over the last 4 days, I have no appetite, my thoughts are negative and repetitive and I am in a very worried state. I feel like I am going crazy, I am concerned that the weed has permanently stuffed me up. The anxiety is the worst, it is basically constant, like my brain is pumping adrenalin through me all time for no apparent reason and it is causing me great concern and panic. It feels like acute withdrawal I had in the first week of stopping some months ago. Could I be going through withdrawal again even though I only drank and smoked a little bit of weed a week ago now? Is this PAWS? I didn’t experience anything as overwhelming as this in my 78 days of abstinence, why now? Will it go away?
    I know now I have to stop for good I obviously can’t handle it anymore nor do i want it in my life. But if you could shed some light on why I might be experiencing these things I think it will help me get through this. I don’t really know where else to turn to right now. sorry for writing so much.

    • Hi Ben,

      This in addition to the email that I sent you earlier about finding meetings in Sweden.

      Imagine that you had a bad burn on your arm. You went through a period of healing, and then when it was nearly healed you burned it again. Obviously the second burn would be worse, all else being equal, since the previous damage is not yet repaired. Furthermore, even after it healed, that spot would be more sensitive to heat and far more likely to be injured again than the skin around it.

      In an extremely oversimplified way, that’s the situation with our brains. Once we are addicted, and quit, our brains begin to repair the abnormal changes that took place to accommodate the drug(s). Eventually, we begin to feel better as our reward system recovers from the rebound effect of quitting, and so we think, “Hey, a couple with my mates won’t hurt!”

      Wrong. The situation, while far more complicated, is analogous to the burn example. We not only revert back to our previous addiction almost immediately, but we also discover that things go downhill rapidly, and the healing is interrupted. We have to do it all again. There are all sorts of complicated reasons why researchers think that happens, but we really don’t know for sure, yet. Hopefully, when we do, we’ll be able to devise some way to make the discomfort of PAWS last for shorter periods. However, it’s unlikely that we’ll be able to reduce it completely.

      Acute withdrawal (the first few days) occurs when the body is like, “Oh s–t! I don’t have my drugs!” After that subsides, we get into post-acute withdrawal (PAWS), the period where the body is actually getting back to normal. That can take months. It is, for some people, the proverbial “two steps forward and one step back.” Sometimes it’s several steps back, but the trend is always toward recovery as long as we remain abstinent. (See burn simile, above.)

      We need to concentrate on healthy living: good food, rest, moderate exercise, vitamins, avoiding stimulants (helps us sleep) and watching our blood sugar. See the article on PAWS for that info. We also need to have some fun, and we need the company of people amongst whom we can relax because we know they understand. Get thee to a meeting!

      Feel free to contact me if you need a little leg up. You’re in an unusual position, and until you get established in the AA community, you may feel as though you need to keep in touch. Of course you’re welcome to contact me any time, anyway, as are all the folks who come to this site.

      Keep on keepin’ on!


  • Bill,

    I am an avid reader of you blogs and they have been helping me immensely through my detox and recovery. I’m 80 days clean as of today and I was a chronic MJ user for five years with medical grade MJ for the past four years. The last three months have been a full blown roller coaster to say the least.. I had a break-up with a veryyy unstable EX-girlfriend which is a big reason why I smoked as much as I did. Since I went cold turkey with the relationship and the pot, I’ve been experiencing crazy symptoms of anxiety/depression, intrusive thoughts, hopelessness, and overall I find myself to be emotionally numb. Honestly, I feel like I’m going crazy because one day I’ll wake up fine and the next day you would think my dog died. I’m taking an SSRI to help with the anxiety/depression and trying to eat healthy, I’m just wondering if you had any insight on how long these symptoms last for pot users. I feel like I should be better now, but just when I start to feel better, I end up taking two steps back. I really appreciate the help. Thank you.

    • Hi Alex,

      Congratulations on your 80 days! Well, 81 now, I guess. ;) I’m proud to have been a small part of it, but don’t fool yourself — you’ve done most of the work.

      You’re living proof of the fact that cannabis is addictive, and that there is a prolonged withdrawal syndrome. It’s been my experience that most of the folks who claim it isn’t have never tried to quit completely, or did so with the aid of some other drug. And, of course, like most drugs it makes us a bit stupid, and kicks in our denial big time.

      I wish I could tell you that things are going to get better right away, but the fact is that even though weed doesn’t have a really acute withdrawal phase (for most people), PAWS can and often does continue for months. Your symptoms are classic, and like all PAWS symptoms, they are a major reason for relapse. Do be careful. The SSRIs should help, but your determination to remain abstinent is your biggest weapon.

      The good news is that your episodes will gradually lessen in intensity and duration. When it begins to seem as though it’s hopeless, remember that you submerged your brain in cannibinols for five years. It’s hardly unreasonable of your body to take a bit of time to repair the changes that took place. You overstimulated your brain’s pleasure center, and now you are experiencing the rebound effects. It will get better.

      In the meantime, the best things you can do for your self are: 1) good self-care. Make yourself get some mild exercise every day, even if it’s just walking around the block for ten or fifteen minutes (30 is better, but anything helps). Make sure you watch your nutrition, and take a multivitamin morning and evening — with meals. Vitamins are food ingredients, and should be taken with food for the best absorption. 2) Hit some NA meetings. We need the support of people who know what we’ve been going through.

      Please do keep in touch. Not only do I like to keep track of how “my” folks are doing, I’m especially interested in PAWS as it relates to pot. We’re learning more and more about what a nasty drug it really is, and the experience of folks like you is an important addition to the field.

      Keep on keepin’ on,


      P.S. It’s not really two steps back, it just seems like it. We addicts expect our quick fixes. You are progressing every day, whether it feels like it or not.

      Another thought: DON’T go off the SSRI yourself. Discuss it with your doctor. If you think the rebound from MJ is bad, you don’t even want to think about what sudden withdrawal from an antidepressant is like!

  • Thanks Bill
    I hope things get better soon. I had to miss work this week because it got that bad. I feel a little better today and just want to feel normal or OK again. I’m gonna give the Paxil time and see what happens. After what I’ve been through in the last 10 months it can’t hurt to give this a chance. I just feel as bad now as I did when I was around 2 months sober. I thought I was through with feeling this crummy.

    • Felt that way too, a couple of times. I had a relatively painless 3 week detox because of benzos, and the PAWS really nailed me a couple of times. One of the things that got me interested in the subject.

      It gets better, I promise!


  • Hello again Bill.
    I had come on here about 4 or 5 months ago to ask you some questions. At the current moment I’m 10 1/2 months sober from alcohol. I had started feeling way better as time went on. I had my up’s and down’s with anxiety and I’m pretty sure P.A.W.S. as well. I started working again back on March 13th. My first week was anxious and nerves were up and down. I was able to work again. I had really good days and days were I felt overly stressed and would get bad anxiety. I would feel shaky, dry mouth, tremble, head zaps, weak in the legs, burp a lot.. I would notice that it would stop if I was away from work and away from driving. My question is this. Is it normal what I’m going though? Like I’m not sure if it’s P.A.W.S., anxiety or both. Last week I had to leave work twice because of how bad it got. I didn’t know that after how far I got that I could do a total 180. I finally got fed up and went to see my doctor. I was prescribed the generic version of Paxil. I’m on day 3 today and feel really anxious, headache and weak in the legs. I’m trying to figure out what to do. I’ve read to give it time and that my body needs time to adjust. I feel scared to work and I shake when I drive. Just needed some input. Thanks for your time. Your a good man for helping so many of us.

    Thanks, Jerry

    • Hi Jerry,

      Good to hear from you again, and congratulations on your 10-1/2 months!

      PAWS symptoms are often triggered by stress, and it is likely that was the case for you. Paxil is the antianxiety drug of choice for addicts, but can sometimes take a few weeks to have an effect. Don’t give up on it. In the meantime, try to rest, eat well, and remember that it does get better.

      I wish I had something more to tell you, but I’m afraid the only cure is time (and, perhaps, the Paxil). Meetings and a bit of fun couldn’t hurt, either.

      Keep on keepin’ on!


  • Dear Bill,

    I’m just checking in to say thanks agian for your help, in my early recovery. I’m now 22 months and 15 days clean, off Rx Opiates and benzos. I’m active in my local NA group, and I work my program diligently. I lost a very fine teaching career to addiction (after 33 years). I’ve regained the love of my Family, my self respect, and a lot of serentity and peace. Rx drug addiction outstrips all other drugs abused in the U.S., with the exception of alcohol. I find satisfaction in helping others who are going through the hell of addiction. Upscale Rx drug addicts, are ( in my experience) the most difficult category of addicts to get into the NA rooms.They are “Addictted” but they aren’t “Addicts”. The Stigma is so great, they will lose their lives rather than lose their face. I know many professionals who go to AA, and claim that their problem, is alcohol, because they fear the social stigma of Drug addiction. Honesty is a hugh part of the program for me, I just don’t feel honest in AA, without saying ” I am and Addict”. Many old time AA members resent Addicts. One told me “This is about alcohol”………… I replied ‘” I thought this was about Recovery”.

    NA recognizes that alcohol is a drug, and welcomes Alcoholics, as we do all addicts.Total abstinence from all drugs (alcohol included) is a fundamental tenant of NA. We work the same 12 Steps.

    Incidentally, I still have some physical pain ( as many Rx opiate addicts do). I can deal with it, far better than I could deal with addiction. I occassionally still have some mild PAWS episodes. However, I recognize them, and that always has helped me deal with them. I wrote you in my first 4 months, and the information, and kindness you showed me, served me well. Only yesterday, I mentioned this site to a newcomer in my NA homegroup. Keep up the goodwork Bill, and thanks.


    • Hi John,

      Congratulations on your (nearly) two years clean and sober! I know it was a long, hard row to hoe, and I’m delighted to hear that you’re doing so well.

      I — as you and the rest of the readers know — am a polydrug addict, but my drug of choice was alcohol. That was more a case of acceptability than anything else. I chose not to involve myself with some substances because I knew I wouldn’t be able to get them without jeopardizing myself, and booze got the job done, with a little bit of help from some benzos and amphetamines. I’m equally comfortable at both AA and NA, and am certainly more than qualified for both (along with several other fellowships, if I’m being honest). I tend to hang with the drunks, mostly, simply because I’m in my 7th decade and the age of NA members tends to be skewed toward the 20’s and 30’s.

      Back when my ego was bigger than my recovery, I used to identify as “Bill, and I have a desire to stop drinking,” just to annoy the old-timers. I skated the edge of talking about drugs, never failing to mention them at least once when I shared, and generally got a kick out of giving the deacons the finger. Someone asked me once why I always said that, and I replied, “Because some of the assholes don’t like me saying I’m an addict.”

      Eventually, as I learned more about the history and traditions of the 12-step groups, I realized who the asshole really was. While I believe that people who need to share should be allowed to share about whatever their needs dictate, I’ve realized that not talking about drugs at AA meetings is simply good manners. You don’t put your feet on the table when you dine with the queen, either, although you certainly have the “right” to do so.

      And after all, I can talk about recovery all day and all night without mentioning any substance, because booze and drugs are what recovery isn’t about. Recovery is about living a good life and doing the next right thing, and that translates the same at any meeting.

      Congrats again, and

      Keep on keepin’ on!


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  • Hey there,

    I quit drinking June 12, 2011. I’m on day 293. I quit without AA or any other program, I just got tired of drinking. I drank for about 6-7 years, never an all-day drinker, always at night time and around 4-8 units of beer until I got sleepy and fell asleep or passed out. In this time I have had good days and bad days. For a few months off and on I would feel good, then all of the sudden I would feel off… anxiety, jittery, just “not right” – Before I drank alcohol I never felt this way nor while I was drinking (buzzed, hungover, feel better and repeat)

    When I was drinking, I was generally hungover the next day. If it was really bad, I’d quit for a few days until I felt better. During these years, I did have quite a few 30 day periods of no drinking (the prove to myself I can stop phases) felt better and went back. Just wondering if it is normal/common to feel this way almost 10 months in and what I may be able to do to deal with this easier and speed up the healing process.

    I have read up on PAWS and a thing called “kindling” –

    Thank you.

    • Hi M, (I’ve deleted your email address, since you seem to wish complete anonymity.)

      Congratulations on nearly 10 months clean. If it’s working for you without AA, more power to you. Your drinking pattern sounds like it wouldn’t have disrupted your life too much, so you may have avoided the need to relearn the sober living skills that many alcohol abusers lose during their drinking careers. You might gain some benefit from AA, nonetheless, including making a lot of non-drinking friends who could be loads of fun and the opportunity to help others who maybe haven’t had it quite as easy as you have. Obviously that’s your choice, but it wouldn’t hurt to give it a look-see.

      Four to eight beers an evening, even for three or four nights a week, is entirely adequate to develop an addiction to alcohol — especially over such a prolonged period. You were most fortunate to be able to quit as you did, especially with repeated episodes of withdrawal. The kindling you refer to is very real, and can result in extremely serious withdrawal complications after repeated withdrawals. Thank goodness you “got away with it.”

      It is not uncommon for the post-acute alcohol withdrawal syndrome to continue for a year or more, although most people experience marked improvement sooner than that. Everyone’s brain chemistry, and the reactions of their bodies to chronic alcohol use, is a little bit different, so the “typical” withdrawal is more of a rough average of anecdotal information. Given your exposure, some symptoms at 10 months isn’t out of the question. I would expect them to continue to improve.

      In the meantime, watch your diet, avoid caffeine and sugar, get a little exercise (30 minutes of walking every other day is about right), and try to get a reasonable amount of sleep.

      Again, congratulations on the good decisions, and

      Keep on keepin’ on,


      PS: Don’t forget to have some fun. If recovery isn’t fun, you’re doing something wrong.

  • Bill,
    Take what medicine? I don’t want to have withdrawls from another drug.
    Does aspartame cause problems with recovery? I am trying to pinpoint my fear and anxiety.
    I don’t need to go to meetings. I dont have a problem, and staying sober is quite easy for me, but recovery is difficuilt.

    • Wesley,

      The “medicine” is AA. I repeat that recovery is about learning to live clean and sober, not about staying sober. If you choose not to avail yourself of a valuable resource, that is your decision. I don’t want to seem unsympathetic, but I’ve given you the best advice I can. What you decide to do with it is your affair. I would, however, point out that your own decision-making is what got you where you are. You admit that you’re depressed and confused, yet you choose to ignore advice about the most important decisions you’ll make for the foreseeable future.

      Good luck with that.

      Aspartame won’t affect your health, regardless of what the quacks say.

      Be well,

  • Greg, I am pretty much feeling exactly like you. I’ve tried Celexa(20 mg), and I felt more like I was high than helping me. I had a few good months, and now(March), I am feeling like crap. I am thinking very negatively, and create events in my head that lead to no good end. I think I am suffering from the syndrome of depression. I think and feel really negative, I look at everything so black and white, and think so rapidly how everything works.(OCD), and I feel it’s not really special. I don’t feel that my Paws comes and goes, I kind of feel it’s always there, and it hits me harder at times.My memory has improved, but still bad. But I am getting better at putting things together. I am a full time student, and at first, I had trouble putting information together. I would forget it moments later. I don’t even know how I passed some of my classes. This semester, I am doing a lot better, I can soak up information a lot better and can recite it back better than before. I am still lacking though, but I know these must be part of PAWS. I really hope this goes away soon. I have a lot of anxiety about being in public, but I manage to put myself in the situation for a simulation purpose of getting my brain use to it, because it was so blocked out before with drugs. I need to get use to the response from the stimulus. The worse paw symptoms is when I feel agitated, and I feel like I am not getting enough air in my lungs. I am not freaking out at this point usually, like sometimes when I go thorough paws, I am extremely fearful; very scared. But I feel as if I am suffocating, and I don’t know why. Last night it kept me up all night,and I tried to ignore it. I was paying attention to my breathing the whole time. Is this common?

    • Wes,

      Get out of your head and get to some meetings. By not doing the single most helpful thing — and thinking too much — you’re stalling your own recovery. If you don’t take the medicine, don’t complain about the aches and pains.


  • Hi Bill,

    Thank you for your thoughtful, informative replies. Like you, my withdrawal has been mostly emotional and psychological rather than physical. I did have physical symptoms the first couple of weeks but they subsided.

    I am still in disbelief that I can get this bad this far out (last drink March 16 2011). I am still able to work, but ever since the 2nd week of March my mental state has taken a hit. I find it hard to find pleasure in any activity. It is hard to feel love or attachment to family and pets. My mind races with looping catastrophic thinking. After my last cycle ended in September, I was doing okay and I greatly enjoyed October through February (with intermittent bad days). I still felt off in the head but I felt positive emotions. Now it feels as though I am back in worst of it (almost similar to my 3rd month off). And I have not encountered any new stress either.

    They say that it is times like these that we are in danger of relapse. For me this is not the case. I actually only miss alcohol when I am feeling good. The temptation is there but I am strong enough to resist. When I feel bad, like I do now, I am actually afraid to go anywhere near it because I associate alcohol as the reason for my suffering. (Hot Stove Syndrome)

    I did try to get on SSRI’s (Lexapro and Celexa) back in April, but I just could not stomach the side effects. The only time I was able to successfully get on any AD’s in the past was when I had a benzo to use during the first couple of weeks until it kicked in (this was in 2004). But that was well before I became addicted to alcohol (I also became addicted to benzos in 2008 and 2009). And that was when I was just facing common work-stress related anxiety, not anxiety and depression caused by a CNS damaged by heavy binge drinking for 4 years. I feel it wouldn’t take long for a benzo to wreak serious havoc on me.

    So I have resorted to waiting this out… like I did during my last 2 cycles, each lasting about 1 month. Sadly, I realized that I only exercise and watch what I eat when I am in one of these cycles, but I guess that exercise and a healthy diet are just as important/crucial when we are feeling better. I splurged during the holidays and didn’t really exercise much, now I feel things have caught up with me.

    I am seriously considering joined AA. I saw that there is one locally, but I don’t know how I feel about it because I don’t feel I need help staying off alcohol. I know for a fact that I will not resort to alcohol no matter how intense these feelings get. I guess I fear that people will think it is not possible to feel the symptoms I am feeling at over 1 year out and that will cause me to panic and think something else is wrong with me, even though I know I never experienced anything like this before alcohol and benzos. But I will give it a try. I do know that my life needs more structure.

    In the meantime I will continue to work on my physical and mental health which includes a daily routine of the following:
    – 20 to 30 minutes of sweat-inducing jogging
    – 30 minutes of Tai-chi Qi Kung and meditation
    – Ensure Plus (sort of a liquid multivitamin)
    – Healthy eating (more fruits and vegetables, less sugars, refined/processed foods)

    I want to thank you for this site. What I have read has greatly helped my spirits.


    • Hi Greg,

      It is not uncommon for PAWS to hit a peak at about a year, and you need not worry about people in AA and what they say or think. Remember that despite the combined experience of 75 years, any single AA member is just that. Unless they are a professional, they are in no position to have an opinion on what is appropriate for someone else. In fact, in the rooms that’s called “taking someone’s inventory,” and is considered to be a sign that maybe the person doing so needs to concentrate on their own issues a bit more.

      When in doubt, check back with me. I do know what I’m talking about, and I will always give you the best advice I’m able.

      You’re doing most of the right things for yourself, but you’re spending too much time in bad company. You need to get out and spend time with other humans, instead of stewing in your own juice.

      Recovery is not about not drinking or using drugs, Greg. If that were the case, we could lock people up until PAWS was finished, cut them loose, and they’d be just fine. Silly as that sounds, consider this: we spent years learning to live with drugs and/or alcohol. Now we need to learn how to live without them. Recovery is about learning how to live drug-free, clean up the wreckage that we created in our lives and the lives of those around us, and reintroduce ourselves into the real world. I know of no place better than AA to get on track and follow that path. If I did, I would tell you, just as I would tell you if I thought you were best served by not going.

      A side benefit: you will meet a lot of wonderful people. So don’t shortchange yourself. Commit to going to a meeting a day for 30 days. At that point, if you don’t believe it’s for you, at least you’ll know that you gave it a shot. If there aren’t that many meetings available, just commit to attending 30 meetings at whatever frequency they are available. I promise you will gain a lot, and lose nothing.

      Have I lied to you yet?

      Keep on keepin’ on,


  • Thanks for the quick reply. I remember i felt the best when i went camping for a week. My paws was gone, i thought i made it lol. So what should i do to accomdate this? Dont lift heavy weights? When i played basketball at the gym, i left feeling terrified. I played for 90 minutes full court. I was so freaked out, i was feeling so scared. Should i lift two to three days a week? I thought working out was a good thing. Is it normal to be so indecisive during paws? I over analyize everything and feel i can’t make a decision because i see two sides on everything.

    • Hi Wes,

      Mild aerobic exercise is walking fast enough to work up a sweat, continuing it for about 25-30 minutes, and then cooling down with ten minutes of walking slower. 90 minutes of full-court isn’t mild, it’s highly strenuous, crosses over to anaerobic at times, and (as you found out) is not the best thing for PAWS. Try 45 minutes of half-court and see how you feel. Your gut is your best adviser on that.

      If you want a recommendation, which you probably won’t like, here it is.

      Give up heavy lifting until all your PAWS symptoms are gone. Sure, you’ll lose bulk and definition, but if that’s all your self-image is about it’s all the more important for you to find something else to do. Heavy anaerobic exercise is not necessary for health. Unless you’re a professional athlete who needs strength and bulk, it’s strictly cosmetic.

      Lift light weights with high reps for not more than 25 minutes every other day for stamina and muscle tone.

      Run for half an hour every other day (alternate with the weights). Stretch, warm up, run, cool down with a 10-minute walk, and then take a shower and relax. If you want to shoot hoops or engage in really strenuous exercise, monitor how you feel afterward. If you feel good, fine. If not, cut back on whatever it was.

      Find something that’s fun to do that doesn’t require strenuous exercise. Walk in the park or woods. Take up birdwatching. (Watch it! I’ve been a birder for many years.) ;) Play frisbee. Swim some — not laps or water polo, just mess around in the pool. Go someplace fun with people from NA or AA. You get the idea. Meditate. Lots.

      Become a human being, not a human doing.

      Whether you like it or not, this is good advice. Up to you what you do with it.

      Keep on keepin’ on…just not as frantically.


  • Why should you stay away from heavy exercise? I saw you posted something about that. I feel horrible after i work out, i feel that natural high for 20 minutes, then after that high subsides i feel my paws symptoms. I am an exercise and wellness major. I spoke about my paws hitting,and i really feel exedrine xd and the caffeine vitamin waters put me back in a rutt. I lift really heavy for 5 days a week, should i stop?

    • Hi again Wes,

      There are three reasons why heavy exercise is not the best idea for people in early recovery.

    • Heavy exercise itself can be addictive. At the very least, it creates stress, and stress aggravates PAWS.
    • Anaerobic exercise breaks down tissues, creates waste that taxes the liver and kidneys, leaves us tired, and does nothing to relax us. Light aerobic exercise, on the other hand, relieves stress, does not further break down a body that is trying to rebuild itself, promotes relaxation and improves sleep.
    • Finally, the endorphins released by the body during strenuous exercise are themselves mood-altering, and they can keep the brain from completely repairing — or at least slow the repair — of the opioid receptors. In effect, they provide a little shot of drugs every day. This greatly slows the recovery from PAWS.
    • The letdown you feel after you finish exercising is actually a withdrawal syndrome from the increased levels of endorphins.

      In early recovery, we want to promote healing in the body and further emotional and psychological wellbeing. This is far better served by moderation in all things, rather than extremes of any kind. Heavy lifting five days a week is extreme, and itself borders on addiction.

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  • Oh yeah, I should state that my cycles of “depression” are not really the kind where I want to just lay around, sleep, and hope for death. It is more along the lines where my anxiety gets worse and I get ‘depressive’ symptoms that I am dealing with another recurrence of the symptoms.

    The depression never gets out of hand and always subsides after a few weeks. I am 1 week into it and this is my 3rd cycle of it in a year of being sober. Maybe it isn’t really depression (I have never had depression in my life prior to alcohol, so I have nothing to compare it to). But it mainly consists of me having intrusive memories, emotions running wild, and racing negative thoughts for a few weeks along with high anxiety. Also, the world and it’s problems become more real to me (even my sense of smell). Then after a few weeks things subside.

    I am feeling pretty positive in spite of dealing with this yet again, but I have found that after each cycle my baseline symptoms do improve (memory gets a bit better, emotions get more level, etc).

  • I am recently 1 year sober from alcohol. I was a heavy binge drinker for 4 years (about 3 times a week). After a rough couple of weeks I pulled through and life was manageable. Then around the 3 month mark I got hit with massive depression and anxiety. It eventually eased up on its own (I am on no meds) after about 3 weeks. Since then I have had two other episodes of high anxiety and depression. One being in August (4 weeks) and the other being as of last week. I think I am experiencing PAWS.

    In between these flare-ups, I seem to be doing relatively okay… although my memory is shot, I have a hard time making decisions, nothing really interests me and I have occasional insomnia. I should mention that I went cold turkey off of klonopin about 1 year before I quit drinking. I just kept on drinking for a year after I quit it until anxiety and depression caught up with me and forced me to quit.

    I have had moments where I felt like myself (where I enjoyed life and didn’t feel so cognitively impaired). But I just find it hard that 1 year after quitting alcohol things could still get this difficult. I am currently exercising every day, eating healthier, and even doing occasional meditation. I should say that in April of last year I did have a 1 week relapse on klonopin due to the intensity of the withdrawal symptoms. I have been trying to find my way out of this mess for awhile. I do hope things get better.

    Is it normal to have things get so intense around the one year recovery mark? I don’t think the anniversary is causing psychosomatic symptoms, because I didn’t really connect the two until after I started getting hit with this deep depression again.

    Still struggling,


  • Hi. Great site. I’m been off of Norcos for over two weeks now. I was taking up to 120 mg. a day before quitting. (This is not my first go ’round with detoxing from opiates.) I’m still experiencing some sleeplessness, which seems normal, but I am still unable to eat without serious protests from my stomach. Also, my stomach hurts and/or burns off and on all day, even without eating. I’ve tried antacids, prilosec, baking soda water, etc., but nothing seems to help alleviate the problem. The pain, pressure and burning seems to be centered around my navel area. I’ve dropped about twenty pounds and am having difficulty recouping any strength or stamina because I can’t eat without causing myself great discomfort. Does this seem within the range of normal? I don’t remember this happening before. Thanks in advance for any advice you may have. p.s. Psychologically, I feel okay so far. Am attending NA again and have a lot of support.

  • I would love some personal advice. My personal background is this: I’ve had been using opiates for 2.5years for recreation. Oxi to be specific. I used to take one 30mg break it into fragments and take fragments throughout the day. I gradually increased to 1.5 a day (45mg) and stopped there for a year and then began realizing that I was losing my humanity. All day was clock watching waiting for the next time for the next “ration”. Massive Intellect was lost. I became a very basic creature just trying to satisfy needs when previously was a big picture person. I decided to quit. I weened myself down to 5mg a day and spent days of agony on the couch. Dec 5 I stopped taking completely. 4 days later physical agony was over. A feeling remained… a feeling of living life behind glass. Uncaring, unfeeling, joyless. Stressful situations yielded a feeling of confusion and hopelessness. Researching showed that physical agony is often the opening act for Post Accute Withdrawl Syndrome. I’ve has been fighting it full force. I used the advice, exercising, drinking only water. It is now day 102 of being completely off with no slips. Much has been regained. Intellect, social abilities, memories. and there are even some days of the week where I feel completely fine. Sometimes naturally feeling good makes me have cravings. Will there ever be a day that this is over? When my friends are over is it ok to drink alcohol in moderation? Any prognosis would be nice.
    thank you so much

  • The type of psychiatrists that one should consult when one is withdrawing from ETOH, narcotics, and/or benzos (xanax, ativan) are addictionologists. The ‘run of the mill’ psychiatrist does not have the expertise or understanding of PAWS. rbb

  • Sorry, on a smart phone.. i started to get paw symptoms which is why i quit. Bad anxiety and had panic attacks. My mood changes so quickly now, and i over analyze everything. I stopped october 18, really want this to go away. I feel like theres another person trapped in me because of this all. I feel lost with reality. Im very intelligent, but i feel emotionally trapped. I wonder if people have felt like me before

  • I wonder if drinking four vitamin waters had anything to do with making my triggers extremely worse. I am so fearful, so scared. The vitamin waters i found out had 75mg of caffeine! About as much as a red bull, and i consumed roughly four of them in a two hour span. How long are these symptoms suppose to last when they trigger? They sure seem to last always two to three weeks. The racing negative thoughts and mood changes, with anxiety and panic attacks make me wonder if their is an underlining issue that the oppiates may have triggered. I saw a psychiatrist when it happened, and he told me i was just an anxious person. Told me to calm down haha. He didn’t seem to know about paws.. or cared to really take note i came off opiates. I had paw symptoms dung themk of using, which is mainly why i quit.. started geting bad anxiety.. my ind and concentra

  • Hi,

    I am wondering if I am going through PAWS. I have been extremely depressed for the past 4-5 months. Around may last year I began recreationally using suboxone. Before that I had been experimenting with opium tea and other opiates. I had tried heroin and pills before but never liked them because of their short half life. The poppy tea lasted all day and I enjoyed that buzz because it enabled me to get work done. In may I decided to just start taking suboxone everyday indefinately because it also lasted long and was less of a hassle for me to obtain = it was cheap. I had also broken up with my girlfriend of eight years. So, from may until august I was high every single day on about 2mg of suboxone plus I’d take 1mg of xanax every night on top of drinking every night. At some point I hit a wall and the suboxone stop working effectively. It only lasted an hour or so after taking it and I began to feel like my brain was recieving electric shocks and I was also experienceing rapid heart beat and palpitations. I stopped everything all at once and went through two weeks of acute withdrawl symptoms. After that I felt back to normal and things seemed to be looking up. Shortly thereafter, I met another girl and quickly fell in love. I began to feel anxiety and about her breaking up with me and when I felt that anxiety, I really craved drugs. After about two months of dating, she cheated on me with her ex lover and eventually she left me for good. I relapsed into heroin for about 3 weeks and then a week on suboxone. The last suboxone I took was in november. I have been severely depressed ever since with spikes of happiness every once in awhile. But this is a mystery to me. The reason I mention my personal emotional traumas is because I cant tell whether the depression I am feeling is a result of heartbreak (loniless, rejection, etc) or PAWS. I wasn’t on opiates nearly as long as most people on this website or people I know. All I know is that I’m depressed as hell and I have not been abole to make work in months (I am an artist) which has never happend to me. Its been hard for me to hold a job, and maintain social connections. I am desperate.

  • I been dealing with paws for a long time now. What does it mean when it talks about peaking three to six months? I used opiates for two years, abusing them. I feel so freaked out and scared when it hits. I think so narrow, rigid,negative, and frightful. I over analyze me being insane, and i start freaking myself out. I have racing thoughts, and they freak me out. I took a musinxd, and i was wondering if it made my symptoms worse.
    I have had better days, and my memory and concentration has greatly approved. Im 24, and quit doing opiates 5 months ago. My symptoms stay longer than a few days, they tend to last two to three weeks. Then go sway for a month or two. They anxiety and racing thoughts really make me really fearful. Would taking a small dose of xanex to relieve these problems be ok? I don’t know what to do. I am afraid it will never go away. I used opiates and marijuana, until these symotoms started to occur

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  • Hi Bill;
    Thank you so, so much for the information on PAWS. I am in my mid 40’s and have been drinking heavily for 15 of the past 20 years. During the past year I have been cutting down and I have been “only” been drinking 1-2 nights per week for the past 5 months. I have drank 4x in the past month. I was beginning to believe that I was going crazy and was going to have to live with severe anxiety for the rest of my life. I just couldn’t figure out why even though I am making changes in my life, working with a therapist, I could not shake the physically triggered anxiety, etc. I experience MANY PAWS symptoms. I knew about acute withdrawl – but I never knew about post acute symptoms. I read about it yesterday on the internet – needless to say – I have been reading all weekend. It all makes so much sense to me now – my anxiety, inability to cope with stress, how the little things become enormous, repetitive thoughts, paranoia, and it goes on and on. I think I have been keeping myself in a state of eternal post acute withdrawl. Scary to think that I will have to go through PAWS for a while – many a long time – but better than continuing to drink and live in an irrational state of mind.
    Do you believe there is any merit in having my serotonin levels checked – or anything else for that matter? It seems like even though I have significantly cut down on my drinking – the PAWS is ever present – any drinking regresses brain function . . . . ?

    I am printing this article and I am following your recommendations. My PAWS symptoms are so bad at times I feel I am losing my mind and I don’t know who I am anymore. I guess I am finally so sick of being sick all the time – 4 hours of drinking at night is not worth the next 4 days of hell.
    I feel that I have just come upon life saving information. Again – thanks so much – you are now bookmarked. :)

  • Hey Bill,
    I just happened to stumble onto your website while searching about paws syndrome.I am a 41 year old mother who took hydrocodone,diet pills,nuerontin,and muscle relaxers for 2 years.I decided that I couldnt live my life doped up any longer and have been clean of all but the neurontin for 8 months.I had quit taking the neurontin also but when I was going through the early withdrawal symptoms I was given Ambien for sleep which I took for 19 days and each of those days that passed I found myself getting worse instead of better.I went to the ER 3 times because I thought I was having a heart attack.In researching online I realized I was having anxiety from the Ambien and stopped taking it.The funny thing is not one doc ever mentioned that they thought I was having anxiety and when I asked if they thought it could be the Ambien they told me it wasnt.Anyway I decided to stop taking it and let me tell you the withdrawal from getting off the Ambien was 100 times worse than all the others combined. After the 3rd day into getting off the Ambien my mother talked me into taking a neurontin to see if it would help with the withdrawal symptoms and suprisingly it did.I hadnt slept for like 3 nights and I finally did that night. Then I found myself having to take the neurontin to help with the devestating depression I was having. 6 months later I was still depressed so I went to a doctor and was put on zoloft which I have been taking for 2 months.I am currently on 50 mgs.It has helped somewhat and am thinking when I go back she will probly want to up it to 100mgs. The main concern I have is about the neurontin. Im wondering if it is hindering my brain from making the seratonin it needs like the opiads and diet pills did. I know it isnt an opiate but dont really know that much about it. I was hoping that after I got the zoloft in my system that I could get off the neurontin but that doesnt seem to be working.I find I still need to take it also for the depression. I dont know if you know anything about neurontin but if you do I would certianly appreciate your take on wether it is safe for me to take right now.I guess im afraid its hindering the process of getting out of this stinkin depression.Sorry this is so long and thank you ahead of time:)
    Thank you again,Katrina

  • Hi Bill,

    I am a social worker worker with parents who have been using heroin via IV for (mother for 4 years and father much longer) years. They are both in outpatient treatment and are no longer together. The mother states it will be a very long time before she will be able to care for her children (stating at least a year.) The children have been living with their paternal uncle and his wife since October 2011. The current caregivers of these children ages 5, 3, and almost 2 are no longer able to care for them. The father has his own place now two miles from the paternal uncle (meaning the father’s brother) who is caring currently for the above three children. This father wants the children to return to him. He has been clean around 3 months but is experiencing a lot of PAWS as he looks very tired and states that if he could he would sleep all day everyday. He is in out patient treatment for 9 hours per week and attends NA AA groups. He gets random supervised drug screens around 2-5 times per week. I am faced with recommending that all three children return to his home or placing the children in foster care and allowing the father to get more clean time before having the responsibility of caring for them full time again. The children would have daycare/school should they return with their father. Do you have any thoughts on whether or not it would be safe for the children to return to their father given his approximately three months clean time from Heroin and any thoughts on likely hood of relapse with three small children in the home? The children are very close to their father and it would be stressful to move schools/daycare and live with a new caregiver with the possibility of the siblings being split up should there not be a foster home able to care for three siblings. However, I do not want to put the children in a situation in which the father may not be able to handle given the short clean time he has. He states this is the first time he has ever tried to get off of Heroin. He reported to have been using 4-5 bags per day via IV prior. Any thoughts would be appreciated.

    Thank you,
    Social Worker

  • Hey again, Bill,

    Sorry to once again reference my PAWS hypochondriasis with you, but you’ve really been my intermittent guru along this road; I am a year and a month through PAWS, and I have to say that recently things seem to have gotten suddenly worse. It started a little over a month ago with these craving sensations, and recently has involved lots of the symptoms that had long since pretty much gone away. I don’t know how I happened upon this, but I’m worried my plentiful diet of bananas may have something to do with it (yes, I know, I know) – upon researching, Bananas basically ferment as they ripe (the peels contain alcohol flat out, apparently) and while I’ve avoided any brown bits, etc, I sure haven’t been eating stark green ones.

    I’ve searched on this topic to no real avail, so I figured I’d come to the guy who’s kept me conceptually clear: do ripened fruits pose a potential danger? I wouldn’t be inclined to ask if I didn’t feel so physically odd. I remember you saying you only relapse in your head, and I’m still not with any desire to drink, it’s just my physical self that feels off. Thanks as always for any feed back.


  • You article was very inspiring and relieving to read! I’ve been sober for about 4 days now, and I was wondering I were to be prescribed zoloft or any medication for anxiety if that would stop my brains recovery? I do believe I drank and did drugs to mask a underlying problem, your input would be much appreciated!

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  • Bill,

    Quick question: I am currently looking into antidepressants to help with Paws. The past few weeks I’ve been getting some terrible cravings and the withdrawal symptoms are getting worse. I found a drug called Buprenorphine. Its an opioid used to reduce or stop withdrawals from opiates. Its been seven months since I quit and I was wondering if taking this drug would make my problem even worse, since it is an opiate. I also plan to see a psychiatrist who specializes with drug abuse. I want to start a mild antidepressant like zoloft. What do you think about taking buprenorphine? would it help or only make things worse?


  • Bill,

    Thank you for your prompt response. I have had blood tests (and scans) taken as part of my alcohol rehab and I’m sure my GP said that there was no sign of diabetis but will double check. I haven’t mentioned the itching to my GP yet. I have a little permament liver scarring but have been told it will not get worse as long as I remain abstemious.

    Regarding the itching, it is on my legs (calfs and shins) and seems worse at nights. It also occurs on my back just below my shoulder blade. I guess I am a bit overweight but probably not more than 20lbs. My diet is much better than when I was drinking, I try to eat regularly and mostly healthily, although maybe a bit too much. I can do aerobic exercise. I play golf twice weekly (walk round the course – no buggy) as well as regular cycling (by necessity having currently lost my license!). The foot pain occurs after about 30 mins solid walking – it’s relatively ok on the stop-start of a golf course and ok on the bike. I cannot jog/run though because of the pain which I used to do fairly regularly.

    What you have suggested certainly makes sense and I will follow up with my GP.

    Thanks again,


  • I have a question about PAWS. My husband took a MAX of 15 mg a day of roxy for a little over two years. He’s been clean for 60 days but says that he’s going through Paws. For whatever reason he think this is going to last 6 months or more. I keep explaining to him that it wouldn’t last as long as someone who was taking 5 or 6 pills a day, or more for a longer time and that is usually what the websites are referring to. His addiction wasn’t extreme. After two months of this I’m starting to feel like it’s just become an excuse for him to not behave properly or take responsibility around the house. I’ve always been an extremely optimistic person but this has brought me down a lot and I’m not sure whether or not I believe he’s suffering from this any more. I realize you’re probably not a doctor but in your experience, how long should this last for his “minor” addiction?

  • Hi Bill,

    Just came across your site a couple of weeks ago and must congratulate you on your excellent article on PAWS. I have also read all the responses which I found humbling and illuminating in equal measure.

    I am a recovering alcoholic having just past my 9 month sober mark this week and am feeling pretty good (but not complacent) especially having got through my first sober festive period. Like many others I went through all the immediate withdrawls including being medically detoxed (twice) having had a seizure on at least one occaision.. For me the anxiety and panic attacks were worst as well as losing my sense of balance which was very worrying.

    I was very interested in your theory on 3 monthly recurrances as this week I have started itching again which happened a while ago – maybe after 6 months but I hadn’t heard of PAWS then. I am hoping this will pass as it seemed to before, do you think this will recur on a regular basis? The only other ongoing symptom I seem to have is sore feet (soles and toes) when I walk any distance. I have recently seen my GP about this and he suspects it might just be fallen arches but having done a bit of research myself, (dangerous I know), I think it might be neuropathy. If so do you think this might eventually heal itself or am I stuck with it?

    For others reading can I concur with you and other posters who say a sober life is a much better life and continually gets better – it is and does!

  • Hi-
    I stumbled onto this site as I was looking for things on meditation but found this information very interesting. I have a question. How do you know if you are addicted to something. I have a serious health issue in which I am in very severe pain. The pain at one point was even causing convulsions in my body. I am on methadone and occasionally vicodin. I take 10 mg of methadone every 12 hours. During certain times of the month, my pain is so bad that even the methadone doesn’t touch it and that is when I will take my vicodin as well. This isn’t every day. If I do take it, I will take it in the morning, and again at night as well. That’s it. Otherwise, I only take the methadone as prescribed. I have been on it over a year and have never not used it as prescribed or asked for a high script. But I hear how addictive it can be so I am concerned about it. Could I have your thoughts on this. Before this health crisis happened in my life (I ended up immobilized and unable to walk, sit or stand for over a year- until a very high risk surgery that I had performed to try to help me). I am not being able to walk better but without my pain medications, I can barely move. I never was a pill taker in my life until this happened. Not even for headaches. I tended to just not take them. Not I have several medications I have to take including the two I have mentioned here. How do I know if I am addicted?

  • I suffered through 18 months of horrific xanax withdrawal (PAWS), whereby I felt every day like I had a severe case of the winter flu (minus the fever and cough) – malaise, lethargy, and an unremitting mental fogginess. It wasn’t until my physician prescribed —– did the diabolical symptomatology lift. This is just a note/suggestion to those who are suffering from any type of long-term benzo withdrawal. I have been to hell and back! RBB

  • Bill,
    I’m celebrating 6 months of sobriety (from alcohol) today. I consider myself one of the lucky (and blessed) few to have stumbled across your site a few months ago. Actually, I feel like I was ‘guided’ to your site at a time when I was trying to make sense of all the PAWS symptoms, thinking that I would NEVER recover!
    One of the reasons I was able to get to the 6 month point was in large part due to the support and inspiration I got from your writings/responses on this site.
    As part of my healing, I give thanks and gratitude at the end of each day for someone or something that has helped me become a better person. Tonight, my gratitude will be offered for you – for making me realize how beautiful and happy life can be without being a slave to alcohol.

    One of my favorite quotes:
    If you have built castles in the air, your work need not be lost; that is where they should be. Now put the foundations under them.
    Henry David Thoreau

    This is what sobriety means to me — laying the foundations under all those dreams and goals that in the past alcohol took priority over.
    I know I have a long way to go, and challenges to overcome, but right now the taste of sobriety is too ‘intoxicating’ to trade for any other mind altering substance.
    Thank you from the bottom of my heart. I hope more people will be guided to this site.

  • Hello, I stopped Suboxone about a month ago and started to feel better about a week ago but felt depressed. So I started taking 50mg of Zoloft and my anxiety, restless legs and insomnia came back hard. I read they can be side effects of Zoloft…well I’m good on that haha I don’t need to take a pill for withdrawal symptoms…my addiction worked just fine, thanks! My question is: Is starting an anti-depress so close to stopping a drug a good or bad idea? And if it’s a good idea what would be the best kind? ~Thanks!

  • I havn’t had an alcoholic drink now for just over 3 months! When I first stopped drinking the initial withdrawels of detox were hard but after a couple of wks my sleep and eating were back to normal and I was feeling great, however now I get bad headaches stomach cramps and I am wondering whether it could be a post acute withdrawal symtom! Another thing is all I drink now is coffee about 10 mugs a day!! And not much else liquid form! I eat quite normally???

  • Thanks Bill, I definitely plan on starting to sleep more, eat better, and hit up the gym a couple times a week. It’ll be hard, but I realize I need to because the last few days have been a living hell and reality has smacked me in the face. Also, I think I might see somebody about starting a mild anti-depressant. I’m a smoker, have been since right before I quit pain-killers. They somewhat helped me with the initial withdrawals and they sort of help when I feel the urge now. They help to calm me down when I’m stressed out. I really would like to quit, but I don’t think that now is the best time because I don’t want to be fighting two addictions at once, although it would help me physically if I did it successfully. Do you have any suggestions about that?

  • I’m also currently on metaxalone. Will that prolong the symptoms?

  • I broke my leg in high school and had a serious pain killer addiction. I started buying oxycontin and it escalated. Its been 7 months since I quit and lately its gotten a lot harder to deal with. I’m in college now and rarely have time for some of your suggestions. Do you have any more advice? Ive joined a bible study and am going to see a counselor soon, but its still getting harder all the time.

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  • Hi Bill,

    Thanks so much for this very informative site. You appear to have a wealth of knowledge and experience dealing with addiction and have inspired many struggling people.

    I am a 25 year old male that is about 5 1/2 months clean off a very serious oxycontin addiction (nearly 4 years – off and on, mostly ON). I have stayed totally abstinent from all drugs and alcohol during these months, and am feeling pretty good now mostly, but have my bad days, which I believe may be PAWS related based on some of the symptoms you described (very articulately) above. Things that have helped me are exercise and trying to develop spiritually (although this is certainly a work in progress). I am hoping things continue to improve over the next 6 months as PAWS eases up, but if things stay as they are right now, I wouldn’t have any major complaints.

    I do, however, take an antidepressant for underlying anxiety/depression issues, which seems to really be helping me a lot. Without it, I think I would be much less mentally/emotionally stable and would likely relapse eventually. My question is – do non-abusive antidepressants have any impact on prolonging PAWS? I would really like to continue this medication, but I’d like the peace of mind that I’m not interfering with my body’s natural healing process. Thanks!

    All the best


  • Oh, and sorry for the typos and spelling errors Bill. I was in a huge hurry when I typed this below. Thanks again, look forward to your thoughts. The doctors just suck so bad and are so unsympathetic to this type of stuff, when they were the ones who got me hooked initially to begin with.

    I guess I’m glad I didn’t take a hit of pot until I was in my late 20s, and opiates until my early 20s, and didn’t start real young like some people do. I still marvel that I cold turkeyed everything the way I did. You cannot imagine how bad the intial withdrawls were 2 years ago.

  • Bill,

    I hope you can give me some encouragement. I am in my mid 30s. Two years ago, I cold turkeyed a pain medicence habit of about 1-2 vicodin or darvocet every day or couple of days. At the exact same time, I cold turkeyed an every day five year long pot habit. In addition to this, I also quit smoking two months later.

    Long story short, I had one relapse where I took a hit of pot 18 months ago now. Let me say that the initial desire to quit was for my family members, and every day I am thankful for my life with them now.

    However, I am seriously concerned. Here I am, 18 months clean from pot, 25 months clean from opiates completely and two years free from smoking cigarettes, ALL which I cold turkeyed, and I still think I am suffering from PAWS daily. No joke.

    I have been to doctors who ran blood tests who say all my levels are completely normal on multiple occasions. I even joned a health club a month ago. I am not depressed in the classical sense where I feel sad or upset or overly emotional. But there are two symptoms that have driven me NUTS.

    I still feel, to this day, that my equilibrium is slightly off or not quite right. Strangely, I feel best when I am out driving.

    From Jan. 1 of this year, 2011, until August 15th, I was drinking no more than 1-2 beers every few days, and stopped that abruptly as I realized it probably wasn’t doing me any good.

    While I was using, I underwent and enormous amount of stress, much of which has gotten better. I have zero desire to use opiates or weed or cigartess ever again, and literally have zero craving for it.

    Is it theoretically possible I am still suffering from PAWS? I physically feel fine other than being tired more often than I’d like, except for the equilibrium being a bit off kind of feeling. I suppose, looking back, I have had some kind of substance in my body almost my whole adult life (nicotine, opiates, pot, occasional booze, but never developed a big habit with that and went years without drinking at all). Maybe this will simplyfy my question:

    1996- December 2009: Smoked cigarettes befoe quitting cold turkey
    2004-October 2009: Smoked pot almost daily whenever I had time
    1999-October 2009: Used vicodin, darvocet, some tramadol on and off, went without for months sometimes, before using 1-2 pills of these daily or every 2-3 days from 2005-2009
    June 2009: Used mushrooms once, took too many and had a panic attack, only time I ever did this and never would again….it was really bad
    Jan.1 2011- August 15, 2011: Drank 1-2 beers ever few days, sometimes every three days or so….honest, it wasn’t more.

    August 15, 2011 – now: Sober from everything, was also sober from June 2010- Jan 1, 2011

    Why do I still feel off or like my equilibrium is still a bit off most of the time…mind you, this is somewhat constant, but I still function completely in a highly skilled job. Could I still be having PAWS?

    Please, positive thoughts only if possible…..I have come a long way, and like I said am generally happy. Any suggestions? My doctors swear this is still my body re-adjusting itself. I just want hope that someday I will feel “normal” again. Everything feels GREAT except this off-balance/tingly feeling in my head most of the time…..the good news is I no longer have breathing/panic-type issues and my short-term memory is constantly getting better. Thanks in advance. And sorry for such a long letter.

    I feel like if it weren’t for this constant feeling almost as if I am in a boat I would be 100 percent (that’s the best way to describe it, it’s not overwhelming, but more annoying and upsetting that it has improved but not gone fully away). I know stress makes these things worse, but I just want to wake up one day and finally feel myself again completely. I’ve had days or bursts where I feel about 95% of myself finally on sevreal occasions the past several months, but then I go back to feeling close to the same again for a while.

    Thanks Bill, any tips or advice would help.

  • Hi, good insightful read.
    I am a 10+ year opiate addict who recently switched to Subutex (via doctor) and I’m not sure what I’m experiencing but would love some feedback..

    I switched from vicodin to the sub the first week of September. Things went pretty smoothly early on. After about 10 days though I experienced a strong bout of deep jagged nerves, irritability and anxiety. This lasted a day or two then returned about two weeks later, but a little bit more intense. Wash rinse repeat. It’s now late November and I’m on day four of deep, jangled, jarred nerves, extreme irritability and slight confusion and endless borderline anxiety. Starts in early afternoon and plagues me until bed. I fear it will eventually consume every minute of my life.
    The same day this started I came down with a pretty nasty cold as well…

    I surprisingly have no cravings to start up on vicodin again, but I’m losing my mind over these continuous nervous issues.
    Does this sound like PAWS? The deep jangled nerves, irritability and inability to get comfortable inside my own body?
    I was given Vistaril by the doc and took my first pill today, which only made me sleepy and did not quell any type of nervy feeling for me.
    Could the cold exacerbate these feelings?

    Is there any hope that this will cease or am I stuck?
    I’m rambling… Any insight is much appreciated.
    Thanks in advance,

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  • Thank you, thank you, thank you for posting this! And to the many commenter’s with useful tips to add :)

  • Hey Bill, Thanks for all ur help here on this forum of yours. Been reading the post for a few hours now. Just have a quick question for you. I have been sober for three months up until 6 days ago.. (booze). Went out one night with a friend,and ended up having about 12 drinks with him. I know how stupid i was. Problem is though,I am now having some huge stuff going on because of this one night.. My palms are sweating,pupils have been dialated for 3 days now,lights are so bright I can hardly stand it. Also my anxiety level is now a 10,and my legs are super restless. Do u think this can happen all over again because of a 1 night bender???? Im scared to death that this might not go away. If i had it all over again I would never have done this if i thought this would be the outcome. To be honest with you, I think this is alot worse than my initial withdrawal. I dont get how one night of stupidity could have created all of this stuff. The weirdest part of it all is that this is day 6 ,and today has by far been the worse day so far. How long do u think thse symptoms might go on ??? Kinda desperate here!!!! I cannot work like this,my eyes are so dialated. Couple more things I have are dizziness,and my balance is poor???? I feel like I am going to have a nervous breakdown. Thanks for ur time,and God bless

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  • Hi Bill. I just wanted to get some advice from you. I’ve been having a really hard time lately. I’m currently 9 months clean from vicodin, I was taking them for 7 years daily. But at low doses 1x750mg a day towards the end of the addiction. Also while tapering off that I was using xanax and ativan. low doses also. Been clean from those now 7 months. I’ve been experiencing depression and anxiety, a lot of intrusive, obsessive, negative thoughts. Im scared that I’m going to be stuck like this. I’m currently on effexor and remeron. Both don’t seem to be helping. Now I’m trying gabapentin. Any advice would be appreciated. Thank you, Jesse

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  • I wanted to thank you for your web site and all the time you must spend replying to people. I have 1 question for you, ok first a little history I spent about 12 years on herion and methadone and the last 7 years on subutex 8mg. Think in america you call it suboxone. Did a detox about 10 months ago and have not used since. The first 4 months were not fun with paws, but after that things have gradually improved. To the point where paws is more a little annoying, eg little anxiety for a hour or 2, low energy for a day. But overall things are good. I would like to go out with friends once or twice a week for a drink. But i have noticed if i drink more than say once a week, it increases paws for a couple of weeks. Which i was surprised about because i was addicted to opiates not alcohol. So im guessing alcohol must waken some opiate pathways in the brain.
    My question is when can i start going out for a drink again, which i miss and enjoy.

  • It’s good to hear from you too, in response. I thank you from my heart for being here for us (the comment thread on this just gets longer and longer, huh?) and for myself; that was the comprehensive perspective I needed, and I appreciate it so much. I might as well include, for your potential interest and perhaps anyone reading with a sense of slacked hope, that leaving alcohol out of my life has lead to a truly happier existence for me. Dealing with PAWS directly lead to, for one thing, HUGE changes in my sense of diet that have replenished me not merely through this phase, but as a person (I juice vegetables by the ton now and rather than restricting myself from soda and the like, simply want nothing to do with it) It’s taught me patience and a stronger sense of self than I ever had before. Have I dealt with something many will never be troubled with? Yes. But our problems allow us opportunities for wisdom of self that the untroubled never know. I think of myself as wiser as it concerns alcohol than most people – more convicted and clear. I really do think of regular drinkers as, not inferior to me, just oblivious in a way I’m not, and I think any one who’s dealt with this kind of thing should afford themselves the same pride and confidence. But that’s just my opinion.
    Anyway, sorry for the long post, but you’ve been a major pilar for me through this, the point where my lone, absurd suffering found meaning…and hope, and I can’t think of many better forums for affirmation under that theme. I’m not just keeping on: I’m there. My body’s just catching up.

    All the Best and Then Some
    to everyone.

  • Hey its John, in case you dont remember I posted here about a year ago, I was the 20 year old heroin/methadone addict. I just wanted to tell you that I will have a year sober the 25th! I was bored today and remembered this site and how much it helped me so I thought I’d drop by and say thanks.

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  • Hey Bill,

    Had a question about cooking wine. My wife and I went to another couple’s house last night for dinner, and even before hand, I had asked her whether they were likely to cook with alcohol. She’d explained to her friend that I ate very healthily and that this included no alcohol (not, fairly enough, that I’d had the fun with paws the past year that I’ve had), but sure enough, as I had my second piece of chicken dipped in a wonderful chinese sauce, the cook listed the ingredients, and near the end came “cooking wine”. Great. I happily haven’t had a drop in over nine months. Paws was really winding down. And now this. There is alcohol in cooking wine, come to find, and it seems it doesn’t do much “boiling out” as heralded.

    I just wanted your take on this, because it seems even as we consciously and happily abstain from picking up any alcohol ourselves, it still manages to “get places”, you could say. Personally, I’m scared stupid at the moment (man has it been a long road), but the broader question how extensively we need to fullproof ourselves was something I figured you might have an interesting comment on.

    Thanks as always

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  • I havent checked in for so long!…I remember 4 months ago this website practically saved my life when I thought I was going insane. I relapsed short after with a group of young kids in my AA group. I’ve been on a 2 month binge and I’ve checked myself into a detox center. This will be my 8th treatment, im 21 years old. But I stumbled across this website again, It always reminds me that the symptoms and all the crazy feelings im gonna have for a while are all due to the after effects of Drugs and Alcohol. I just wanted to say Thank you Bill for taking your time and educating those who don’t know about PAWS…This website is amazing!:) Using for 9 years, I know that this isn’t gonna be easy for me, but i’m always gonna reflect on the advice you have given me, and all the details this page has to offer. God Bless…~One day at a time~

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  • Hey Bill,
    Thank you for your response. I’ve pretty much done everything on my own. I detoxed at home, cold turkey. At the time I had no idea about all the risk that can happen from doing so. Luckily I made it though that part. Days 10-16 were my worst. I’ve had the chance to go to different meeting and get together’s, but my anxiety would keep me in the house. My wife has been my biggest support. She has lay’d with me and played calming music in times were I was having bad panic attacks. Those have gotten much better as the time has gone on. Just sometimes I get anxious out of no where. I’ll feel as if I can’t sit still or like I have to sit cause me legs feel shaky and weak. Which doesn’t make since to me cause I have very strong legs. Those are the times that I feel like I’m a puppet to anxiety.

  • Hello again Bill,
    I talked to you a couple of weeks back about anxiety. I went and saw a doctor, they did full chest X ray and an EKG. Everything came back normal. They told me I’m probably having anxiety problems. Anxiety is weird to me, because those test gave me some relief, but I still find myself thinking things are wrong with me. I wanna think that the anxiety is making me feel that way, but sometimes I feel crazy. Like I get dizzy, foggy, can’t sit still and have weird stomach pains. It’s not like a stomach pain, more of numb or dull pain. It just makes me feel weird. I felt fine for the last week and a half then it’s like I just get these symptoms over again. Do you know if anxiety can come and go like that? It’s like I had nothing to be anxious about and there it comes. It feels like I go though good days and bad days over and over again. I’m kinda just lost on what to do. My good days I’m fine, but the bad days make me crazy. I can’t tell between anxiety or me just going though the motions of me being 2 and half months sober.

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  • Thank you again Bill, I am already looking into some some open AA meetings…what you said made a lot of sense. I just thought I was a habit forming person but I now realize that I cant hide from one addiction to another…its a sad feeling, even when sober for a few days, wondering and HAPPY that you woke up the next morning. I am getting help

  • Thank you Bill, this is the first I talked about it in years and you are right on with the blood pressure. Finances are bad, trying to avoid a foreclosure but I know I will be OK. I want it to bad to stop trying.

  • Hi Bill I am Reggie had my first drink when I was 13..I am now 45. Throughout my life I was sober for 1 year. I know this was something I didn’t want but I wanted to be in the “in” crowd. Got the girls had the sex etc. In college I would tell my friends things like “talked to the doc and he said I cant drink anymore” I was trying to find a way out. Now my health is horrible…I am 60 pounds over weight and when I drink, I drink alone….1 to 2 16 oz mixed drinks. Although I don’t drink a much as I used to, it is worse now and I need to stop…I can go a week to a month without but I get the PAWS and right back in…usually the same amount but for 2 to 3 days…hope I didn’t go on to much. Thanks

  • Hi again Bill,

    As far as NA being a great way of life, I can’t confirm or deny that yet. I like a lot of what I hear in NA, but I certainly don’t agree with everything that I hear there.

    Right now, the fellowship is amazing to me. I get to meet all these people who are just as screwed up as me……I thought I was the only person on the planet who was so screwy. It’s comforting to know that I’m not the only person whose thinking gets skewed so very easily. We addicts exhibit SO many behaviors that are common, it’s just stunning to me AND very educational. Some of those behaviors that I hear others share about give me the insight or courage to look at myself and realize that I have those same behaviors. My addict brain hides those behaviors from so my addict brain can keep getting me to repeat them. Once I become aware of the behaviors, at least then I have a fighting chance to improve them.

    My favorite two lines from the basic text are: “You never have to use drugs again.” and “We have proven to ourself many times that we can not use drugs successfully.”

    Honest to goodness, the fact that I NEVER HAVE to use drugs again never dawned on me until I read it in the basic text. Understanding that I wasn’t so hot at using drugs successfully is another one, not until I read it did I fully understand it.

    I enjoy NA a lot right now, I’ve made some real progress with my recovery, I guess as long as I keep taking what works for me and leaving the rest, NA is a great way of life!!

    Dang it, did you just do some kind of Jedi mind trick on me to get me to agree that NA is a great way of life?? LOL

    Don’t get all teary eyed dude, but this webpage has helped me immensely with staying clean. There were a few times I wanted to throw in the towel, but understanding that the PAWS would eventually get better helped to keep me keeping on. Know what I mean?

  • Hey Bill, it’s been a while since I’ve updated you, almost 6 months I think. Well, I have 1 year, 2 months and 2 weeks off of Suboxone as of today, BUT I had a four day lapse (hydrocodone) about 3 months ago. That relapse was just what I needed, it got my ass into NA real quick!! I just got my 90 meetings in 90 days this past Monday, got my 90 day key chain too. I have a sponsor and a home group as well.

    Before my lapse, I thought being sober meant quitting drugs. Boy, was I wrong! Being sober means working a recovery program… does to this addict anyway.

    Anyway, here I am well over a year off of Suboxone and I still have some issues that I believe are related to PAWS. I experience some anxiety issues, still get the sweats sometimes (it’s like my internal thermostat still hasn’t come fully back online) and some other really light symptoms. So, I figured I’d read through the PAWS article again to see if I could improve anywhere and the nutrition section hit me like a ton of bricks. I’ve been dropping some extra weight for many months now and I’ve been doing it by basically borderline starving myself…….I know, I know…..I’m a knucklehead!!

    So, I’m gonna start working on my nutrition now because I am quite sure it has a lot to do with why I feel crappy.

    Thanks again Bill

  • Thanks Bill.

    I’m starting to think that as well. I’ve been trying to avoid meds. I notice the times I get bad panic and anxiety, there’s something that triggered it. I’m just trying to figure out if I can do this on my own or do I need meds. I was thinking I just had anxiety about quitting. Never thought that maybe I always did have and was covering it up.

  • Hi Bill, My name is Jerry. I was a heavy drinker from 2007-2011. I would drink a pint of vodka 4 to 7 nights a week most weeks. On June 15th of this year I quit drinking cold turkey. I am now 2 months sober. It has been a crazy 2 months. I never seeked medical help. At the time I didn’t know I needed to. I also have no insurance. I called an anxiety hotline the other day and talked with a anxiety help center person. After telling them what I have been going through, they said I probably have P.A.W.S. I told them about when I first stopped it wasn’t to bad. Got to day 10-15 and went though… throwing up, panic attacks, no appetite, shakes, sweats, headaches, etc. Then out of no where I feel fine for the next 5 days. Then I go back to feeling sick, just not as bad this time. So over the last 2 months I have had many Up’s and Down’s. Here lately I started feeling way better. I went to my 1st ever dentist appt. last Friday. I got so worked up while I was there and had to leave. Since then I have had bad anxiety and panic over the last 4 days. I don’t know If something triggered it or what. I gotten to where I can control my anxiety better, but this weekend has just been bad. I get car sick, anxious, can’t sit still, upset stomach, shaky legs. I haven’t been able to work out like I normally do. I’m trying my hardest to stay away from meds. Do you have any opinions for me?

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  • Wow, thanks Bill! I will. I want to hit up meetings and talk to other people. I also feel that quitting everything is best because not only do I want to quit, I want my brain and body to fully recover. Do you agree that its best to quit completely anyway in order to heal the brain and body damage? I was terrified my brain would never recover and I would be stuck with these symptoms forever. That got me so low I almost wanted to drink again! I sincerely want to just feel better, and every time after I quit, these symptoms made me so cranky and moody and upset it pushed me back to drugs and alcohol and even caffeine and candy. I just sincerely want to feel like my old self again, and think straight and feel like I’m all there all the time. Maybe drinking, even socially, is bad for my brain and body recovery? I don’t want to risk it anymore. Thanks for your help and understanding!

  • I have been struggling for months now with these symptoms and I didn’t fully understand why. After trying too quit drugs and alcohol, I went back to school and I was unable to concentrate, study well, sleep, memorize information, and I started getting muscle spasms (like involuntary twitches), I suffer from anxiety attacks and start shaking sometimes. I wondered why I was not getting better and I realize even though I quit Vicodin, cocaine, Ecstacy, hallucinogens, and marijuana, and stopped drinking heavily, I was still drinking alcohol socially and picked up a habit of caffeine. I realize in order to recover I must quit everything and not even have one drink. I recently relapsed and went on a binge of Vicodin, alcohol, and even caffeine for the come down, just buying expresso after expresso and drinking them like real alcohol shots. I thought I could get by drinking socially, but now I do understand how severe addiction is and what I have to do. I have to quit everything!!!!

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  • Hi Bill,
    Ali here. The one with all the symptoms from hell for a whole year. Happy to report that my last tough symptoms are a few months behind me. I think I had experienced pretty much everything: diziness, twitching,depersonalization, headaches, hot flashes, anxiety, heart attack like symptoms, fear, you name it, i had it. For a year I thought I was almost dying pretty much 90% of the time.
    I remember that some nights when I was sleeping in the same room with my 2 yo son, I would leave the door open (we usually close it ) because I was thinking that if I die, he should be able to come out of the room at least. Yikes. I am so happy that’s behind me. I am in a good place now health wise, and I am not afraid that I will pass out while coming home from work or while I am with my kids.
    I am grateful that I survided this year, it was honestly the toughest year of my life. Good luck everyone, it does get better.

  • hello bill.
    its been a while since i posted and thing are still going good for me havent had any cravings for the pain pills in a while. i wanted to let your readers know that time does heal your first 30 days of sobriety is the hardest. your mood changes every few minutes your judgement is clouded. every day you will find yourself having more and more good moments than bad ones 3 months clean now and i usually only have 1-2 bad days a week where i feel fatigue and moody so i just lay on the couch and take cat naps all day.
    im still on that rough gravel road but see rout 66 is just a few miles down the road,,good luck

  • Bill, Thank you so much for the clarification and information. I will off the NyQuil Gelcaps. I do take Melatonin, but I ascribe to the ‘less is better’ rule. I take 1 cc of liquid melatonin sublingually at bed time from Neutraceutical Solutions in Corpus Christi, Texas. Their theory is that we do not need much because the brain produces some (just not quite enough as we get up there in years). If you take a 2 or 3 mg tablet (the common size available over the counter), it is too much and you sleep like a baby for 3-4 hours, but you wake when your body metabolizes it and your brain says, ‘Oh, it’s time to get up!’ Yes, I am very glad that I am finally totally clean and I have the first hope in my life that I can arrest this condition and live the kind of life my Higher Power (in his infinite Love) wants me to live. Before you congratulate me too much however, I want you to take a stroll over and look in the mirror. If I had not heard about PAWS from my Nurse Girlfriend, I would not be in this favorable position. You were a valuable ‘Eskimo’ in my life. I suspect you might have heard the story about the Eskimo that guided the non-believing alcoholic out of a blinding whiteout after he prayed to God to help him. The man later was explaining to his drinking buddies that that AA God stuff was overrated because after he prayed to God for help, an Eskimo rescued him instead…

  • Bill, I am sorry that I wasn’t more informative with my post. I have not had a drink since Halloween of 1992 and I have been doing a 2 hour weight training regimen at the Y every other day for several months and I walk a few miles a day between gym workouts. I try to limit my coffee to one a day in the morning, but I may have my one cup as late as 3 pm, which should not be an issue as I am talking with my West Coast girlfriend until 9 PM her time (midnight my time). The Valiums were not on a regular basis and I have not had them for a few months and experienced no adverse affect when I stopped taking them. I just am concerned about either of the sleep aids I am used to taking if needed (Nyquil or Valerian root) ‘treating’ my PAWS and preventing the healing process from taking place…O by the way, I gave up a 45 year Marijuana habit a couple of months ago, as well! I have had no cravings for it and as a matter of fact, I had sort of forgotten that I ever smoked it and almost forgot to mention that! As I said, if either of those sleep aids are a danger to my recovery, I will forgo them both and sleep when I can, but it sure would be nice to sleep at night when everyone else does… Thank you

  • Dear Bill, I am doing well but am having trouble sleeping for longer than 3-4 hours sometimes. Even though I was taking them infrequently (5mg 2-3X a week), I completely stopped my Valiums months ago as soon as I read the section on PAWS. Is it permissible to occasionally take a couple NyQuil Gelcaps (I read the ingredients and there is no alcohol as I am an alcoholic as well). If not, would it be acceptable to take a couple Valerian Root capsules? I am retired, so it is not as big a problem as it would be if I were working or had regular commitments, but it would be nice to sleep at night regularly. I do a 12 Step meeting every day but that is mostly in the evenings… Thank you and the people who post to your blog- they help me feel connected with the Human Race!

  • in Regards to Mel’s (and anyone else) question(s) on Xanax (alprazolam) detox:

    Detoxing from xanax can be very difficult and dangerous if not done correctly, particularly because xanax is a high potency short acting benzo. Because it is a high potency benzo, it only comes in small mg doses, thus making it very difficult to slowly reduce the dosage (unless you have an analytical milligram scale). Additionally, due to the very short half-life of Xanax, you are likely experiencing what is known as “interdose withdrawal,” where you basically begin having withdrawal symptoms in between your daily doses.

    That being said, the standard method of detox from a benzo such as Xanax is to switch to an equivalent dose of a much longer-acting, low potency benzo (Valium aka diazepam is the best, while some use Librium aka chlordiazepoxide), and then do a gradual dosage reduction over a period of several months (often 6+ months in heavy long-term users). Luckily for you, the xanax dose you have been taking is not that high compared to some users. This all MUST be done under medical supervision from your psychiatrist or general practitioner etc…

    The golden rule for a benzo taper is THE SLOWER THE BETTER. If done correctly, a slow valium taper with dose reductions every 2-4 weeks (depending on your comfort level and withdrawal symptoms) can be virtually painless with very mild withdrawal symptoms. Also, published studies have demonstrated that a slower taper correlates with decreased probability of post-acute withdrawal syndrome (PAWS). In other words, if you do a rapid taper, you are far more likely to experience protracted withdrawal symptoms.

    The purpose of switching to an equivalent Valium dose (1mg Xanax = 20 mg Valium) is twofold: Firstly, because valium has a VERY long half-life (up to ~150-200 hrs–among the longest of all benzos), the serum concentration of the drug will not fluctuate wildly as it does with Xanax, making for a smooth taper and eliminating the interdose withdrawal phenomenon. Secondly, because Valium is a low potency benzo, it comes in tablet sizes of 10mg, 5mg, and 2mg (in most countries), allowing for small incremental dose reduction. In fact, you can often get a compounding pharmacist to prepare custom dose capsules, solutions…etc.

    This method is the gold standard of benzo detox, is tried and true and backed-up by years of clinical experience. All the aforementioned data including specific dose taper schedules and benzo equivalency charts are available at the following University-affiliated website:

    This link will take you to what is known as the “Ashton Manual,” which details absolutely every aspect of benzodiazepine dependence and detox protocol. What’s more, it is published by a renowned medical expert in the field of psychiatry and specifically benzo withdrawal/detox. Read this manual cover-to-cover (so to speak) and educate yourself on the process. When discussing this with your doctor, it is important that you are well informed, and if he disagrees with this strategy, refer him to the previous link or better yet print the whole thing out and hand it to him. Doctors are notoriously unaware of the proper protocol for benzo detox/taper.

    I wish you the best of luck, and remember, if done properly (slowly) benzo detox can be accomplished with minimal discomfort. There is no reason to hurry!


    ****I am not a medical doctor, but am a Ph.D student in the field of neuropharmacology/neuroscience and have extensive first-hand experience with benzo withdrawal. Any advice given is for informational purposes ONLY. Always consult a medical doctor. Period.

  • Hey Bill! So Im checking in! ~ I have a few questions actually , I’ve been having muscle spasms in my body lately, and Ive noticed i start actually have the CRAMPS when I start having panick attacks…Normally the attacks occur when Im not doing something involving recovery(keep in mind im very new, 30 days now) and I’ve spent most of my time hanging out in meetings and doing the coffee shop thing afterwards, and until I go somewhere with ppl that arent in recovery, even if they arent using or even drinking I start feeling anxious…During my past binges ive abused alot of benzos ect.. and even though i dont use them for long periods of time Im wondering if that could possibly still be “withdrawls” Im having? ~ Ive started eating right, water only with lime, ive been staying away from caffeine, sodas of any sort and juices with high sugar. Dramatically changed my diet, and it helped with my “crazy” thoughts, esspicially the breakfast part, that has incredbily helped some of my mental states I sink into sometimes. I did read up that muscle spasms occur when the brain sends some kind of signal??? ~ I was low on pottasium two weeks ago so ive been eating 2 bananas a day but im still not sure if the pottasium kicks in quickly or if this is gonna be a progress, the doc said it was pottasium related but he didnt specifically tell me how long it takes things to get back. Sorry if im rambling , it just gets overwhelming sometimes, cus ive had a good week and up till today i experienced the uncomfortable muscle spasms with the panick attack. Im really not wanting to see a doctor but I don’t know whats going on…and how do you feel about non-narcotic medications in early sobriety?? for anxiety?? ~ Thanks so much for your time

  • Wow This page has really helped me! ~ I’m 20 days clean from benzos and other street drugs. Right now Im going through a horrible depression stage and I seriously thought I was bi polar. After reading this article i’ve realized that one, im not bi polar, and two, my eating habits are really bad for my early recovery stages, I always wondered why in treatment they forced the whole breakfast thing on us, now i know. I appreciate your help Bill. This was exactly what I needed to read!!

    “this too shall pass”

  • Hi. I have been having a really tough time with paws.I first started smoking marijuana in high school at about 16. Pretty heavy daily.I stopped smoking because when I was about 18 I got introduced to vicodin…. I liked that feeling way better. Whatever strength 5/7.5mg I could get . I never had to take more than 2 pills a day to get that mood lifting energy effect I liked.Very rare would I go over that amount only when I had surgery. Over the years I was always afraid of running out so I gradually went down to 1 a day. half in the am and half at noon. I thought in September of 2010 that I could start to cut back to just a half a pill a day. I started to notice I was having weird thoughts felt kinda anxious at times couldn’t sleep so I started to take xanax .25mg at night .I then started to freak out that vicodin was doing this to me and stopped cold turkey on Jan.30.2011. I didn’t go thru rough physical withdrawals but about a week after I was hit with the worst anxiety and depression.The anxiety is constant worry about my mental health. Just being scared because I’ve never felt this way before. I do notice that it comes in waves. I found an addiction psychiatrist and he put me on Mirtazapine to sleep and Buspar for anxiety. I still wasn’t getting any relief so now just started effexor. I’m almost 4 months clean from vicodin. I can’t go to work or do much at all really. I just hope this is paws. I just want the anxiety and depression to go away. I smoked marijuana for about 3 years and used vicodin daily for about 5 1/2 years. I’m now 24 and just want to feel normal.

  • Hi Bill,

    I stumbled upon your website today when I was looking for answers to what I am going through. You seem to have a lot of knowledge I need help. I was taking oxycodone for 2 years on and off and tried to quit last year. I was prescribed xanax when I was 23 and am now 33. I use to get .25mgs to take as needed. Some days I would not take any other days I would take .25 or 1 mg. 4 years ago I had a baby and after her birth I had a very hard time sleeping. When I look back now it may be from the percocets I took first week or two but after I stopped them I could never sleep. After the baby started sleeping through the night I went to a dr and started lunesta, didn’t work then got on ambien, that worked good and was on it for 6 months then it stopped working so I was adjusted to ambien cr. Keep in mind I was still taking xanax on ocassion for anxiety.

    Well then that ambien was no longer working so I tried after a week of no sleep my xanax. I took 1 mg and slept amazing. After that I talked to my psych doc and she agreed that the sleep issues could be anxiety related and had no issue prescribing me the 1 mg a night for sleep and an extra 1 mg for when needed. This was 2 almost 3 years ago. I had no idea how bad this was for me. Then I hurt my back 2 years ago and started taking 15 mgs of oxycodone. I only took a half a pill 3x’s a day cause any more made me sick. I took that for almost a year then had surgery and was taking 90 mgs a day for 3 weeks. After my surgery I realized I was up to such a high dose so I weaned down and started suboxone. I only took the subs for 5 days and had a nervous breakdown. I had racing thoughts, felt like I was going to loose my mind or die. I quit the subs cold turkey that night but the entire time I was still taking xanax which the dr who prescribed me the suboxone knew about when he prescribed it. At my worst I have been at 3 mgs of xanax at night to sleep. I am now down to 1-1.25 to sleep at night and try not to take any during the day.

    I eventually relapsed when I quit the oxys and subs cause I was so depressed. I went to 6 primary dr’s, 1 addiction dr and 5 psych dr’s told all of them exactly what I was taking and none of them ever said that xanax could be the issue. I have weaned down on my xanax on my own slowly but feel so anxious and restless. Anyhow I am starting to ramble on, I quit the oxycodone again 2 months ago. I have relapsed several times cause I get so scared about how I am feeling. I can not go in patient I can not afford it and my kids need a mom. I have no one to help me except my husband and do not want him to lose his job. We are already in bad shape financially. I am now 4 days out from a 2 day relapse on the oxys, I still am taking the xanax 1.25 mgs a night. I am so afraid of quitting the xanax don’t want to have a seizure or die. What is the safest way to detox of xanax without causing harm? I am in for a long road I am sure but I need to get my self right for my kids. I need help trying to figure out what to do. I go to 2 dr’s now but don’t feel like they know what they are talking about, one tells me all this is just in my mind and I need to be positive the other says I can just quit the xanax cold turkey. I am so afraid and so helpless. I feel like I can’t find any answers please help me

  • Hi Bill, thank you for your priceless words and information. After reading the section on PAWS, I gave up marijuana on April 13th. I was in such horrible pain from withdrawal that I no longer wanted any and your words came through to me loud and clear.
    I have been smoking mostly every day since I discovered it in 1966 while serving with the Marines in Viet Nam and I am proud to say that I do not have the slightest desire to smoke it any longer. Smoking marijuana pretty much guaranteed that I would not get sober, even though I have been in a 12 Step program for sex addiction since June of 1992.
    I have a wonderful sponsor, am working the steps with him and have hope for the very first time in my life that I can untangle the damage done to my poor brain and become the whole, healthy person that my wonderful girlfriend already thinks I am!
    I have been noting BD (bad day) on my calendar so that I can look back and gird myself for the next onslaught that PAWS will most certainly bring every 90 days or so. I have had 2 periods of 90 days sobriety and immediately acted-out and lost it. I have never before been able to endure the excruciating pain (emotional and physical) that comes as my brain repairs and rewires itself properly, but I am now doing so.
    I am in complete awe of the way all of the many invaluable tools have dropped into my life one by one as soon as I approached my recovery with the dedication and eagerness that it requires. Thank you and my prayers go out to all of the suffering people I have read about on this blog and I give thanks to you, to them, to my Higher Power and to my beautiful nurse girlfriend who came back into my life just as I am becoming healthy enough to be the kind, compassionate partner that she so richly deserves.

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  • hey all has ben a while since i posted but wanted to let every one know it does get better being drug free for almost 2 months now your body and mind goes through alot of changes the paws it isnt as bad as it seems if you eat right and get lots of sunshine and rest
    it does get better with each day so dont give up
    listen to bill he does know alot about addiction and the setbacks of using only 1 time
    now it’s time to get off the internet and go enjoy the sunshine and plant flowers with my new found energy :)

  • I really appreciate what I’ve learned here. I am 15 months off Paxil and Klonopin (for anxiety) and 9 months off Ambien (works like a benzo). Have been worried about my symptoms, many physical in nature including balance issues, depersonalization, cog fog, insomnia and fatigue, burning hands/feet/head, blurred vision, etc. I was put on all medications for anxiety and sleep and I am 32 years old. I’m trying not to fear the worst, but also trying to be realistic in my expectations for healing. These last nine months have been brutal. Can I expect symptoms to lessen in severity over time? thank you for what you’ve done here!

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  • Bill,

    Good work on turning my little question into a brief but very interesting discussion, and thank you once again for the clarification. Very much appreciated.

    PS: Have you ever written or been approached to write a book? It’s rare that your kind of insight is accompanied by an equal strength for conveying it.


  • Hi Again, Bill,

    Sorry to pester you with what is a pretty hypocondriacal (that’s a word, right?) concern, but I’ve read that even alcohol fumes will mean trouble for someone going through PAWS. Unless I’m crazy, I certainly experienced it when I got a whiff of some Brandy a while back.

    This doesn’t seem improbable, but it’s gotten to the point I’m fearful of the alcohol-based ink in my drawing pens for how I’ve felt since using them yesterday (these are really fine tip, almost odorless pens, too). I didn’t know if you had any insight on this, whether alcohol scents merely aggrevated PAWS or could set it back considerably. It seems like you’d have no choice but to run into them now and then. I just figured I’d see what you knew. Thanks as always for your time.

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  • My name is Eddie S and I am a sex addict. I have been in a 12 Step Program for recovery since 1992. I have had very little lasting sobriety (90 days twice) because I had no idea I was doing so many things wrong- no wonder I had no luck in sobriety.
    I recently (2008) reconnected with a lady that I was very attracted to 40 years ago. We both regularly thank God that we did not pursue a relationship then, as it would have certainly gone down in flames; we both had way too many lessons to learn- plus I have been an active addict all my life. We are very much in love and I approached my recovery with the effort it deserved when I retired in April, 2010. I also was overweight, so I began regular weight training at the YMCA. I have had good luck with Herbalife as a weight loss program in the past, so I am doing that as well. I was 250 pounds when I retired and I dropped 40 pounds in one year. A lot of that weight was caused by stress from my job.
    My girlfriend is a Nurse and she heard a discussion of PAWS at a seminar in Florida this month. When she recognized some of the symptoms that I have reported to her, she called and told me about it. I immediately burst into tears of gratitude and relief at this news.
    I have been a Marijuana user since Viet-Nam and my doctor prescribed Valiums for my infrequent anxiety attacks. After hearing about PAWS, I discontinued both. Had I known this information 19 years ago, I could have saved myself an incredible amount of pain.
    We also both gave up candy, which has always been problematic for both of us.
    I have a feeling of hope that I have not dared realize because of my difficulty in recovery in the past.
    The only problem I am having is coffee- my girlfriend and I are coffee lovers! I have dropped to one cup a day, however. Thank you so very much for this literally lifesaving news…

  • hello bill
    perhaps you are correct to say it is withdrawell even after being clean for a while .
    but as far as support i have non only myself to rely on as my girlfriend is addicted to marijuana a drug i tried 1 or 2 times when i was a teen didnt like that mellow buzz i have always ben a get up and go person.
    i have ben with my girlfriend for over 10 years we have 2 kids togather and i also have 3 other from previouse relationships..
    me getting of drugs i had to do all by myself she didnt help with the kids any so was hell cooking for children when the smell of food turns the stomach.
    if she had a say in the matter she would prefer me to be on drugs
    so 3 weeks ago i told her its either be a drug free family or she can leave and have her drugs ..
    since then i have found her weed stash several times and she even bought me some pills that i flushed away (what kind of love is that)
    i have gave her one more chance to fly straight or fly away…i already know how its going to end its only when

  • hey bill
    was just sitting here thinking of how and why im a addict it all started back in the summer of 1968 the year i was born there was no laws agains giving narcotics to babies the drug i was given was called paregoric and was given the drug daily until i was about 5 years old.
    what im asking is … chances of staying clean are lower than someone who has only got addicted after they become an adult.
    today has not ben a good one probably one of the hardest in the past 2 weeks but they are to be expected.
    i can only hope today passes as quickly as it started

  • hello bill just wanted to touch base again with the person/persons like me who has helped me through this i have found it easier to not count the days since i last took a pill its only a reminder of past ways i can say in the past 45 days i have only took 4-5 pills and none of them in the past 3ish weeks :) it is a long road that has gotten smoother as time passes.
    now that i have my mind back and really read the top of this page Post-Acute Withdrawal Syndrome i have realized that if you follow those steps your headed in the right direction.
    when i get the feeling of mild withdrawell again i devote 45 minutes to myself . i eat a snack,get up and walk around the yard ,come in take a warm shower and take a 15 minute power nap and feel good again until bed time so it can not be withdrawel but only one of my senses needing attention
    hopefully every one who reads this will re=read the top of this page and understand that becoming sober doest happen over night but you can recover faster if you eat ,exercise,rest,love in the healthy way that nature intended
    until later live safe and sober

  • hello bill
    just thought i would drop in and post a progress report.
    its ben hard staying clean the past few days the weather finally warmed up into the mid 70’s and have ben out doors alot doing spring yard work that gives me great joy .
    it’s the nights that i dread as i am tired witch im not used to seems as if the lortab gives alot of energy and paws takes it away’s not withdrawell craving for pills or the high they give
    it’s just so darn hard getting used to normal as the years have passed and age has ravaged my body i no longer know how i should feel at age 43…
    how do you feel in the mornings when you wake up?
    in fact i really want to see how every one who post on this site feels when they wake just as a reference to whats normal for all stages of paws/withdrawell

    p.s : bill i really want to thank you for hosting such a great site that is not judgemental when we fail 1 time or 3 times you have really help me with so much great reading and advice you have gave in the past to others

  • hey bill,

    I’ve been clean for 11 months from the bud. I still feel quite detached and dreamy. I’m very paranoid and am also full of horrible anxiety. My family says that i’m just fine. I feel freaking crazy though. Everything is just very distorted. They all say “keep going your perfectly fine”. It seems like they have know understanding of how i feel, because I appear just fine, but inside I feel insane. Does this seem like PAW still after 11 months clean and just from smoking ganj. When ever I bring up my feelings of crazyness (everyday) my girlfriend just states it hasn’t been 2 years. I’m thinking good god it was only pot this seems to complex to be the thc. In your opinion i just want to know if you think this could be PAW? It’s almost been a year and at the moment don’t feel much better then the first month of being clean. I’m slowly starting to go pro marijuana again and am thinking I can use on a schedule. Which i know is probably irrational right now because I would be just running from my problems and I couldn’t stay on a schedule lol. I just want to figure out what the hell is the problem. Most people don’t seem to have this problem. Which makes me very jellous. I hope this is just PAW. What do you think?

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  • Thanks for the feedback. A fMRI is something I will definitely look into in the near future. I do try to maintain a some what healthy life style. I usually exercise 5 to 6 days a week, mostely weight lifting and a cardio work out at least once a week. Is this possibly too much stress on my body? I would consider my diet to be fairly healthy. I may drink a 12 oz soda once a week, but dont usually finish it. I dont drink coffee but do try to fit a cup of green tea into my diet every so often. From what i hear the antioxidents in green tea can be quite benifical in preventing cell oxidization. I try to eat as much lean meat as possible, if i have to or am just absolutely craving beef or pork, I will eat it. It is difficult to maintain a stable timed diet between work and school. I was wondering if you have ever read anything about Dr. Bob Gibsons brain regeneration?

    It seems like this doctor has put a significant amount of time into his research and that it might be something worth trying. I did notice above that you stated something in the order of natural herbs can sometimes be a negative aspect in our recovery. From what i’ve read, the vitimans and supplements Dr. Gibson suggest seem fairley healthy and benificial. After all he did live to be 108.

    I will defitinely try to manage my schedule a bit better and find time for relaxation, and possibly switch up my workout? Once again I appreciate your time.

  • Of coarse not NEARLY as intense…haha

  • oh yeah,
    I did fail to mention that the PAWS often feel like the initial opiate withdraws…I suspect this is normal? even a year later??

  • Hi
    This article on PAWS has been quite helpful and informative. I am a recovering drug addict and have been clean for 392 days now and yet I still suffer from post acute withdraws. At times I can’t help but wonder if I have an underlying health condition that is contributing to my abnormal feelings. I recently turned 21, and often stress over my condition because I feel that I am to young to live the rest of my life with these symptoms. Opiates were my drug of choice, but like most addicts I indulged in poly-use. I still endure many of the psychological symptoms you described above: inability to concentrate, memory problems, and every once in a while I deal with emotional difficulties too. I am currently attending college working on a bachelors degree, as you can imagine these symptoms can be troublesome while studying for school. I’ll have episodes of PAWS that come in waves, say every two months, and it only last for approximately two to three weeks. However when they hit I notice a significant difference in my study skills. I have to re-read chapters several times and still have trouble processing the information, trouble concentrating in class, its often difficult to recall information I’ve recently learned while taking test. As you’ve mentioned, stress can enhance PAWS, but I find it nearly impossible not to stress when I have a big exam. I also strive for perfection in my academic life so a “C” is almost unacceptable in my studies. From what I have read and understand, most of these symptoms will subside for the most part, and I hope completely since I’m so young and my body and brain still have a couple years before reaching full maturity. There are also other physical symptoms such as; upset stomach, digestive problems, and chest pains in the region of the heart. Can these also be symptoms of PAWS with opiate addicts? I know opiates can cause tissue damage to the heart that is irreparable, however I only experience these symptoms when the PAWS seem to strike. Once in a while I do encounter a sharp chest pain outside of the PAWS episodes, but they are becoming less frequent. I have been to several doctors, have had chest x-rays, EKG’s, blood culture, white blood cell count, blood test, HIV test, ect. Yet, every doctor has told me that they can’t find anything wrong with me and that I seem like a healthy young adult. I know the use of cocaine and benzodiazepines with opiates have a huge contribution to these symptoms. I only used ‘heavily’ for about two or three years, with a few months of failed recoveries in between. I was just wondering if you’ve ever heard of these physical conditions being part of PAWS, or if I should keep seeking professional help from physicians. I can only spend so much on doctor visits and laboratory test, as I am a ‘broke college student’. If there are any references you can give me that will point me in the right direction I would greatly appreciate it.

  • Thanks for your reply, Bill. Wonderfully kind and wonderfully worded. According to the doc’s, my blood levels are all fine and dandy (which was both comforting and confounding, at first) and I’ve always been a naturally slim guy. So, indeed I will keep on keeping on. Again, I want to reinforce how much easier this is when you have some idea of what’s going on, and, especially, access to someone who is willing to offer feedback. My doc’s idea? Antidepressants. Not all the pills in the world are as useful as one person who can tell you what’s wrong, and that you’re not alone. (Also, time frames are nice).

    Thanks again!

  • PS: It seems I am not to late to the party at all, but was looking at the first comments rather that last :D

  • I fear I may have come a bit late to the party, but I have to say that this is heartening to read. I left alcohol behind three months ago, and while I no longer want anything to do with it (no cravings! So pleased to finally be looking at alchohol the right way up) I’ve experienced difficulty with abstract thought, and funny craving-like ‘sensations’ ever since. It’s driven me up the wall with frustration (I’m so ready to rediscover life as normal) but now I feel I understand better. I have excercised very well, laughed, and gone up and down with my diet (I got into sweets a bit a few weeks back, at a total loss of direction), but I can see now that an incosistent diet may be what’s making my progress so slow.

    I had a question? Is a little sugar OK? I have no problem ignoring candy and sweets in general, but it seems there’s sugar in just about everything to some small degree and it seems impossible to avoid. They say integrate fruits and vegatbales; are apples OK? Even with the amount of sugar they provide? Fact is, I’ve experienced the craving sensations from drinking orange juice, so I’m getting pretty paranoid.

    I am ready to get better – totally. I am ready and happy to have a better and more consistent diet. I just don’t feel I understand how precise that diet needs to be. Again, I’m quite late to the party here, so I’m not sure if I’ll hear back, but I wanted to thank you for this extensive breakdown and for your consistent responses to people. You’ve given probably one of the more difficult interior struggles of my life a sense of orientation I dearly needed.


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  • 3/28/2011
    posting today is alot clearer than last week seems as if paws symptoms get milder every day it only take remembering how you felt before the addiction the mood swings are almost gone and after only 4 hours sleep last night i dont feel to tired .was caused by to much caffeine witch i have discovered is best to avoid during the first few weeks especially when getting up in the morning to your usual cup of coffee and pill try gatoraid and a snack..its all about changing your daily routine .
    here is a few things i do to get past the need to return to old ways of last month
    1. when sad cry(unwanted releases of endorphines)
    2. when happy smile.. laughter stimulates the body for a natural buzz (much needed release of endorphines) regular healthy meals even when you dont feel like it (need natural energy to be happy)
    4. go to bed when you feel tired
    5. walk when you feel jittery -take a shower -or a trip to the door to look outside for a minute does alot for the mind and body
    6. remember that tomorrow will be a new day good or bad dont give up

    i flushed my bottle of 120 white devils i have no use for temptation in my life

  • sorry for the mistake in the date was feburary and march not april as i have slight memory problems since stopping pain pills in the past month

  • hello bill
    i have read alot of your help forum and decided to post i have experienced full blown hellish withdrawel not once but 2 times in little over a month .(relapse during paws)
    i quit lortab and oxycontin due to the fact that they didnt work any more .i do have other health issues but nothing life threatening
    i quit just because i didnt feel emotion any more and felt like crap all the time so this will be a first for my doctor as he has never had a patient to quit pain medication on their own account before.

    the first time i quit was april 21 2011 i expected withdrawell but it was hell on earth for 7 days and 8 nights no food and lots water and health drinks every trip to bathroom i flushed a few pills then the withdrawell eased back and i had a few good days (only 3 days) now the neuropathy and arse pain was still there nothing changed but at least i could feel again both physicaly and emotionaly witch was a strange feeling after so many years numbed up.
    so i thought i was clean and took a lortab so i could do some things around the house (BIG MISTAKE) I continued to take a few a day for 3-4 days total of 7 pills then ran out of script (april 17 2011 )so again i go through another 4 days of hell to get back to where i was a week earlier . so now i think to myself every time i look at my bottle of white devils not today my friend maybe tomorrow..
    to clarify myself temptation will be there all the time you just need to find the a way to not fall into the darkness

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  • nice post I really appreciate the info!

  • Thank you Bill

    I have thought of going back to NA, but felt disgusted from the last bout with them. At first I wasn’t sure if I was going through WDS or not, because of the small amount I had been taking, and other medical issues I have.

    I went back on the Prozac for the depression, my anxiety has been elevated to the point that the Valium I have for anxiety doesn’t even touch it. One thing that scares the hell out me is during the days I am not working, if I lay down to nap, I wake up suddenly, shaking all over, and immense feelings of dread running through my head. I have to get up and shake it off. Then I start wondering if somethings other than Wd’s are causing this. Is this part of PAWS?

    I have been getting an exercise program going for the past month, 45 minutes three days
    a week and this does help, and eating healthy. My brain is all just fuzz, thank god my job is not difficult and I work a lone or else I wouldn’t have one.

    I do fairly well till it’s time to come home, that is when I feel the worst. I dread the evenings. My husband has no clues what I am going through and doesn’t try to learn. he just turns the TV on and I wait till I can exit and go to bed. I never liked TV anyway, it bores me to tears. I worry about him and our relationship as it feels strained. I have tried everything I know how to teach him about the medical conditions I have and it goes in one ear and out the other. He’s a good guy, but short. He survived stage 4 throat cancer, and has the attitude that if you can’t just quit something then You are a “weak puke.” he use to do everything way back when and just stopped with no problems.

    Life at home isn’t very pleasant for either of us, and I feel it is my fault. Ya feeling really guilty and sad. Sometimes I wish I hadn’t decided to stop taking the meds this isn’t the way I planned our time together to be. I did this on my own by my choice .

    And Bill I never did have the intestinal problem, probably, because I am missing much of mine.

  • been reading about Paws, I am having them. Some things I don’t understand. I was on norco for cronic pain from a serious illness. I started reading about opiates, learned much, especially the part about pseudo pain they can create. This is what made me decide to stop taking my meds. I have to make one statement really clear, I was not abusing my medication, took as prescribed, never doctor hopped or had a desire or need to seek out more than prescribed. I just wanted to see if the pain was real and if I really needed this drug. I should have told my Doc what I was doing , and taped off, I know this now. I thought I had died and went directely to hell.

    I stayed clean for 5 months, but there was real pain, from the surgery and my fribro. I kept waiting for those magic endorpins to kick in, I assume some did, but not enough. I started taking the Norco in very small amounts 5mg somedays @ night, somedays nothing if I was not hurting, no pain no need. Winter came and the hurts got worse. Sometimes I had to increse the dose to 3 5mgs on somedays. Then soon I started noticing on the days I didn’t take anything my nose would run like like crazy and and i was sneezing all the time. At first I thought, allergies, then I remembered how bad this was when I had stopped taking the Norco. I just couldn’t believe that taking such a small amount could scre someone up. Well, I bascked off of them completely and it was just like before, when I stopped taking the higher does daily. Now I am afraid of the drug. I am going through the same WD’s as before and the PAWS are here. I’ve been taking an aspirin when I start to hurt, helps enough. I can’t take Mortrin do to digestives problems and tylenol will eat holes in my Liver.

    How in the hell can such little usage and low doses cause all this hell? I had my cript refilled last march 1st 2010, for 180 10mgs of Norco, gave away ten of them to a friend who ran out after he had knee replacement surgery. and i still have about 20 left. Don’t have any desire to touch them.

    I am fearful of the cronic pain, but there has to be something out there that doesn’t do this to a person. These Opiates, any of them are just plain evil.

    Since i have stopped taking them, does this mean it will be as bad as when I stopped the High doses, which back then was 60mgs daily, and seldom missed a dose, took just as prescribed. Also why didn’t my doctor warn me of how damaging opiates could be, especially longterm use?

    I did go to NA the first time due to fear from the detox. I learned alot. Several of the woman there told me that they didn’t think NA was where I needed to be because I wasn’t craving or abusing. I felt lost and stopped going.

  • Hi Bill. I’m closing in on 1 year, and have been experiencing all of the symptoms you described. I didn’t know much about Post Acute Withdrawal until now, and in my struggle to rid myself of these feelings I have seen a general practitioner who prescribed anti-anxiety pills. Reading this has confirmed my nervousness that these are both unnecessary and counterproductive, and I would like a second medical opinion. As you said, “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.” My question is, who exactly would one of those knowledgeable people be? A psychiatrist? I’m not quite sure who I should be making an appointment with. (I don’t have a group or anyone like that to use as a springboard for local numbers etc, since I didn’t do a rehab program but quit alone.)

  • I just need to say that I don’t have a manic-depressive disorder as that offhand diagnoses would chew at me otherwise. It is just something that is happening often with recovery regarding benzodiazepines where recovery is a wave like occurrence with periods of normal (not manic) experience and phases where excess of stress or readjustments causes problems with memory, concentration, tension, repetitive thinking, emotional instability, anxiety (PAWS?) and some depression when reality of another wave is meaning that healing is not over and there is still some time until I am out of the woods.

    The thing is that depression seems to be connected with the acceptance which was by a large margin lifted by your article. And for that I thank you again.

    Greetings from Serbia!

  • Hello Bill,

    Your article has brought me relief as I can finally put a finger on what is happening to me. I have been given clonazepam for muscle / stress problem for about 7 months where I unknowingly reached a stage where I couldn’t function without it. I relocated to other country, had no support and have been plagued by traumas in the earlier parts of my life, and on top of it I stopped taking it almost cold-turkey.

    For about one year I barely had any relief, with severe agoraphobia, delusions, etc, second year it was bit better. Through that time I was able to isolate and take care of myself but I basically made myself crazy trying to find a solution where I only needed time. At third year mark I went to psychiatrist who gave me benzodiazepines again and made me believe her that they were not to be blamed (and they were). So after few months I realized I again got addicted to them, but this time I took several months of tapering until I finally been able to quit.

    This time it was much easier then the first time as I learned a ways of helping myself. I stopped taking any alcohol, caffeine, started eating properly and exercising as much as I could. Now is 1 year 9 months since I stopped taking it and I have 32 years. I am feeling some kind of waves where for some time I feel good, positive, energetic and where I finally say to myself that I am healed and other waves that last a few weeks at the time and brought by stress where my thoughts are rushing through my head, feel depressed, anxious, with mood changes and similar experiences you describe in your article.

    I am a software engineer and now one stress barrier is in front of me – finding job, as now I am starting to feel ready to search for it for the first time. I am sleeping right, eating properly, exercising and going to dance lessons, doing everything I can to help my body reach the balance. What I fear now is the prospect of job interviews that will bring a lot of stress my way but it’s proba
    bly not that hard as I might think it will be. I also fear getting the symptom wave in the inopportune time where I would want to present myself in the best light, but I guess there is nothing I can do about it other than to take care of myself and give myself to higher power to give me opportunities to prosper.

    Thank you very much for your article.

  • Hi Bill,

    Thanks for the reply. Yes I agree with you it would be good to edit the article a little. From what I have seen, in general, benzos seem to produce the worst symptoms, then opiates, then alcohol and other psychtropic drugs and then stimulunts. This is quite generalised I know, but I am certain that benzos and opiates appear to be the worst culprits.

    I am going to email the person who runs the local treatment centre, and maybe look into creating a powerpoint presentation.

    Thanks again for your help!

  • Hi Bill,

    Thanks very much for this article. If I wasn’t aware of P.A.W.S I don’t think I would be here today, I would either be dead or using. It is the knowledge that in early recovery the symptoms I am displaying are temporary, that has helped me get through them.

    I’ve been using drugs for 12 years, and I went into rehab on methadone, heroin, benzos and alcohol. After the acute withdrawal (which was brutal) I experienced extreme depression and anxiety in the first month or 2. After that I had waves of not sleeping, stress, anxiety, depression off and on for the next few months. I am 7 months clean now and the symptoms still come and go now and again, but far less severe, for a shorter period of time and I can easily recognize them for what they are and not ‘live in them’.

    I see so many people get clean, then within a few weeks they start to ‘live in’ their p.a.w.s symptoms, believing how they feel is what recovery/sobriety feels like. It is sad to see, and often the advice in the rooms will be “You’re not working your steps hard enough” or “You’re not praying enough”. It’s a pity as I see so many people fall due to not having the awareness of P.A.W.S.

    I have been printing off this article and handing it around friends in meetings. It is the only article I found that has a slight 12 step edge to it which is good. I am going to pass it on to the person that runs my local treatment center too, as I feel a P.A.W.S workshop would be massively beneficial.

    Awareness of P.A.W.S is vital in my opinion. For me, a lot of my using was because I believed i had damaged my brain, beyond repair. I would experience a day of cleantime and believe that, how I felt was how I was going to feel forever. The fact is I had never had more than a day abstinent in 10 years, so had never given my brain and body a chance to heal.

    Thanks again,
    Oli P

  • I never took anything else other than alcohol. I am not a friend of pills, thanks God for that!
    My symptoms are pretty much the same as in the beginning, but stronger. I have weird feelings scattered through my brain (I googled that and it seemed more like icepick headaches but not really). Sometimes it feels like my nerves are too exposed; sometimes it feels like a hot sensation through my head; it basically starts with one part of the head and keeps moving.) They not extremely painful, but they come with fear and with malaise and some sort of depersonalization. At times I feel so weak that I am afraid I am going to pass out. At times, my heart is acting out, too. I don’t feel like eating or doing anything else other than sleep. I keep googling to see if other experience such symptoms but it seems that most people’s symptoms are psychological, not physical like mine. But again, I had all sorts of blood tests and scans which came back negative, so unless it’s a misterious illness which didn’t show up in tests, it must be PAWS.
    I don’t feel like that all the time, I have moments when I feel like I can move mountains and that’s what keeps me going.

  • Hi Bill,

    It’s me again-Ali from the previous posts. Just wanted to report that at 9 1/2 months it hit me again, with such a strong force that I had to take 2 days off from work, which hardly happened before. This time I am getting a little depressed over it, because the light at the end of the tunnel seems so far.
    But I am hanging in there, what else can I do. I am not thinking about relapsing-I would probably become even sicker and I couldn’t go through this whole process again.
    Sometimes i feel that 9 months is a lot, but I’m not even half way there (if it will take 2 years and no more). Anyways-I hope to have better news at my 1 year anniversary, although I am almost sure it will hit me again.
    Stupid alcohol!

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  • Hey its John, I just wanted to check back in and thank you again, this information has really help me get through the past couple months. You’re really doing a good thing here.

    Still sober btw!

  • thank you bill–i’m sure that i’m depressed…how could you not be after having your baby put down! things were going pretty well when penny got sick—we just retired—just finished a new home in hawaii…kids and grandkids doing well..etc…penny and i went through some hard times togeather, we were in a car wreck that should have killed us both..and during my darkest days of addiction she was my only joy…i’m proud of myself that i have not thought of drugs as a way out….i think i will recover from this–i’m just reeling from the loss…thanks again

  • i have been sober since 5-23-09…since then i have had many challenges regaining my life…re-connecting with family…loss of my best friend…hip replacement surgery..lost 70 lbs…but when i got blindsided by the death of my precious dog penny on 11-10-10 i didn’t think i could go on…nothing in my life even compares with this…i have been physically sick for 3 mo…unable to focus on the smallest of tasks….after all my problems over the years people are tired of seeing me so down…i hope i can snap out of this funk before it consumes me…i’m grateful that i havn’t been tempted to use because that would be the ultimate dis-respect to the girl that gave me the most joy in my life

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  • I am four weeks clean after 6 years on-and-off opiate use, 1.5 years of which I spent using every day, many times a day. I decided to get help when my best friend overdosed and passed away in her sleep. I tapered (medically unsupervised, only because the Sub Doc wanted me on it for a year) from two 8mg tablets of Suboxone twice daily to 1mg once daily over the course of four months. Had I not been in graduate school, I would have gone cold turkey.

    The withdrawal was awful. Less intense than Heroin withdrawal, but long and lingering. It wore me down many times, but I pushed through it. Four dang weeks of full-on, total-body torture will drive anyone mad.

    It is week four and I still have PAWS, and only within the last 3 days have I been what I call “functional”. I was in agony for what I thought would be forever. Honestly, I feel that support is really the best help you can get. I have a lovely man who took care of me the whole time and was so patient with me, even when I was impatient with myself.

    The second best thing I had, and what is helping me with PAWS the most right now, is acupuncture. I am not kidding. Everyone out there seems to be relying on the pharmaceutical industry to fix something that started this whole mess. Well, I got sick of that cycle. I can honestly say that it made me feel better than the Immodium AD, Clonidine, Ativan, and Ambien ever did. I felt so energised and alive and re-vitalised after my first trime that I went to see King Tut’s exhibit the same day I got treatment. I felt de-stressed, re-aligned, and was also able to eat properly.

    Nothing compares to the euphoria I got from having treatment and the subsequent first night of real sleep in weeks that followed that evening. I am continuing treatment with remarkable results. The second treatment made me tired instead of euphoric, but I also had not slept properly the night before. The times between treatments are getting longer, and the results are lasting longer and feel stronger. I start classes again on Monday, and I start work again on the 30th. I feel hesitant, but so much more prepared for my new existence to begin now that I have acupuncture in my life. It balances my moods, helps with my stomach upset and insomnia, and relaxes my frustrated mind. I highly recommend getting treatment.

    Stay strong!

    P.S. I am not a doctor (yet). I did, however, go through just about everything that is listed as an aide for withdrawal and can honestly say that acupuncture saved my mind from totally falling apart when nothing else gave me peace. I am keeping a positive attitude and haven’t felt depressed at all yet during my PAWS. I have a flat affect and do not feel quite normal, but I sincerely believed I dodged the depression bullet thanks to my positive outlook and acupuncture.

    P.S.S. My doctor told me that my physical withdrawal would last for four days at the most. HA HA HA. So I was only able to get a 6 day supply of sleeping pills, blood pressure, and anxiety medications. Curing pills (Chinese herbal formula for stomach problems) and acupuncture and Kava Kava did the rest for me. Hope that I helped someone!

  • Today i am 40 days off suboxone, before the sub i was addicted to lortab, i took sub for 4 months..i finally decided enough was enough and i quit clod turkey at 4mg a day, i flushed all the rest down the drain…i feel so tired all the time but wired up as soon as my head hits the pillow(weird)..most of all my concern is regarding my legs being weak and tired every single day, it takes all i have to get them moving, they hurt sooo damn bad, my blood sugar is fine because i work in a medical office and keep a check on it, i just need someone to tell me this is normal or not, thanks

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  • Hey Bill, great website.

    I’m just after some advice. I haven’t had a problem with alcohol or illegal drugs, but am in the process of weaning off prescribed medication, those being Seroquel and Lexapro, which I have been on these for around 5 years.
    I didn’t really need the lexapro in the first place and wish i never started it. I did need the seroquel for schizophrenia for a while, but realize now the initial problem that got me diagnosed can’t be treated with medication, which is just masking the issues and making me avoid addressing them.
    I started tapering off without my telling my psychiatrist, who now just wants to up my medication again and add another drug. How would I go about finding someone to help come off the drugs, as well as support me to change my lifestyle and develop lifeskills to move ahead and improve myself. These drugs are really not the answer.

  • I found out about PAWS a couple of weeks ago and have been reading up on it as much as i can. It was quite an emotional experience for me when i stumbled across it while i was looking on the net for damage addiction does to the brain. I cried while reading about PAWS as it came as such a relief to me that what i have been experiencing on and off for the past year and a half was there in front of me in black and white, a mixture of relief and happiness that i will never forget.
    I was addicted to prescription meds and cocaine and was in treatment for 7 months, I went into treatment in June 2009 and left in Feb 2010. When i left the hard work started and i felt as though i was going crazy, I had thinking that can only be described as chaotic, emotions so up and down that i was scared of myself, bad anxiety and depression and a twitchy face and hands. I was so angry because i thought that once id stopped using id be stable and have some sort of normality in my life instead id found that i had some serious problems to deal with. I consulted my Doctor and he prescribed me Citalopram for the Depression and Anxiety but this was before id heard of PAWS i am now going to speak to him about the possibility of me coming off the Medication and start following the advice that you have given in your article and any other bits and pieces that i can find.
    I have drank socially(never having had a problem with Alcohol) around five or six times since leaving treatment, i know i have to have a rethink on this if i am to make a full recovery.
    I will mention before i go that not every single day of my recovery so far has been bad, id have amazingly good days in with the bad days where i can honestly say that i have felt tremendously happy and positive and once upon a time, i would never have dreamed id be getting through the Day without some sort of pick me up so i am making progress. I don’t know why PAWS is not talked of more, could it be that active Addicts and Alcoholics may find recovery more daunting with the thought of a detox, withdrawal then PAWS to go through? i didn’t even hear of it talked about at any meetings or in Rehab, shame really it could have saved me from thinking i was going completely insane. Thanks for taking the time to read this and Thank you for the Article

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  • Didn’t Rumpelstiltskin die from lack of sleep? :)

    I concede, you won this round, I’ll be back in a couple of few months to see if I can defeat you. It’ll take me that long to come up with something clever to say!

    *sigh*…can’t believe I’m getting my butt kicked by an old guy. :)

  • Dear Bill,

    I wrote you about 6 months ago , soon after getting out of rehab, for RX opiates and Xanax. am doing fine. I a little over 7 months clean now, and I am active in my NA home group.

    I now understand the spirituality sans religion. Life if a lot easier now, it’s great being clean and not having to live in fear. I just wanted to thank you for your guidance in those first difficult days.

    It also helped me to cope, by understanding about PAWS. By learning to recognize it , I was able to cope with the symptoms. It still hits occasionally, but it seems to be milder, and less frequent.


  • Hey Bill,

    Well I just typed a big old note to you explaining how I’m doing and I didn’t have something in the name or crap filled in right and lost it. Dang it!!

    My 7 month anniversary off Suboxone is tomorrow, no relapses…not even close. The saying ‘think the drink through to the end’ seems to happen automatically for me.

    All the rage and uncontrollable anger is gone. I laugh all the time now, my awesome smart ass powers have come back. I feel pretty normal now….sometimes happy, sometimes in the ‘middle’, sometimes sad….like I said…normal.

    As far as PAWS, I can’t say I have any….maybe some slight sleep issues, which is normal for someone at the point in recovery that I’m at.

    Anyone considering quitting Suboxone, I did it and you can too. I jumped from way too high a dose, I cheated on my taper and yet I made it. It was difficult, no doubt about it, but I’m living proof that it can be done!

    Lastly, Bill….I didn’t want you to go on any longer thinking you won the “lack of sleep never killed anyone…Fatal Familia” arguement. I just didn’t want to embarrass you on your own website and make you cry. No one likes to see an old guy cry!! :) :) :0 Yep, the smart ass powers are up and running nicely! HAHA

    Thanks for all the help Bill,

  • Just wanted to let you know that in my first 3-5 months, I ended up reading through this article many times, and it really kept me afloat. The information about adjusting your eating habits and all was truly priceless. I really thought I was going to have a big problem with panic until I realized I was just VERY HUNGRY….learned that my base metabolic rate is around 3200 (I’m a runner and I do physical work), and without throwing down a good 1000-1500 calories of beer at night I have to eat quite a bit more during the day! Still fighting with it, I carry a lunchbox full of snacks(nuts, fruit, etc.) every day to work, but I’ve still lost 15 lbs. I’ve been sober for 8 months now, and when I do feel uneasy/anxious, I have the confidence to know I can control it.

    The things I took from your article that were the most important to me were to eat well, take time every day to relax (I took verrrrry long walks), and yes, play! You have to relearn…so much of my recreation, friendship, and interpersonal relation had shifted to hanging out in bars, or sitting around getting wasted in people’s houses, porches, etc. You have to invite people out to do other things with you, or find your friends who are constructive and creative and fun without getting drunk.

    The article really kept me going, assured me I wasn’t losing my mind – permanently at least.

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  • Hey bill,

    It’s been about 4 months since I’ve talked to you last. I’ve been clean for a total of 7 months. I’m nervous because I’m still having some symptoms of PAW. I’m having a hard time convincing myself that pot can cause such a thing. I can feel really foggy time to time, overreactions still take place, my memory is completely shot, trouble solving problems that I know damn well are simple, and just feeling really crappy. I haven’t felt horrible the whole time by any means, it’s just this last week. I feel like this crazyness is never going to fade away. I just feel so dumb and insane. I hope to god this is just all PAW. I just never thought off marijuana being harmful. I still have dopey dreams and cravings at times can be thick. The thought of smoking some dank is mouth watering. I feel CRAZY!

  • Bill,

    Not sure if you have any oppinion about this, especially since you are a male, but it’s worth asking. In your knowledge, does PAWS make a pregnancy high risk? I became sober more than 6 months ago, had some pretty bad withdrawal symptoms which are becoming less frequent and easier to handle, and I was contemplating about becoming pregnant sometimes next year, when I will be about 1 year clean. Did you ever hear/read anything about risks associated with PAWS?
    Now I know you are not a medical doctor or an OB/Gyn, and I don’t want to put pressure on you..maybe you can just refer me to other sources.


  • I am interested in your thoughts on marijuana. Do you think it is addicting and if so do you know the effects it has on the brain? Also do you believe people experience withdrawal symptoms ? If someone has been using it most of their lives, how do you believe it affects them? I am frustrated with the argument that it is not ”like” other drugs. I believe it is just as dangerous. Thanks for any insight you have to offer……

  • Ali,
    I am into my 10th month of sobriety from 15 years of xanax use. The symptomatology of PAWS has persisted through-out this period of time: fatigue, malaise, lack of motivation, and weak legs. Many days it is a chore just to take a shower. I am told repeatedly that these symptoms will diminish and disappear – that hope is what keeps me from relapsing. Bruce

  • Hello again, Bil. This is Ali from a few posts ago. I am 7 months sober and have been through a lot during this time. I just wanted to share with everybody that my MRI/MRA and all other tests came back OK. This is my confirmation that the scary health issues I thought I had were NOT due to a strange condition other than PAWS. I’ve done so many tests lately, only to be mocked by doctors, but due to a good health insurance I was able to speak up and kind of push the tests. The only test I did not take was the hypoglycemia test but I’ll probably have that done, too, just to make sure.
    I still don’t feel 100% good. For instance, this morning I was lacking energy to the extent that I felt that even a small gesture like turning my head would consume too much energy. I try not to become depressed-I hate that feeling, plus I have 2 little ones to care for. I don’t feel good enough to exercise, and I go to sleep at 8.30PM most nights.
    From these posts, for many others it seems that the symptoms were mostly psychological. For me, they are also physical and even though I am 7 months sober, sometimes I still experience twitches in my limbs/body, or very vague but unsual/worriesome headaches. I do have psychological symptoms as well though-for instance, I am very sensitive to bad news such as deaths, accidents, diseases etc. and sometimes I am afraid that I can hurt myself/others.
    This website was very helpful to me and I hope my experience can benefit other people, too. I am still not out of the woods, but I take one day at a time and I thank God my new job is not stressful, otherwise I don’t know how I’d do it.
    I still love to hear about other people’s experiences, it makes me feel that I am not alone.

  • Thank you! Im a 20 year old recovering heroin/methadone addict and everything you wrote rings true with me. Im actually pissed at my clinic because they never even told me about all this crap when I decided to taper off methadone. I have already suffered from depression and anxiety most my life so you can imagine that this “PAWS” has sent me over the edge.

    Seriously, thank you.

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  • Hi Bill,

    I’ve been contemplating the idea of all the symptoms I’ve experienced for the past 9 months to be PAWS but I’m still not convinced so maybe you can help? Up until the point I decided to put the the ole bubbly down I would say I was more of heavy drinker for the last year or so but I did drink on occasion heavily (once in a blue moon) before that for around 7 to 8 years. My problems seemed to start with my joints specifically my left knee started getting sore but I was running a lot and working out a lot! My knee got so bad that I could hardly walk due to sharp pains in my left knee cap. Shortly after that I decided to take up swimming to help strengthen my knee…so just to get you caught up on what time frame we’re at now, it had been roughly 3 weeks since I had a drink that I began to have balance/equilibrium problems too among other symptoms you mentioned. As for the balance problems, it got so bad that you could actually see my gate was off when walking and if I was sitting still I felt like I was on a boat! My gate did start to improve after several weeks but the rocking sensation lasted for months. During this time I did have a few relapses, so skip to now, I have now been sober for 4 months (NO relapses) due to reading up on PAWS because all the doctors I’ve seen and tests done only found that my right ear was working about 30%, so that would explain the balance issues but not the cause! One thing I did notice when I did relapse is when I got totally wasted I would get my balance back. Oh and one more thing I almost forgot to mention was when riding in vehicles my balance problems would all but disappear (very strange) but I found something on Mal Disembarqment Syndrome that could explain this due to possible drug abuse! I know this is a huge mouthful but 4 months is the longest I’ve ever gone without drinking and I do feel better than I did, like I said I now only notice balance issues about 1% of the time and can think fairly clearly. However, I due feel ear and jaw tension on the right side of my face more than anything but was at it’s worst the last time I drank and would flare up more when riding in a car almost as if I was claustrophobic (very intense fullness in ear pain) if that makes any sense? All in all, does any of this sound like it could all be related to PAWS, again the longer I stay away from using the better I get and the fact that I still think about using sometimes worries me :/ Thanks for the great article, I wish this syndrome was more understood throughout the medical field!

  • Hi Bill,

    Your article on PAWS is probably the best I’ve read so far on this subject. I started researching general withdrawal symptoms when I began experiencing (strongly) most, if not all, of the PAWS symptoms; I couldn’t concentrate/think clearly, had impaired memory, severe lack of sleep, emotional overreaction AND emotional numbness, major issues managing stress, etc… As a result of the above I have decided to take some time off work in order to focus my time and efforts on getting physically and emotionally better. My addiction however is different to the ones I’ve seen posted here. I was addicted to tobacco. My first question is fairly straightforward: do you believe people who quit cigarettes can suffer PAWS?? I smoked for over 20 years and although I haven’t found many references to tobacco related PAWS, I’m convinced that I’ve been suffering it.

    I decided to quit over 10 months ago and my psychological/mental state has been a bit all over the place (and not in a good way) for a while now. The physical withdrawal symptoms were not difficult to overcome and although I do get some strong cravings occasionally, I can weather them quite easily. The emotional/sychological withdrawal symptoms have been a different story. I simply feel “different”, I seem to suffer from anxiety and I become overly conscious of everything I do, say, feel. I feel less interested or not interested at all in things I used to be interested in. I haven’t been to a psychologist/psychiatrist because I wanted to overcome all of this in a “natural”, drug free way – as many people have before me. And because I was told that PAWS symptoms will get better between 6 to usually a max of 18 months? Is it safe to say that from month 10 on I should see some improvements (I know its not an exact science but any thoughts)? Do people return to feeling “normal”? What does success look like? Lots of questions, I know…Many thanks for your help

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  • So I just looked back over previous comment s and I guess that it has been 2 months now since I stopped taking antidepressants. I think I said one month in my comment a few minutes ago. My fatigue also causes me to lose track of time….. :(

  • Hi Bill,
    I just thought I’d jump on to say that I am trying the St. John’s Wort and it seems to be pretty effective. I scheduled an appointment with a Rhuematologist that another friend in recovery recommended to me.
    When I talked to my general physician about my fatigue a year ago he treated me like he didn’t believe me, or like maybe I was crazy. I know I need a new regular doctor. The nurse, when taking my blood test at that visit, said “You could probably do this better than I can” and laughed. I thought that was very unprofessional and almost a trigger (as an IV meth user I am now also addicted to needles) and I only went back to hear my results. The good news is I do not have any of the dreadful diseases that are commonly spread by needles! However I am at a loss as far as the cause of my constant exhaustion and sometimes aches and pains.
    I have been feeling inadequate and worthless because of this for so long. I can function, but I cannot function effectively. I struggle through every day. I am excited to find a doctor that won’t treat me poorly when I tell him I am in recovery. I hope he can help me find some answers.
    In the meantime my therapist (she also does my EMDR therapy) is suspecting that I may have ADD. This is terrible news as the medications that are used to treat it are amphetamines and I will not take them. I have been seeing her for two and a half years and I do trust her judgment but I think we need to keep looking for answers as I am not willing to accept that diagnosis at this time.
    The real problem with all this is that I feel so defective. I am not physically able to lead a normal life. I am easily confused and find it hard to concentrate. I have had a headache for a solid month now (ever since I went off Welbutrin). In two days I will be celebrating my 3 year sobriety birthday, yet I still feel awful. So few IV drug users stay sober that I wonder if I haven’t truly destroyed myself or maybe my brain beyond healing. That thought makes for a pretty bleak future.
    I am looking forward to my appt with this doctor. I remain hopeful for now…
    Still trying to fake it til I make it.
    Thanks for listening.

  • Unfortunately, I waited a couple of days too long to contact my Addiction Drug Counselor about the anger I was feeling, unfortunate for that idiot I cracked I mean. Yeah, once that happened I knew that I was not managing this area of my life very well and reached out for help. We figured out that it mostly stems from stress. I have flown more over the years than I care to remember and I just detest it. The long drive to the airport, park and wait for a shuttle, security, wait, wait and wait some more then get crammed into this slender tube that does 600mph at 30,000ft. Go get a rental car, try to navigate an unfamiliar city. I was going to pop one way or another because I was not doing anything to de-stress along the way. I just kept adding up every little stressor until….BOOM!

    Stress, left unchecked, will lead you to doing things that are out of your nature or doing something you know you shouldn’t do. Be warned y’all.

    Thanks again Bill

  • Hey Bill, it’s amazing how you don’t seem to age, your picture today looks the same as it did 5 months ago. You must be in great shape. :)

    I just wanted to chime in on a previous post about the 30, 60, 90, etc day escalation of PAWS. I too thought you were off your rocker when you mentioned this, but I didn’t want to hurt your feelings so I didn’t call you a numbskull or a dipstick or a crazy old man…glad I didn’t because I got hit with them at 90 days and again here a few days ago at the 5 month mark. I mean it was a clearly evident escalation of classic PAWS symptoms, I couldn’t believe it. Thank goodness I have maintained an attitude that allows me to work through these temporary situations.

    Now, after bragging about my wonderful attitude I must admit that there have also been several, several times along the way when I notice my temper is ridiculous…borderline rage. I’ll go from pissed off to full blown rage instantly, hell I got in a fight at the airport right at my 3 month mark. This guy was tailgating me right out of the rental car agency, I flipped him the bird, he got out of his car, I got out of my car and I clocked that idiot. He came out of his car like he thought we were going to argue, I wasn’t interested in talking or arguing and he paid the price. Now at 5 months I have a much tighter grip on my horses, but it is still a challenge from time to time.

    If I have learned anything, it’s that withdrawal is a PROCESS. For some it can be a long, long process while others seem to bounce back a little bit quicker. Either way it takes time.

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  • What do you mean when you say “I’ve been nuts” because of alcohol withdrawal? I’ve heard people saying that a lot of times, but never understood what it means.

  • See above pithy, terse note on experience with PAWS

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  • Hi,
    It’s me again, Al from a couple of posts ago. I keep coming back to this website everytime I feel crappy. And right now I feel worse than crappy. Since last time I wrote, I had very good days and very bad days. Couple of days ago, around my 6 months anniversary, hell broke loose. I thought again I was having a stroke-the feelings in my brains are not very painful, but sometimes it feels like my veins are bursting. This time my heart was pounding and my face flushing. It was terrible and I was very scared. I ended up making an appointment with a neurologist which made fun of my symptoms, but sent me to do an MRI and MRA, stating that the CAT Scan I previously had is not accurate. I did not tell him about my alcohol withdrawals because I wanted to make sure that there is nothing else wrong with me. So sometimes next week I will know for sure if this is PAWS or something else.
    I just wanted to share this because before I experienced this, I wouldn’t have believed about PAWS cycles, but it hit me hard at 90 days, and it hit me even harder at 6 months. God knows what’s in store for me at 9 months, 1 years or after that..but hopefully after the MRI results I will be able to relax a bit.
    This is the craziest, most painful time of my life and if I didn’t live it, I would have never believed that it can be so hard. Now I can finally understand and forgive my old man who fought with this all his life. Good luck to everyon ou there. I keep thinking that this is the price I have to pay for the years of abuse.

  • Thank you Bill! It was good to hear back from you! It is awesome that you have seen so many high school reunions! (SMILE)
    I guess I’m not actually opposed to going back on anti-depressants. I am scared of the side effects. I have noticed lately that I am very irritable. I have been off medication for a month now. Does this go away? I have two children, my daughter Nora is 6 years old and my son Wyatt is 2 years old. I want to be the best mom I can be and being so crabby isn’t fittin the bill…
    I have been seeing the same Psychiatrist since I got sober. He has been wonderful but I’m not getting better, I seem to get worse. So I am trying to find a regular doctor in my area that knows about fatigue. My problem is the same as it is with anti depressants. How do I know if the medications they may prescribe won’t end up making things worse? How do I heal from what i’ve already done to myself with Paxil and Meth? It seems the more I add the worse I get…. Do I dare try another chemical at this point?
    It is very hard for me to determine what my problem really is and how to treat it. I really need help though because I am so exhausted that I can barely function. I have a strong desire to get well, yet not a lot of energy to keep looking for answers.
    I am totally committed to my sobriety, I haven’t gone to many meetings lately, I will go to one this Thurs night. Until then I will continue to do the best I can with what I have and to look for a good general practitioner……
    Thanks again for your response! I really appreciate your input! I am now convinced that I need to be as informed as possible about my situation to make the right decisions. Thank you for your help.

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  • I was an IV meth user. I will have three years of sobriety in a month. I have been on several anti depressants. I quit taking medications almost a month ago. I still have terrible fatigue, trouble mentally (by this I mean to include memory, concentration, mood swings, negative thoughts, etc.) and I am 60 lbs. overweight… I was on Paxil for almost two years and have tried many others. My Psychiatrist is equally as willing to let me go off medication at this time in my recovery as he is to try something else (namely Effexor) but I am afraid of further weight gain and the withdrawal syndrome associated with Effexor. So I am staying off medication at this time.
    I can’t help but wonder if I could still be experiencing some withdrawal syndrome after all this time. The symptoms sound the same. Could it really last this long? Have I made it worse with anti depressants?
    In the past I have tried some of the things you have mentioned in this article with great success! I can personally attest to walking as a quick and easy remedy for most of my worst problems. I began to walk around the park next door to my apt. I found that if I walked for 30 mins each day I felt a lot better, my fatigue improved and so did my mental clarity. I was unable to maintain my routine and my fatigue makes it soo difficult to get started again.
    After reading this I vow to go walking tomorrow.
    Thank you for this information. I have found it very helpful. I am a single mom, and i am a full time student in chemical dependency counseling. I am very busy and just exhausted from the minute I wake up until the time I go to bed. I will utilize this inform