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.
Symptoms
PAWS symptoms reach a peak from three to six months after we get clean. Any use of drugs or alcohol, even in small quantities or for a short time, will effectively eliminate any improvement gained over that time, as it will keep the brain from healing. There are a variety of symptoms. Not everyone will experience all of them. Here are some of the main ones.
Inability to solve problems
Inability to solve problems leads to lowered self-esteem. We feel embarrassed, incompetent, and “not okay.” Diminished self-esteem and fear of failure lead to living and working problems. These all add to our stress, and the stress further exaggerates the other problems. Six things contribute to this: trouble thinking clearly, emotional overreaction, memory problems, sleep disturbances, physical coordination problems and difficulty managing stress.
Inability to think clearly
Our brain seems to work properly only part of the time. Sometimes our head just feels fuzzy because of the changes that occurred in our brains while we were using. The changes take time to improve. It is also due to the simple fact that we are trying to process a lot more information than we did before. While using, we mainly thought about getting more, using, and turning off our brains. Now we are considering the myriad things necessary to truly live our lives. To begin with, it can be a bit much.
Inability to concentrate
Abstract reasoning suffers, and we find our minds, like a confused cowboy, jumping on its horse and riding off in all directions. Also related to the reasons above.
Rigid, repetitive thinking
Thoughts go around and around in our heads, and we are unable to put them into useful order. We have not yet developed the ability to channel our thoughts and concentrate on one thing at a time.
Memory problems
We may hear something, understand it, and 20 minutes later…it’s gone! This sort of thing complicates our lives in many ways. It upsets supervisors, annoys significant others, and makes us wonder if we’re losing our minds.
With memory problems it is hard to learn new skills and absorb new information. We learn by building on what we have already learned, and memory difficulties can make it very difficult (if not impossible) to do that. Again, these difficulties add to stress, especially if we do not understand what’s happening to us. We may think, “This sucks! I might as well be high.”
Emotional overreaction or numbness
People with emotional problems in early sobriety tend to over-react. When this overreaction puts more stress on our nervous systems than we can handle, we react by “shutting down” our emotions. We become emotionally numb, unable to feel anything. We may swing from one mood to another. These mood swings may baffle us, seeming to come without any reason, and may even be misdiagnosed as bipolar disorder. If we have developed insulin resistance or diabetes as a result of our drugs and drinking, this can become extreme. (See H.A.L.T. below)
Sleep disturbances
Disturbed sleep is common in recovery. It may last only a short time, or a lifetime. Often, this depends on what we consider to be a problem. If we are night owls who used alcohol or pills to get to sleep in the daytime, we may discover that the only solution is to make significant changes in our schedule, and perhaps even in our occupations. Sleep deprivation stresses the body, prevents our minds from working well, and generally exaggerates any other difficulties we may be experiencing.
We may experience changes in our sleep patterns, sleeping for long periods at a time, or getting sleepy at different times of the day. Although these may persist, we are usually able to adjust to them. The important thing is to be willing to adjust. We may not be able to keep to our old sleeping habits.
Stress
Difficulty managing stress is the most difficult part of post acute withdrawal, and of early recovery in general. Early on, we may not be able to distinguish between low and high stress situations, because for so many years we managed stress by using mood-altering substances.
Worst of all, the other PAWS symptoms become worse when we are under stress, and this causes the stress to increase! There is a direct relationship between elevated stress and the severity of PAWS. Each amplifies the other.
At times of low stress, the symptoms of post acute withdrawal may lessen or even go away completely. When we are well-rested, relaxed, eating properly and getting along well with others, we seem to be fine. It is easy to see how we can get careless at these times, and many a relapse has occurred when things seemed to be going just fine.
Abstinence
Recovery from the damage caused by our addictions requires total abstinence. Abstinence means avoiding drugs and alcohol completely, unless we are under the care of a physician who understands both addictive disease and pharmacology. This specifically includes herbal remedies which, in many cases, are just as powerful and dangerous as prescription drugs.
Understanding and recognizing PAWS symptoms
Because we are addicts and alcoholics, and because repeated relapses will eventually be fatal, we must realize that understanding PAWS is, literally, a matter of life and death. It is absolutely essential that we gain an understanding of post acute withdrawal, be able to recognize its symptoms when they appear, and know what to do about them. We must understand these things well enough that we are able to put them into effect even during periods when our addict instincts are telling us that we don’t want or need to!
We need also to learn about PAWS, and means of controlling it, when our stress levels are low, in order to be able to prevent the symptoms or be able to recognize and manage them if they occur.
Stabilizing our episodes of PAWS
When we begin to experience PAWS, we need to bring it under control as soon as possible. Here are five steps that can help.
Talk!
We need to talk about what’s happening, to people who will listen and not criticize us. In addition to badly needed support, it helps us to clarify our feelings, look at them more realistically, and helps us recognize our symptoms. When we are in our own heads, our thoughts just go around and around. When we force ourselves to tell someone else, we often find that it puts them into order and they begin to make sense.
Ventilate!
We need to express as much as we can about what we are feeling, even if we think it sounds dumb or irrational.
Get a reality check!
We need to ask someone if we are making sense — not just in what we’re saying, but also our behavior. We must be sure our perception of what is happening matches up with reality.
Set a goal
What can we do right now to improve our situation? Taking action and changing things is our choice.
Think back…
…over what has happened. How did the episode start? What triggered us? What could we have done to reverse it sooner? Were there other options that might have worked better?
Self Defense
We are responsible for protecting ourselves from anything that threatens our sobriety, including anything that triggers post acute withdrawal symptoms. No one else can do it, because no one else can feel the warning signals. Learning about addictive disease, working a program of recovery, finding out more about PAWS—all of these things reduce the guilt, confusion and stress that intensify the symptoms and lead us to relapse. If we learn to do these things, we will begin to accept our own needs, and learn to be firm about letting other people, places and situations push us into reactions that threaten our sobriety.
We must identify our own stress triggers. Then we must learn to change them, avoid them, change our reactions, or interrupt the process before our lives get out of control again. If our Aunt Frizzy is blaming us for all the family problems, and letting us know it every chance she gets, we may need to avoid her for a while (a few years, a life…who knows?) If we find ourselves walking past the beer cooler too often in the store, or past a certain street corner, we need to recognize that, and change our routes through the store and the neighborhood.
Tools
Here are some things that will help us avoid PAWS, or control it when it sneaks up (which it will). They may be the most important things we will learn in the first few months of our sobriety. They are so important that we encourage you to print out this article, and to share it with others who may need it too.
Nutrition
With our organ systems damaged by alcohol and drugs, we were not—and may still not be—able to absorb nutrients properly. This, combined with our inattention to diet, has created deficiencies that we must deal with. All active alcoholics (and most other addicts) suffer from malnutrition to one degree or another, and we may continue to feel the effects for months after adopting a healthier lifestyle. Malnutrition contributes to poor health, and poor health contributes to stress. Unless we consciously improve our diets and properly supply our nutritional needs, the poor eating habits that have carried over from our using days guarantee that we will continue to fail at getting the nutrients needed to recover. Our bodies are repairing themselves, and they need the proper materials to do so effectively.
It isn’t necessary to load up on stuff from the health food store. It is much better to spend all that money on good healthy food at the market (although they’ll never tell you that at the health food store). However, we should take a good multivitamin every morning with breakfast. Yes, you will be eating breakfast.
Hypoglycemia – the secret demon of relapse (H.A.L.T.)
We’re tired and hungry. It’s been a long day, and we won’t be able to have dinner for a couple of hours. A candy bar is just what we need to pick us up and get us through. Forty-five minutes after eating the candy we are angry at our boss, arguing with our co-workers, suffering with tense muscles and a nasty headache, and life sucks again. We’re thinking about using.
Has this ever happened to you? Then you already know something about hypoglycemia.
Our brains use glucose, a kind of sugar, for fuel. If our brains are completely deprived of glucose, we will die just as quickly as we would if our air were shut off. Fortunately, our blood carries glucose to our brain, and as long as our heart is beating we don’t usually have to worry about its fuel supply. Usually.
Glucose is manufactured by our bodies from the carbohydrates that we eat. Carbohydrates (carbs) are a class of nutrients that include several kinds of sugars, pasta, bread, potatoes, and similar starchy foods. Practically all foods contain some carbs, but the most concentrated sources of them are sugars and alcohol.
In addition to fueling our brains, glucose provides energy for every cell in our bodies. Without glucose in the right quantities, our bodies just don’t work right. The carbohydrates most easily converted into glucose are the sugars. This is why we like them so much. Our bodies recognize that they are a ready source of energy.
The problem arises when we are in need of food and our bodies get a big jolt of sugar. The sugar is quickly converted into glucose. The amount of glucose in our blood rises very quickly, and we feel a burst of energy. We may feel some mood alteration as our brains receive a huge jolt of fuel.
We just received a reward for eating some sugar.
The big dose of sugar on an empty stomach causes our blood glucose to rise rapidly. A center in our brain detects the rise, and signals the pancreas to produce more insulin to help our cells absorb the extra sugar, but it produces too much. The insulin causes us to burn the extra glucose rapidly, and our blood sugar comes down, but because there is too much insulin, our glucose levels drop too far. (In diabetics and people who are insulin-resistant the mechanism is different, but the effect is the same—or worse.)
Our bodies—and our brains—are now low on glucose. The brain is running out of fuel. Waste products build up in our muscles. Along with inefficient signals from the brain, this causes tightness and muscle tremors. Partial paralysis of facial muscles may make it difficult or impossible to smile. Our heads begin to ache. Thinking gets fuzzy. Energy levels drop. We push people away, if we don’t scare them away. We may feel sudden bursts of rage, that seem quite reasonable. We begin feeling sorry for ourselves. . We are HUNGRY, ANGRY, LONELY and TIRED.
The big catch? Most of us, in our addictions, knew all too well how to quell those nasty feelings–by using. Poor me…poor me…pour me a drink
Important Point: We taught ourselves to interpret the symptoms of low blood sugar–hunger–as needing to use.
So, how do we avoid the trap? Easy in principle, but it involves some attention, some learning, and some effort. Basically, we don’t let ourselves get hungry.
Diet for Recovery:
- Three nutritious snacks each day,
- between meals and at bedtime
- Avoid Sugar and Caffeine
Meal Planning
We are “trapped” in a culture that tells us Three Square Meals A Day is the way to eat. Many of us interpret that as one “round” meal at breakfast time—a doughnut, or bowl of cereal, and a cup of coffee—one “rectangular” meal for lunch—a sandwich and another cup of coffee—and one huge meal in the evening. Since these aren’t really spreading the fuel around too well, we fill in the low spots with candy bars and some more coffee. Our poor pancreas! For, in addition to all that sugar in fits and spurts, caffeine also causes blood sugar swings!
We really need to get this thing under control! Hunger produces stress. Blood sugar swings produce stress. Stress aggravates PAWS and, as we have seen, is extremely dangerous to our sobriety when combined with hypoglycemia—which is caused by poor eating habits, too much sugar, and caffeine. Are we beginning to see a trend here?
Alcoholics and addicts in early recovery literally “take our lives in our hands” each time we plan our daily meals.
A quick word about diet:
Our diets should consist of a balanced mix of vegetables, fruit, carbohydrates, (such as potatoes, whole-grain rice, and dark breads,) protein (not necessarily meat), fat, and dairy products. A nutritionist can be a great help in the beginning, and there are thousands of books on nutrition and meal-planning that may be consulted. If we don’t know how to shop and cook, now is a good time to learn.
The US Department of Agriculture’s Food and Nutrition page is a good place to begin.
Scheduling
We should try to plan our schedules so that we do not skip meals—ever—and so that we can have nutritious snacks between meals.
- We must not snack on candy, donuts, soft drinks, (incredibly high in sugar,) potato chips, or other high calorie, low nutrient foods.
- We should carry raw vegetables, wheat crackers, a half sandwich (peanut butter and jelly on whole wheat is excellent; easy on the jelly), nuts, or even a package of cheese and crackers.
- These, along with a glass of water or milk, will keep our blood sugar steady and our moods elevated until time for the next meal. Having a nutritious snack before we begin to feel hungry will prevent our craving for sweets, as well.
It’s a good idea to actually schedule our snacks, halfway between meals and about ½ hour before bedtime. We must not miss breakfast!
Losing Weight While Eating Six Times A Day
These eating habits are not inconsistent with meal planning for weight loss. Competent dietitians and honest diet doctors know that several smaller meals are more conducive to weight loss than three larger meals, since the body more easily uses the smaller quantities of food, and is less likely to store it as fat. Properly planned meals will contribute to our health, energy and feelings of well-being, and make it easier for us to engage in exercise, (the real secret to weight control.) Our hunter-gatherer ancestors ate fruits and berries during the day, and gorged on game when they could kill something. Metabolically, we aren’t very far from those folks. The big difference between us and them?
Exercise
Exercise helps our bodies to rebuild themselves and maintain proper functioning. It also helps control our metabolism and prevent unnecessary weight gain. (Weight gain due to increased muscle mass may precede any loss due to burning fat.) Exercise produces chemicals in our brains that act as natural tranquilizers and relieve pain, anxiety and tension. It greatly improves our chances of getting a good night’s sleep.
Our ancestors lived together in small tribes of no more than twenty or so adults and a few children. They walked from place to place, following the food supply, eating whatever they could find. They carried everything they owned with them.
This lifestyle, during the eons preceding the beginnings of agriculture, is the lifestyle for which our bodies are best suited. Humans—like the herds we have followed since the beginning of our history—walk.
So, how much should we walk? Simple. We should walk fast enough and far enough to work up a sweat, and continue walking for at least 20 minutes thereafter, followed by a slower cool-down of 5 to 10 minutes. We should do that at least three times a week—preferably every other day.
We can walk at the mall; walk to the store; walk to the park. We can walk with a friend. When we’re walking we can chat, unlike most other forms of exercise. All we need is decent shoes and, if we’re over 50 or under a doctor’s care, our physician’s permission. And while we do it, we’re continuing a tradition that goes back thousands of years. How about that, sports fans?
Relaxation = stress reduction
Playing and relaxation are absolutely essential to a successful recovery.
Playing is not so much what we do as how we do it. Playing is having fun, laughing, and being childlike and free. Playing is not working at preparing for a marathon, participating in competitive sports at which we “must” win, or taking chess lessons. Of the 37 definitions I quickly scanned, perhaps the one that best describes it is “participating in an activity for amusement.” If it isn’t fun—if we have to work at it—it isn’t play.
Other ways of relaxing include bubble baths, our walk (by ourselves or with a friend), a massage, a swim, and watching children and animals at play. Whatever we do, if we don’t feel better after doing it, it was the wrong choice.
Meditation
Meditation is part of the 11th Step: “Sought, through prayer and meditation, to improve our conscious contact with god, as we understood him, praying only for knowledge of his will for us and the power to carry that out.”
Regardless of how we feel about god, we need to meditate. We need to learn to calm our minds, and to allow our subconscious to help us solve problems by serving up whatever it may have processed during the rest of the day. The only way to do that is to meditate in one form or another.
Think that’s too hard to learn? You already do it. Daydreaming is meditation. All we need to do is apply the skills we already know, whenever we want to.
One of the best relaxation exercises is also one the simplest. We find a comfortable sitting position. We move our bodies until our weight is centered, so that we can nearly go limp without changing position. We begin counting our breaths in our mind. We count up to ten, and then start over. We think only about breathing. In comes the fresh air and we…relax…and breathe the tension out. If other thoughts come in, we don’t fight them, we just recognize that they are there, and go back to counting breaths, always silently.
This is one of the oldest and most-used relaxation techniques in the world. It goes back at least 3500 years. We can do it for five minutes, then ten, working up to thirty minutes or more. It might be a good idea to set an alarm, in case we fall asleep sitting up. It happens.
Spirituality
Spirituality is an active relationship with a power greater than us, which gives our lives meaning and purpose. When we work a spiritual program, we consciously try to become a part of something bigger, greater and more powerful than we are, whether that be a 12-step group, our family, other humans generally, or that “god as we understood him.”
Trust in a higher power gives us a peace of mind and serenity that comes from awareness that there is something that is not restricted by our own weaknesses and limitations. Through spiritual development, we develop new confidence in our own abilities and develop a sense of hope. Through a spiritual program we can reach toward the future with hope and a positive attitude.
Spiritual discipline is uncomfortable for many recovering people.
We have lived lives of immediate gratification, and discipline is the reverse of that. Many of us have trouble with the concept of a higher power, as well. We may have been brought up as atheists or agnostics. Perhaps the god of our childhood was a vengeful god whom we cannot even begin to contemplate in the light of some of our past behavior.
This is why we say that our higher power can be god, as we understand god, or our recovery group, or the great outdoors — whatever. Recognizing a higher power is simply admitting that we aren’t perfect and don’t know everything. We let all those grandiose feelings go, substituting a bit of humility instead, and becoming willing to listen to the ideas and advice of others. In a sense, it is not so much recognizing the presence of a god as it is the realization that we aren’t one.
Spiritual discipline should always include meditation, fellowship, and regular inventory of spiritual growth. It is about our relationship with the human spirit. It is not about someone else’s idea of a relationship we should have with a god. That is religion. While religion may be an important part of our recovery, it cannot take the place of spirituality.
In working on our spirituality, it is important that we use the principles of our 12-step programs. They provide guidelines for “increasing our conscious contact with god” (as we understand god). We do not have to have any particular image of, or belief in, a god to increase our conscious contact. We have only to be willing to recognize the possibility of a “higher” power, — be willing to experiment at listening, and opening ourselves up to others and their ideas.
Many people joke about having a tree as your higher power. The writer had that sort of relationship with a majestic Casurina tree for some time. He used it to remind himself that he was not nearly as good at taking care of himself—yet—as that beautiful tree. Did it work? Who knows? At the time of this writing, he is 20 years clean and sober. Something did.
Peace and Contemplation
It is important that we structure our lives in such a way as to spend time alone each day. We need to examine our values, and look within ourselves to determine whether our lives are in harmony with those values. Perhaps we can combine this with our meditation, contemplating life issues and then meditating to let our subconscious come up with some answers.
Journaling
We strongly recommend keeping a journal, and writing in it every day without fail—even if we only write the date. Forcing ourselves to organize our thoughts and put them on paper clears our minds. Reading what we wrote some years later can be highly instructive, and lets us see how we have grown in our recovery.
Balanced Living–the aim of recovery
Balanced living means that we are healthy physically and psychologically, and that we have healthy relationships with others and, more importantly, with ourselves. It means that we are spiritually whole. It means that we are no longer focused on just one aspect of our lives. That is no longer necessary. It means we are living responsibly, giving ourselves time for our jobs, our families, our friends, and time for our own growth and recovery. It means allowing a higher power to work in our lives, even if that is only the influence of people around us. With balanced living, we addicts and alcoholics give up immediate gratification as a lifestyle, in order to attain fulfilling and meaningful lives.
It means a balance between work and play, between fulfilling our responsibilities to other people and our own need for self-fulfillment. It means functioning at our optimum stress level: maintaining enough stress to keep us functioning in a healthy way, but not overloading ourselves so that it becomes a problem.
Stress, in and of itself, is not necessarily bad. It can be the tension that keeps life interesting. But stress is unsafe for us until our new found ways of dealing with it are second nature. Until then, when it arises we run the risk of returning to our old ways of stress management.
Balanced living requires loving ourselves and taking care of ourselves. Nutrition, rest and exercise all receive the proper focus in our lives to provide energy, manage stress, allow freedom from illness and pain, fight fatigue, and rebuild our damaged bodies.
If we are under a physician’s care, and have been told to take certain medications, we do so. We do not stop taking them without consulting the physician. We communicate with our physicians regarding the effects that we perceive, the ways that we feel, and function as partners with her/him in our own treatment. We do not take the advice of amateurs, in the rooms of recovery or out of them, in place of the counsel of doctors with twenty-plus years of education. That’s just plain dumb. However…
We always tell our health providers that we are in recovery, and always double-check their suggestions regarding medications with a person knowledgeable about their effects on recovering people. Doctors are not pharmacists. They do not have time to study drugs and the details of their action. A good relationship with a pharmacist has saved the butt of many an addict/alcoholic.
Summary
Freedom from physical distress allows psychological growth. When we feel good, it is easier to do the work we need to do, eliminate denial, guilt and anger, and move on to self-confidence, self-esteem and learning to feel good about ourselves.
Balanced living requires a strong social network that nurtures us and encourages a healthy, recovery-oriented lifestyle. This network provides a sense of belonging. It includes relationships in which we are a valuable part of a whole: immediate family members, friends, relatives, co-workers, counselors, therapists, employers, 12-step group members, and sponsors.
Recovery is not about quitting alcohol and drugs. It is about learning to live a life that does not require mood-altering chemicals to be worth living.
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
If you found this article useful, please consider checking out more of my writing on the Sunrise Detox Blog.
Pingback: Is this PAWS? If so, it stinks! - SoberRecovery : Alcoholism Drug Addiction Help and Information
Pingback: Whiners Anonymous, Part 69 - Whiners are Winners - Page 10 - SoberRecovery : Alcoholism Drug Addiction Help and Information
Hi David,
Buprenorphine is a synthetic opiate use in detox and maintenance therapy. It is an addictive drug, the same as the other opioid drugs, is eminently abusable, and will simply take you back to square one. A. You’ll be addicted to it in about two days. B. You’ll have to detox from it, assuming that it doesn’t lead you back to other drugs. C. You’ll have to go through PAWS all over again. This is true for Subutex, Suboxone, and any other variants.
If you’re depressed, an antidepressant is a good idea. If you simply want help with the PAWS symptoms, and depression isn’t one of them, then it isn’t indicated. You have access to experts through the school, or at least access to information about who to see. Find a physician who specializes in treating recovering addicts, and let him or her advise you. You also need to attend regular support group meetings, get 30 minutes of mild aerobic exercise every other day (or at least 3 days a week), watch your diet, and do the other things outlined in the PAWS article. Those things will go far to reduce your cravings. Don’t go looking for drugs to solve your problems. It didn’t work before, so why should it work now?
Bill
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?
David
Back atcha, Eric,
Keep in mind that effective aerobic exercise raises your heart rate to 50% above normal (minimum), and keeps it there for at least 20 minutes. That’s roughly 120 b.p.m. for most folks. You have to work to achieve that. Golf and casual cycling don’t get it.
The tests at most rehabs don’t include fasting blood sugar or glucose tolerance tests, because the metabolism of most patients is messed up to the point that they are relatively useless. Most tests aren’t accurate until after about three months of abstinence.
I applaud your efforts. Keep on keepin’ on!
Bill
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,
Eric
Hi Eric,
Thanks for writing. I strongly suggest that you have a fasting glucose tolerance test. You are describing neuropathic symptoms, but they are not commonly a part of PAWS. Diabetes, however, is common in alcoholics, and neuropathy is very much a part of hyperglycemia. I began developing symptoms similar to yours many years before I was accurately diagnosed. You may be pre-diabetic, or just developing full-blown diabetes. You didn’t say where the itching is occurring, but if it is on your legs — especially the calves — that could be another early symptom. A dermatologist can help you work with those symptoms and suggest possible emollients.
You may find that the symptoms can be reversed or at least ameliorated. Please look into this soon. I also suggest mild aerobic exercise. If you turn out to have insulin resistance or early-onset Type II diabetes, enough mild exercise could be of enormous benefit in slowing or reversing the disease. If walking is a problem, consider swimming if there is a facility near you. If you are more than 20 lbs. overweight, look into some weight loss programs, or have your physician refer you to a dietician who can help you set up an eating plan that will help you lose.
Please stay in touch, and
Keep on keepin’ on,
Bill
Hi there,
“Roxy” and “roxycontin” are misnomers for Oxycontin (oxycodone). There is no actual drug named “Roxycontin.”
Ten to fifteen milligrams a day for two years is quite adequate to produce a full-blown addiction. The quantity used is less important than the time factor. People who use higher dosages do not necessarily have more severe addictions, although their tolerance to the drug is higher. Tolerance and addiction are not the same thing. Addiction refers to physical changes in the brain that must be returned to normal over time after abstinence. That’s what’s happening in PAWS. Tolerance, on the other hand, refers to the amount of drug necessary to achieve a “high,” or relief from acute withdrawal if a high is no longer possible. ms
Unfortunately, oxycodone has a prolonged post-acute withdrawal syndrome, one of the reasons that relapse is so common. Six months to a year is not unusual. In addition, depression is a frequent accompaniment to opioid withdrawal and could account for your husband’s lethargy. I would encourage him to read the PAWS article and take the steps suggested. In addition, he should seek some sort of outside support, such as a therapy group or Narcotics Anonymous.
It is common for family members to feel impatience and anger when their loved ones fail to snap back immediately after detox. You might find some NarAnon or Alanon meetings helpful.
Thanks for writing. It’s not often we hear from family members, and they most certainly have a big stake in this part of recovery.
Bill
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 Ladeesse,
Without getting into a lot of technical details, addiction occurs when the brain adapts to an alteration of brain chemicals in such a way that it then requires the presence of whatever caused the change in order for us to feel normal. Drugs and certain other things cause the alteration. Withdrawal occurs as the brain adapts to the removal of the stimulus over the short term. PAWS (Post-acute Withdrawal Syndrome) occurs while the changes in the brain return to normal over time, which can vary from months to years depending on a number of factors.
If you have been taking 20 mg. of methadone a day, plus the occasional Vicodin, it is safe to say that you are addicted. Both are opioid drugs, and for practical purposes there is no difference.
It is clear from your letter that you are not having especially good results with your present medication. I suggest that you contact a pain study connected with a teaching hospital, or a physician who specializes and is board-certified in pain treatment. He or she can advise you further on this matter, and perhaps suggest alterations in your medication regime that will be of benefit.
Good luck,
Bill
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?
Hi Roger,
Xanax is the worst of the benzos for prolonged PAWS. It can last for up to two years in some individuals. Been there, done that.
Unfortunately, for reasons both ethical and legal, I can’t pass your suggestion on. Perhaps one of the sobriety forums would be an appropriate forum for your highly useful information.
Thanks for writing,
Bill
Hi Darcy,
Thank you! Notes like this are what keep me keepin’ on.
Congratulations!
Bill
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.
Hi Christine,
Congratulations on getting the monkey off your back. Just remember, that doesn’t mean the circus has pulled up stakes and left town.
Depression is common in early recovery. It needs to be dealt with promptly, because there is no telling how serious it may get, nor how fast. Often the drugs mask clinical symptoms, and severe depression can come on rapidly when they are discontinued.
Keep in mind that it usually takes several weeks for antidepressants to reach their full effectiveness, so it’s not a good idea to switch around too rapidly. That said, if you are experiencing side effects that are seriously impacting you, a change might be in order. Be sure you discuss that with your physician. If you don’t like the answer, you should certainly consider a second opinion, but having done so, if there is a consensus, you need to follow it. Depression is nothing to mess with. I lost a family member to it a couple of years ago.
Everyone’s brain chemistry is slightly different, and finding an AD that works well is a matter of trial and error. For that reason, as well as ethical ones, I can’t suggest anything. However, I would suggest that you talk about it with a physician who specializes in treating people in early recovery. There are a variety of medications that work in different ways. One of them should work for you, and it is entirely possible, if not likely, that you will be able to discontinue it down the line a ways. HOWEVER, DO NOT DO SO WITHOUT THE GUIDANCE OF A DOCTOR! It can be fatal.
Look around the local treatment centers for the names of their medical directors and other affiliates. Don’t rely on a GP. They are not trained in addiction, and can’t be relied upon to provide the best advice or treatment. That’s not their fault. They can only keep up with so much information. Nonetheless…
I wish I had the magical answer, but I’m afraid those just don’t exist. Please stay in touch.
And keep on keepin’ on,
Bill
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!
In brief: lose the coffee. Drink lots of water. Not only is the coffee likely part of the problem with the stomach cramps and headaches, it is also a diuratic and you are almost certainly badly dehydrated, which would explain the headaches all by itself. The caffeine is probably causing fluctuations in your blood sugar as well.
Don’t try to quit the coffee all at once. Taper off by substituting a glass of water for every other cup of coffee, then tapering off further in a few days. Trust me, you’ll feel much better. THEN we’ll discuss possible PAWS symptoms. Those you have now are mostly of your own making.
The fact is, more than about 3-4 cups of coffee a day don’t provide any real “lift.” They merely stave off the symptoms of coffee withdrawal, which are sleepiness, lethargy and headaches. Cutting back won’t make you slow down. You’ll sleep better, have more energy, and may discover that you can do away completely with this addiction as well.
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???
Hi Dave,
I definitely would hold off on trying to quit smoking. While I am a firm believer in getting rid of all addictions (how can we claim to be clean and sober when we’re using a drug that kills more people than all the illegal drugs combined, plus alcohol), you don’t need to add any more stress while you’re in PAWS.
I am not a believer in detoxing from anything “cold turkey” when there are perfectly acceptable aids to make it easier. Breaking an addiction is work enough on its own without making it more miserable than it needs to be. I was three years sober before I tried to quit, and found it relatively easy at that time, using the patch — although I chewed a lot of toothpicks over the next couple of years. I don’t necessarily recommend waiting that long, but don’t try to quit right now. When you do, I most definitely recommend replacement therapy, either the patch or the gum. I believe the patch is better, because it helps break the oral fixation. Really, there’s not a lot of difference between popping a piece of gum and lighting up to get the high, when you think about it. The patch doesn’t give you any reward for particular behavior, it just helps subdue the withdrawal — which can be pretty nasty, depending on how much you smoke and your particular brain chemistry.
If you go to the gym, concentrate on gentle aerobics. Exercise is stress, too. I really recommend walking over formal exercise, because it’s relatively stress-free and pleasant, as opposed to becoming work like most gym outings turn out to be. Do some light resistance exercises (no body-building) and plenty of aerobics like swimming or treadmill. Walk outside if the weather permits.
Don’t “plan on starting to sleep more, eat better, and hit up the gym.” Do it!
And keep on keepin’ on.
Bill
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?
Hi Dave,
I’m not going to beat around the bush here. Oxycontin is a difficult detox and its post-acute withdrawal can last a long time. My “suggestions” are more like you-damn-well-betters. These are the things that have been proven over decades to help with PAWS, not something I pulled out of my hat. As you can see from the other comments they work, but it’s still a hard row for some folks to hoe, and those that don’t take care of themselves are at high risk of relapse. And relapse, if you manage to quit again, means you have to go through all the detox and PAWS again. Much easier and better for your health — physical, mental and spiritual — to do it right the first time.
You say you “rarely have time.” All I can say is to make some time. You can find time to hit some NA meetings, for one thing. They only last for an hour. Walk for exercise between classes. Pay attention to your diet. Budget your time so that you will have the necessary rest. These things are all a matter of organizing your life and some self-discipline. When you take a break from studying, meditate for a bit. It’s good for your mental health, and more effective rejuvenation than — for example — gaming.
As far as the Bible classes go, they’re fine for your soul, but they have nothing to do with recovery. Recovery is a specific path that is not addressed by religion, but by the things of the human spirit: self-worth, compassion and understanding for others, give-and-take, forgiveness, kindness, fellowship and the other spiritual things that comprise the life of a human being in society. These things can be incorporated into religious practice, but in themselves have nothing to do with sitting in a room discussing someone’s interpretation of scripture. They are skills that are developed by practice, not by contemplation.
If I had any other suggestions for you, I would gladly share them. The PAWS article is my best advice, and is 100% in line with the recommendations of competent addiction professionals. Whether you choose to put other pursuits ahead of your recovery is up to you. Just remember, anything that you put ahead of sobriety, you are likely to lose — along with the sobriety.
Please stay in touch, and
Keep on keepin’ on!
Bill
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.
Pingback: on the edge.ready to throw the towel in... - SoberRecovery : Alcoholism Drug Addiction Help and Information
Pingback: Kicking the oxys - Part 5 - Page 18 - SoberRecovery : Alcoholism Drug Addiction Help and Information
Hi Thomas,
Congratulations on your 5-1/2 months. Oxys are a tough detox, and the PAWS is usually pretty nasty too. You seem to be doing pretty well, and taking care of yourself in the ways you need to. There is no question but that your rough periods are due to PAWS. Exercise (aerobic), watching your diet, restricting sweets and stimulants, and working on your spiritual development are all going to help.
I can’t answer your question about prolonging PAWS, because I don’t know what kind of antidepressant you are taking. I know of no antidepressants that are likely to interfere with recovery. Some anti-anxiety meds can, Ativan being one of the worst. You don’t really begin to recover at all if you have benzodiazepines in your system, because the brain can’t begin to normalize with them present. Talk to your pharmacist. Pahrmacists are an invaluable source of information.
I hope you’re attending some kind of support group. They are essential. As you’ve probably read previously, very few people are able to get sober and remain that way on their own. Community is the hallmark of emotional health, and isolation the reverse. Additionally, folks who haven’t been where we have may mean well, but they really don’t know how to help. How can you explain being willing to do anything to get another fix to someone who hasn’t felt that horrible fear? Hit a few meetings. It will help, and you’ll make some lifelong friends.
Stay in touch, and keep on keepin’ on!
Bill
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
Thomas
“You cannot imagine how bad the intial withdrawls were 2 years ago.”
Bet me. I didn’t get into this racket by accident, I earned my membership. Also, I’ve worked in detox units.
Bill
Back at ya’, Jen.
Of course the cold can be making things worse. Don’t they always? Combine that with how we used them as an excuse to get messed up, and they can be nasty triggers.
BTW: if you’re still drinking, stop. See Joe’s reply for why.
Bill
Hi Joe,
Thanks for writing, and congratulations on getting clean.
The good news — as you have reported yourself — is that things are getting better. My guess is that you’re simply having a prolonged dose of PAWS due to your having been drinking until recently, and that you can expect further improvement.
Cannabis and opiate drugs can both mess you up for extended periods, and the two together can create quite an uncomfortable post-acute withdrawal that can last for months or years. Using other drugs (such as alcohol) in the meantime simply keeps many of the changes that your brain is trying to reverse active that much longer. That’s why we recommend complete abstinence for complete recovery. The neurological effects of many substances overlap, since they all affect the same portions of the brain. It’s also why blowing a little weed can trigger an alcoholic or other addict to pick up the old “drug of choice.”
Hang in there. I’m predicting things will continue to improve. Remember, it took years for you to mess up your brain. You can’t expect it to recover on your schedule.
Keep on keepin’ on,
Bill
Hi Jen,
Thanks for writing, and congratulations on getting off the other opiates. This is an interesting situation, since you have stopped “abusing” drugs, but are still technically addicted. As I’m sure you are aware, buphrenorphine is itself an opioid drug.
You didn’t say what quantities of Vicodin you had been taking, but my guess (only a guess) is that you are reacting to the reduction of drugs. That isn’t uncommon with replacement therapies. Over a period of ten years your body underwent a lot of changes (especialy your brain) to accomodate to the unnatural levels of stimulation that the Vicodin provided. It wouldn’t surprise me if altering the dosage time of your Subutex might also change the times you experience these symptoms. If that is the case, and if you aren’t taking split doses, you might request that the doctor prescribe a lesser dose b.i.d. and see if that helps. It’s also possible that some short term medication for the anxiety and edginess might be in order.
One thing is sure: you are not experiencing PAWS, although you may experience some of the same symptoms. You don’t go into PAWS until you are completely clean for a couple of weeks. In any case, I hope your plans are to taper off on the buphrenorphine and become entirely opioid-free. Subutex and Suboxone are themselves addictive drugs and — assuming that you don’t want to take them for the rest of your life — you’ll have to complete opiate withdrawal and go through PAWS eventually. Might as well get it over with all at once.
I strongly suggest that you discuss this with a physician who specializes in treating addicts. A local treatment center would be a good place to check for referrals. Most physicians (even some who run detox clinics) have only a cusory understanding of addiction and addiction pharmacology. I also suggest that you attend some support group meetings. There should be some in your area. Google “NA” and check out a couple of the sites. It is extremely helpful to be able to talk over your feelings with someone who has been there. Support is a critical part of getting clean and sober, and those who avoid it are far more prone to relapse.
Please stay in touch, and
Keep on keepin’ on,
Bill
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,
Jean
Pingback: Post Acute Withdrawal - SoberRecovery : Alcoholism Drug Addiction Help and Information
Pingback: 100 Days - SoberRecovery : Alcoholism Drug Addiction Help and Information
Thanks for sharing your experience and encouraging others. Do some cardio, too. It helps the sleeping.
I QUIT DRINKING 2 YEARS AGO AFTER 35 YEARS OF BEER DRINKING AFTER A COUPLE OF WEEKS I STARTED TO FEEL TERRIBLE HAD CHEST PAINS, BODY TEMPERATURE DROPPED , DID NOT SLEEP FOR ALMOST 5 MONTHS, COULDNT CONCENTRATE ON ANYTHING, WOULD SWEAT DURING THE DAY TO THE POINT I WAS SOAKED , AND I HAD THE WORST PANIC ATTACKS THAT WOULD COME ON OUT OF NOWHERE THE BAD THING WAS I DID NOT REALIZE I COULD HAVE DIED I DID NOT REALIZE I WAS IN TOO DEEP BUT AFTER TIME I DID START TO FEEL BETTER MY SLEEP HAS NOT RETURNED TO NORMAL YET BUT IT IS MUCH BETTER AND I HAVE BEEN USING VITAMIN B1 AND POTASSIUM AS WELL AS A MULTIPLE VITAMIN I AM ALSO A LIFETIME WEIGHT TRAINER SO I AM STILL IN GOOD SHAPE FOR SOMEONE IN YOUR 50′S IF I CAN GET THRU THIS ANYONE CAN YOU JUST HAVE TO SUCK IT UP AND DECIDE WHAT YOU WANT OUT OF LIFE I FEEL MUCH BETTER MY SKIN LOOKS MUCH BETTER EYES ARE CLEAR AGAIN I AM FEELING LIKE I DID WHEN I WAS 15 BECAUSE MY DRINKING STARTED WHEN I WAS 16 AT A PART TIME JOB AND WENT ON TILL I WAS 50 BE STRONG AND STICK WITH A PLAN IF U MUST GO TO A DOCTOR………..
Hi Jason,
What you’re going through is perfectly normal. Think of it as your body reminding you that you’re an addict. Actually, that’s exactly what it is.
Addiction creates changes in our brains that persist as long as the drug (and, often, similar drugs) is in our system. Once acute withdrawal is over the brain begins the process of repair. While this is going on, we get a variety of symptoms that often vary with individuals since everyone’s brain chemistry and physical condition, organ function, etc. is slightly different. That’s PAWS.
Until PAWS is over, any exposure to the drug will trigger semi-acute or stronger post-acute symptoms. Even after that — years after for sure, and lifetime for most of us — exposure to the drug in any quantity will re-activate the craving. Whether or not that will lead to actual physical relapse in every case is problematic. However, we need to remember that relapse occurs before we pick up, not when we pick up. If we’re seriously thinking about having a drink, we’re already in relapse. At that point, if we don’t start taking care of ourselves and hit some support meetings, we’re likely to fall all the way off the wagon.
Hang in there. It will get better.
[Note: This is a repeat of an email, posted to maintain continuity in the thread.]
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
Hi Jesse,
In haste: Gabapentin (Neurontin) is good. Be aware that you can expect PAWS from the benzos for up to several months, depending on how long you were taking them. If less than five or six weeks, they shouldn’t be a problem. The Vicodin recovery should be getting along. Depression and similar feelings are normal for that. It will improve. There will be periods of feeling better that will get longer over time. Remember that you had seven years for your brain to adjust to the drugs. It will take a while.
If you’d like more information, please write back and I’ll try to give you some more details. Have to go to work.
Bill
Pingback: Hello, I'm new here and need help. - Page 2 - SoberRecovery : Alcoholism Drug Addiction Help and Information
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
Pingback: Approaching 30 days. - SoberRecovery : Alcoholism Drug Addiction Help and Information
Hello Bob,
My, you’ve really been down the road with the opioids, haven’t you? I suspect you now understand why I’m not a proponent of substitution therapy. In any case, congratulations on finally bucking off the monkey.
You have discovered why professionals refer to “addiction,” or “addictive disease,” rather than to heroin addiction, cocaine addiction, etc. The fact of the matter, little understood by the world at large, is that we don’t become addicted to drugs, but to the effects that they have on our brains — specifically on the pleasure center. The pleasure center is located in the sub-cortical region of the brain which means, among other things, that it is not amenable to conscious control. Its purpose is to reward us for behavior that is survival-oriented, both for us as individuals and as a species: food-seeking, reproduction, competition for resources (which, if you think about it, covers a huge area), social interaction, and so forth. When we accomplish these things our brains reward us with a jolt of neurotransmitters that make us feel good.
Drugs short-circuit the process by either stimulating the production of these neurotransmitters (principally dopamine and serotonin, although it’s really not that cut-and dried), or by mimicking their actions. They allow us to control the production of the good feelings. Since we are pre-programmed to seek those feelings, we tend to do it quite a lot. Over time, actual physical changes take place in our brains in order to accommodate the unaccustomed (and unnatural) levels of neurotransmitters or the chemicals that mimic their actions. This occurs in several ways, but we’ll simplify it by saying that our neurons grow additional receptor sites to deal with the surplus. This means, in turn, that we need more of the drug’s effects to reach the levels that give us pleasure. This tolerance is one of the first signs of developing addiction. Eventually we reach a point where we need the stimulation in order to function anything like normally, and we’re hooked for sure.
When we go “cold turkey,” the sudden absence of neurotransmitters causes the syndromes that we call acute withdrawal. The length of the acute phase lasts anywhere from a few days to several weeks, depending on the drug. Simple drugs, like alcohol, tend to have the shortest acute phases, while those that metabolize into other active compounds can take much longer. Methadone is an excellent example, having not only a longer but more severe acute withdrawal syndrome than other opiates. The symptoms of acute withdrawal, generally speaking, are the reverse of whatever effects the drugs had. Opioids, for example, calm us and slow the action of our digestive tract, and the withdrawal symptoms are the jitters, nausea and diarrhea, among others.
Post-acute withdrawal is the period when the body, including the brain, is getting back to normal — or as normal as it will ever get. Those extra receptor sites slowly become dormant and stop pestering us for stimulation, and there are myriad other changes. The main thing to remember is that while the body and brain recover from the changes, the changes do not necessarily go away, and if they do, it is usually over a period of some years.
You can easily see where I’m going with this. During PAWS, if we use drugs or alcohol, we will re-stimulate the addictive process by interfering with the progression to normalcy. Any amount of extra simulation, whether by the drug of choice or another, can have this effect. We don’t have to get drunk or high. In the case of opiates, the neurotransmitters involved are practically the same combination as with alcohol, and drinking can and usually does lead back to the use of opiates or similar drugs, if it continues long enough.
So. The answer to your question is twofold. Obviously, we can drink as much and as often as we wish. However, if we do so even in small amounts, we risk reactivating the addiction.
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.
Thanks
Hi CK,
Sure, and it does me old heart good to hear such good tidings. It’s wonderful that you’re doing well, and I’m delighted to have been a part of it, however small. Remember: you’re the one who did the work, and you’re the one who will need to keep on doing what you’re doing to continue your success. That’s what “keep on keepin’ on” means — that we build on our success.
Recovery is sort of like a muddy stream bank. If we keep at it, we’ll get to the dry ground, but if we stand still for any length of time, we end up back where we started. The same is true if we walk along too close to the edge. One misstep and we’re sitting on our butts in the mud again.
Shel and I went to a meeting this evening to hear a friend tell her story. It was inspiring. This is a woman who went from being an uneducated young mother, barely in her teens and a drinker from the age of 8, living off the men in her life, to a successful addiction therapist. She did it simply by getting sober, going to a lot of meetings, and trying always to do the next right thing for her and her kids. That’s what keepin’ on is about! Not slogging along, but just doing the next right thing and getting on with life. May yours be long, and continue to be happy.
And keep on “not just keeping on.” That’s what it’s about. When folks ask me “How are you,” I’m likely to say, “OK so far!” That’s the name of that tune.
Bill
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.
Hi John,
Glad you’re feeling better and coming up on a year. Give yourself a pat on the back — you’ve earned it. That said, remember that this program is one day at a time, and one year is just 365 days, with a 366th day coming the day after. A lot of folks relapse at about a year, because they get cocky. Please be assured that your addiction is quite capable of knocking you on your butt, regardless of how much time you have. That applies to my 22 years just as much as to your one year. The only difference is that I’m now in the habit of being clean and sober. Sobriety is as much a habit as addiction is, and as we feel more comfortable we can fall back into our old ways of thinking — and, eventually, doing. Remember: relapse comes before we pick up. You’ll read that over and over again if you hang around here.
I’m not trying to rain on your parade. By all means enjoy your anniversary — and don’t forget to pick up a key tag at a meeting. Folks like yourself are a powerful force for the newcomers, and your example may be what some poor schmuck with two weeks clean needs to see. It’s hard to relate to old-timers when you’re barely over shaking out, but a guy with one year…”hey, I might be able to do that.” I firmly believe that the most valuable 12-Step work we can do is attend meetings regularly. What if some poor guy needed a meeting and no one else showed up? Don’t laugh. I’ve seen it happen. Him, me, and a cup of coffee at Denny’s.
Again, congratulations!
And…well, you know….
Bill
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.
Dude! Glad to hear you’re doing OK, and that you’re paying attention to the details.
This is a good question, that needs more attention than it gets. First of all, you can relax regarding the PAWS. The likelihood of that tiny amount of alcohol contributing to any extension of your PAWS is remote, especially since it was consumed with food. Likewise, your sobriety is intact; it was not your intention to use and, indeed, it is impossible to avoid alcohol entirely — although that does not absolve us from remaining vigilant.
It is quite true that cooking alcohol, especially when used in sauces, does not evaporate completely in most cases. However, unless the sauce is reduced at extremely low temperatures, most of it is removed. Since, however, we can’t be sure of that — or that the chef didn’t taste it and decide it needed another touch after the fact — we need to be careful.
I believe, as does my-wife-the-shrink, that this is mostly a matter of intent and due diligence: we do what we can to avoid knowingly ingesting any alcohol, and deal with each issue if and when it comes to our attention. Having asked about alcohol in the sauce, and having done your due diligence, your attitude alone would indicate that your head’s in the right place and that you’re going to be OK. If someone had handed you a beverage and you’d chugged without even smelling it, that’s a “whole ‘nother smoke,” as they used to say in the Marlboro commercials.
Yes, it’s a good — a very good — idea to avoid alcohol in food if it is possible to do so. But remember this: we relapse in our heads, not in our bellies. The state of mind that leads to using any drug is just as important as the physical act — in this sort of case, even more so. As I’ve written (and said) dozens of times, relapse comes before the drink.
To take another example, let’s say you’re at a wedding, and inadvertently get hold of the spiked punch. Maybe you’re distracted, and take a swallow without smelling it and making sure — no question, you took a drink! But did you relapse? Of course not! You jack up your due diligence, go to a meeting, talk about it, stay in touch with people in the program, do a good Tenth Step and get on with life. Shit happens. If you’d taken a glass of champagne to toast the happy couple “just this once” — well, I think you can see the difference there without further from me.
Good to hear from you…
Keep on keepin’ on,
Bill
Pingback: Physical recovery times - SoberRecovery : Alcoholism Drug Addiction Help and Information
Pingback: How Do You Remain Positive? - Day 11 w/o Oxy - SoberRecovery : Alcoholism Drug Addiction Help and Information
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
Pingback: I need your opinion. - SoberRecovery : Alcoholism Drug Addiction Help and Information
Thank God you made it back! Now you know why they say “stick with the winners.” You know what to do, so
Keep on keepin’ on!
Bill
Sent from my HTC Thunderbolt
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~
Pingback: 90 Days - SoberRecovery : Alcoholism Drug Addiction Help and Information
Hi Jerry,
I’m at work, so I have to be brief. The information in my previous reply is the best advice I’ve got. If you do nothing else, concentrate on the details of the PAWS article. Next would be a 12-step group. I’m sure you can come up with all sorts of reasons for not doing the things that make you uncomfortable, but keep in mind that if you were functioning at 100% physically and emotionally we wouldn’t be having this conversation.
It’s good that your wife is so supportive. Sounds like a keeper for sure! Don’t waste her efforts, nor your own.
I don’t mean to imply that you aren’t doing all you can…I just haven’t heard any assurances that you are. Of course, you don’t have to answer to me. I don’t count. You’re the important one here, and you deserve the best shot possible.
As always,
Keep on keepin’ on!
Bill
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.
Hi Jerry,
Anxiety can come and go as you describe. However, the symptoms you are describing could also be particularly severe incidents of PAWS. If you are watching your diet carefully, getting exercise (aerobic), taking your vitamins and getting enough rest, you are doing about all you can on your own. You could try meditation, but that would probably be self-defeating if you’re unable to sit still for any length of time.
A recovery-oriented therapist might be able to help. If you’re getting palpitations and are agitated, a doctor might prescribe generic Inderal. It is not addictive, nor is it mood-altering. It’s a beta-blocker that just sort of slows down the rapid firing of nerve cells that can create tension leading to anxiety attacks. That would be preferable to the benzodiazepines that are often used for anxiety. You need to work with your doctor on that. Chances are good that if you break the habit cycle, you could get off the drug in a fairly short time.
What sort of supports do you have? Are you going to meetings? Got a sponsor? Hanging out with other recovering people? These are all powerful tools in early recovery.
All I can do from this end is answer questions and try to alleviate some of your concerns. You need to be working at your end on the things mentioned above.
Please keep in touch. I can almost guarantee that things will improve with time if you stay clean, but there are some things that can help you along.
Keep on keepin’ on,
Bill
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.
Pingback: Class Of July 2011 pt 3 - Page 11 - SoberRecovery : Alcoholism Drug Addiction Help and Information
Pingback: Question about detox - SoberRecovery : Alcoholism Drug Addiction Help and Information
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
Hi again, Reggie,
You can’t do it on faith alone. Get some supports. Hit some AA meetings, meet some people, and give yourself a head start on recovery. VERY FEW PEOPLE ARE SUCCESSFUL AT GETTING SOBER ALL BY THEMSELVES. Even those who manage to stop drinking permanently find that they have trouble coping with their lives when it comes to other people, the affairs of everyday living, cleaning up the messes they’ve made, and so forth. We call these people “dry drunks,” folks who are sober, but just as miserable as they were before. As a former sponsor of mine said, most memorably, “When I got sober things didn’t immediately get better, but they got real fucking clear!”
AA and the 12 Steps — but most importantly the guidance of others who have experienced the same things — help us make the changes necessary to again become productive members of society, help others, and regain our self-esteem. Without those changes and the accompanying feelings of being right with the world, we might as well go ahead and drink, because it or some other addiction is nearly inevitable in the long run.
Please, my friend, if you can’t do anything else for yourself, avail yourself of all the loving help, freely given, that’s available to you in the 12-step fellowships. My education didn’t help me stay sober, nor did my high IQ, my independence or my various other skills. None of them had anything to do with the issue of recovery. I got basic training in treatment and aftercare, but the most important part didn’t cost me a thing except admitting that I couldn’t do it by myself. My prayer for you is that you will find the strength to admit that too.
Keep on keepin’ on. You only have to do it one day, one hour, one minute at a time. You can do it.
Bill
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 Reggie,
As I said to Ron (below) I’ve been there and SO done that! I was 18 when I started, and 45 when I got sober. Same deal. I knew I needed to stop, but ultimately decided I couldn’t. I figured I’d die drunk. Then there was an intervention by my employer, I went to treatment, and I can’t tell you how relieved I was. I finally realized that there was a path I could follow that wouldn’t lead me to the gutter any more.
I don’t know your financial situation, but I strongly encourage you to get into a treatment program, even if you have to find a government funded one. Contact your local mental health society, or call crisis line for referrals. You need physical and emotional support while you get through the first couple of weeks. Be extremely careful about trying to detox yourself. Alcohol detox can be dangerous, even fatal, especially for people who have high blood pressure, which fits your profile. Success in the past does not guarantee it the next time. Be extremely careful. If nothing else, the next time you decide to try, pay CLOSE attention to the PAWS article, and get to some AA meetings so you can get the support of people who understand where you’re coming from. I’ve worked in detox facilities, and am currently employed by one to write educational material. Trust me.
Please stay in touch, and
Keep on keepin’ on!
Bill
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 Ron,
As I mentioned in a two-line bio sketch on another site I write for, “Bill has been there and done that…probably a lot of that. He has the ratty t-shirt to prove it.” (http://sunrisedetox.com/blog, if you care.)
You’ll begin to realize soon, if you haven’t already, that recovery isn’t about quitting drugs, it’s about learning to live without them. I got a lot of that in treatment, but it didn’t really sink in until I spent some time in the rooms. The similarities among us — all of us, not just addicts — are quite amazing, especially since we all start off thinking ourselves so special. Once I relaxed with a “just another bozo on the bus” attitude and began to relate to the folks around me, I discovered what a great bunch they were. Today, nearly 22 years later, I still feel that way. A great many of my friends are in recovery — not because I’m afraid to associate with Earth people, but because I prefer the company of folks who have built their lives around service to others and the 12 Steps. I hang out with Buddhists for the same reasons. Buddhism has a great deal in common with steps 10, 11 and 12, the ones we call the “maintenance” steps. I prefer to call them the permanent steps, since as long as we keep them firmly at the forefront of our lives we need never worry about relapse.
Please keep in touch. You are an inspiration to others who read these pages, and I always enjoy your letters. You have a great sense of humor, and you’re not afraid to laugh at yourself. Those are two traits that will serve you well in recovery. You’re perceptive, too. Most folks never notice the mind tricks. Maybe someday we’ll meet at a World Convention or something.
In the meantime,
Well, you know….
Bill
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?
Hi Ron!
Good to hear from you. Congratulations on your clean time, and on finding the secret at last. By now you know exactly why I push the 12-step groups so much. It’s a great way of life, isn’t it?
You are most likely right about the nutrition being a big part of the problem. We get into such bad eating habits when we’re using that we forget how important it is — if we ever knew to begin with. And of course, being addicts, we jump right in with both feet. No diet for me, I’ll just stop eating for a while. LOL
Quick primer on dieting. Starvation diets cause your metabolism to slow down, trying to conserve energy. That makes it harder to lose weight, which is why so ma y people’s weight bounces up and down constantly. The key is learning to eat a good diet, and adjusting your caloric intake to your level of activity. If you want to know the best ways to handle weight problems, get a copy of Diabetes For Dummies. There’s a lot of great information in there even for non-diabetics — and given the proliferation of the diabetes epidemic, you can’t take care of yourself too well in the diet and exercise area.
Gotta go. Keep on…etc.
Bill
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…..it 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
Long-term anxiety (unfocused anxiety) is caused by imbalances of chemicals in the brain, same as addiction. It can be induced by the prolonged use of certain drugs of abuse, but usually occurs spontaneously. It’s most common in people past adolescence.
The danger in trying to overcome it yourself is the possibility of its progressing. I’m not saying you shouldn’t, just be very careful. If you notice things getting worse, get to a mental health professional. I understand your desire to avoid pills, but you need to understand that problems of this sort are organic, and sometimes require medication. Just as I take pills for my diabetes, so do some folks need them to normalize other bodily functions.
Anxiety can sometimes be treated without drugs. Contact your local mental health association for a referral to a physician or therapist who can help.
Keep on, etc.,
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 Jerry,
Sorry you are having a tough time of it, but congratulations on your 2 months sober. The first two months aren’t easy for anyone, but your anxiety attacks are a concern, as they are not a common issue in post-acute withdrawal (although not unheard of).
I’m not qualified to diagnose your problem, and even a medical doctor would be pushing ethics to so so over the Internet. A good medical history would be necessary, along with some face to face talk and probably some lab work.
However, if someone asked me for a direction to look, I would suggest investigating the possibility of a preexisting anxiety condition that you may have been self-medicating with alcohol without realizing it.
My best suggestion is to see a good GP for a general physical, and then see what turns up. In the meantime you might think about attending a few AA meetings. You would probably find the support helpful, and might get some more insight into your drinking.
Please stay in touch and let me know how things go, and of course
Keep on keepin’ on!
Bill
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?
Pingback: Paws? - SoberRecovery : Alcoholism Drug Addiction Help and Information
Hi Tiff,
Very briefly: we become addicted because actual physical changes take place in our brains that cause us to need the drug(s) in order to approach normal functioning. These take place over time, but fairly rapidly on the way “up,” because our brains are constantly subjected to the chemicals. Conversely, when we get clean and sober, it takes a long time for things to get back to normal. Sometimes they never do. What we call PAWS is the period during which this is happening. For some folks — very lucky ones — it takes only a few months. For others, it can take years, and for others yet it will never happen completely.
Now here’s the tricky stuff, the way addiction fools us and gets us once again decorated with a monkey. As long as the brain is stimulated — even a little bit — by alcohol or other drugs, it will not begin to return to its normal functioning. Furthermore, it doesn’t necessarily have to be the same drugs we were addicted to. Most drugs work on similar pathways to the pleasure center, and so it is quite possible for — say — benzodiazepine tranquilizers to keep the pathways open for alcoholics and opoid addicts. And then, to top things off, in recovery our brains retain many of the changes that took place while we were using, and just create ways to work around them. Re-introducing the drug(s) at a later time can activate the old neural pathways, and in a very short time we’re right back where we left off.
In short, complete abstinence is the only SAFE course for recovering people. Sure, it’s possible that I might be able to have a drink now and then. Hell, I’ve been sober for nearly 22 years at this point. But what if I’m not able to do so safely? I was 45 when I got sober. I’m now 67. What would happen to me if I ended up back where I started? I can tell you for sure, it would get a whole bunch worse in short order, because I don’t bounce back like I used to, nor am I in the same physical condition I used to be in. The martial artist who could walk for miles and run a few of them is no more.
I also have to consider this: knowing how miserable I was for so long, what does wanting to take a chance on going back to that say about my frame of mind? If I’m thinking that way, I’m already in relapse. Relapse comes before we use. We can relapse and never use. We call that a “dry drunk.” Personally, I’m not taking the chance of ruining everything I’ve regained for the questionable pleasure of turning my brain off for a while. That’s why I meditate. It’s cheaper, healthier, and there are no hangovers.
Stay in touch,
Bill
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!
Hi Tiff,
Congratulations on your second successful detox. Let’s hope it’s the last. There are people who claim that total abstinence isn’t necessary for sobriety, but I know only about two people in my two decades around the rooms who have been successful with that (although no doubt there were more — possibly not addicted to begin with). I know teetotaling was the only route for me. I suppose I could have tried to see if I could drink socially, but I was terrified I’d discover I couldn’t. It was just much easier not to.
Don’t forget to build your support group. Hit those meetings. It’s like George Carlin once said (and he really did say this one) “Just because you’ve got the monkey off your back, it doesn’t mean the circus has left town.” Watch the rest, diet, avoid the caffeine and sugar, take your vitamins, get some exercise, and
Keep on keepin’ on!
Bill
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!!!!
Pingback: When and how to notice change? - SoberRecovery : Alcoholism Drug Addiction Help and Information
Pingback: Is it PAWs? - SoberRecovery : Alcoholism Drug Addiction Help and Information
Pingback: Does the depression ever end? - SoberRecovery : Alcoholism Drug Addiction Help and Information
Pingback: Doctors ........ need to rant - My Way Out Forums
Pingback: foggy brain - SoberRecovery : Alcoholism Drug Addiction Help and Information
Pingback: Class of March 2011 Pt 5 - Page 8 - SoberRecovery : Alcoholism Drug Addiction Help and Information
Hi Ali,
Thanks for sharing your recovery with us. I’m so glad it’s working for you, and your words of encouragement may just be what that one person needs to hear at this exact time. I encourage you to keep on helping others. Sometimes folks have a hard time relating to old farts like me who’ve been clean for what must seem like ages. It’s good to have people with less time to testify to the fact that it works. And, after all, don’t we all owe some paybacks?
Now you can be a good mom to that two-year-old. How wonderful that must feel!
Keep on keepin’ on,
Bill
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.
Good on yer’ BIH. Proud of you.
Keep on, etc….
Bill
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
Similar to the one about the 4-wheel, the boat and the helicopter.
Glad I was able to help.
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…
Ah So, Eddie,
I had you confused with someone else, so most of that made perfect sense in the other context. Sorry ’bout that!
I wouldn’t think that Valerian would be a problem. Nyquil, different story. According to the information I have, it is 25% alcohol by volume (50 proof). The only alcohol-free version, to my knowledge, is Children’s Nyquil. If you need a sleep aid, I would try generic Benadryl (Dyphenhydramine). The sedative/hypnotic components of Nyquil are antihistamines (apart from the ethanol), and most folks get the same effect. Like other antihistamines, some people (especially older men) find that DPHM causes difficulty with urination. If that happens, simply discontinue use and things should get back to normal in a day or so.
As with all drugs, if you are taking other medications check with the pharmacist to see if there might be interactions.
Don’t worry too much about PAWS. You are doubtless experiencing some after getting off the grass. That’s normal, and you can expect several months of it. (Congratulations on that, by the way. Now you’re really clean and sober.) Try the exercise/snack routine and see how it goes. Also, avoid computers for about two hours before bedtime (phones, too). The light from the screens interferes with the production of melatonin, which is the hormone that tells you you’re getting sleepy. A 1 mg. tab of melatonin might help to begin with. Get the sublingual. It’s not absorbed well from the g.i. tract. Most folks find that taking it immediately before bedtime and then going to bed is the best way to use it.
And, as always,
Keep on keepin’ on!
Bill
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
Hi Eddie,
Sorry to hear about your sleep disturbance. That’s not unusual in early recovery and, as they say, no one ever died from lack of sleep. (That’s true only in an extremely narrow sense, however, as lack of sleep has recently been shown to shorten lifespan.) Valium messes folks up, and 5 mg 2 – 3 times a week is enough to cause some long-term consequences, especially if concurrent with alcohol.
I had similar problems in early recovery. I found that I had to simply stop drinking coffee or any other caffeinated beverage at about 2 PM, and on no account later than 4. I also discovered that the more exercise I got, the better I slept — provided that I got it two or three hours before bedtime. Making sure that I had a decent snack before retiring also helped.
I would not imagine any harm from Valerian root (although the standardized extract is probably a better choice), but I am not recovering from tranquilizers and I can’t say what the pharmacological effects might be. I can only suggest that you consult with a doctor, or at least monitor yourself carefully with the help of someone else in the program with considerably more time than yourself. I know people with many years of recovery who use Valerian with no apparent consequences. However, I can’t say what effect it might have in early recovery. I would certainly not use more than recommended, any more often than recommended. You might talk that over with your sponsor. If you don’t have a sponsor, get one. You are not getting anywhere near all the program has to offer if you’re not following the directions on the box.
This probably seems like pretty-much a non-answer, but it’s the best I can do. People’s reactions to drugs vary so much that it’s impossible to predict how they might affect someone going through PAWS (or not going through PAWS, for that matter), and that is even more true of potentially psychoactive substances. I’d try the caffeine reduction, the snack before bed and the exercise first. If that doesn’t work, then let your conscience be your guide. If you have that feeling in your gut that it might not be a good idea to do anything, then it probably isn’t. Good rule of thumb.
Keep on keepin’ on,
Bill
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:
http://www.benzo.org.uk/manual/
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!
–Ian
****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.
Hi Stephanie,
You’re doing great. You’re hanging with the right crowd, mostly, doing the right things, and asking the right questions.
Emotional turmoil is normal during early recovery. To answer your last question first, I am told that Vistaril is effective for anxiety and appropriate for recovering people. Keep in mind that I am not a physician, and am not qualified to give medical advice. However, that information comes from a source that I trust implicitly.
Avoid benzos. Not only could they be a trigger, but they will prolong PAWS. Check any unfamiliar medications online or with your pharmacist (who is usually a better source than your physician who, although she prescribes, does not have anywhere near the training in that area that a pharmacist has).
Potassium enters and leaves the body rapidly. If your issue is K related, it should subside quickly. If you are still having problems, ask your doctor about a K supplement if the bananas aren’t getting the job done. Consider Magnesium and Calcium supplements along with the Potassium. For the time being, I would take a moderate supplement, rather than depending only on Ca and Mg rich foods. You may or may not be absorbing and using food sources efficiently at this point. Don’t overdo either, and forget the megadose advice you may find here and there. With a few notable exceptions, they are ploys to sell supplements, rather than good medical advice. Also, eat some yoghurt or take probiotic supplements for a while. If you are not taking a multivitamin, start. You don’t have to buy some super-pills. Despite all the fuss about supplements, an ordinary one-a-day or similar brand, morning and evening with a meal, is all you really need. Vitamins are food, and they are rarely absorbed properly unless taken with other food.
Muscle spasms occur when the muscles receive scrambled signals. Minerals help normalize the transmission of nerve impulses. You weren’t specific about the spasms. If they are cramps, that is different from — for example — restless leg syndrome, an intense need to move the legs and feet, or spasms (jerky uncontrolled movement of a muscle or muscle group). In any case, diet and exercise are the treatments of choice unless they fail over a fairly long period. Then other intervention may become necessary. That gets medical, so I’ll stop here.
I will mention that if you have not been checked for blood sugar disorders, you need to have that done, especially if you are overweight, or if there is diabetes in your family. Some of your symptoms are consistent with blood glucose issues.
The simple answer to the anxiety is that your mind is trying to tell you something. It is not always an emotional disorder; sometimes it can be your subconscious exercising common sense. Perhaps hanging out with people who are not in recovery is not the best course of action for you at this time. Consider that carefully.
Overall, it sounds as though you are doing pretty well, especially considering that you do not have expert support. Do what you’re doing, see the doc and get checked when you can, and
Keep on keepin’ on!
Bill
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
Congratulations on your 20 days! I’d like to tell you that the worst is behind, but you’re already aware of the reality there. I can tell you that it will get better — slowly, but better. In the meantime, you’re on the right track. Don’t forget to use your supports, and develop new ones.
I won’t lie to you. Speaking from both personal and professional experience, I can tell you that benzo recovery is a bear sometimes. Expect some rough days. The bad news is that PAWS from benzos can last for a long time — up to two years, depending on amount and length of use. The good news is that now you know you’re not going crazy. Keep that in mind on “those days.”
A decent breakfast is probably the single most positive thing a recovering person can do for their emotional and physical health, apart from abstinence. I can’t over-emphazsize the importance of the nutrition portion of the article. Thanks for validating it.
Please stay in touch, and
Keep on keepin’ on!
Bill
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.
Pingback: Why do coffee/cigarettes not affect P.A.W.S.? - SoberRecovery : Alcoholism Drug Addiction Help and Information
Hi Ashley,
Congratulations on your nine months clean.
I have good news and bad news. The good news is that your symptoms will improve over time. The bad news is that benzos (Klonopin) can have a very long post-acute syndrome, especially when combined with other drugs. I can’t say for sure, but I would expect your symptoms to begin to lessen soon. However they will likely remain for some time yet. Benzo withdrawal can take up to two years. My brain was scrambled for at least that long.
Pay attention to the suggestions about nutrition and exercise. You might also consider meditation, which often helps if you stick with it. Article here. Walking a mile or so a day is the best thing you can do for depression and to stimulate recovery. Mild aerobic exercise also promotes sleep.
Please stay in touch, and
Keep on keepin’ on!
Bill
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!
Pingback: The dry drunk - My Way Out Forums
Pingback: Losing my memory - Page 2 - My Way Out Forums
Again, thank you.
It has been suggested, however I don’t have the kind of temperament to spend the terrific amount of time that the birth of a book entails. At some point I may do a sort of anthology of other writing, but I haven’t given that much more than passing thought. Perhaps when I have more time. In the meantime, this project (personal) and the other writing I do about recovery (remunerative) are about all I have time for.
Thanks for asking. You never know. If I do it, you’ll read it here first.
bw
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.
Best
Hi CK,
Smells are the most powerful of memory stimulants. A whiff of Shalimar can take us back to a love of 40 years ago. The smell of freshly mown grass, bread baking, and thousands of other scents are powerfully bound to our memories.
Doubtless this is a survival issue: in the days when we were just another critter on the veldt (albeit rather smarter than average) we needed all our senses to interpret our environment. Confusing the smells of various animals could be the difference between eating dinner and being dinner, and we didn’t have time to think about it. Our sense of smell is hard-wired to our sub-cortical brain.
So it’s not surprising that certain smells can trigger cravings, just as certain sights and sounds can. Even today, after more than 20 years without a drink, certain smells trigger the idea — not craving, just the idea — of a drink. Perfectly natural, and nothing to fear as long as we know about it and respect its power. (I wouldn’t spend too much time whiffing Mount Gay, regardless.)
The scent of alcohol won’t aggravate PAWS, or set you back insofar as your physical healing is concerned. Its psychological effects are something that you’ll have to evaluate for yourself and make decisions based thereon.
As to your pens, I’d just set up a fan across the room so that there’s a gentle breeze blowing the odor away from you, and forget about it. In any case, being aware of this will probably take away a lot of the mystery and power.
Keep on keepin’ on,
Bill
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.
Pingback: The Reflex to Drink - SoberRecovery : Alcoholism Drug Addiction Help and Information
Hi Eddie,
Letters like yours keep me going. Thank you.
FYI, the coffee doesn’t seem to be a big deal health-wise as long as you’re using less than 400 mg of caffeine a day (about 4 strong cups) and it isn’t interfering with your sleep. I use caffeine, but never after 4-5 pm, and no more than a couple of cups a day. Certainly cutting back is good (and none is probably better), but as long as you’re not taking it with a lot of sugar on an empty stomach it’s not likely to be doing you much damage. (Current research bears me out on that, BTW.)
It’s amazing how many people believe that you can “cut down” on drug use and start to recover. You were not alone. Lack of knowledge about the physiology of addiction has kept many people in PAWS for years, when they could have recovered completely had they known that abstinence wasn’t just abolitionist bull. And the increased relapse potential has killed a bunch of them.
Sounds like you have quite a lady there. Better hang on to her.
Keep on keepin’ on,
Bill
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…
AA, NA, Nar-Anon, Al-Anon: all sources of support, and one or another has to be within your reach. As to whether or not I’m correct, it really doesn’t matter. If you act as though I am, I guarantee things will go better than if you don’t. That’s all that counts.
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
Hi BIH,
You are absolutely right in what you are doing for yourself, and right in the message that you are passing on — all except the “it can not be withdrawal” part. Your brain controls your senses, and withdrawal happens in your brain.
“Post Acute” withdrawal refers to the withdrawal that takes place after we stop the shakes, chills, diarrhea, and all that fun stuff that we refer to as “acute” withdrawal. It will be several months before your brain is back to normal, and choosing not to think of it as withdrawal is setting yourself up for relapse, because it allows you to start believing that you are in control. Believe me — you are not in control. At three weeks from your last pill, you’re barely past the acute phase. You can ameliorate most of the symptoms, but control them? Not on your life. They will come as they come, and you need to know that ahead of time so that you can be prepared.
I say this not to discourage you, but to keep you from being blindsided later. You can expect rough periods at approximately 3-month intervals. No one knows exactly why this is true, but it most assuredly is. If you are not aware of that, and haven’t prepared for it by building the necessary supports, it can be extremely discouraging. Most relapses in the first year occur at about those times.
Keep on doing what you are doing. You’re doing exactly the right things, except that I strongly recommend adding a support group to your program of recovery if you have not already done so. Having others who understand where you are coming from is invaluable — and you’re likely to make some new friends.
Sorry to have delayed answering this, but it was on my laptop, and since I was laid up yesterday I didn’t get back to it until I got in to work this morning.
Keep on keepin’ on,
Bill
Hi BIH,
That’s a really good question and, as far as I know, no one has a really definitive answer. However it makes sense, and anecdotal accounts would seem to bear it out to a degree. On the other hand, both my daughters had Sedadrops when they were little (who knew?) which were essentially the same thing as Paregoric, and only one has even used drugs. I can’t speak to whether or not she’s an addict (she’s been clean for years) but even if she were, she has the genetic background in spades, with alcoholism and addiction on both sides of the family. So who knows? Early exposure? Genetics? I suspect both could be factors.
I know one thing: knowing what I know now, I would never have taken the chance with my kids, nor would I ever approve of it again for any child. People, especially children, simply don’t need narcotics unless they’re in severe pain. I’m sitting here having just had three days of tooth pain and an extraction this morning, and I have been quite comfortable with Advil and an occasional sip of cold water on the tooth when it got a bit dicey. Same goes for all the dental pain I’ve had since I got clean and sober. Narcotic drugs just aren’t necessary for pain in most cases, but doctors don’t understand addiction (or addicts) and they’re usually happy to give us what we ask for. By the time they get smart to us, it’s usually too late.
But I digress. In short, I wouldn’t be at all surprised if you’re right. It makes sense considering what I know about theories of addiction. But a specific answer, if there is one, will have to come from someone else.
Keep on, etc,.
Bill
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 …..my 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
Hi BIH,
Took the weekend off, so I’m just getting to this.
Opiates in lower quantities (still addictive, though) do tend to give us a lift. And withdrawal is usually the opposite. You can expect things to get better — and your energy to begin to return — as time passes. Can’t tell you how long, though. It varies with individuals. It will get better, though.
Actually, apart from a bit of stiffness that I accept as the price for having lived well into my seventh decade, I usually feel pretty good in the morning — provided that I’ve gotten a decent night’s sleep. The stiffness goes away more slowly than it used to, but in a few minutes after rising I feel pretty good. A little t’ai chi helps.
Give time time. We used for years, and it’s only our addict thinking (I want to feel good now!) that causes us to find trouble accepting that the repairs take time. Just be thankful it’s not one-for-one, and that you don’t have to recover equal to every minute you used. We get off easy in that regard.
Thanks for the kind words. How could I be judgmental? I’ve been in the same boat, and I know how easy it is to fall overboard! Believe me…
Keep on keepin’ on,
Bill
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 ..it’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
Hi Josh,
I have good news and bad news. The bad news is that heavy cannabis use, especially in young people, can produce PAWS that lasts for up to two years. The b.s. that it’s not addictive and there is no withdrawal is totally bogus, spread by people with their own agenda regarding legalization and with no real regard for people who might suffer from its use — or at least denial combined with willful ignorance.
The good news is that it gets better. The degree of PAWS depends on several factors including how much, how long, how old, and questions involving individual brain chemistry that are still poorly-understood. The two things that are certain are: (1) recovery is a process, not an event, and sometimes it’s slower than other times but it does get better, and (2) using again will simply put you back at square one, and you’ll eventually have to go through all this again except — guess what — it will be worse.
As far as controlled use is concerned, go through the comments and read some of what I’ve written about keeping neural pathways open, etc. As long as the drug is in your system, your brain can’t repair itself. Doesn’t matter how little. That’s the fallacy that a lot of people fall into. We are no longer cucumbers, we are now pickles. Things that worked before we used heavily don’t work the same now, and we can’t go back to being cukes.
No two people recover the same way because of the issues mentioned above, and we don’t choose the hand we’re dealt. Envying someone because they’re having an easier time of it is not only silly, it’s setting yourself up for resentment. Take care of yourself, get to meetings, get a sponsor, work the steps and help other addicts. If you’re not doing these things you’re not doing all you can do for yourself and it’s no wonder things aren’t going too well. If you are, then keep it up. If nothing else, it will help distract you until things get better again. And they will, as long as you don’t use. If you do, your misery will be speedily refunded.
Stay in touch, and
Keep on keepin’ on.
Bill
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?
Pingback: I am a cautionary tale - My Way Out Forums
Hello again, Patrick,
I’m trained in the scientific method, so the first thing I look for when evaluating sites like the one you linked to are references to research published in peer-reviewed journals. I couldn’t find any. Then I read the article to see if there is specific information. Again, nothing. There are a lot of extremely general statements, but none of them even begin to be specific. (In contrast, I wrote an article on addiction last night. The first thing I did was explain the mechanism in the brain with specific references to the neurotransmitters involved.) In the entire site there are no references, not even to anecdotal “research.”
Given that the good doctor (if such he indeed was) began practicing in the late 1930′s, he would almost certainly have done his signature work before 1970. At that point in brain research, only a tiny amount was known in comparison to what we know today, and very little of it had been applied to addiction. Since then, some of the finest minds in medicine have put millions of hours into the subject, at a cost of billions. If there were a magic bullet beyond abstinence, we would all be using it in treatment. Apart from advocating good nutrition and a healthy lifestyle, no one has (yet) discovered any of these miracle cures.
So, we have no references, no peer-reviewed research, no anecdotal research or results, and an article that — while it is generally true — could have been written by anyone. You may draw your own conclusions from that.
Good nutrition and adequate vitamins and minerals are important, but no one has yet shown that extreme amounts of them confer any benefit. Even Dr. Sabin’s research into Vitamin C, one of the most thoroughly reviewed bits of research in medical history, is still in doubt. I would stick to the USDA food pyramid (just revised), and take a multivitamin morning and evening, always with food.
You might want to consider cutting your heavy workouts down a bit, and just taking a long walk once or twice a week. Walking is good for us emotionally, and has a calming effect, which is why walking meditation has been a mainstay of Eastern practice for thousands of years.
With respect to the meat, no one needs more than about six ounces of protein a day, regardless of how much bodybuilding they are doing. Your statement that you are “eating as much lean meat as possible” is not specific. If you are gorging on meat, you need to balance your diet. If you merely meant that you avoid fat — more power to you.
We have a tendency, when we are unsatisfied with answers, to look for authorities who will give us the answers we want. We addicts are especially good at that; it’s one of the ways we kept our denial in tune. Please consider the source. An anthropology professor of mine once remarked that if anyone could show him a shaman who profited not at all from his ministry, he might join that religion. Good advice, and it can be applied to purveyors of health foods and vitamins just as readily.
Keep on keepin’ on,
Bill
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?
http://www.restoreunity.org/brain_regeneration_in_heroin_addiction.htm
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.
Yes, PAWS sometimes mimics withdrawal symptoms. It occurs to me that some of your complaints could be anxiety-related, another reason to work on chilling out on a regular basis.
Hello Patrick,
Using heavy drugs and drinking heavily during your teenage years can severely affect development of the connections in your brain. Sometimes these repair themselves with time, and sometimes they don’t. It takes a skilled neurologist to make definite statements about the issue, usually after an fMRI scan.
However, there is no need to panic. Even when the above is the case, there is usually some improvement. Also, PAWS itself can recur for up to two years, in decreasing increments. Finally, it does sound like stress is creating some of the problem. You might do well to allow yourself to be a bit more imperfect.
I would continue with the understanding that things will get better, and see what happens. I also suggest that you structure your time so that you can at least take a walk, go for a run, or otherwise get some exercise during periods of stress. Exercise is one of the best antidotes for stress, provided that it is not too competitive. If you are a fierce competitor, consider changing your exercise regimen to one that is more relaxing.
I’m guessing that the issue is not dietary, unless you change your eating habits considerably when you are cramming for an exam. If you’re doing energy drinks, that could explain a lot. Pay particular attention to your diet when you are feeling symptoms, avoiding sweets (except with meals in reasonable amounts) and consider weaning yourself off caffeine
You can research your symptoms at http://mayo.com, http://webmd.com, and similar sites. I suggest, however, that you trust your doctors, continue to take care of yourself, and try not to worry about your brain’s future. You are doing the right things, and it is what it is. Worry only makes it worse.
Keep on keepin’ on.
Bill
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.
Wow! Thank you!
bw
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!
Hi C.K.,
Congrats on your three months. Sorry you’re having a little PAWS trouble, but that’s perfectly normal. You can expect it, off and on, for quite a while. If you were using alcohol only, it should clear up in a few more months if you take care of yourself, get some supports, and start rebuilding your life. So that you won’t be caught off guard, it tends to run in three-month cycles: 3, 6, 9, and sometimes 12 months into sobriety. No one know why that is, but the combined experience of millions of recovering alcoholics and addicts is a strong indicator.
The trick is to avoid sugar for sugar’s sake. Sugar is a problem because it goes straight to our head — literally. If we have something sweet after a meal, or combine it with some complex carbs and a little protein (think PBJ) then there is a “cushioning” effect and we don’t get the big blast all at once. Combine it with other food, and don’t take it when you’re hungry.
I also suggest that you might want to have your doctor run some tests on your sugar metabolism, especially if you are overweight. There is always a chance that you are developing a pre-diabetic condition. Diabetes and booze go hand in hand. I am diabetic, controlled with two pills a day, and those pills changed my life from one of mood swings and bad temper to what I can truly call serenity — sometimes. And sometimes is all we can expect. We are human, and life is life.
Just have faith that it will get better. If you can’t manage that, have faith that I have faith.
Keep on keepin’ on,
Bill
PS: It seems I am not to late to the party at all, but was looking at the first comments rather that last
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.
Thanks
Pingback: brain scan images of drug & alcohol abuse - SoberRecovery : Alcoholism Drug Addiction Help and Information
Good for you! It’s great that you’re feeling better and doing what you need to do for yourself. You should, however, be aware that the symptoms of PAWS come in waves, and you can expect to feel discomfort from time to time. I mention this not to discourage you, but to keep you from being blindsided by stuff you thought was long gone.
Those are good rules, too. Concise and to the point. I hope they’ll help someone who was overwhelmed by the information in the article.
Thanks for staying in touch. Don’t be a stranger, and
Keep on keepin’ on,
Bill
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)
3.eat 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
P.S
i flushed my bottle of 120 white devils i have no use for temptation in my life
Dear Bird,
“…you just need to find the a way to not fall into the darkness.”
Some of those ways are easier than others. For an addict, keeping pills around is a guaranteed way to make abstinence more difficult. If you really want to quit, get rid of the bottle of white devils.
I noted the discrepancy in dates, and didn’t think twice about it. Such lapses are common in early recovery. You can expect improvement in that and other symptoms of PAWS if you take care of yourself and remain clean of all mood-altering substances. If not, you can expect precisely the same effects over and over again. The brain does not have a chance to repair itself as long as we keep it stimulated. Even an occasional pill will prolong the addiction.
I strongly suggest that you find some support at NA, PAA (Pill Addicts Anonymous) or a similar fellowship. If you feel unable to do that, then there are a number of sites online where you can interact with others who have been there and who understand. In recovery, half measures mean nothing, and just quitting without any other action is a half measure.
If you have been reading through the site, then you know what my advice is regarding just about every situation that arises in early recovery. I suggest you re-read the PAWS article, and consider making it your bible for the next few weeks. I guarantee that if you follow those guidelines — not just the ones that sound good to you, but all of them — you have an excellent chance of remaining clean and sober. Give it a try. If you don’t like it, the world will be happy to refund your misery.
Please stay in touch, and
Keep on keepin’ on.
Bill
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
Pingback: My very short term suboxone detox - Page 3 - Drugs.com
nice post I really appreciate the info!
Hi Katherine,
You did not mention that you are still on Valium. I don’t know what is causing your problems generally, but you will not normalize completely from your other drugs until the Valium is out of your system. Valium has an effect on the brain similar to alcohol, and has its own PAW syndrome. It is also an extremely dangerous detox, due to the possibility of seizures, blood pressure spikes and several other potential problems. I would not suggest that you attempt detox on your own, but rather that you be medically detoxed by addiction professionals if at all possible. Short of that, the taper should be very slow and vitals should be monitored closely.
While we are on the subject of addiction professionals, I suggest you find a good one to help guide you in your early recovery (which has not yet begun). The doctor you have now clearly does not understand addiction, or you wouldn’t still be on a benzodiazepine — and certainly not for extended periods. No benzo has yet been approved by the FDA for long-term therapy, and there are excellent reasons for that, including brain damage from long-term use that can become permanent. Doctors who prescribe them for more than the few weeks that are recommended are doing it on their own, in the face of overwhelming evidence that it’s a lousy idea.
http://en.wikipedia.org/wiki/Benzodiazepines
I can’t speak to your marital problems except to say that your husband sounds like what we in recovery refer to as a “dry drunk”: an addict who has stopped taking drugs but has done nothing else to change his/her life. They tend to be miserable people who make those around them miserable as well. I am not accusing your spouse of that, but your description fits the syndrome to a T. That is why NA is so important to people who want to be in recovery. It doesn’t teach us how to quit, it teaches us how to live after we quit. Your husband is not your problem; he is his own problem. You can’t change him, but you can grow yourself. Or not.
As to your own experience with NA: if you really wanted to go, you wouldn’t let the statements of a couple of people put you off. You have found a good excuse for avoiding the changes in your life that would be involved in a recovery program. Obviously, your response will be that I don’t know you, and who am I to “judge” you. I’m not judging you. That is a reaction so typical of people who dabble in recovery that it is a cliché, “I tried, but they kept me from doing it.” It is based on fear of change, and is completely understandable. It can also be deadly.
You are doing everything that isn’t too scary — which is to say, not very much. It’s time to move beyond that and begin making some real changes. We change the things we can…and darned if a lot of the other things don’t change right along with them. If we fail to make all the changes that we can, we get few results. I truly want you to succeed, but my blowing smoke will not help. I give direct information based on a lot of experience, both in recovery and working with people who are in recovery. Whether or not people act on it is up to them. When it comes to deadly diseases — and, make no mistake, addiction is a deadly disease — we find the best experts we can, and follow their direction if we want to recover. Find a good addiction therapist or treatment program, and get started.
Bill
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.
Hi Katherine,
I wish the last paragraph of your comment could be read at the beginning of every NA meeting in the world. You seem to have run afoul of some addiction “experts” who were giving themselves too much credit.
I suggest that you not let a few people — who speak only for themselves, not for the fellowship of Narcotics Anonymous — drive you away from a shot at your recovery. However, you might find Pills Anonymous a bit more attuned to your specific issues. If there are no meetings in your area, you can contact the World Service office for some online support. If I were you, I’d give NA another shot; try a different meeting. Raise your hand and tell them what happened the last time. You’ll get more support than you expect.
Moving on. The people at NA were patently wrong. Norco is acetaminophen and hydrocodone, which is also sold under the brand names Anexsia, Dolorex Forte, Hycet, Liquicet, Lorcet, Lortab, Maxidone, Polygesic, Stagesic, Vicodin, Xodol, Zamicet and Zydone. That mixture is commonly prescribed, and hydrocodone is highly addictive. Incidentally, if you’re not drinking alcohol and don’t have a pre-existing condition, acetaminophen taken as directed will not hurt your liver. If you are drinking alcohol, we needn’t even be having this conversation, because you won’t get over your opiate addiction until you stop drinking as well. The two complement each other (and both encourage us to do stupid things).
Based on your own statements, you are — without question — addicted to opiates. You described developing tolerance (needing to increase the amount of drug to get the same effect) and some classic withdrawal symptoms: runny nose, sneezing, and generalized pain. I wouldn’t be surprised if you had also noted some diarrhea and general agitation, which you may not have attributed directly to the withdrawal.
You also ran afoul of the common misconception that as long as you take medication as directed, you won’t get addicted. Couldn’t be farther from the truth. It’s the length of time you take it that accustoms your body to the presence and changes the receptors in the brain to require it to be comfortable. The amounts are far less important.
As an example, I took benzodiazepines according to Dr.’s orders — often, if not always — less than the dose prescribed, but I took them for several years. It took five days to detox me from alcohol, and three weeks to detox from the benzos. PAWS lasted a lot longer than that. Looking back, I realize I had post-acute symptoms for years, although I didn’t recognize them at the time.
Welcome to the club. Feel free to join in; there are some nice folks here.
Everyone’s brain chemistry is different. There is no way to predict how severe your acute and post-acute withdrawal will be this time around. Offhand I would guess that it won’t be as bad as before, but there’s no saying for sure.
As to why your doctor didn’t warn you: he or she probably didn’t know. Most doctors know far less about the drugs they prescribe than they pretend to. Anyone who doesn’t do their own research and self-advocate when necessary is far more trusting than addiction professionals are, I assure you. My wife is also in this field, and we have both worked in detox (she still does, part-time). Our doctor asks her for information about some of the drugs he prescribes.
God bless him. He knows what he doesn’t know. That is not true of most physicians, who become so accustomed to projecting an air of competence that they end up fooling themselves into thinking they know more than they actually do. (About many things: back in my days as a flight instructor I hated to get doctors as students. Very hard to teach them anything.)
I think I’ve touched on everything you asked and mentioned. I would add, please give NA and/or PA another try. The 12-Step programs are not infallible, nor are the human beings who make them up, but they are the best shot at not only overcoming addiction but learning to live a happy life afterward, and they’re FREE! What’s not to like?
Except our own fear.
Keep on keepin’ on, and stay in touch.
Bill
Dear Katherine,
I’ll get back to you later today. There are answers. We haz them. Right now I need to get some sleep.
TTYL,
Bill
Hi Jakub,
Sorry to take so long answering. I got busy writing and lost track of the email notifications.
First of all — DON’T stop taking the anti-anxiety pills without checking with a physician, pharmacist or looking them up online and checking if there is any withdrawal. You didn’t say what they are, and some medications used for that purpose can cause dangerous effects during withdrawal unless it is done properly.
I am not one of those folks who says people in recovery shouldn’t take medication. I do think we have to be careful, because most doctors know nothing about addiction. If you’ve read any of the other comments on these pages, it will become clear that they don’t know much about drugs beyond what the pharma reps tell them, either. On two separate occasions, I’ve had to refuse prescriptions from doctors who knew I was a recovering addict, and claimed they were right up on things and wouldn’t prescribe anything addictive or that could cause me to relapse. One wanted to give me Vicodin for oral surgery (I took Advil; it worked just fine), and the other I can’t remember — it was some kind of tranquilizer that could easily have triggered my alcoholism, just can’t recall the name.
That said, I take medication for an “outside issue,” and so does my wife, who is an addiction therapist. Often addicts are self-medicating issues, and need a bit of help after we get off our drugs of choice.
Your first stop should be your pharmacist. Then check drugs.com. You can email me…use the contact form. Check with a treatment center in your area, or at an AA or NA meeting to find local docs who understand addiction. If you’re especially lucky, you may get one who is in recovery. Follow the guidelines in the article. They’re tried and true — I didn’t just pull them out of my hat. Especially important are exercise, diet and rest. Often we try to make up for lost time when we get clean, and end up stressing ourselves out. You’ve made it a year. You are obviously doing something right. Keep on keepin’ on, and stay in touch.
Bill
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.)
Dear Viktor,
If you will re-read my reply, you will discover that I did not diagnose anything, offhand or not. I am probably no better qualified to do that than you are yourself, and even if I were it would be unethical to do so online. I certainly hope that your diagnosis is correct, and that you continue to improve.
What I did is provide information, which is my purpose here. You are most welcome to that.
bw
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!
Thank you for the letter. I’m glad that the article was useful and informative. It’s good that you managed to get off the benzos successfully at last. They are horrible drugs when used for long periods, although in rare cases they are necessary, and as you have discovered the post-acute withdrawal can take a very long time.
I am concerned about your description of “waves” of ups and downs. While it may not be anything but more adjustments, if it continues for much longer I would consider speaking with a physician who understands manic-depressive disorder. It is possible that your symptoms could be related to that condition.
You didn’t say where you live. If you are in Western Europe you might be able to get some assistance with your medical issues, since you are currently unemployed.
Good luck, and feel free to stay in touch.
Bill
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.
Opiates in general aren’t that much worse than other drugs when it comes to post-acute withdrawal, with the exception of methadone, although the acute phase is terrible, as with alcohol and benzos. (Alcohol and benzos can be fatal in acute withdrawal without medical care, and opiates can convince you that you’re going to die, although actual death is rare.)
Methadone is by far the worst, for the same reason as benzos — both metabolize into psychoactive compounds that prolong the withdrawal until everything is out of the system. Benzos have the worst overall effect when it comes to PAWS. Their effects can take a year or more to completely disappear, and in severe cases — heavy use over several years’ time, not so rare with doctor-shoppers — sometimes things never normalize completely.
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 Oli,
Thank you for the kind words. I agree with you 100% about the need for concerted education about PAWS, and about the severe lack of it in most cases. I started lecturing about it (the article is a result of those notes) around 10 or 11 years ago. As far as I can tell, even today there is little or no information about it being passed on in treatment centers — certainly not enough, as is clear from the comments on this page.
I am an avid supporter and active participant in 12-step programs (despite what I see as some fairly glaring shortcomings), but their failure to carry this particular portion of the message doesn’t surprise me. I believe that is a matter of Traditions and tradition, combined with lack of information about the medical and psychological details which are, after all “outside issues.” Likewise, there is no getting around the fact that the programs are quasi-religious in many people’s eyes, and that they often carry with them, in those cases, the superstitious fear of change that is attendant upon highly conservative endeavors of all sorts.
That said, with all their flaws and geriatric wrinkles they are still — and will probably continue to be — the best we have been able to come up with as ongoing support for drunks and other addicts, as well as primary support for those less fortunate than we, who are unable to enjoy the advantages of primary treatment and aftercare. However, I believe it incumbent upon we who are aware of PAWS to carry the information to others, as as it is truly a live-saver in some cases.
I really need to re-write portions of the article. For example, I need to mention that the post-acute withdrawal from benzos is about the worst of any class of drugs, and that it can last for months and months. That would be useful, don’t you think? I, too, tend to rest on my laurels, and my “real jobs” (which include writing about addiction and recovery) take up much of my time. Sometimes our brains need a respite from thinking about this stuff, although we should certainly never forget about it. However, I am motivated by the letters I get here, most recently yours in particular, and I’ll see what I can do.
Keep on keepin’ on, and stay in touch. And remember…if you’re not having some fun, you’re doing something wrong.
Bill
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
Beyond me. Even if I were a neurologist I couldn’t diagnose over the Web. If you’ve been tested for diabetes, the only other thing I can suggest (apart from toughing it out until it goes away) is see a neuro.
bw
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 Ali,
Sorry you’re having trouble. Congrats on hanging in there.
I’m sorry, but I don’t recall if you were taking any medications along with the alcohol. Some of the tranquilizers can give you a nasty time for a number of months.
It’s not uncommon to have a rough spell at nine months. That chip system didn’t evolve the way it did for no reason. It doesn’t hurt to have goals. What we need to avoid is expectations.
I sure hope things get better for you. One thing is sure — if you don’t use they’re unlikely to get much worse. You didn’t mention what symptoms you are having this time. If it’s depression, fresh air and sunshine — weather permitting — are a good medicine, especially if you live in the north where the days are short this time of year. Forcing yourself to hit some meetings is good, too. It’s like they say, the only meeting you really need is the one you really don’t want to attend.
Keep on keepin’ on,
Bill
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!
Pingback: feel like I'm falling off the wagon - SoberRecovery : Alcoholism Drug Addiction Help and Information
Pingback: Henhouse talk with all our friends, part 11:) - Page 9 - SoberRecovery : Alcoholism Drug Addiction Help and Information
Hey John!
Congratulations on your success, and thanks for the kind words. It’s a case of “giving it back in order to keep it.” Doing this, and reading your responses and others helps keep me sober, and it seems to help others too. What’s not to like?
I have to hit the sack. I’ve been writing all evening, and have a ton more to do tomorrow.
Keep on keepin’ on….
Bill
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
Hi Lexi,
When we speak of PAWS, we are talking months, not weeks. You can expect symptoms to come and go for some time yet. It takes our brains a long time to repair themselves after years of neurotransmitter imbalance. Know that it does slowly get better, but be aware that you have some “fun” still in store.
I recommend getting off the Kava Kava as soon as you feel able. It is a mood altering substance and, regardless of what people claim, it can lead to relapse in two ways, first by preventing full recovery of the brain and second by the mere fact that we are seeking relief from life by mood-altering, which is a state of mind that can be fatal to an addict.
Doctors in general usually know little about the neurophysiology of addiction, recovery and relapse. It is a specialized field. I suggest finding a personal physician who specializes in treating people in recovery. Ask around at your NA meetings, or at AA if you’re not comfortable in NA. Some folks find it a bit hard core.
Keep in mind at all times that recovery is a process, not an event, and that it goes according to its own schedule, not ours. Don’t give up.
So far as staying strong is concerned, I didn’t really start recovering until I surrendered. Just a thought.
Keep on keepin’ on,
Bill
Dear Dan,
You are describing a severe case of clinical depression, possibly triggered by Penny’s death combined with that of your other friend.
Depression is caused by chemical imbalances in the brain. Some of us have them, and some don’t. They are not at all unusual in recovering people, and the symptoms can be triggered by stress such as prolonged periods of grief.
I suggest most strongly that you call your local Crisis Line and get a referral to a therapist who can evaluate you and refer to a doctor who will prescribe antidepressants. Antidepressants are not mood-altering in the sense of being abusable, and do not constitute relapse. They are far preferable to any of the likely results of profound depression, which can range from debilitation such as yours to suicide.
You are also in need of grief therapy. That’s why I suggest the therapist first. If you cannot afford these things, there are probably resources in your area to help. DO NOT DELAY. I am not exaggerating when I say that this could well be a matter of life and death.
Best wishes on your path to recovery from depression.
Bill
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
Pingback: One Year and Under Club Part 2 - Page 8 - SoberRecovery : Alcoholism Drug Addiction Help and Information
Pingback: Class of May 2010 Part 2 - Page 15 - SoberRecovery : Alcoholism Drug Addiction Help and Information
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!
Although the symptoms you describe are pretty common in people who are in early recovery from opioid addiction, it wouldn’t be a bad idea to have a checkup re the leg pains. It is possible that the analgesic effect of the Suboxone was masking an unrelated condition.
Recovery begins when we’re off all drugs, and so does PAWS. Keep an eye out for other symptoms, and do some mild walking if your physician clears you. That will probably help some. Time will do the rest.
Congratulations on your 40 days! and…
Keep on keepin’ on,
Bill
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
Hi Jim,
Your question begs another: what makes you think your doctor is wrong, or — should that be the case — that you do not need to be on medication? I am no expert on schizophrenia, but my wife has a great deal of experience in that area, and I am assured that actual cases need to be treated with medication, along with therapy. You might give that some thought. I’m not saying that you are wrong, but I would be remiss in not pointing that out.
With regard to changing physicians, I would suggest that you call your local mental health society and get a referral to one who specializes in treating folks with your complaint. If you have a teaching hospital in your area, that would be another good place to inquire. Having done that, I would get the second opinion and go with the suggestions of either one (or both) of the doctors. Find one that will listen and try to work with you, but remember that he or she is the one with twenty-odd years of education.. We do ourselves no favors if we go against the suggestions of experts, once we find that they are in agreement.
Another option would be to find a psychotherapist who could interview you and help you decide the direction in which you should move. It is always good to advocate for ourselves, but it pays to remember that when it comes to personal health issues there is a danger that our viewpoint is biases so that we really don’t know what is in our best interest.
These are the only suggestions that I fell comfortable giving you. Anything more would be outside my area of knowledge. Even if I were further qualified, it would not be ethical to give more specific advice to someone I haven’t even spoken with.
Good luck on your journey,
Bill
Pingback: 90 Days and Under Part 4 - Page 3 - SoberRecovery : Alcoholism Drug Addiction Help and Information
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.
Hi Kirstie,
Thanks so much for writing! Letters like yours keep me comin’ back.
I know what you mean about PAWS, both online and in treatment and at meetings. It isn’t mentioned much — this article seems to be the go-to place on the Internet, and that’s ridiculous! It is especially so regarding treatment, since I was lecturing about it in a treatment center more than ten years ago, and others have been writing about if for much longer. It is not new stuff, and yet I get comments like yours all the time. It may have to do with a proliferation of therapists and program directors who are not themselves in recovery. I don’t know.
I understand better why it doesn’t get discussed in meetings directly: it doesn’t lend itself to sharing in the way we’re supposed to, and I think those who know about it don’t want to be seen as lecturing…or don’t understand it well enough to articulate it. The system of chips and key tags used by the groups is aimed at the typical rough spots as recovery progresses, but no one seems to feel it necessary to talk about it in meetings. (I think the traditionalists may be partially to blame there, as well. Some folks — usually very loud folks — believe that if it’s not in the book you don’t need to know about it. Patently dumb, but there it is….)
In any case, AA and NA are virtual necessities to stay sober, regardless of their flaws. The Twelve Steps saved my ass, and that of most of the people I know with long-term recovery. As to PAWS, I make sure that anyone I sponsor knows about it as soon as we get together, even people who are well past the point of needing to worry. That and this article are the best I can do. Perhaps you can help spread the word.
I encourage you to withdraw — VERY CAUTIOUSLY — from the benzodiazepines, and to cease the “social drinking.” Both the drugs will keep your brain from “rewiring” itself into its normal state. It may be that your doctor is not well-versed in addiction. That is the case with most physicians, as they receive little training on addiction even today, and the science is changing so rapidly that it’s really hard to keep up with it unless one has a particular interest. I suggest you check with your treatment center (or one in your area) to find a physician who specializes in treating recovering people.
You don’t have to wait until you’re off the Citalopram to start using the tips in the article. They are good advice for anyone…simply good health practices.
Thanks again for writing, and
Keep on keepin’ on,
Bill
PS: Regarding the social use of drugs, especially alcohol: the first thing booze does is deaden the executive functions of the brain, the parts that allow us to make good decisions. Thus, “social drinking” is not only an indication of not being committed to recovery and keeping PAWS active, it is also the proximate cause of many (if not most) relapses into other drugs.
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
Pingback: Class of December 2010 Part 2 - Page 9 - SoberRecovery : Alcoholism Drug Addiction Help and Information
Hi John, and congratulations on your seven months!
Sounds like you’re doing exactly what you need to be doing, and just about where you should be with respect to PAWS. Xanax is especially nasty when it comes to PAWS, and you may feel symptoms from time to time for quite a while yet. They should lessen over time, though, and of course you know what it is now, and how to cope with it.
I’m delighted that you found my stuff helpful. Notes like yours are what make this thing worthwhile.
Keep on keepin’ on,
Bill
Heh heh heh…
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.
John
No one likes to see an old guy cry!!
(Only my therapist.)
Re: lack of sleep. Name me someone who died.
Wonderful to hear from you, Ron!! Glad things are going well. You’re an inspiration to all of us.
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,
Wow.
I feel humbled…and you have no idea how unusual that is!
Thank you.
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.
Pingback: PAWS is killing me right now, how long did it last for people - SoberRecovery : Alcoholism Drug Addiction Help and Information
Pingback: Nearing 90 days, felt better at 9! - SoberRecovery : Alcoholism Drug Addiction Help and Information
Hi Josh!
Congratulations on your seven months. Don’t stop now — imagine having to go through all that shit again!
What you are experiencing is not unusual at all in recovering heavy smokers, and the symptoms are typical. If you are suddenly feeling urges, and it hasn’t been the usual thing, then there is probably some immediate reason: stress, failure to go to meetings and/or work a program, a new romance, a broken up romance…you get the idea. How did we deal with stress “back when?” We turned off our brains with drugs. An important part of recovery is learning new coping skills so that we don’t feel as though we need to do that.
There is a lot of mythology floating around about pot. The people who claim it’s “no worse than alcohol” are missing the point. Being skinned alive is “no worse than” being boiled to death slowly — it’s just different. That’s exactly the comparison that applies. No one is talking about replacing booze with weed, they want it to be legal in addition to marijuana. You are living proof that it’s a lousy idea.
You can look at this two ways. 1) You are miserable, you want to blow some boo, and life sucks, or 2) that you are learning an extremely valuable lesson about what cannabis can do to folks’ heads, regardless of all the propaganda about it being relatively harmless.
Go to a meeting. Talk to another addict. Help a newcomer. Do something to get outside your own head. This is all occurring in your brain because of chemical imbalances. Don’t, for cripes sake, start the process all over again. You will just get more messed up, and it will take longer the next time.
Stay in touch, and
Keep on keepin’ on!
Bill
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!
Hi,
Congratulations on your 6 months!
I can think of no reason that there should be a physical problem affecting either you or your child, unless you are on some sort of medication. In that case, you should discuss the matter with your physician.
That said, there is the possibility that the hormonal changes associated with pregnancy and post-partum could have a powerful effect on you emotionally. I think it unlikely, but everyone’s chemistry is different, and we all meddled with it in slightly different ways.
I would counsel you to proceed with reasonable caution. Discuss the matter with your physician, an OB, and let them advise you. Fortunately, you do not have to make the decision right now. One thing is absolutely certain: you have a much better shot than you would if you were using.
Keep on keepin’ on,
Bill
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.
Thanks!
For my specific remarks on marijuana/cannabis addiction, see the article here: http://sunrisedetox.com/blog/2010/03/15/so-whats-the-story-on-cannabis-addiction-and-detox/
As to my position, let me say up front, for those readers who don’t know, that I am a retired cop, former rehab counselor, and recovering alcoholic and drug addict. I also support decriminalization and/or legalization and regulation of cannabis, because of the inequity of the government’s response to a relatively low-impact drug.
Having said that, I have to note that nothing in my (fairly extensive) experience leads me to think that there is much — if any — merit to the “Safer Than Alcohol” argument.
We are not talking about replacing alcohol with pot; we are discussing the reduction of penalties for, and/or legalization of another drug. There is absolutely no indication that people who abuse or are addicted to alcohol will stop using it, or ameliorate it in some way by the use of cannabis.
The argument that drunks who toke will drive less is absolutely anecdotal and based on opinion. There is no study that covers that premise, and there is just as much reason to believe that we will have a certain number of even less competent drivers out there as to believe that the number will be reduced.
This entire argument is a non sequitur. The naked fact of the matter is that alcohol and cannabis do not relate in any meaningful way, except when they overlap. One is a dangerous, addictive drug that is known to ruin lives and kill innocent bystanders, but that is protected by big money interests and societal prejudice. The other is a relatively benign drug that is demonized by the same factors. (The alcohol interests are afraid that grass might supplant booze, too. They needn’t worry.)
Let’s decriminalize possession of small amounts of cannabis, lower the penalties for possession or sale of somewhat larger amounts, and give some real open-minded thought to legalization and regulation, without clouding the issue with arguments that are all-too-easy to refute or discount.
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
Hi Ali,
Good to know that you’re hanging in there.
As I suggested to you some time ago, the glucose tolerance test is one of the first ones you should have had. Your symptoms as described are all indicative of a possible blood sugar problem. Please get the tests done without delay. Should it turn out that you are diabetic — and that is a reasonable possibility — you could be seriously damaging your health by continuing to ignore the issue.
Regards,
Bill
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.
Methadone is a tough detox, one of the worst. There are a lot of active metabolites that make it seem like forever. The post-acute portion is rough, too, but it does get better. You should have been thoroughly informed about these things, but many (if not most) professionals don’t know enough about it themselves. Hard to understand, since I started talking about it fifteen years ago (as did others), but…there it is.
Congratulations on your recovery. Stick to the suggestions in the rooms and in the PAWS article, and you’ll be OK.
Keep on keepin’ on,
Bill
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.
Pingback: Why We Don't Get Better Immediately After Quitting Alcohol - My Way Out Forums
Pingback: sober 24 days but... - SoberRecovery : Alcoholism Drug Addiction Help and Information
Pingback: 52 days sober - SoberRecovery : Alcoholism Drug Addiction Help and Information
Hi Dan,
Thanks for writing, and congratulations on your 4 months. The worst is behind you.
It would be nice if the medical field understood addiction in general a lot better. Doctors who are competent in addiction also understand PAWS, but they are not thick on the ground, believe me. Some of the most ridiculous statements about addiction I’ve ever heard came from doctors.
Your problems don’t sound like PAWS to me. If things continue to improve I wouldn’t worry about it, but if they don’t I’d see a neurologist about a workup. Drinking and drugging can sometimes mask underlying symptoms. You should not be having PAWS-related neuro symptoms at 120 days clean from alcohol, unless you were drinking a great deal more than you reported. If you were also using drugs, that could explain some of the anxiety problems, especially if you were using tranquilizers such as Xanax, which have a very long post-acute syndrome.
The fact that you started experiencing the equilibrium problems after taking up swimming raises the question of an external ear infection that possibly perforated the eardrum and began affecting the inner ear. You’d have to see an ear specialist about that, but as a former competitive swimmer I can tell you that such things are not uncommon.
In any case, you’re clean and sober now. You’ve crested the hill, and it’s all downhill from here if you don’t drink or use drugs. Hang in there, and stay in touch.
Bill
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 David,
Thanks for the compliment. I’m quite proud of that article. The feedback I’ve gotten has been enormous, and I feel as though it’s done exactly what I hoped it would do.
Nicotine has complex effects on the body. When it reaches the brain it excites production of several enzymes that, in turn, affect the production of several neurotransmitters. At low doses it enhances the actions of norepinephrine and dopamine in the brain, which causes stimulation. At higher doses it increases the the effect of serotonin and opiate activity, which calms and even has some pain-killing qualities.
The residual effects of nicotine addiction (PAWS) can last for some months, but should not be causing you much discomfort at 10 months clean. I’m not a doctor, but I suspect that there may be some disruption in your serotonin and dopamine cycles that is only peripherally related to the nicotine. It is even possible that you were self-medicating that condition during your years of smoking. The symptoms you mention would be consistent with that possibility. Essentially you are describing moderate depression, and depression is known to be associated with the serotonin and dopamine cycles.
I suggest that you see a specialist, and explain the situation. It is possible that you are in need of an antidepressant. I applaud your desire to remain drug-free, but there is a huge difference in taking a drug for pleasure/stimulation and taking it because you need to adjust your brain chemistry for your own wellbeing.
In answer to your final questions, success looks like feeling normal, with an occasional thought about smoking that is easily put aside. However, “normal” is relative, and your normal may not be the optimum condition for you, overall.
I hope this has been helpful. I would like to have been able to give you good news — and, in a way, perhaps I have. I really believe that if I were in your shoes I’d see a doctor about the symptoms I was experiencing.
In fact, I did.
Keep on keepin’ on,
Bill
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
Pingback: Advice for a Newcomer - SoberRecovery : Alcoholism Drug Addiction Help and Information
Hi again, Dana,
In response to both your posts:
I don’t completely understand why you went off Wellbutrin to begin with. It is the most effective antidepressant for the majority of speed addicts, and it is a relatively benign drug in comparison to some of the other antidepressants. At a guess, your serotonin receptors haven’t normalized yet, and that is probably the cause of a number of your complaints. It is even possible that you have naturally low serotonin levels, and were self-medicating with drugs to begin with.
It’s also natural to us to expect quick results. What good was a drug that didn’t give us what we wanted quickly? The fact is, post-acute withdrawal from some drugs — meth and benzos are two of them — can take years. In some cases, complete recovery simply doesn’t happen. That’s why it’s so hard to get us speed freaks clean.
When you do find a doctor that you can work with, I suggest that you let her do her thing and follow suggestions. It’s perfectly natural for us addicts to think we know what’s best for us…but we rarely do.
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.
~Dana
Just keep the repressed anger thing in mind. There are many ways to relieve stress. There was some reason you chose violence. Just sayin’.
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 Ron!
Thanks for writing and reinforcing this crazy old man’s statement.
The three month thing is strange, and as far as I know no one has a handle on why it goes that way. Apparently there are physical and (perhaps) psychological aspects to it, but no one understands what they are. The early members of AA noticed it first, and NA discovered that for some drugs it extends even further than a year, thus their 18-month key tag. Benzodiazepines are especially bad…PAWS can last for years!
After we’ve been clean and sober for a while, things from the past that we had repressed by drinking and drugging often begin to bubble to the surface. It’s not uncommon for anger to be one of the manifestations of this old business. If you keep having feelings of rage — where you just don’t care, you’re going to jump in and do somebody — you might want to talk it over with a decent therapist. If this sounds like more crazy old man stuff, just remember that I was right before.
I pooh-pooohed that shrink stuff for quite a while after I got clean, and it almost caused me to relapse. Obviously, having worked in the field, I’m rather more tolerant of the idea now. Anyway, many addicts and alcoholics (especially those who grew up in addicted families and/or with abusive parent(s) have unresolved rage that can come out sideways and cause real trouble. Just a word from one who knows.
Glad you’re doing better now. It is indeed a process, and sobriety is not so much a goal as a journey. I still find things I need to work on from time to time (and my wife finds them even more often). Thing is, she’s one of the best therapists I know, and she’s usually right.
Keep on keepin’ on,
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.
Pingback: Birthdays are always the hardest - SoberRecovery : Alcoholism Drug Addiction Help and Information
Pingback: Question for drug users - My Way Out Forums
Pingback: 87 days and ???? - SoberRecovery : Alcoholism Drug Addiction Help and Information
Hi Bruce,
Thanks for writing. Post-acute withdrawal from some benzos, like Xanax, Valium and Ativan, can last from months to several years, depending on the person. (It’s thought that there’s a genetic component that causes it to vary in individuals.) That usually results in at least some of the symptoms that the meds were originally taken to treat — depression, mania, and so forth — in varying degrees of severity. You seem to be one of the lucky ones, having received the gift that keeps giving.
Hang in there. It does get better. Been there, and done exactly that.
Stay in touch; let us know how you’re doing, and
Keep on keepin’ on,
Bill
Alcohol and other drugs scramble our brain chemistry. In the process of normalizing, not everything swings in the right direction at the same time. This can make for some rather odd combinations of neurotransmitters, and those often lead to varying degrees of irrational thinking or behavior (or both). Then, in my case and many others, there was the blood sugar thing. Add to that the skewed thinking brought about by years of addiction and the necessary adjustments we had to make in order to convince ourselves we were more or less OK, and “nuts” is a polite way of describing it.
In addition to recovering from alcohol, I was also recovering from a long-term addiction to benzodiazepines. PAWS from some benzos, like Xanax, Valium and Ativan, can last from months to several years, depending on the person. (It’s thought that there’s a genetic component that causes it to vary in individuals.) That usually results in at least some of the symptoms that the meds were originally taken to trea — depression, mania, and so forth — in varying degrees of severity. I tended to be grandiose and manic a lot. Definitely not rational in a number of respects, i.e., nuts.
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
Pingback: Has this happened to anyone?? - SoberRecovery : Alcoholism Drug Addiction Help and Information
BTW: Have you had a glucose tolerance test?
Hi,
First of all, congratulations on your healthy attitude. Those of us who didn’t have such a rough time will have difficulty appreciating what you’re going through. I was nuts for the first couple of years, but my PAWS experience was more subtle. I’ve known a lot of folks who had hard times, however, and many of them didn’t make it. Some of us are just lucky. I was sober for several years before I was able to go back — with the help of journals — and realize just how sick I was. I was fortunate enough to be in very good health and condition for a 45 year old, so I just exercised like a good addict and managed to hold off a lot of the physical stuff. The mood swings were a bitch, though, and at the time I didn’t know what I know now.
The good news is “This Too Shall Pass.” The cyclic nature of PAWS is still a mystery, but the anecdotal evidence is simply too great to ignore. Hang in there, and stay in touch. It may help someone else to know that you’re having a hard time and are able to stick with it.
Keep on keepin’ on,
Bill
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.
Hi again, Dana,
I actually missed quite a few reunions back in the ’70′s and ’80′s, but with luck will be attending a bit more frequently now.
I don’t ordinarily make recommendations about drugs, whether prescription or OTC. I’m going to make an exception here, because I know the following to be safe. If there is a GNC Nutrition Center near you, pick up a bottle of St. John’s Wort Extract. I believe it comes in 300 (possibly 400) mg. capsules. Be sure to get the extract. It has yellow flowers on the label, and is called “Nature’s Own” or something like that. House brand, anyway. Try two of those in the morning, and again in the evening. It could help your edginess and make it a bit easier to be around the kids. St. John’s Wort (“wort” means “weed”) is prescribed in Europe for mild depression, and you may well find it helpful. You can always escalate from there with a physician’s help. Naturally, if you begin to feel profoundly depressed, see someone immediately.
You might check with a couple of treatment centers in your area and see if they can recommend a psychiatrist or internist who specializes in addiction. Most doctors know very little about it, and even psychiatrists are often ignorant of the fine points. The unfortunate thing about psychiatrists is that most of them have come to rely on drugs instead of therapy, which is often the indicated treatment. Just a suggestion. Many, if not most, doctors think they know more about addiction than they really do…just like the general population. If one sounds iffy, look farther regardless of his or her credentials. They get very little training in med school, so if they don’t specialize they tend to rely on anecdote rather than keeping up with the field, which is progressing rapidly.
I once had a physician who knew my background and swore he understood the issues write me a prescription for Vicodin, ten minutes after we had our addiction discussion. Said it wasn’t addictive. You have to self-advocate, and run like hell if you get the wrong suggestions. Like the general population, again, they mean well, but…
My guess is that your fatigue and edginess are related to the Paxil. However, it would be a good idea to get a general workup to rule out things like diabetes or insulin intolerance, among other things. They can also cause mood issues and fatigue. When it comes to medicine, remember that I am a layperson.
I applaud your attitude, and your determination. Keep on keepin’ on…
Bill
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.
Dana
Hi Dana,
Thanks for writing, and congratulations on your three years. I’m sorry to have taken so long to get back to you, but I’ve been up to my neck at my “real job,” writing for another site where they expect me to produce because they’re foolish enough to pay me, AND I just attended my 48th high school reunion this past weekend. Whew! I’m ready to relax and get back to writing to you guys.
Your symptoms sound much like what I would expect from someone with brain chemistry scrambled by Paxil. It has a very real and prolonged withdrawal syndrome all its own. Although it’s not what we usually refer to as PAWS, it certainly qualifies as a member of the family.
I can certainly see where you’d have trouble forcing yourself to exercise, given all the stuff on your plate. Remember that ANY exercise is better than no exercise. Even if you are able to take a stroll around the neighborhood with your child, it’s better than sitting around — and good for the child, as well. He or she gets to be with Mom in a different setting, where neither of you is afflicted with the same old routine.
Please remember the basic equation of recovery: stress = relapse. You’re in a high stress situation, and you need to establish a healthy routine for two reasons: your health, of course, but also as a check. Departing from the routine, making excuses, etc. for not doing what we need to do, is a sign that we’re slipping backward.
Meth beats up your body worse than anything, and your serotonin receptors worst of all. It takes about three years to get where you’ve gotten, and you’re pretty close to on schedule. Keep a close eye on yourself for signs of depression…like continueal exhaustion. If things start sliding, it’s time to ease up on something (like school), hit some extra meetings, spend some time playing with your child, and adopt the life of a human being, not just a human doing. If you can handle things without medication, fine. BUT, remember that you have someone else to answer to. You have to take care of yourself in order to take care of your kid. If you have to let some other things go a bit….oh well.
And remember, there are worse things than being on psych meds. It’s great to want to be 100% clean, but sometimes that can lead to 100% dead. I’ve had it happen in my own family. Be careful!
Thanks so much for writing, and please stay in touch.
And, of course,
Keep on keepin’ on!
Bill
Hi Ron,
Sorry to take so long to answer, but I’ve been up to my neck, and you’re clearly doing fine.
Great to hear that you’re progressing, and congratulations on your four + months. It sounds as though you’re about where you should be. (Boy, I used to hate it when those know-it-all old-timers told me that!) Things should keep getting better, slowly, but be prepared for some bad periods. The course of true PAWS never doth run smooth, to paraphrase some other old guy.
I really appreciate your staying in touch, and your updates help others who are in the same boat to realize that it does get better.
KOKO…
Bill
Pingback: Help - SoberRecovery : Alcoholism Drug Addiction Help and Information
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 information the best I can. I am desperately looking for some way to get better. Life feels so difficult right now. I am sure this will help if I can just keep it going.
Hi Ron,
Great to know that you are doing well. Don’t expect to feel good all the time. That’s not the human condition. We addicts convinced ourselves that it wasn’t all right to not feel good. Reality is, life is mostly feeling OK, punctuated by periods of happiness and (briefly) joy. On pretty rare occasions we feel crummy. If they aren’t rare, we do something about it: rest, good food, exercise, help another addict, get out of ourselves. If that doesn’t help, we seek professional help.
In your case, it sounds as though you’re about where you’re supposed to be. Feeling the way you express at 18-1/2 weeks clean is par, but many don’t recover that fast. Count yourself lucky.
Please continue to check back. It’s good for me to know how you’re doing, and it’s good for others to learn that it’s working for one. more. addict.
Keep on keepin’ on,
Bill
Pingback: Fantabulous Secular Connections Check-in Part VIII - Page 5 - SoberRecovery : Alcoholism Drug Addiction Help and Information
Hey Bill, how are you doing? i think my last post was around day 69 and today i am around day 130. i finally stopped intuitively knowing what day it was around 110 or so and to me, that meant i was getting better. last night marks the 3rd night in a row that i slept properly. until then i would wake during the night at 2am and not be able to get back to sleep until 5am. i had several nights from the 2.5 month mark forward that i would get 1 night of sleep followed by 2 or 3 interrupted, but then i would sometimes get 2nights in a row, but never 3! All in all i would have to say i am about 95% back to ‘normal’. i don’t know if i would go so far as to say i feel better than i did before though…because i sure did enjoy the getting high part of addiction, but it’s funny because i no longer crave the high? i only crave to be normal. my energy is still low, although much better than it was. i certainly can’t complain for where i am today though. just wanted to drop you a quick note to let you know all is well and i am moving forward a day at a time. thanks again for the great article and helping me.
Pingback: June 2010 Sobriety Group Pt 3 - Page 10 - SoberRecovery : Alcoholism Drug Addiction Help and Information
Pingback: cravings and urges - SoberRecovery : Alcoholism Drug Addiction Help and Information
Pingback: Day 6! - SoberRecovery : Alcoholism Drug Addiction Help and Information
Pingback: Day 11 and not nice. - SoberRecovery : Alcoholism Drug Addiction Help and Information
Pingback: Feeling hungover - SoberRecovery : Alcoholism Drug Addiction Help and Information
Hi Steve,
Thanks for writing, and congratulations on your red chip. You’re doing the right things for yourself. Keep it up, and you’ll be wondering where the time went, like us old guys.
I was fortunate (though no fault of my own) to have received treatment in what was — at that time — one of the top two treatment facilities in the country. They, too, were very heavy on the life issues, the Steps, and practically everyone on the staff were in recovery from either an addiction or codependency. (And this was back in the days when codependency was a long way from being a household word the way it is today.) Among other things, we learned the basics about PAWS. When I got active in the field I was appalled to learn that it was given very little attention in most programs. After more study on my part I decided to do something about it, and developed a lecture series that I delivered where I worked.
Unfortunately, there is still not enough attention paid to this part of addiction education in treatment, IMNSHO. That’s why I set up the page on PAWS, and it has turned out to be — by far — the most useful thing I’ve done so far to help my fellow addicts and alcoholics. Who knew?
Anyway, this isn’t about me. Regarding the restless leg syndrome: I’m glad you found a solution. Be watchful for problems with stomach irritation taking that much ibuprofen. Always put something in your stomach beforehand. 800 mg. is the dose in prescription Motrin, and like aspirin and other NSAIDS, it can reduce the production of the mucous that protects the stomach lining from its own acid.
As time passes, try cutting it down. If the RLS continues for much longer — say, another 60 days — I’d see a physician and get a blood glucose workup. RLS can be a symptom of diabetes, which often goes along with addiction, especially alcoholism.
Sounds like you have the HALT concept. Carry some cheese or peanut butter crackers with you for those emergency moments that you described…especially if/when you’re short on sleep, but otherwise as well. Just keep some with you, period, and if you eat them replace them. That may be the best advice you’ll get from me. I suffered from glucose problems for a number of years in sobriety before being diagnosed a diabetic. My diabetes is stable with oral medication, and I was lucky to catch it at a point where it could be stabilized without insulin injections. Believe me when I say you need to keep those issues firmly in the back of your mind.
Remember, though, that dessert’s OK. Just don’t make it the whole meal, and don’t pig out on goodies. All things (mostly) in moderation is the key.
Keep on keepin’ on, and let me know how things are going.
Bill
ps: I deleted your email address from your comment online because you stated you were in AA. Gotta watch out for those Traditions!
Hello All,
To Bill-what a great site. I trully appreciate the way in which you give back, us addicts need to find a way to give back, so kudos to you.
I am 34 days clean today. After trying to kick numerous times from Vicodin, Oxy, Dilaudid and eventually Herion i entered a 30 day rehab and have come out with a new lease on life. The great thing about the rehab i went to was the focus that addiction is a symptom of not dealing with life on life’s terms. With that said, i’m now an active member in A/A and have begun working the steps with my sponsor. Meetings are incredibly important to me because I dont feel like an outcast and I have a reminder of where i was in my addiction and that i never have to live that way again. What a relief it is to know that i’m not alone and i’m not a worthless human… us addicts live with guilt and shame.
PAWS-boy do i suffer from it, especially the RLS. I discovered that taking 800mg of Advil at night really helps. Albiet, it does take a good hour to kick in, but when it does it brings good reflief. I am also taking vistiral for evening anxiety as prescribed by the Dr in rehab-it works well and helps me sleep. I also found the importance to eating well. I changed my diet to include more fruits, starches (rice) alot of chicken and fish and cut the candy down to a minimum. Yesterday was tough (h.a.l.t) hungry, angry, lonley, tired all kicked in due to only 3 hours of sleep the night before… sometimes lack of sleep is unavoidable. Around 10am HALT kicked in full force, but after a balanced lunch i felt much better-amazing what a good diet can do!!!!
I look forward to any replies.
Steve
One other thing, Hugh. Even though the caffeine and sugar don’t seem to be an issue at this time, keep an eye on them. They can cause mood swings even well into sobriety, due to compromises in the endocrine system caused by drugs and alcohol. Too much stimulation isn’t good, regardless of how legal or common the source. For one thing, it leads to depression when we haven’t got it. The Middle Path, remember.
b.
Hi Hugh,
It’s good to hear from you again. I’m glad you’re doing better. I love getting letters that I can answer and try to help someone over a rough spot in their recovery, but even more I love getting those that show there is, indeed, light at the end of the tunnel.
You’re doing just about everything right: taking care of yourself, sharing with other people, using your available supports. You didn’t mention whether or not you are going to meetings. Even though you’re doing well I still suggest making some connections within the recovering community. The time will probably come when you will need some guidance that your family and friends — no matter how well-meaning — won’t be able to provide. Clergy try to help, but they are often not equipped with the knowledge and skills to help addicts, regardless of their good intentions. Folks who haven’t “been there” simply cannot understand. For those reasons, we need connections in recovery groups.
Keep on keepin’ on! I’m really proud of you, and just tickled to death that I’ve been able to help.
Regards,
Bill
Hi Bill,
It’s been 2 months since I last left a comments, and at the 8th month,
The aftermath of PAWS is really about get re-connected with myself and get adapted to my-new-self, get things done slower but solid. Identifying the source of stress that really effect my life during PAWS time is really important as well.
I was lost and panic in the 6th month, a lot due to the impair in my memory and interpersonal skills, I was feeling like a loser. Luckily to me that during my peak time of PAWS, I find a way to get other people at work and family to support me, its really important to let some of your most trusted people know your situation, people that can help and support you to regain your confidence. I confided my situation to my wife, my aunt and one of my best friend at work, those people were/are really helpful when I’m down at night or stressful and breakdown during working hrs, and being able to talk this out also help to release a part of stress inside my mind.
Oh and I’m going to church every Sunday, and pray whenever I’m feeling down, God does listen in my case,
I didn’t really experience the sugar/caffeine effect as the article mention those I frequently over-consumed those, or maybe I’m in another situation that I haven’t come to aware yet,
I’m taking smaller steps at work and have to work longer hours to get it done, I have to take notes for everything so I can remember, (I did write up 2 100-page notebooks,) but after get things done one by one, it did help to regain the situation, memory does get better, Im able to recall things quicker know, thanks god and the notes that I was writing,
Overall, It does get a lot better, I’m writing it here so anybody who are at the point of doubting is it getting better can have a boost of confidence to go on beating this PAWS thing
Remember, don’t make or think of situation that can make you use the drugs again, whenever you are down the most, do cry, do pray to God or hit something, someone but don’t relapse.
Pingback: Taking a long hard sober look ! - Page 2 - My Way Out Forums
Pingback: Birthday blues - SoberRecovery : Alcoholism Drug Addiction Help and Information
Hi Ali,
Good to hear that you’re hanging in there, and taking care of yourself as best you can.
PAWS can come up with some pretty unusual symptoms from time to time, and it does tend to come in waves. However, your symptoms sound more like anxiety than PAWS to me.
Since you seem to have good insurance, you might consider a consultation with a psychiatrist, if your internist has given you a clean bill of health. (I assume he did a fasting blood sugar test…some of those symptoms could be diabetes.) The shrink can evaluate your symptoms in terms of her specialty, and advise you further.
I wish I could be of more help, but there are too many variables to give you any useful information beyond that above.
Keep on keepin’ on,
Bill
Bil,
It’s Al from few postings ago. I am a 33 woman who quit drinking over 4 months ago, and felt like hell on and off ever since. I just want to ask if the feelings i am having now are normal. I feel like there are electrical shocks going through my brain, and even though they are mild and not continuous, they worry me. I also feel like my heart is not acting normal, although I can’t figure out what it is. Is not pain, not flutering, just something different and uncomfortable. And of course, I am tired. Now it’s been over 4 months and I know that PAWS means psychological changes, but what I feel is physical, is this normal? (las day i drank was 4/22)
Just to clarify, I already had a CAT Scan which came back OK, all blood tests were OK and while I do seem to have a minor heart issue (mitral valve prolapse), I wonder if it’s PAWS related or not. I never felt bad until after i quit drinking. Sometimes I feel a little confused too, but not as bad as I used to right after I quit.
From your experience and stories you may have heard, is it normal to have this kind of feelings for so long? Again, they are on and off. I.E, I felt good all August long, but on or about August 27 I started to have this feeling of being extra tired-which doesnt go away. I truly feel like I opened Pandora’s box when i decided to quit drinking.
Thanks so much for doing this, it means a lot to many of us.
Pingback: Almost 1 year, still feel like a newcomer! - SoberRecovery : Alcoholism Drug Addiction Help and Information
Go for it! I truly appericate the respone and support.
Josh, you are living proof of the bullshit in the claim that marijuana is not addictive. It most certainly can be, as you have so eloquently expressed. Thanks for your letter. With your permission, I would like to use it on a blog I write for a detox facility in Florida. Please let me know if that’s OK with you.
PAWS is not limited to so-called “hard” drugs. The brain has cannibinol receptors that are normally activated by cannibinols produced by the body. The active cannabinols in marijuana (mostly THC), attach to those receptors and cause the high. Over time, the brain grows more receptors in order to attempt to handle the increased levels of drugs. Eventually, as you have seen, if we use enough it becomes nearly impossible to get high and stay high for long.
At that point, if we quit or try to taper off, we leave a lot of the extra receptors empty. This is what causes the withdrawal symptoms that you have described, and the symptoms do not clear up entirely until we have been off the drug for a long time. The period between the time the THC is out of our system and when our brains finally “normalize” is the period of PAWS.
I suggest getting some medical help to get through the first few months. I don’t know what might be available in your area, but you could check the SAMHSA site for possible leads. http://findtreatment.samhsa.gov/ Please make the effort to get some help. You don’t have to do it alone, and you obviously want to be free of that awful burden.
Stay in touch, and let me know how things are going.
Bill
I’ve been smoking pot for about 3 years now, and was smart enough never to get into anything hard because that would equal death. Around 16 yrs. of age I was put in a juvinile program “rehab” do to all my marijuana tickets. Things were alright for the first couple weeks without out my bud, but as they days went on things became very dysfunctional. I always felt stoned without out the euphoria. My reflexes were slow, I was socially impaired, i couldn’t concentrate, and had mad swings of emotions. I’ve never cryed as much as I did that year.I felt suicidal and very depressed. I’ve been going on what I call smoking binges for awhile now. I smoke literally all day. I couldn’t work or go to school, because by the time i smoked a few bowls i would be completely sober in a half hour. I had to be high. My tolerance became to high and the bud was not enough, no matter how much i smoked i couldn’t get high because i always felt fried, wihtout the euphoria. I was wondering if PAW could be the result of HEAVY MARIJUANA USE? I’ve been having these symptoms for over 3 years now, because everytime i sober up i make usually to 4 months and every thing is so dysfunctional and scary i relapse into another binge. THank you SO MUCH FOR THE SUPPORT
Dear Bill,
Congratulations on making it through to the other side, and congratulations on your two months.
It is possible that your syndrome with your legs is PAWS-related, however I am not qualified to diagnose it — nor is anyone else via email. That said, your condition is probably not directly related to PAWS, but could have been masked by the action of the drugs. Those symptoms are not a joke, and need to be investigated immediately.
I strongly suggest that you find a good specialist in internal medicine, and have a complete workup. Be sure that it includes a glucose tolerance test. Do not go to the doctor you have been seeing. You need a specialist, and you need one that you can trust. This is no joke. I am unable to think of anything related to symptoms like those that could be good. Off the cuff, diabetes is a distinct possibility, and diabetes that has advanced to the stage of severe leg problems needs to be addressed right away, as it causes other problems that are less obvious.
Get the checkup, and take it from there. In the meantime, try to follow as many of the guidelines in the PAWS article as you can.
Good luck, and get on it right away, please.
Bill
First off I have been addicted to every opiate I know of in the past. I have detoxed “many” of times. Last time was a Cold Turkey detox from 120 mg of Methadone a day = 3 weeks of pure acute withdrawal hell, but I went 5 years clean. I relapsed “to get high” for about 2 months, and was fed up already. My Dr. put me on 20mg of Suboxone a day. At the time it was the “Miracle Drug”, which there is NO such thing.
I was on for about 6 months, and tapered down to 2mg a day then actually forgot to take it for about 3 days, since I only took it when I couldn’t stand it anymore. I stood off for about 3 weeks! Well, my Mother, which is all I have now, was worried, and wanted me back on subs. as a deterrent. You have to understand I know I shouldn’t have got back on, but we had just lost everything in Hurricane Katrina, and my Farther had 6 different types of Cancer since I was 13. He finally committed suicide, but I TOTALLY accepted why he did it, and I am an only child, so I will do ANYTHING for my Mother. I was fine, but I figured since it was so easy this time I would do it “for her”.
I got back on for a year, and I knew she was O.K. , so I started the taper again on my own, because my Dr. could care less. I got to the point where I was at before, but this time it was way worse, and I have a great job, so I wound up on it for 4 years total. I finally took all my added up vacation time, and weened down to 2mg a day, then every 2 days, then 3 days, then 4days (twice ea. time).
I am off! I can handle anything mentally that comes my way with GOD’s help. I KNOW this! I was also a drug counselor for 6 years, so I know what to do, and not to do. My problem right now is I’ve been off for 2 months, and my LEGS/RLS with that electricity feeling running through them is what is my problem STILL. Feels like I am endurance training all the time, but can’t stop. You know the saying, “Feel the burn”, well that is what it is like. I sleep well, thank GOD! When I am awake though my LEGS bother me so bad! Sometimes when I wake up, and I vomit in my trash can next to my bed just because of the intensity I feel in my LEGS and BODY right when I come out of sleep. I sometimes wish I could get my LEGS removed. Not really, but I feel that way!
Suboxone long term, for me, is the worst thing I ever did to myself. Is this a part of PAWS, and if so will it go away, and when? Is there “ANYTHING” I can do to help with this? This to ME is worse than the initial acute withdrawals, because it never goes away! I even fall asleep with it, but after work I’m so tired I just pass out. If you can help me in any way it would be much appreciated! Thank you so much, and GOD Bless!
For everybody out there-it does get better. I decided to quit drinking after a pretty bad hangover, and what followed was hell. For over 3 months I lived a nightmare not knowing what’s wrong with me. I had a Cat Scan (thought I was having a brain tumor), an EKG (thought I was having a heart attack) and many doctor’s visits. It’s been almost 4 months now, and I still have bad moments, but most of the time I feel normal. In the beginning I felt like I had a tight band surrounding my brain-and the anxiety and fear that came with this feeling were surreal. Then I had episodes where my heart felt like it would explode-very scary. Add hot/cold flashes, extreme lack of energy, fear of death and you have an accurate description of what my life was since April. It got worse aroung 3 months and now it seems to be almost normal-except I still have days where I feel like I don’t want to do anything, and after a work day I am pretty exhausted.
I didn’t even realize that my problem was so big-but the withdrawal so so strong that I must have damaged my brain/body pretty severe.
All this information about PAWS is very helpful and I keep coming back to this website for support and to read about other people’s stories. I basically read all the comments and prayed for all these people. I wish everybody luck in their recovery-it’s so much worth it.
Thanks for writing, Al. Glad you’re feeling better. Three, six and nine months tend to be the worst spots for alcoholics. Feel free to write and share what’s going on with you.
Keep on keepin’ on,
Bill
About the medical detox, I probably should have done that, but a small part of my long term recovery plan was to experience a brutal withdrawal so the memory of that pain would never leave me…I over did it a bit I think! I will tell you that I went to see my GP before I quit using opiates to get a full physical. He gave me the works and after all my tests came back he said I was in excellent health for 42 years old, even my liver after that severe abuse from all the tylenol in hydrocodone and oxycodone was fine.
I hate to bring this up, but when you say “lack of sleep never killed anyone”, to someone who is in the throws of withdrawal and not able to sleep, it’s almost rude…besides the fact that they want to drop kick you through a window when they hear it. Have you ever heard of Fatal Familia? Lack of sleep most definitely does kill, it takes about 9 months though, and a complete lack of sleep.
P.S.—I read the entire article again this morning. I missed a few gems when I read it yesterday. I bet when I read again tomorrow I find another few gems. I think that whole article should be committed to memory. If you would include the stuff about how addiction takes place in the oldest part of the brain in the article, that would be great too. I found that discussion fascinating and very helpful. It helps us addicts to understand what is going on and why it’s going on. It gives us some sort of security that we’re not cracking up for no good reason.
Thanks again for the great work,
Ron
Hi Ron,
Vicodin and Percocet, eh? Nasty stuff. Having used for that long, you were indeed lucky to have avoided liver damage, especially if you combined it with alcohol at all. (Most of us do.)
I probably say and write a lot of things that make people want to “drop kick me through a window.” I believe in calling a spade a spade, and I would rather anger someone with a statement like “no one ever died from lack of sleep” than risk the effects of something like “oh, you poor baby…of course you can take something to help you sleep.” As far as Fatal Familia Insomnia goes, it’s an extremely rare, inherited, prion-related disease that damages the brain by causing a buildup of plaque in the thalamus. Profound insomnia is one of the major symptoms, but I believe the jury is out on what actually causes death. I mention that only because I am basically a smartass.
I’ll give some thought to your suggestion about addiction and the primitive brain. The article is already pretty long, and I have to consider the attention span of many people in recovery (which is often virtually nil). I’ve been thinking lately that a companion piece about addiction in general might be good, but on the other hand so much has been written about it that it seems rather like re-inventing the wheel somehow. I will definitely think about it, though. Thanks for the idea. Maybe I could synthesize some of the stuff from the comments. Hmmm…
Thanks again for your kind words, and
Keep on keepin’ on.
Bill
PS: You (and anyone else) can contact me privately, if you wish, using the link at the top of the page.
What a kick butt article, I have been searching for weeks for some kind of clear and concise information on opiate PAWS and finally hit pay dirt. I call PAWS Post Traumatic Not Getting High Anymore Syndrome, but now I know there is more to it. I am 69 days clean from 13 years of severe opiate abuse culminating in a three year stint on Suboxone. I wish I had a doctor who understood the first thing about Suboxone…she had me on 16mg daily until I did some research on it and found out how irresponsible it was to keep someone on such a high dose for so long. I managed to wean myself down to just over 1mg per day and quit June 4/2010. The next 30 days consisted of me getting bitch slapped 24/7. It was borderline unbearable. It’s truly amazing what the human body and mind can tolerate. I had weaned down from 16mg to 1mg way, way too quickly and paid the price. The next few weeks consisted of much milder symptoms with sleep being the biggest issue, lack of anyway. A couple of weeks ago I began complaining to my wife more and more about how long is this crap going to last and she hit me with the two by four of truth…she said 13 years of abuse won’t go away in 60 days you dumb!@#. She was right. I am finally sleeping somewhat better, Central Nervous System is calming down bit by bit. My pissy attitude is improving slowly. I am getting better and very proud of myself for how far I have come. Lots of help made it possible, meetings, friends and my personal relationship with my God. Finding websites like this are also priceless. It always helps me to read about addiction, read what others have gone through and discovering how they made it out of the dark lonely cave of addiction.
I have book marked this site because the article on PAWS is something I will refer back to often, it is masterful, it is educational, it is powerful and it is comforting….thank you so much for taking the time to do it.
Ron
Hi Ron,
Congratulations on your 70 days! It sounds as if you are doing exactly what you need to be doing for yourself, and it’s working. Keep it up!
It’s horrible that so many physicians set themselves up as detox docs without knowing anything much about addiction (or, perhaps, just enough — but let’s not go there). To make things even worse, as you found out, Suboxone has the worst detox syndrome of any of the opioid drugs except methadone. Long-term maintenance is a crutch, not treatment. You should really have been detoxed in a medical facility, but you got through it, though, so good on ya.
Thanks for your kind words. Of the many things I have written, here and elsewhere, the PAWS article is the one that gets the most appreciation, by far. It’s linked to from a number of places, and lots of folks seem to find it useful.
I still get a thrill from letters like yours. After nearly 21 years in recovery myself, it is incredibly gratifying to know that something I have done is helping others. The first couple of years were the worst for me, as they are for most people, and I didn’t find out why until some years later when I was gathering material for lectures while working in addiction treatment. I’m sure knowing about PAWS would have helped me, and I’m glad to be able to pass that information along.
Please stay in touch, and let me know how you’re doing. Feel free to ask questions. If I don’t know the answer, I’m at least a helluva researcher, and folks’ questions help keep me up to date and on track in my own recovery. Working in the field you see a lot of old timers who’ve relapsed after 15, 20, 25 years, and it seems that they have the worst time of anyone getting back into recovery. Thanks for helping to “keep me green.”
Keep on keepin’ on,
Bill
Pingback: I'm not sure if I can cope with life sober - SoberRecovery : Alcoholism Drug Addiction Help and Information
Bill,
I am 65 days off Rx opiates. I am clean, no drugs, no nothing.
I have been through detox and primary care. I am a 61 year old male. BA. MA. ABD. I taught for 33 years at a small Community College. I was a damn good teacher, and a pretty good writer. I was also a good husband and father.
Now, just walking around is a hard thing to do. My family doesn’t understand. I was sent off to be fixed for 6 weeks..and I am still broken.
My education didn’t save me from addiction, nether did my wonderful family, nor my religion. RIGHT NOW I AM NOTHING MORE, OR LESS, THAN AN ADDICT.. a recovering one.
Until today I didn’t know what PAWS was. It is good to know that there is a name for what I am experiencing. I thought I might have had a stroke. I knew something was wrong. I have every symptom in the book. At least, I know now, ..there is a book.
I am attending NA meetings. Sometimes they are poorly led, and that bothers me. I am now unsure about everything I have ever believed. When things go wrong at NA, I get really upset. I have staked my life on NA.. I think that’s what set off my PAWS.
Anyway, thanks for the information on PAWS. It has made today a little easier. I’ll do what you suggested.I hope to be an ongoing disciple, of yours.
John W.
Hi, John,
First of all, congratulations on your (now) 67 days — and my apologies for not having replied sooner. My wife is in the process of setting up a new office for her psychotherapy practice, and we’ve been busy hanging pictures, arranging (and rearranging) furniture, shopping for same, and so forth. Yesterday and most of today was especially busy, and I just got to the mail.
Addiction takes place in the sub-cortical parts of the brain. Those portions evolved long before our cortex, where our monkey minds reside. Education, religion and so forth don’t impress the primitive brain much. It’s sort of like riding an elephant. We’re in control as long as our desires and those of the elephant don’t deviate too much.
Addiction causes actual physical changes in the parts of the brain that involve pleasure and reward. When we remove the drugs, or when they drop below the level at which the brain is comfortable, it sends signals to the rest of the body that it needs more…just as when we are hungry, thirsty or horny. This is a survival issue, as far as the brain is concerned, and the signals are strong and difficult to ignore at first. As the primitive brain adjusts to the reduced stimulation, the messages become less intense, and eventually pretty much go away. However, it takes time. It took a long time for our brains to become altered, and it takes quite a while for them to return to normal.
Your condition at two months is entirely predictable. Some folks (I was one, thank goodness) breeze through PAWS. I avoided most of the physical and emotional discomfort, but I was as crazy as a loon for the first year or so. I also watched people close to me from treatment and the rooms drop like flies. They were not so fortunate, and I’ve seem many folks fall by the wayside over the succeeding years. In practically all cases, they failed to take care of themselves by watching diet, rest, exercise, avoiding unnecessary stress and hanging out with other addicts who could relate to what they were going through.
As addicts, we trained ourselves to get more, NOW. Waiting and patience are not our nature. They are, however, intrinsic to recovery. It will get better. You will improve. And it will take time. I’m some years older than you, but I got sober at 45. It is harder for older people, but entirely doable. Just keep hanging in and doing what you’re doing. Re-read the article on PAWS and try to apply the suggestions to your program. You might also read through the comments. There is a lot of material there that has accumulated over the several years since I first published it.
Feel free to write and ask questions, or just bitch. That’s why I’m here. It’s what I do. And keep up the meetings. It’s exceedingly rare for people to make it without the fellowship.
Keep on keepin’ on…
Bill
Pingback: Does life ever become "enjoyable" again? - Page 2 - SoberRecovery : Alcoholism Drug Addiction Help and Information
I was a smoker for over 25 years with numerous failed attempts to quit. I quit smoking about 3 months ago, with the help of Chantix, and felt fine until just recently when most of the symptons you desribe above came crashing in on me. It was a shock to my system, hard to understand and even harder to desribe as I never suffered this kind of depression before… I thought I was going mad or in the middle of a mid-life crisis or something. I was totally at a loss to do anything about it or even tell anyone because I didn’t really believe it myself!
I had initially dismissed my cessation of smoking as a cause because it had been so long since I quit and my body was well clear of nicotine etc but the more I looked up my symptoms the more paranoid I got about it, and the Chantix I had taken to help me too. Sites had me diagnosed as bi-polar, manic depressive and in a permanent state of pyschosis, they were the first I came across and fed my paranoia to no end initially until I had a brief moment of reason and finally confessed all to my wife who brought me back to reality. My confession surprised her as much as it did me because I have always been a glass half full kind of person that can find the good in everything, including the bad and have never suffered from depression of any kind really. I was literally hanging on by a thread at the edge of reason before I confessed. What a relief it was, it didn’t change anything in the short term, in fact the symptoms got worse but at least I wasn’t alone and hiding my problem anymore. The more I looked in to the symptoms I was suffering the more reasoned websites, like this one, came in to view.
I do get and have had many of the symptoms described as PAWS and I’m still not entirely convinced I’m a sufferer of it but the explaination detailing the processes of what we go through struck a chord with me and make complete sense. At the very least for me this website (and others like it) has identified the problem I have and helped me realise I’m not alone in my madness. I think I can get on with the process of recovery now that I know my body is repairing itself and learning to cope without my lifelong addiction to nicotine.
Hi Duane,
Thanks so much for writing. You are the first nicotine addict who has written in a long time, and it’s important for your letter to be seen by others who are suffering with the same issues.
You are, indeed, suffering from Post Acute Withdrawal from nicotine, which is one of the most highly-addictive drugs known. The entire range of PAWS symptoms are common to ex-smokers, and they help to explain why it is also one of the most difficult addictions to kick. The depression is especially characteristic of nicotine withdrawal. Here’s why.
Serotonin is the neurotransmitter that gives us the “up” feeling. Its production is either stimulated or its actions mimicked by drugs such as amphetamines, methamphetamine, cocaine and, of course, nicotine (along with a number of others). For our purposes, the source of the serotonin doesn’t matter.
Heavy stimulation of the brain’s serotonin receptors makes us feel goooood. However, the brain compensates for the high levels of the chemical by creating more serotonin receptor sites. This causes us to need more stimulation to get the lift. Over time, we reach a point where if we are separated from the drugs that cause the stimulation of the receptor sites — or if the level even falls low enough for some of them to remain unstimulated — we begin to feel uncomfortable. We are addicted. We have created a situation where our brain needs the drug for us to function normally.
When we quit, our brain begins to protest vigorously. One of the major symptoms of withdrawal from stimulants, including nicotine, is the exact opposite feelings from those that the drug initially caused. The drugs took us up; the withdrawal takes us down. Here’s the kicker: until the brain normalizes the number of receptor sites, we will continue to feel the withdrawal. For some reason that we still don’t understand, these symptoms seem to peak at about three month intervals after stopping, especially if there is other stress occurring. Those are the classical times for relapse: three, six, nine months, and sometimes a year or more.
The treatment is the same as for any other PAWS situation. There is essentially no difference amongst nicotine and other drugs, except that the nicotine doesn’t get you very high when you’re using it. It’s sneaky.
You may assure your wife that your symptoms are very real, and that (while they are literally in your head) they are nothing over which you have control. These things are happening in a part of your brain that evolved long before the ability to reason, and you can’t talk yourself out of them. What you can do is take care of yourself, and force yourself to remain active.
The good news is: this, too, shall pass. And because you are no longer putting poison into your body you will have many more years to enjoy the peace that will eventually come.
Again, thanks for writing, and
Keep on keepin’ on.
Bill
ps: I smoked for 35 years. I know exactly what you’re going through. I’ve been clean since 1994, and it was the most difficult of all my addictions. But you can do it if I could.
Thanks Bill, now i know the nature force behind those addiction that make ppl really hard to quit. It’s a tough process but i’ll hang in there, i cannot put my future at risk, i really need my mind and my brain back to normal the soonest it can.
Here’s a little more info:
Addiction occurs in the primitive brain” that evolved long before the relatively recent development of the cerebral cortex and its ability to reason. These parts of the brain are not amenable to coercion, logic, willpower, or thinking problems away. They are the parts that control the functions below the level of thought — in a sense, below even the subconscious.
These are the parts of the brain that control our breathing, heartbeat, and other bodily functions, the parts where we feel pleasure, pain, hunger, and basic emotions such as fear, anger and lust. They communicate with our cerebral cortex, where we carry out the activities that we call thinking, and we are then able to respond to them in complex ways. However, while our “thinking brain” is able to influence the primitive portions of the brain to a certain degree, it can’t tell it what to do. And, unfortunately for us addicts, it can’t control the messages sent to other parts of the body. We are able to ignore those messages, to a degree, but we can’t turn them off.
In the human body, survival issues speak with an extremely loud voice, and can, in most cases, easily overpower the wiser counsel of our cerebral cortex. People with normal reflexes can’t not jump when they hear a sudden loud noise, and that’s a good thing. Imagine a situation where, on hearing a noise in the jungle, we had to consider all the possibilities: wind in the trees, small animal I can eat, piece of fruit falling, another person, unknown cause, or maybe a big creature that wants to eat me. People who wasted time with all that thinking wouldn’t have many kids. Most wouldn’t even make it to adulthood, and so they wouldn’t pass that particular tendency along to their descendants.
So, our bodies heed the primitive brain in survival situations, and we run, jump to the side, or stand perfectly still until the cause of the noise has become more apparent. Then our thinking brain comes into play, and we decide whether to continue or to go back and display to our kid brother, the trickster, the anger that is a normal response to being scared out of our wits.
The powerful survival signals from our primitive brains have an important purpose, but they can cause problems. For example, when we use drugs, including alcohol, long-term changes take place in our brains. The primitive brain develops an actual need for the drugs, and interprets their absence as a survival issue like hunger, thirst, and our “fight or flight” reflexes. Because of the force of these urges, which can easily overpower our reason and common sense, we tend to ignore the messages of our thinking brain, and seek more drugs. The more used to the drugs we become, the more difficult to think our way out of the box we’ve built for ourselves. We are addicts.
Much of the recovery from addiction and the odd behaviors and impulses that it entails take place on the sub-cortical level. We recover by taking good care of ourselves, both psychologically and physically, and allowing the brain to recover slowly on its own. Until it does — until it recovers to the point that it stops sending us those signals that it needs the drugs for its survival — we have to watch our step. The bare fact of the matter is this: for an addict, using is more natural, more in keeping with the immediate needs of the survival brain, than not using. If we are not vigilant, in times of stress we may heed the primitive brain rather than the rational brain, and things go rapidly downhill from there.
Thanks a lot for the very quick reply, i took your advice and learn each tip by heart, there are 2 more questions: the article said i should avoid sugar in my diet, will it be ok with high-sugar tropical fruits or it just might as bad as a candy bar? And you mention the sugar-hunger effect, is it ok to take sweet dessert when you are already full? That will be all. Thank you very much!
Hi Hugh,
As a general rule, avoid sweets when you’re hungry. If you need a snack of fruit, that’s fine, but don’t overdo it. Stick to the Middle Path. Fruit has a different kind of sugar that doesn’t give your body the jolt that refined sugar does. Dessert is fine, just don’t overdo it.
You also need to know that you will have good days and bad. Eventually you end up with a lot more good than bad, but it can take a while.
Hang in there.
Bill
I wanted to thank you for this blog. Yours is one of the best presented summaries of Gorsky’s thoughts. I point many people here when they post about how miserable they are even after they stop drinking.
Thank yuh. Thank yuh ver’ much.
It’s such a relief to read this article, i quitted Ecstacy 6 months ago after a year of frequently using it, from then i have felt all the symtons above, i’m in vietnam so very little that people know about this PAWS, i was desperate because i thought i’m going crazy, im working in a very stressful and competitive company that makes my PAWS even worse, im at the 6th month of abstinence and experiencing the very bad memory problems, and that is my biggest fear because it has a very bad effect on my job, is there any way i can get my memory recover quickly?
Dear Hyu,
Thanks for writing, and congratulations on having dumped the uppers! I was a speed freak myself (ecstasy — MDMA — is an amphetamine) and I know first hand how they can mess you up without your even realizing it until it’s almost too late.
The bad news first: PAWS takes its time. Just as they didn’t get screwed up overnight, i takes quite a while for our brains to get back to normal. The drugs make actual physical changes in our nervous system, and that has to be repaired.
The good news is, Paws is cyclic, and 6 months is one of the notorious hot spots. It is not surprising that you are having trouble now, and it will pass. The best advice I can give you is to return to the article and re-read it, with particular emphasis on the rest, nutrition, exercise and mental/spiritual aspects. If you can find a meeting of Narcotics Anonymous or AA where you live, that might help. All addictions are pretty-much the same. Try some meditation.
Remember two things: it takes time, and it does get better. Your stressful job certainly is a factor. I realize that there is probably little you can do about that, but to the extent that you can, I strongly suggest trying to alleviate some of the stress. That’s where exercise comes in — the BEST stress reliever! BTW: standing on your feet or working is not the kind of exercise I mean. I’m talking a long walk, a workout in the gym, a run, or something like that, where you go steady for at least half an hour.
Be mindful that if you use again, it will not get better — only worse — and that it will put you right back at square one for the PAWS.
Keep on keepin’ on, have faith that things will improve, and feel free to write.
Bill
HI. I am/was a chronic pain patient who was taking Opiates for almost 6 years. I wrote “am/was” because I decided to get off the opiates to see if I could manage the pain without. I went into detox on April 4th and am able to manage my pain without the opiates…an anitinflamatory is working very well. Yea!!! I was on a large dose of Fentanyl (150 mg every two days) and Percocet (30/10s 4 times a day) for most of the 6 years.
So, I am just about 3 months sober and I am experiencing PAWS BIG TIME!!! Today I feel like I just got out of the hospital again: creepy crawlies, tremors, sweating, fogginess, irritability and depression. I knew about these symptoms and knew that they come back to haunt me; but I have two children to care for and PAW is really getting in the way!!
Yesterday I got in to see a Therapist who deals with addictions. He thinks I should be put on Suboxone because of the length of time I was on the drugs. He is referring me to a psychiatrist who is certified in that area. The therapist suggested I go on it, and taper off of it slowly so as to avoid the current symptoms and to avoid any symptoms from the suboxone.
Please give me your opinion on this asap. I really am struggling to make it through the day right now. (And by the way, I go to Physical Therapy twice a week because I got SO weak during the detox and recovery. I am also taking the vitamins and eating pretty healthy. I will stay away from the sweets from now on though!)
Thank you for your help!!
Dear Linda,
Congratulations on your success in getting off the opiates, and on your three months (just about). Even with detox, it’s not easy; without it, it’s pretty close to impossible.
You are experiencing the reason that so few people successfully recover from addiction. PAWS is no joke, as you can testify, and simply telling folks to “get over it” is not the answer. PAWS is also cyclic. Three months is one of the “humps” in recovery where the symptoms become worse. Many opiate addicts report feeling withdrawal symptoms at the three month point. Fortunately, they pass after a time. In short, your condition is nothing unique.
You did not say if you are attending meetings. The support you get there is, in my opinion, absolutely necessary for optimum recovery. I encourage you to attend as many as possible. They are especially critical during periods of crisis like the one you are in now.
Suboxone therapy is problematic. It is not an easy drug to get off of, and many physicians do not understand its use. Just because it can be used in a certain way is no guarantee that it is really indicated for every patient. My wife, who is more versed in the details of detox than I, suggests that you check with your doctor to see if Neurontin and/or Lyrica might serve instead, to control the PAWS to a degree, and also perhaps to alleviate some of your pain. If he is unwilling even to consider these possibilities, that alone should tell you something. We need to remember that the business of psychiatrists is, largely, the prescribing of psych medications. In most cases, it is their primary tool. When you have a hammer in your hand, problems start looking like nails.
Therapists can also fall into the trap of suggesting easy ways out when they might apply other resources such as group therapy and individual counseling — and suggesting meetings.
Good luck, and please let me know how you’re doing.
Keep on keepin’ on,
Bill
subscribe me for a friend
I’m sorry that I can’t do that. You will have to subscribe by clicking either the “Email Subscription” or the “Subscribe in a Reader” link beneath the photograph.
Thanks for reading Digital Dharma,
Bill
Pingback: Is sobriety difficult or is it me??? - Page 2 - My Way Out Forums
Pingback: Is sobriety difficult or is it me??? - My Way Out Forums
Bill –
I have been on 1 mg clonazepam for 13 years (as prescribed by a doctor). The last 11 years of the 13 years, I was drinking a lot. I stopped drinking over 8 months ago and am slowly tapering off the clonazepam (with a doctor’s help). I have had pretty much the same level of PAWS for these 8 months. I was at a group therapy meeting last evening, and one of the other members thought that I may not recover given my age (56) and the mixing of benzos and alcohol for so long. Is there any reason to believe that recovery will not occur as long as I stay away from alcohol and get off the clonazepam? He seemed to think I may have destroyed my neural receptors. Thanks.
Unless your fellow group member is a neurobiologist, I would be careful about giving his assumptions regarding brain chemistry too much weight.
The most likely reasons for your still experiencing PAWS are (a.) that you are still on benzodiazepines and your receptors are unable to recover, keeping you in mild physical withdrawal as well, and (b.) the fact that PAWS can last for several months — even up to two years — in some cases.
Pay close attention to the section in the article regarding nutrition and physical exercise, continue with your group sessions, hit a few AA meetings to make some new sober friends, and get off the Klonopin so that your neurological recovery can begin. You should be able to taper in under two months with a doctor’s help.
Congratulations on your eight months! Please be assured that it does get better, just like they say.
Regards,
Bill
Hi,
I have been off opiates for 9 months now, I quit cold turkey and recovered from physical withdrawals by giving myself much needed alone time and nurturing my body. I am having trouble dealing with the psychological aspect though…
Most of the time I feel numbness all around….After being hired for a new job, I am nor excited or pleased….just numb.
I am still having trouble connecting with people…I sometimes get stuck inside myself and have trouble conversing with people. I suppose it has gotten better over time, but I can’t tell.
I am wondering about the malnutrition….I became very bone-poking thin during my abuse and since I quit I have slowly gained back an appetite to food. I still have not gained any weight and my menstrual cycle has stopped for long periods (and I am not pregnant)……
Dear Zeldanne,
You are describing a classic case of chronic depression, perhaps aggravated by PAWS and even other physical issues — and certainly by your evident attempt to do this difficult job all by yourself. (At least you didn’t mention any support, either psychological, medical or in the 12-step rooms.)
You need to understand a couple of things about addiction.
Addiction occurs in the sub-cortical portion of the brain — the parts that evolved long before the relatively recent development of the cerebral cortex and its ability to reason. These parts of the brain are not amenable to coercion, logic, willpower, or thinking problems away. They are the parts that control the functions below the level of thought — in a sense, below even the subconscious.
These are where much of the recovery from addiction and the odd behaviors and impulses that it entails will take place. We recover by taking good care of ourselves, both psychologically and physically, and allowing the brain to recover slowly on its own.
Sometimes addiction can mask underlying conditions, such as depression, that then show up “in spades” when the drugs are withdrawn. Combined with the depression that is common — in fact, almost “normal” — in recovery, it can be devastating. Other physical and psychological issues that were also masked by the drug(s) ,may surface as well.
I suggest you see a physician who is affiliated with an accredited treatment facility, and who is skilled at dealing with addicts in recovery. You need a good physical workup, and someone in the medical field that you can trust. If you cannot afford a physician, check with your local mental health association to see if they can refer you to someone with the skills you need, perhaps on a sliding scale, or pro bono.
Needless to say, I also suggest a support group of your choice. My own preference would be Narcotics Anonymous. You need to be able to talk to people who have been where you’ve been, and who understand what you’re going through. (However, don’t let them give you medical advice.)
You have accomplished, on your own, a feat that few people manage with support. I congratulate you. Now it’s time to let someone help you to carry the remaining burden.
Please feel free to write.
Bill
Pingback: sub taper >2mg - Page 42 - Drugs.com
bill ur the man i have 3months clean i read this article when im stressed im 20 yrs old recovery from opiates n this info has helped me like a lot
thanks Rob, and congratulations on your two months!
Keep on keepin’ on.
Bill
I have been clean from oxycontin for almost 3 months. I have gotten to a point in my sobriety where I’m extremely depressed. I mean, DEPRESSED. I can barely get myself up in the morning and taking care of my three kids is like hell. I don’t know what to do. I’m on prozac, after trying about 12 other antidepressants. I don’t know how to get out of this rut I’m in but I feel like I’m drowning.
Depression is a condition not necessarily related to recovery. I strongly suggest that you find a psychiatric teaching hospital in your area and get a good workup. Depression is frequently fatal. You cannot fool around with doctors who (clearly) depend only on drugs to treat it. Short of that, find a good therapist who is experienced in treating depression. Your local mental health association can advise you, and you may be able to qualify for free treatment, or treatment on a sliding scale.
You should also be aware that most antidepressants take up to two months to become effective. You have not been clean and sober long enough to get relief from even one, really. If your doctor is not aware of this, then he or she is obviously not qualified to treat depressives.
Please do not delay. Those kids need you in good shape. Here is some information that should help.
I’m a recovering heroin and well really every other drug in the book addict. I’ve been clean for almost two years, one of which I spent in jail, before that I drank and drugged for 11 yrs. I’ve been in a 12 step program since the day I’ve been out of jail. I think i’m losing my mind. The fear, social anxiety,rage and insecurity going on in my head is unreal, and that’s the thing it’s not real but I can’t grasp that. I pray and don’t really know what I’m praying to. I don’t want to use anymore but I’m miserable like this. Can these symptoms be PAWS?
Dear Joe,
Sorry I couldn’t answer right away. I know how hard those hard times can be.
At two years it’s unlikely that the issue would be PAWS per se, but it’s entirely possible that your issues are partly for physical reasons: nutrition, exercise, and watching your sugar intake would be a really good idea. Junk food and fast foods especially will screw you up. This is not the diet that our bodies evolved to eat, and they rebel if given too much of it. I know that eating well takes more time and costs more, but it will bring benefits if you are able to handle it.
Exercise — at least 1/2 hour a day of steady walking, bball or something similar is a must. That is what our bodies are designed to do. We neglect it and it costs us.
The sugar issue, as outlined in the section on hypoglycemia, is another issue. You might re-read it. If you have not had a physical and can arrange one, either through a private physician or the health department, it would be a good idea. Many addicts and alcoholics have blood sugar issues, and it can screw your head up more than you could possibly believe. I thought I was going nuts at about 18 years sober — then I found out I had diabetes. Controlling the sugar made a HUGE difference. Now it’s just other folks who think I’m nuts.
Last — but by no means least — WORK YOUR PROGRAM. Talk to your sponsor. Make the steps part of your life. If you haven’t done the 4th through 9th, it’s clearly time. You have to work on getting your past behind you, and that’s how it happens in AA. Also, if you can call your local mental health association, or an outreach program for ex-cons, you could probably find a group therapy session for little or nothing. That will help you work through some of the other issues.
No one can work your recovery for you. I don’t mean to imply that you haven’t been working, but I’m trying to point you in some productive directions. Remember, even Bill had to see “outside practitioners” in his sobriety. Sometimes the rooms aren’t the only things we need.
As far as prayer goes, check out the Third Step Prayer. It’s the way to pray. Asking for stuff doesn’t do much. Asking for help — and then listening for the answers — helps a lot. Meditation helps, too. If you can find a meditation group, join it. You don’t have to explain yourself to them, just be there. Otherwise, read this and go for it on your own.
Feel free to write. And keep on keepin’ on. You know what awaits you if you don’t.
Regards,
Bill
Pingback: my temper control switch is broken - SoberRecovery : Alcoholism Drug Addiction Help and Information
Pingback: Post Acute Withdrawal?? - SoberRecovery : Alcoholism Drug Addiction Help and Information
Hi Bill!
Thank you for this wonderful article. I wanted to share some information that has been helpful to many folks I know. Taking a relatively high dose of a fish oil supplement increases the “good fat” levels in the brain, making it a lot easier for the body’s natural fee-good chemicals to pass through cell membranes. This helps normalize brain functions and reverses problems like depression, mild forgetfulness, and lack of stamina. There have been numerous studies showing the effectiveness of fish oil supplements on clinical depression, and anecdotal evidence is growing that this supplement may also help with PAWS.
There are many good sources of Fish Oil, but you need to know what to look for. You want a highly concentrated fish oil (Omega 3) supplement with at least 50% fish oil. Make sure the supplement has been distilled to filter out mercury or other toxins. Most supplements contain two types of good fats: EPA and DHA. Only the EPA has been shown to improve mood, so look for a supplement that has higher levels of EPA. Avoid any supplement containing “cod” liver oil, to avoid too much vitamin A, which can be toxic.
Most depression studies have used relatively high doses. Folks will likely need to take a higher dose than indicated on the bottle to achieve a therapeutic level for depression and PAWS symptoms. Up to 3 grams a day of fish oil is considered “safe” by the FDA.
A word of caution: people with bleeding disorders, people who take aspirin every day, diabetics, or people who are pregnant should speak with their doctors before taking any fish oil supplements in any dose.
Anyone who does this should be aware that there might be a little bit of “leakage” because of the high levels of oil in the stool. Omega 3 is prescribed for the reasons above, and is also known to lower trigylcerides. All in all a good idea for folks whose fat metabolism is almost certainly skewed.
Great website! I am 152 days off Adderall. I took it for six years at a max dosage of 65-70 mg. I still feel fatigued.
What are your thoughts on this? I feel like I should start to feel better by now. I sometimes feel like this is as good as it gets.
Thanks.
Hi Lauren,
Thanks for writing. A lot of folks read these comments, and each question helps fill out the picture for everyone who comes after.
As a former speed freak, I can sympathize. You are feeling the normal depression that comes with removal of amphetamines. It does, however, seem to be lasting a bit long. If you are eating well, taking vitamin supplements, and walking a mile every other day (or more often), and getting out and associating with people at meetings and so forth, then there are two possibilities that come to mind: 1) that your serotonin production may have been suppressed more than we would expect, or 2) that you may in fact have an underlying condition that was being medicated by the Adderall. It is not uncommon for people to be drawn to drugs, especially stimulants, because they really do help them function better, initially.
I suggest that you speak with a doctor who is familiar with these issues. A local treatment center should be able to refer you, or if there is a university teaching hospital nearby you should be able to find someone who is well-versed. It may be that a selective serotonin reuptake inhibitor (SSRI) like Wellbutrin would be helpful. SSRIs increase natural serotonin levels, but do not get you high. The doctor could then help you get off the SSRI later, if indicated.
In any case, the admonition to get good nutrition, exercise, take a multivitamin morning and evening (with meals) and get out with people still stands. I realize this might be what you want to do least, at this point, but it is the best possible medicine for the post-amphetamine blues.
Keep on keepin’ on,
Bill
Pingback: Class of May 2010 - Page 13 - SoberRecovery : Alcoholism Drug Addiction Help and Information
Pingback: Neuropathy - SoberRecovery : Alcoholism Drug Addiction Help and Information
Great article! I just came off a severe opaite addiction. It has been 22 days and I am feeling better every day. The worst symptoms I have are diaherea and a little fogginess. The insomnia after I got home from detox was horrible. I didn’t sleep for 9 nights. I see an addiction doctor who won’t prescribe ambien, klonapin, or any habit forming drug. He prescribed anti histamines but they did not work for sleep. Finally he put me on Seroquel for sleep. I had never been on it before, so I wondered if there are any withdrawl symptoms associated with it. They started me on 450 mg at night. I did that for about 7 nights. Last night I took 200 mg and I slept just fine. I have been on Seroquel for about 8 days now, so I just wonder how long (if at all) it takes to get off of the Seroquel.
Congratulations on your 23 days!
Your doctor is right on in refusing to prescribe habit-forming drugs. Addiction is a disease, not specifically related to any one drug, and we are prone to become rapidly addicted to other habit-forming drugs and behaviors. Since most psych meds are mood-altering, they can easily affect our judgment and lead to relapse back to our drug of choice. When we take drugs (as you know very well) we are not in our right minds.
Seroquel can cause withdrawal symptoms if we go off of it cold turkey. If you are now sleeping well, talk to your doctor about your concerns. Seroquel is available in doses as small as 25 mg, and tapering off is no big deal. Just make sure you do taper, or your insomnia (and some other unpleasant symptoms) could come back.
Here is a link to a fact sheet from the manufacturer in Canada. It will tell you what you need to know, but does not express a withdrawal protocol. That should be between you and your physician.
http://www.astrazeneca.ca/documents/ProductPortfolio/SEROQUEL_CIL_en.pdf
Hit those meetings, and good on yer! Keep on keepin’ on.
Bill
I returned to pain management after being off for over a year. I have a bone degeneration disease that has already taken all cartilage from my arm and is now taking my bone mass. I have had 6 surgeries so far to try and correct with no success. They are going to do a full arm and elbow replacement surgery soon. I was on methadone and percocet for only 4 months this time and I was tired of the symptoms. I went off the meds with no withdrawl symptoms and thought I was fine, now 6 weeks later I am sick, tired, my temper is rising, and rushes to the bathroom constantly. I am in horrific pain, but I Dont want to go back to the pain meds. How long can i expect this to last? I wasnt even on the meth and percs very long and now withdrawl symptoms immediately. I am afraid of the paw and how it will affect my job. Veyr scared right now
Your question is beyond my ability to help. I suggest that you contact a university medical center or teaching hospital near you for a second opinion. Unfortunately, when it comes to extreme pain management, there is sometimes no way to avoid the drugs. However, you should definitely get expert help with the management.
I wish I had more to offer, but I cannot ethically or morally advise you on this issue, as much as I would like to help.
Pingback: delayed withdrawals? - SoberRecovery : Alcoholism Drug Addiction Help and Information
i use to smoke a lot of weed i smoked since i was 13 i did other drugs but i stood with weed
the last time i smoked some weed was on april 20 2010 but i didnt like the way i was feeling so i stopped smoking weed, i told my self im gonna change i had thoughts going through my head on how im going to change, i was at work on april 30 2010 i think i experienced paws it was so scary i thought i was going crazy so i smoked some weed but the thoughts were still there, i cried to my mom told her what happend got depressed,now im on lexapro for depression and alprazolam for anxeity but i havent taken alprazolam since yesterday and im only 18 years between but i put alot of stress between those ten days didnt sleep right was that paws
Probably not. More likely it was acute psychological withdrawal. PAWS (Post-Acute Withdrawal) comes later. You didn’t mention how much you were using. If you were smoking large quantities daily, you could have been experiencing some physical withdrawal.
I am not qualified to diagnose your condition. You are probably on the right track. See how things go, and stick with your doctor’s advice for now — remembering that alprazolam is addictive and should not be used for longer than about a month. Believe me, you do not need a benzo addiction to add to your troubles. Been there, done that.
If the medications don’t help, consider seeing a mental health professional to help you sort things out. I’m not saying you’re nuts, but there may be an emotional component or a problem with a chemical imbalance. I assume your doctor gave you a good physical. If not, that should be done right away to eliminate any physical issues.
Finally, hit some NA meetings. You need to be able to talk to people who have been through similar stuff and who know where you’re coming from.
Pingback: Question motivation/drink after 75 days - SoberRecovery : Alcoholism Drug Addiction Help and Information
I had my last drink back in October and began experiencing PAWS about 2 weeks later. In December, my doctor put me on 4 mg Klonopin to help with the PAWS. That made me very depressed over 6 weeks of use, and I was able to get off 3 mg of it in 3 weeks. (Still taking 1 mg which is what I had been taking while I was drinking. Plan to get off that once the PAWS improves.) It’s been nearly 200 days since my last drink and about 90 days since getting off the 3 mg Klonopin. This is probably a dumb question, but does the clock start over after the 3 mg of Klonopin, basically negating the 3 months of time I had prior to the Klonopin? Also, my PAWS is the stable kind (as Dr. Gorski describes it) and hasn’t really improved over these 6 months. Does it eventually improve as long as I abstain? Thanks.
Klonopin (clonazepam) is a benzodiazepine drug that has effects on the brain similar to alcohol. Until it is out of your system, I’m afraid that you won’t have much luck in overcoming PAWS.
This is the danger of dealing with physicians who do not really understand addiction and addiction pharmacology.
You have been operating under doctor’s orders, and I see no reason that you need to start “the clock” over again. However, I would get off the Klonopin the rest of the way so that I could really start my recovery.
Be aware that withdrawal from even small dosages of clonazepam raises the potential of seizures.
And congratulations on your six months!
Pingback: PAWS (Post Acute Withdrawal Syndrome) - My Way Out Forums
Pingback: On suboxone: when does my sober clock start? - SoberRecovery : Alcoholism Drug Addiction Help and Information
I will be doing thr rapid detox next week wondering what are the chances of going
thru paws. have been using oxy for about six years. also has anyone else gone thru
rapid detxox.
The likelihood of your experiencing PAWS symptoms is about 100%. It is a normal consequence of getting rid of the drugs, and is not related to the manner of detox — if you survive detox.
Which brings me to the matter of “rapid detox.” I don’t know anyone who has had it, because most of the people I know have been treated by reputable treatment facilities. The fact of the matter is that rapid detox is a dangerous medical procedure that is marketed as a cure-all by people who should know better.
First of all, general anesthesia is dangerous under any circumstances. That is multiplied many times by the medical complexities of opiate detox. People have died from the procedure, my friend. I would never recommend it, nor would any professional I know.
In addition to the above, detox is only the first part of recovery. In a normal detox protocol (several days of buphrenorphine detox, in one form or another, accompanied by education, group therapy and both medical and peer support) you not only receive the beginnings of the grounding you need to continue, but can be referred to follow-up treatment, NA, etc. and given the information that you need to understand your disease and why the follow-up is needed. With rapid detox you are thrust out into the world with all your nerve endings bare and unprotected (almost literally) and no place to go.
I would add that the relapse rate after rapid detox is incredibly high, even for a form of addiction that has a high relapse rate under the best of conditions.
I suggest that you re-think this matter. Seriously. I have nothing to gain from this. You don’t know me, I don’t know you. Think about it carefully. Research it on some reputable websites, not just sites that are trying to sell you something. See what you come up with.
In any case, good luck. You’re moving in the right direction, if perhaps on the wrong horse.
Pingback: 2010 Class Of February - Page 14 - SoberRecovery : Alcoholism Drug Addiction Help and Information
Ahhhhhh! Fell totally off the wagon tonight! It was a slow process that built up over a month as I went from 2 1/2 months completely sober to having non-alcoholic beers to enjoying one glass of red wine every few days at dinners out to one glass of red wine an evening and thinking I could do that occasionally to 3 glasses of champagne tonight! Feel simply awful! What do I do now??? Is PAWS gonna start all over again! So mad with myself as I didn’t get drunk, just very slightly buzzy but now 2 hours later feel headachey and know I am gonna be sick tomorrow! So hard because I am not drinking alone but am a Society Writer/Photographer so have to be out and around partying people every day for work! What would you advise to get back on track again?
Hi Cheryl,
I removed your image and email address.
Taking your issues in order:
1. Non-alcoholic beer is a mind-f**k. It’s like saying you buy Playboy to read the articles.
2. Alcoholics can’t drink at all, as you have discovered. I’ve been in similar situations. I just say, “Thanks, but I’m not drinking tonight,” or “No thanks, I finished my share.” After a bit people get the idea. Get a glass of soda with a twist, carry it around, and if you have to set it down watch it like a hawk to be sure someone doesn’t “do you a favor” and freshen it for you. People don’t really care whether you drink or not, as long as they think you’re taken care of.
3. If you don’t want to slip, stay away from slippery places. I understand about the job, but if it’s a problem you need to decide what’s most important to you. Attendance at AA and a good support group and sponsor will help. If you are finding excuses not to do that, then — again — you need to decide what’s really important to you. I was worried about who might see me at meetings, as I was a very high-profile public official. It was six months before I ran into anyone I knew, and he was one of the Councilmen.
4. It is a truism: anything you put ahead of your sobriety, you will lose anyway.
This is a disease of relapse. Don’t kick yourself too hard. Just learn from the experience. Remember, too, that alcoholism never “gets better,” and it is progressive — it gets worse. Women, unfortunately, have it worse than men because they produce less of the enzyme that metabolizes alcohol and so they get a double whammy: drunk faster because they’re smaller, and drunk longer because of the lack of the enzyme. The disease is 100% fatal if not arrested. It is arrested through abstinence, not “enjoying one glass of wine.”
You are probably in for a bit of more acute PAWS, since you opened up the neural pathways again. Again: learn from it.
Best wishes. Feel free to contact me privately using the Contact link if you wish. Gotta get to work.
Bill
Namaste Bill
Thank you for this well-researched, well-written and comprehensively covered article. I have been sober just over two months and this article clearly explains to me why I have felt “spaced out,” headachy, tired, and reactive to small stressors since I stopped. My life of daily drinking for over 40 years has come to an end, and has largely been motivated by the invaluable assistance and support of people like you and the selfless research that has bought PAWS information to the doorstep of alcoholics like me. The observation in the article that, “PAWS symptoms reach a peak from three to six months after we get clean.” and that “Any use of drugs or alcohol, even in small quantities or for a short time, will effectively eliminate any improvement gained over that time, as it will keep the brain from healing,” are words that will keep me going.
Thank you once again!
Pingback: Physical changes in early recovery - SoberRecovery : Alcoholism Drug Addiction Help and Information
Pingback: Class of March 2010 - Page 2 - SoberRecovery : Alcoholism Drug Addiction Help and Information
Pingback: PAWS (Post Acute Withdrawal Syndrome) - SoberRecovery : Alcoholism Drug Addiction Help and Information
Pingback: Class of November Part 12 - Page 20 - SoberRecovery : Alcoholism Drug Addiction Help and Information
Pingback: Craving Crack and guy insecurities... - SoberRecovery : Alcoholism Drug Addiction Help and Information
This is an awesome article and I agree with all of the others that say “you really know your stuff.” I wish I had had this information 22 years ago when I quit drinking. I lived life as a dry drunk for 20 years before getting into a 12 step program and wow! I still have urges but still have the fear that comes along with the urges. If I would have had the knowledge that’s wrapped up in this one article I could have saved myself a lot of unnecessary suffering. I now have a 20 year old daughter that I brought home after she was beaten very badly while drunk….it scared her enough to ask for help….what scares me is that she says she doesn’t want to stay here forever..”I just want to get well enough to say no” is what she said to me. She has many of these symptoms and at one time or another has been diagnosed with bipolar, so this article really hits home with me and I want to share it with her so that she can understand how important it is to her recovery. She’s doing great, going to meetings, eating better, exercising with her sister, but she still keeps in touch with two guys that were in her life, both of which still drink and drug, and one that she had been doing crack with. So I thank you so much for your article. This has really been an eye opener for me and I know that, even if my daughter doesn’t stay sober this time, she will at least be armed with some really great information!!
I found this article because my fiance is a recovering alcoholic of 19 years and was a drug and alcohol counselor for a few years. He called me and told me to look up Post Acute Withdrawal Syndrome, and here I am, armed with terrific new information that will help me and my daughter….thank you!!
I have been sober for 23 years with three, one drink relapses, twice at weddings, and once watching a football game, and my daughter is almost two weeks sober. She looks wonderful, and it’s so good to see her smile and look healthy again. I’ve really missed her. I hope more of us find there way to this site……
Thanks for your kind remarks. It’s letters like this that make the whole thing worthwhile.
Good luck to you and your daughter. Tell her I said, “If you keep on doing what you used to do, you’ll keep on getting what you used to get” doesn’t just apply to drugs and personal behavior, but to people, places and things as well.
If those folks are still using, they do not have her best interest at heart. They want their using buddy back, regardless of what they say. She needs to understand that.
Bill
Pingback: 2 Weeks clean from pills, need advice - SoberRecovery : Alcoholism Drug Addiction Help and Information
Dear J.,
There is no way that anyone could ethically advise you via the Internet, especially given the variety of drugs to which you have been exposed. I will go so far as to suggest that your primary care physician doesn’t seem to be very knowledgeable when it comes to pharmacology. Few are, relying far too much on the detail men and ladies when they should be educating themselves via the literature. You should probably be completely detoxed medically, and then started on an experimental regimen from scratch.
I can only suggest that you contact a psychopharmacologist who specializes in detox, and perhaps get the necessary referrals after she has reviewed your case. Your local mental health association should be able to suggest a competent physician.
Thanks for writing. I wish I could be of more help.
Bill
Pingback: 17 days and counting - SoberRecovery : Alcoholism Drug Addiction Help and Information
I have been sober 25 days now. I experience PAWS mostly as it has to do with my blood sugar. If I don’t eat right I start feeling bad, and start feeling paranoid that I am losing my mind. I have only found a couple other articles that are written well about PAWS. Reading this while I am feeling like I am losing my mind helps to me to relax. Thanks for sharing your knowledge and experience.
You are most welcome. Having been and done there and that respectively, it’s a pleasure to share with others and sometimes help with a tough road.
Just keep in mind that the other road was a lot tougher.
Oh yes, one other question. My sleep problem is one where I fall asleep but almost immediately wake up in a “startle” or “terror.” This happens for multiple times before I finally am able to sleep for a few hours. It makes going to sleep a bit scary at times, but I keep hoping that it will pass in time. Does this sound like something caused by PAWS, and could it pass over time? Thanks again.
Sleep disturbances are common in early recovery. The subconscious has been repressed for a long time. Additionally, we tend to sleep more lightly, and thus remember more dreams since we generally recall best those that occur just before we awaken.
For goodness’ sake don’t get involved in sleep meds. As disturbing as this can be, no one has ever died from lack of sleep. Exercise and good nutrition are helpful here, and you might try some melatonin from the health food store, with the permission of your doctor. (It’s important to remember that health store preparations are drugs, too, regardless of how “natural” they are, and can interact with other OTC or prescription medications.)
Hello. I read your excellent article on PAWS about 4 months ago. I know that I am clearly an alcoholic and have been sober for 136 days today. In October, I was taking a drive to see my 2 sisters when I began having unbelievable anxiety attacks. I knew for certain that it was my use of alcohol and decided that alcohol consumption was over for me. (I had been through this about 12 years earlier and just did not want to do it again. I didn’t know that it was PAWS at that time.) About 2 weeks later, I started having virtually all the symptoms that are mentioned in your article. I couldn’t figure out what was going on but knew that it must be alcohol-related. That is when I found your article. I went to my family dr and, over the course of time, ended up taking 4 mg of prescribed clonazepam daily to help with the anxiety. Unfortunately, neither of us thought about the extreme depression benzos can cause. I ended up going to the ER in a suicidal state which got me into a mental health facility for 3 weeks. That was torture; however, they did get me an appointment with a psychiatrist and therapist after I left. I was also weaned off the clonazepam in that 3 weeks but had to begin taking 0.5 mg twice a day when I got home. The total withdrawal was too horrendous to bear. So, I am currently taking meds (prescribed by a psych) for anxiety. We are going to deal with the 0.5 mg clonazepam in the future when I am feeling less anxiety.
Through this entire ordeal, I had forgotten that this was all probably precipitated by PAWS. I thought that the effect of alcohol was probably long over. I was a relatively heavy drinker for many years. It just occurred to me today that 136 days is only 4 to 5 months. This may very possibly still be anxiety, sleep problems, etc. attributable to PAWS. I could have saved myself a lot of trouble if I had thought about it sooner. I just finished a couple weeks on the anti-depressant Cymbalta (for the anxiety and depression). The side effects were horrible, and I am having some withdrawal from only 2 weeks of use. I have read nightmares of people who are trying to get off Cymbalta but can’t get past the withdrawal. I suspect it will be on a lot of lawyers’ hit list very soon.
Anyway, does it seem likely to you that the anxiety, sleep problems, etc. are a result of PAWS and not me just cracking up? Thanks for your consideration.
Your supposition could well be the case. On the other hand, alcohol and drugs often mask other problems that then rear their ugly heads when the “self medication” is removed.
It would be not only stupid of me, but unethical as well, to comment more directly than that.
I will comment on a couple of other things, however:
Good luck, and don’t give up. The booze will cheerfully refund your misery.
Bill
I have just been studying PAWS at my recovery meetings. We are doing alot of recovery work started a month or so ago. I am so learning alot, I have been using most of my life. I started at the age of 15 yrs old. Now I am 47, this is the very first time I have tried to stop everything completely? I only relapsed 2 times. For 5 minute’s, but 5 minute’s is 5 minutes. I started my clean date over because of the relapses. But, I have not relapsed since Oct 6th of 2008. I am so happy and I don’t plan on going back to the other using lifestyle ever. I am so happy for you that you are doing so good and keep up the good work lady, Keep your eyez on the prize like I did. Debrinconcita in Portland Oregon USA.
Pingback: Horrible Mood Swings - SoberRecovery : Alcoholism Drug Addiction Help and Information
Thank you so much for ALL of your postings. I am 7 months out of rehab for opiate, benzo and alcohol addiction. All of this started with emergency surgery a year ago this past January. My life turned upside down. I have lost my professional job, am bankrupt and 30 lbs over weight. My PAWS experience has been horrific. I have found it so helpful to remind myself that this is what I’m experiencing at any given moment. It’s true, there are days when I don’t believe for one second that living with this outcome is worth it. My addiction and withdrawl were so servere all I can do at this point is keep getting up one day at a time. I want to let others know, that perhaps, like me, in the beginning of recovery, I couldn’t take good care of myself. It was just too hard. I couldn’t leave the house, I couldn’t eat right and I couldn’t get anything together. Now, after some time, I am taking vitamins, eating several meals a day, walking my dog, even if I don’t feel like it, making my bed, taking a shower, keeping the kitchen clean and going to meetings. Sound’s simple? It’s not. It took many months to reach this place.
Wow! Opiates, booze and benzos — I’ll bet that was one hell of a detox!
Glad you’re going to meetings. Trying to get clean and stay that way without them is like rock-climbing without a rope — and without any rock-climbing experience. Keep up the good work and nothing will ever be that bad again.
Pingback: Looking for a reason or ten - SoberRecovery : Alcoholism Drug Addiction Help and Information
Thanks for a tremendous article. My partner is now in an outpatient clinic (30 days)for alcoholism. She was asked to stay for an extra 2 weeks after her counselor and other professionals reviewed her case. They felt she was high risk for relapse. I had the opportunity to go to one of the family night meetings which happened to refer to PAWS briefly. I had come across some info on it, but I didn’t feel it really hit it right on. Having been an addict myself, I recognize some of the lasting affects of getting sober. I didn’t know it had a name at the time I was going through it. This article has alsobrought to my attention that my partner may very well be experiencing some of these symptoms. She is now at about 30 days sober after a 5 day inpatient detox. She called me this evening after going back to the facility after the weekend home, totally at a loss. She was feeling displaced and hopeless. She sounded really depressed and said she wanted to drink. I coached her through the best way I could, but encouraged her not to make any rash decisions and to talk it over with her counselor in the morning when she returned to her program.
Even after going through it myself, I have forgotten how heart-wrenching it is on both sides…the person going through it and the ones on the receiving end. I am working on my own recovery with the help of Al-anon, and want to be supportive but cautious that I don’t slip back into my codependency.
Do you have any suggestions for those of us who are the bystanders witnessing someone’s PAWS? I am happy to consider any suggestions, since I want to be supportive to my partner as well as aiding my own recovery.
Thanks so much,
Roxy
Hi Roxy,
Thanks for the compliment. This in haste:
You are doing the single best thing for yourself by attending Al-Anon meetings. Educating yourself is another good thing. Keep in mind that, regardless of the quality of your relationship, you cannot fix you loved ones or friends. There is too much emotional static. Be supportive, listen, but keep the advice to a minimum. You might print out the article and give it to her.
Finally, keep on keepin’ on. We didn’t ruin our lives in a few weeks, and we don’t put them back together that quickly — although, as addicts, we still tend to believe in the “quick fix.”
Good luck, and the same to your partner. Remember the 11th Step. It doesn’t have to involve religion. See the articles elsewhere in these pages for some information on that — under “Addiction” at the top of the page.
Best wishes,
Bill
This article has helped me alot, and answered alot of questions I had. This is so very helpful for people in recovery to know, I can use this for now and for future use in my recovery lifestyle. I thank you so much for the uplifting and great ideas to keep sober life going and know what could be trigger’s in the future to look out for. From Debrinconcita in Portland Oregon USA.
hey bill,
thankyou for the speedy reply. well, i went to my first meeting today. i didn’t speak and was the first one out the door at the end, but it still feels like progress…. i left feeling glad i went and have already decided on the next one i will go to. pretty scary stuff though as i am not very sociable at the best of times. there was alot of love in the room though
i feel just listening is the best thing for now, as i read in one of the articles on your site…’take the cotton out yer ears and put it in your mouth!’
i hope eventually i will start opening up to people more…thanks again for replying, you’re doing a grand job sir
matt
Hi Matt,
Wonderful that you went to the meeting. Not speaking is OK. If you can feel the love, then you’re getting what you need right now. The time will come. If you can force yourself, speak to a couple of folks when you’re able. If not, at least keep going. You can get a lot by osmosis if you have an open mind.
Thanks for the compliment. I’m just trying to pass on what was given to me so freely. When you think of it, working with other addicts and alcoholics is one of the most important things we can do…and we can all do it. How often do “Earth People” get to help save lives? We do it every time we show up in the rooms.
What if they gave a meeting and nobody came?
Namasté
I posted in Jan of 2009 my experience with PAWS in the first 6 months of sobriety. I am still sober and am going on 18 months. I don’t feel the urge to drink very often now and my life personally and work wise are back to the usual. Meaning I have restored my image, good name and work now trusts me again. I have been traveling quite a lot lately for work and have been managing the stress pretty well.
I just spent a week at a customer site and have to say the trip went well – work wise anyway. During the day I was a true professional. But in the evenings all of the stress I managed during the day caught up with me and I my urge to drink was almost as strong as it was the first couple of months of sobriety.
I could not clear my head, felt like my heart was beating out of my chest and was visibly shaking. I did not drink and did manage to get through it but it was not fun.
I am a heatlhy woman and know think was all stress related. Maybe I took on too much, too soon – a whole week customer facing is a challenge.
Or can Paws really be this strong after 18 months of sobriety?
Hi Tammy,
I’m glad to hear that you’ve gotten a year and a half under your belt. Congratulations! That’s the big deal, not your recent experience. It proves that you are working a good program of recovery, and that you know how to do the right things for yourself.
All organisms will do whatever it takes to avoid stress. Humans are no exception, and us drunks, who know a quick and easy way to make it go away (temporarily), have to be careful. I suspect that what you experienced was less a matter of PAWS than of a simple stress reaction that you were unprepared for, and which simply kicked in the old instincts.
Important point: you didn’t drink. You recognized the problem, and you got through it. That doesn’t mean it wasn’t serious. I suggest meditation, and a daily inventory based on steps 10, 11 and 12. If you don’t know what I’m talking about, it’s time you learned. Hit a few AA meetings. You don’t have to keep going if you don’t like it, but pick up a copy of the book Alcoholics Anonymous and read it from cover to cover. There’s a lot of good information in there. Just remember that it WAS written 75 years ago, so it’s a bit stilted, and we know more about the nuts and bolts of alcoholism than we did then, by a long shot. Nonetheless, those folks worked out a program that has worked for millions of people, and you owe it to yourself to at least research it.
Example: If I were in that position, there are at least a couple of dozen people I could call who would understand where I was coming from, listen to my problem, and help me through it. A recovering alcoholic who lacks resources like that is treading on extremely thin ice.
If you don’t want to try AA, take some meditation classes. I suggest Yoga or Buddhist mediation, as they are proven over a couple of millennia to work wonders. Stay away from the New Age gurus. They’re not all bad, but they’re not necessarily the best at what they do. I’m not pushing Buddhism (although I practice), but I am pushing a proven method of getting in touch with inner problems and working through them in the light of reality and reason. You could also read the article on meditation under “Addiction” on the Digital Dharma links.
I wouldn’t worry too much about what happened. I would worry a great deal about the fact that it might happen again. You need tools to deal with situations like that. Go get some.
Please stay in touch and let me know how you’re doing.
Bill
hello, i have only become aware of p.a.w.s after reading this webpage and like everyone else who has posted , have related completely with what has been mentioned within it. i have been a heavy binge drinker for 16 years and am currently counting days (20 today). this is not my first time quitting but it feels different to me this time. i feel ready to take the responsibility seriously. i also quit smoking last year and that experience is helping.
i am feeling all over the place right now. i keep dropping things, am easily angered (emotional over -reaction). my brain feels too big for my head and i am generally feeling like i’m going a little crazy, yet still feel a very strong resolve to win this time.
i am exercising some and taking vit c(1000mg) and a vit b complex. is that enough per day or should i double up for a while? i was also taking a st johns wort tincture but am going to stop upon reading your article, as you mention total abstinance from all drugs. i have also been taking 5-htp to help me sleep, though i don’t know how effective it really is?
i do worry about the long term damage i have done, i am so anxiety ridden especially when around others, i don’t see that ever going away. can you recommend anything that can help this, it is one of my biggest obstacles.
i am watching my diet now and related heavily to the part of your article about hyperglyciamia, this definately sounds (and feels) like me. i am a vegetarian, but get protein and amino acids from other sources (eggs nuts aloe vera juice etc). can being veggie be a concern during recovery, or a better question would be , do you know of any super foods i should be eating lots of?!
thankyou for your great blog, i will be checking back from time to time to read through it all.
thanks, matt
Hi Matt:
Congratulations on your good work. Twenty days is awesome!
I would add a multivitamin (drugstore variety will do) with breakfast and dinner for the next couple of months, then cut it down to one a day. Always take vitamins with a meal. Our bodies are designed to absorb them with food. The C and B Complex won’t hurt. You don’t have to worry about OD-ing on them, as they’re water-soluble, but take them with a meal and don’t get carried away. I’d say you’re taking enough.
Most important is to eat well-balanced meals. Supplements are great, but food provides nutrients that can’t be put in a pill, not just calories. You should pay particular attention to your carb intake. Sometimes a vegetarian diet is a bit short on complex carbs. Go heavy on beans. They are a good source of protein and antioxidants, especially black beans. Eat them with a little cumin to keep the flatulence under control until your intestinal fauna get adjusted. Beans are also the single best food to help normalize blood sugar.
Watch the sugar. Those outbursts of anger and clumsiness could be due to fluctuations. (They’re also pretty normal. Your body has been screwed up for 16 years. It won’t get better instantly.) After you’ve been clean for a bit longer, you should see a doc for a full blood workup including glucose, but don’t bother right now because your body is still adjusting to its new lease on life. In the meantime, just know that things will get better eventually. Us drunks get to thinking that it’s not OK to feel not OK. It’s fine. That’s how normal people live. Sometimes wonderful, sometimes it sucks, but the average is a whole bunch better than being loaded all the time. As a wise man once pointed out, “If we never have pain, how can we appreciate joy?”
St. John’s won’t hurt, if it seems to help. You can wean yourself off when you feel better. Don’t quit cold turkey. It can cause depression. Some people find that melatonin (sub-lingual) helps with sleep. Again, use it if you need it, but don’t become dependent. No one ever died from lack of sleep.
The anxiety is an issue that you will have to approach yourself. Social anxiety is treatable, but you may find that if you go to a few meetings and just sit without trying to interact too much to begin with that it will begin to fade. If not, I would try to get some therapy. Many of us started drinking because of social anxiety (yr. obdt. svt., for one) and it can be a trigger — besides preventing you from the joy of knowing others. There are drugs that help, too. We take them if we need them, but we always deal with doctors who know about addiction and recovery. Check with a few people at meetings for referrals.
The best exercise right now is walking. It’s low impact, gets you out in the fresh air and sunlight, and will do wonders for both your cardio and your mood. Minimum of 30 minutes every other day — 40 is ideal. Visit the mall if the weather won’t cooperate, but dress in layers so that you can add and subtract as needed, and any temp above zero is OK for walking if you cover your mouth and nose with a scarf.
Most importantly, don’t give up. You will improve. Things will get better. There WILL be bad days…those are the days you need to hit some meetings. Very few people manage to get sober and stay that way without support. AA is the best free deal on the planet for us drunks. DO IT!
Since you found Digital Dharma, I’ll pimp my recovery blog: http://whatmesober.com/
Keep on keepin’ on, take care, and stay in touch.
Bill
Hello! I have been researching a number of different health ailments attributed to the abstinence of alcohol and have finally concluded that PAWS must be what I have. Although, I would like to ask you a few questions since you seem exponentially more educated on the subject then I. Is it possible to experience the symptoms of PAWS and have never been addicted to alcohol? I assume the answer is yes. I don’t say that I wasn’t addicted out of denial but the fact that I could quit and take lengthy brakes from it, without a problem, at any time. But I do suffer from anxiety and figure that even though I was never full-blown addicted to alcohol that it still had an impact and my already sensitive brain. I have been alcohol free now for 6 months and the symptoms (much the same as you described) are gradually improving. I am a 25 year old man, who eats a very healthy diet and works out constantly. Does it sound possible that something like PAWS could be the culprit behind what I am experiencing? My symptoms basically match those you described to a “T” save for the short-term memory loss. I did even experience coordination problems early in my abstinence but that has almost fully returned to normal. So then is it possible that PAWS is what I suffer from even though I am almost certain I wasn’t addicted to alchohol (though when I did drink I’d drink to the point of blackout)?
Thank you for your time,
Bill
Dear Bill,
According to the DSM-IV, an alcohol dependence diagnosis is:
My own definition of addiction in general is something that you keep on doing despite repeated and escalating problems.
It really doesn’t matter whether you were technically addicted or not. What is important is that you have decided you need to stop, and what has occurred since. Although I certainly cannot diagnose PAWS in your case, I would say that the duck theory applies: if it looks like a duck, quacks like a duck, etc…. Your description of your drinking, especially the part about drinking to blackout, indicates that you were drinking quite enough, on a regular basis, to set up the changes in your brain that lead to PAWS down the road.
I’m glad that your symptoms are beginning to abate, and that you are taking care of yourself. You are fortunate to have escaped primary withdrawal symptoms. I suggest that, if you get an urge to drink again, you remember that blackouts are one of the signs of developing dependence, and that if you choose to drink again there is an excellent chance that you will in fact become completely addicted.
You should also know that the neurological changes that take place in our brains when exposed to alcohol over time are not completely reversible, especially for those of us who got lucky and have the genetic predisposition for alcohol dependence. There is a lingering effect that makes rapid progression likely if we drink.
Good luck with your recovery. Keep in mind that there are other forms of addiction as well — such as exercise — and that we need to be careful that we don’t simply transfer our dependence. Endorphins are exceptionally powerful drugs.
Regards,
Bill
Bill, This is Chris a couple articles above. Im now clean for couple months now. Question – I wake up at night with having to urinate on top of not sleeping great anyway from PAWS. I know from my opiate use it made me constipated and when I was using I was able to sleep all through the night without having to urinate.
Is this urination issue a PAWS problem? I dont think I have a prostate issue – Im 38, healthy, athletic, Ive been walking running literally 3 miles a day with a little weight training and great diet too.
Hi Chris,
Good to hear from you again. CONGRATULATIONS on your two months!
You’re way outside my area of expertise when you start discussing urology. That said, you are certainly rather young to be having prostate trouble. I am unaware of such problems being commonly associated with PAWS; however, everyone is a bit different. My GUESS is that there is some kind of infection involved.
I would discuss the matter with a urologist. You are certainly doing all lthe right things (assuming that you also have a support group), and it may simply be that the drugs were masking symptoms. Be sure to come clean with the doc regarding your past. It may help him make a diagnosis.
Let me know how this plays out,
Bill
this is my 6th day of abstinence from opioids.This is my second time withdrawing and i withdrew cold turkey ….didnt take any medication except cetrizine for runny nose.I didnt eat fearing diarrhoea for 2 days and now all the acute symptoms have subsided and am eating 3 meals a day.Some how the acute withdrawl this time around wasnt as bad as the first time.i had abused for 18 months stopped for a month and felt terrible so went back to using it again after 30 days.Now I am dreading PAWS.I knew about PAWS but didnt think it would be that bad and i am so disheartned to learn that this will stay with me for 2 years.But this time I am quite determined to stay off it as my life has still some meaning and fortunately I havnt lost much .My family is intact and my wife as supportive as she can be.
All that youve written is very intresting especially about meals and exercise and I plan on keeping a routine based on what youve said .I hope to write to you again .Am very fragile and weak at the moment so i say i hope because i am not sure.But i pray ill be able to write to you again and be able to say thanx .it was great its working for me.
Dear Deja,
There is no guarantee that you will suffer from PAWS for two years. If you do what you need to do to take care of yourself — including support groups and a diet/exercise/sufficient sleep/multivitamin regimen, there is good reason to expect that you will avoid a lot of the problems. Just be sure not to get sloppy when you start feeling better, and be prepared for the fact that some days will be better than others. That’s how life works.
Remember that addicts who try to do it alone often end up doing the old stuff — alone. Get some support. And keep on keepin’ on. You can do it. A lot of us have.
Bill
Thanks so much for this very vital and helpful article! I have been drinking heavily for 30 years since my first binge session at 17 in college. Unfortunately, none of my family or friends really seemed to notice and while I had some bad things happen, I never really hit the proverbial bottom and have always been somewhat functional. Even now they are refusing to accept that I have a problem. Just maintained a low level of living and existing for all that time. I asked the universe for help and it just opened up and gave me the strength to start the long journey back to my true Self just one month ago. I now feel like Sleeping Beauty or Rip Van Winkle awakening from a long sleep. I look back on all the decisions made in my adult Life and realize that most of them were made in an alcoholic brain fog – from the men I dated and thought I loved to the career moves I did or didn’t make. It’s definitely a weird mental place to be in as so many years have passed and I would’ve done almost everything differently. Do not have insurance (am currently unemployed), so am detoxing at home by maintaining healthy diet and taking supplements. Main PAWS symptom are that I am sleeping a lot sometimes up to 13 hours a day and sweating (but that may be hot flashes
). I am somewhat concerned about more serious signs of PAWS popping up later as I really can’t afford to have long term withdrawal symptoms ’cause I need to get back to work. Does everyone who has long term addiction get PAWS later or just some folks? Also, having non-alcoholic beers and greatly crave sweets, so have chocolate daily! Is that ok? Feel like after all this time, those things are far better than alcohol so not beating myself up about that right now. Should I be?
Dear Cheryl,
Thanks for writing, and congratulations on your successful first month! The worst is behind you, both figuratively and literally, although there may be times in the future when it doesn’t exactly seem that way.
I’ll comment on several things, in the order you mention them. First of all, don’t worry too much about the sleeping, just don’t let it become a habit. If you are not incorporating exercise into your program at this time, you REALLY need to do so. That will help stabilize your body’s clock, help stave off any depression, and help your body do the rebuilding that is necessary. You don’t need to get carried away: a 40 minute walk every other day — more often, if you can fit it in — is all you need. Start slowly, and as you begin to get in shape you will naturally speed things up. The important thing is to pay attention to the time. Fifteen minutes of brisk exercise does not equal 40 minutes of continuous gentle exercise, for our purposes here. If the weather where you are does not allow outdoor walking, go to a mall. (Just make sure that you don’t do too much window-shopping; keep walking.)
Doing the things outlined in the article will do as much to prevent any more severe symptoms as can be done. You have beaten up your body’s systems for decades (as we all did), and it needs time to heal. When you feel able to go back to work, that’s fine. But don’t stop taking care of yourself. One of the odd things about us humans is that we’ll do what it takes to feel better…then we stop. Very human, but also pretty dumb.
Craving sweets is normal, but try to ration them so that you don’t binge and get too much sugar. Pay attention to the remarks on nutrition in the PAWS article. You should know that alcohol beats up the body’s ability to deal with sugar, and one of the first things you should do after you can afford it is see a doctor for a complete physical including a glucose test for diabetes. The good news is that the exercise, good diet and supplements are also the recipe for reducing glucose intolerance. Ration your sugar carefully. Chocolate is a treat, not a meal.
Not to put too fine a point on it, “non-alcoholic” beer is, at best, a mind-f**k. At worst, it can trigger a desire to drink. For one thing, beer can be listed as non-alcoholic with up to 1/2% alcohol content. That is not alcohol free, and people in recovery need to avoid all alcohol possible. But just as important is the fact that you are fooling yourself into thinking you can continue to do the things you used to do…you just can’t drink. That’s a recipe for disaster.
The fact of the matter is that you can now do all sorts of things that you couldn’t do before, now that you’re clean and getting sober, but there are a number of things you can’t continue. If you keep on doing what you used to do, you’ll keep on getting what you used to get.
Finally: you are not employed, and have plenty of time on your hands. You need to get to some AA meetings, whether you want to or not. It is nearly impossible to stay clean and sober without support, and you are obviously not going to get it from your family, who seem dead-set on feeding your denial. With the support of AA, your odds are between 25 and 50%. Without support, they are vanishingly small. Don’t bother writing about your excuses. We’re talking about saving your life, and there are no excuses. Here is a link to a site that lists practically all the meeting information in North America.
Again, thanks for writing and letting me be a small part of your recovery. Stay in touch. You know how to find me.
Bill
Hi,
Thank you for this article.
I never drank alcohol and never used street drugs. I was an accidental addict thanks to a doctor.
I was put on Zoloft for symptoms that turned out to be a severe undiagnosed ferritin deficiency ( iron stores in the cells ). Instead of iron, I was given this SSRI for my symptoms.
Then I found it nearly impossible to stop taking the SSRI without severe withdrawal symptoms…..problems I never had until I tried to get off this drug. So my doctor then gave me benzos for the SSRI withdrawal, and although I took less than the amount I was told to take daily, my body quickly became dependent on benzos! The withdrawal from that was even more brutal than the SSRI! I was in a very worse situation after being given these two prescription drugs than I was with just the undiagnosed iron deficiency. I truly felt like I was on deaths door.
I ended up in a detox hospital to get off 1 lousy milligram of Ativan that my doctor told me to take. I was forced to go to 12 step meetings and forced to say in front of a group of people that I was an addict. I cried, because I’d never touched a sip of alcohol or ever touched a street drug….and certainly never even got addicted to caffeine, gambling or whatever. Until I took these prescription drugs, I’d never been addicted to anything…..ever. But here I was, telling all these people my name and that I was an addict, and being told I had an addictive personality and this is why this happened to me. How the heck did I get in this situation?
Anyway, long story short…..I am now almost 4 years off any medication. But I still feel so physically lousy. Just plain awful all the time. And I know for a fact it’s because of what these two drugs did to me. I feel everything you described in the above article. Everything. A lot of neurological issues that can’t be diagnosed by doctors. Stuff I never had until I tried coming off this rotten stuff.
I was wondering if any of you have heard of this happening ( PAWS ) to people who became addicted to SSRI’s and/or benzos, and still had problems many years out. More importantly, is it possible to heal? I try to eat right ( I’m not perfect but better than I have been my whole life ), I refrain from any caffeine or medications of any kind. I try to exercise as much as I can, but I;ve become exercise intolerant because of this nightmare. It makes me feel worse and revs up all my symptoms.
I have turned to God and delved into my bible for spiritula guidance, but I’ve never felt more alone in my life. I truly feel God hates me for allowing this to happen
Dear Linda,
A tendency toward addiction has nothing to do with character, morals, or what one has or has not done in the way of drugs. It simply means that one’s brain is, for some reason, more prone to modification by chemicals than some other folks’. Some of us are just luckier than others.
PAWS after withdrawal from benzos is common, but it doesn’t last for four years. Benzos have been in use for over forty years, and I can find no record of symptoms such as you describe being associated with their low-dosage use. It is possible that the SSRI had a longer effect, but — again — after four years you should be in better shape.
You say that you have a lot of neurological issues that cannot be diagnosed by doctors, but you “know for a fact” that it is the drugs that cause your problems. Do you see the contradiction there? The drugs may have triggered a problem that was waiting in the wings, but they did not do this to you. I would find a competent neurologist who could help me sort out my problem. If there is a teaching hospital or large medical center near you, that is where I would look.
Blaming God is simply avoiding the big question: “What is the problem, and how hard am I going to have to work to overcome it?” The ball is most assuredly in your court.
“Relapse occurs long before we pick up; using simply makes it official.” That is something I need to remember – thanks Bill
Bill, In response – I did actually see my primary physician prior before taking the prescribed wellbutrin. 150mg a day is what ive been taking. I would suspect the anxiety I had was solely from the addiction – not from clinic depression/anxiety – although they wellbutrin may have helped.
From my experience before – meaning my experience getting clean before – I had the same anxiety not as bad, but I had some that ultimately went away without Wellbutrin. I guess I may have just answered my question.
Bill, I really appreciated your response/comments. The SUPPORT is CRUCIAL everyone!
Pingback: Kicking The Opiate Habit « DadOnFire
Hi, I [self-detoxed successfully.] My question is now – I decided to go on Wellbutrin for the depression that I have from the opiate addiction. Should I stay on the Wellbutrin? Based on what Ive read from the P.A.W.S information – Im questioning whether I should stay on it. I have noticed that my ANXIETY – has subsided – it was pretty severe before I started which was about a month ago.
–Please advise Thanks very much
ps. This is the best post/blog Ive read online by far!!!!
Dear Chris,
Thanks for the nice compliment, and congratulations on your determination and your successful detox. It seems that you came up with a successful protocol that worked well for you. Please understand that I edited it out of your comment only because I do not feel comfortable publishing specific detox information here, since it amounts to giving medical advice that I am not professionally qualified to evaluate. I was actually quite impressed.
Again, on the matter of medical advice, I can only tell you what I would do, were I in your situation.
First of all, you did not say whether you are under a physician’s care. Your remark that you “decided” to go on Wellbutrin makes me wonder about that. If you are, I would ask for a reduced dose to taper you and minimize the chance for triggering depression. As you are probably aware, stopping any mood-altering drug that one has been on for a while risks symptoms that are the reverse of those produced by the medication — depression, in this case.
Short of that, I would consider the exercise/nutrition/support group route, and see how I feel. I might then try reducing the dose of Wellbutrin by half — not by breaking the tabs, but by cutting down the daily intake. Breaking tabs can be problematic, as many drugs are formulated to be absorbed at certain points in the digestive process, and breaking them can subject them to stomach acid (among other chemicals and enzymes) that could affect their behavior — and yours. If the reduction went well, then I would again reduce, then cut them out altogether.
During the entire period, I would closely monitor my mood by keeping a journal and referring back to it as a check on my own judgment. If I found myself becoming noticeably depressed I would seek professional help — IMMEDIATELY if I had any thoughts of self-harm.
Remember one thing: it takes months to recover physically from addiction, and you are already off your drug of choice. That’s the biggie. I applaud your desire to be off all drugs, but it is always better to err on the side of caution than to take chances that could put your head in a place where it again wants to use.
Keep on keepin’ on,
Bill
Pingback: newly sober and going thru PAWS - SoberRecovery : Alcoholism Drug Addiction Help and Information
Pingback: Searching for answers... - SoberRecovery : Alcoholism Drug Addiction Help and Information
Pingback: communication in early sobriety - SoberRecovery : Alcoholism Drug Addiction Help and Information
Pingback: Hello! New with questions... - SoberRecovery : Alcoholism Drug Addiction Help and Information
Pingback: Feeling negated - SoberRecovery : Alcoholism Drug Addiction Help and Information
Pingback: long term withdrawals? - SoberRecovery : Alcoholism Drug Addiction Help and Information
I can’t believe it! Someone actually figured out this is a real feeling. I have been clean from opiates (heroin, oxycontin) for 2 months and 19 days and I thought time heals all wounds, but it seems the cravings have been happening more often and stronger. My friends think I’m crazy or selfish because I can’t seem to stop thinking about it, but I really can’t help it. It almost feels like a natural instinct you can’t control. Even though “I” want to get clean, part of me does not want to let go. I can’t imagine life without having some sort of comfort zone, for me…opiates were it. Letting that go is the hardest thing I have ever had to do in my life! Please keep this knowledge going and spread hope to more people that struggle with this disease. Everyone, keep going….We can get our lives back.
Peace.
Pingback: Need someone - SoberRecovery : Alcoholism Drug Addiction Help and Information
I have some advice for anyone on methadone treatment…methadone is extremely hard to get off of not only b/c of the medication but b/c of the idiotic rules of the clinics..for a long time i could not taper myself off since anyone with a high metabolism is going to experience the highs and lows of dosing once a day…my personal solution was to start slowly taking it throughout the day…simply doing that almost cut my dose in half right off the bat…after that i took 40mg poured it into a 100ml beaker and diluted it with water and then decreased the amount by 2ml a day until i needed a few days to stabilized and then i resumed the taper…once getting to a very low dose the taper needs to be slower (1ml) or diluted more…since they make you dose at the clinic you can easily screw up your entire taper…what i did was hold the dose in my mouth and just spit it out when i left, and when fearing i would have to talk i just casually spit the dose into my shirt while pretending to wipe my mouth with it…once your on 10mg a 40 mg dose is actually 4 doses and once u get down to a few milligrams you should have enough extra left over to taper without needing the clinic…of course I had my wife control the taper b/c when doing it myself i ended up tapering faster than what was comfortable and then falling backwards so it is much easier to have someone else control it by putting 10-20 ml of the diluted methadone into your drinks throughout the day that way you don’t have to think about it or see it….you must also be in the state of mind to want to get off.
Very impressive! Congratulations on your determination to become clean and sober. I hope you’re attending NA meetings to get some additional support.
The cooperation of government with the methadone detox industry is shameful. As you know very well, it is a longer and more difficult detox than heroin and the other opiates, and there are far more effective detox protocols. They call them “maintenance” programs for good reason. They maintain the addiction at full force.
If the government really cared about getting addicts clean, they’d open five-day inpatient detox clinics using buphrenorphine, followed by a month of intensive outpatient. That would save millions of dollars a year and actually get some folks on the road to sobriety. But that gets into discussions of the Drug War and Corrections Industries, which aren’t appropriate here.
Pingback: A question for those in recovery - SoberRecovery : Alcoholism Drug Addiction Help and Information
ma husbanb is going through ttis paws how can i help her pls give me tips
I appreciate your fear and concern. All the tips I know are contained in the article.
A tip for you, though: hit some Al-Anon or Nar-Anon meetings. There is much there that you can learn about helping both your husband and yourself.
http://www.al-anon.alateen.org/meetings/meeting.html
Pingback: Quick question about alcohol & brain fog - SoberRecovery : Alcoholism Drug Addiction Help and Information
Hey thanks for this awsome article.
I am 16 years old and I’ve been doing lots of drugs for the past couple years now.
I have been clean off of everything since 47 days ago and I’ve been having withdrawals for 38 days now. I can feel it’s getting better but I know it is a long horrible process that I must endure for my mistakes in the past.
Ive been eating mostly healthy and working out but now I am even more informed about what I should be doing from this article.
I wrote down alot of the steps and I’m making a scedual right after I’m done typing this..
Thank you for all the tips and advice. I will surely follow them until I am 110% normal again, and even so forth after.
Thank you again and I hope that everyone else going through the same kind of problems will recover and start feeling better soon.. =D
*While I was reading this I was already starting to feel better, how about that*
Hi Tyler,
Sometimes just knowing more about a problem can make it seem less daunting. I’m glad you found the article helpful. Of all the things I’ve written, I think I’ve gotten more comments and compliments about this one than any other (and I’ve written a lot over the past 50 years or so).
I am so pleased that you are feeling better. If you are not doing so already, hit some NA meetings. You’ll meet a lot of awesome people, and get even more useful information.
Keep on keepin’ on,
Bill
I have abused opiates on and off for four years. Went through detox two times when I had insurance, just from being so afraid of withdrawal. Went to counceling once. Of course my abuse continued to grow. I got to the point of being just sick of it. I quit and used a recipe I found online using vitamins an amino acids. I went to get change from my husbands “spare change cup” and found eight pills there (he takes them because he needs hip replacement). By the end of the night I had taken eight to ten pills out and took the pills over the next 24 hour period. This was on the 101st day of being clean. I am so disappointed in myself and feel miserable, but I am determined to pick up the pieces and move on. Had read a little about PAWS, but this article was very helpful to me. I realize I need to be in a program and will look in to it. I guess my question is, Have I lost the time of 100 days I put into sobriety, after a one day binge? Have I lost all recovery ? I so want to be rid of this deamon and your article has helped. Thanks, Deb
Dear Deb,
Quite the contrary: that 100 day investment may turn out to have been one of the most valuable experiences in your quest for sobriety. You now know that you cannot trust your disease. It is going to be with you — in spirit, as it were — for a long time. Recovery is about learning that, and learning to live without drugs.
Your picking up should have taught you three things:
*You must speak with your husband about keeping strict control of his medication so that you will not be tempted “accidentally” again;
*You need a support group that you trust enough to call and talk through urges to use, and that will help you learn to cope with life — comfortably — without using;
*Life goes on. Beating ourselves to death for being human and giving in to temptation is not productive. Learning from our mistakes is, however, imperative.
Relapse occurs long before we pick up; using simply makes it official. If we keep ourselves in a healthy state of mind and body, follow suggestions and generally live our lives as someone who is IN recovery, as opposed to someone who is thinking about being in recovery, we do not reach the state of mind that will cause us to pick up the random pill laying about the house.
As the song would have it, “Pick yourself up, dust yourself off, start all over again.” Except addicts have to be extremely careful about falling down to begin with. Sometimes we find ourselves unable to get up. The good news is, as long as we learn not to make the same mistake again (and, hopefully, none similar as well) we can profit from them.
I’m seeing some wishy-washy thinking here: “I realize I need to be in a program and will look in to it” needs to be “I will call and find the location of a meeting immediately.” PLEASE get to some meetings! You cannot do it alone. Your best thinking got you where you are, and you need some fresh input. The lifelong friends you will make in the process are a bonus.
Remember one other truism: Anything that you place ahead of your recovery, you will eventually lose.
Keep on keepin’ on,
Bill
Hi. I have been a narc addict for several years. I cannot tell you how many times I have done the 5 day cold turkey detox. Early spring of this year, I started taking Subs. I did not wean much and jumped off after just a couple of days of 8 mgs. I was not sick at all for the first 6 days, then hell. I was newly out of a 10 year relationship (still am) and that was my hook up for the subs and everything else. I used to deal with some wild abuse. Anyhow, I am not going back there. It’s been about 6 weeks without the subs and 3 and a half without anything at all. I took some vicodin thinking that would get me off the subs. Stupid, I know. Anyhow, I am not almost a month clean. I was about 6 months on the subs. I did go to a NA meeting. I did not really feel any better but I am still going. I am not experiencing all the symptoms, or I am minimizing them because they don’t compare the the clammy, sweaty, RLS ridden mess I was for a week. I sleep for 4 hours at a time and I am so tired all the time. My head messes with me. I have to talk myself into doing anything. I am trying to get out of the house everyday. This economy is killing my business and I need to get focussed but it is so damn hard. I am exhausted from it all and I just want to not feel lethargic. I am taking vitamins but it doesnt feel like its helping. I am trying here. I am trying. I need help.
Dear Tracy,
The article includes everything I know about PAWS, and all the tips I’ve picked up in 20 years of sobriety. It’s the best advice I can give you, and the best part of the best advice is to go to meetings, share where you’re at, and tell those folks you need help. You will get truckloads of it.
Don’t sell the people in the rooms short. They’ve been where you are now, and they’ve gotten through to the other side in one piece. Their advice is golden. Stay away from the guys and stick with the women.
Apart from that, hard as it is, keep taking the vitamins, eating as well as you can, and take a half-hour walk every day if at all possible. Your body is in the process of repairing itself, and you need to give it the materials and stimulation it needs to accomplish that.
You can’t expect to recover from years of chemically modifiying your nervous system overnight. It took years to mess it up. Things don’t work that way. But you’ve come a long way, and it’s much better than it was. Have faith that it will continue to get even better.
Keep on keepin’ on,
Bill
hey mayb sumone here can help me out, iv read probably everything there is to read on paws and suboxone withdrawal..i used painkillers for about 4 years and been on suboxone for about 1 and half..im 23 years old..while on suboxone i turned my life around and began fighting mixed martial arts and just all together staying away from bad influences and dont even drink…i stopped my suboxone 18 days ago..i jumped off at 2mg a day..i kno i should have tapered alil more but i had the courage to stop that day and i wanted to take advantage..my sleep still isnt there i get about 4 hours a night..i cant focus..so i cant train because i will get hurt if im not on my game…my main questions is is smoking pot helping or hurting me…i find it has helped me eat, sleep ,and relax..i make myself lift weights and run everyday..i was curious if anyone knew anything about the effects of pot on a recovering brain .any help would be appriciated…”damaged people are the most dangerous becuz they know they can survive”
Dear Joey,
If you are using pot, you are not in recovery and neither is your brain. Recovery means abstinance from all mood altering drugs, to allow your body and brain to return to something like normal.
Sorry, but that’s the way it is.
Bill
PS: As a martial artist of 40 years’ standing, I can tell you that grass will seriously screw up your arts. Do the right thing.
hi bill
wow what great info , i am 3 yrs next month and have been told all about PAW for all of my recovery , but did not really take too mch notice , until now , due to lots of changes and stress i am currently suffering , but of course i have been doing all the wrong things i have been eating hocolate for braekfast , no exercise and not teling people how i feel , so now i know what i have to do , thanks natalie
Your letter, like most of the others, makes me feel privileged to have been able to help. Keep on keepin’ on!
Bill
Great information and probably the best i have found in recent search for help with info on withdrawl.I,m a alcoholic and feel like my life has been a 30yr hangover.I work on cars at a Chrysler dealer and the hangovers really hurt now at 53yrs of age.Sometimes i think i will just fall over and die and have to go hide in the Men’s room or go lay down in my car with air on for awhile.I am having some success for the past few months in slowing down ( Going 4 or 5 days in the work week without a drink but hit it hard on the weekend and end up lying on the couch most of the weekend recovering)Smart i know in my heart i have to move to the next step of total recovery as i have found out that my daughter is a Herion addict and she is coming to stay with me a try to become clean. She was in NY (i,m in FL)with her mother going to college and started dancing in a strip club and got started on pain pills and then herion.Today she went to a Suboxone doctor and got a script for the drug up in NY.I have set it up for her to see another Suboxone doctor locally who is also a supposed “Addiction Guru” that comes highly recomended from various people in the Drug recovery field.I don’t know what she is going to recommend for treatment as we are to meet when my daughter shows up. Reading the advice here it looks like Suboxone is not the best treatment option.I’m scared as hell and have my hands full and feel a life change coming.
Dear Dave,
Suboxone works well for short-term relief of withdrawal symptoms, but is not the answer long-term. Total abstinence is needed to allow the brain’s receptor cells to return to normal. As long as they are being stimulated, either by opiates or opiate antagonists, no changes will occur.
The same is true of your drinking. Recovery means that the brain has a chance to return to normal — or as close as it will ever get — and then we need to learn how to live without drinking. Both require total abstinence and some help from folks who know what is needed.
I suggest inpatient detox for both you and your daughter if that is possible. If not, at least try to get it for yourself, since alcohol withdrawal is dangerous if not medically supervised. Then you both need support — ideally through treatment, but lacking that from AA and NA.
You did not say where you live in Florida, but fortunately there are a lot of treatment centers and meetings in most urban areas of the state. If you are fortunate enough to be in Palm Beach or Broward Counties, there are literally dozens of treatment facilities, including county-run free ones, and hundreds of meetings a week.
This is not a time for half measures for either of you. The only way to get clean is to do it wholeheartedly. Otherwise you’re just setting yourself up for another failure, and none of us drunks and addicts need to chalk up any more in that department.
Like the AA book says, “Rarely have we seen a person fail who has THOROUGHLY followed our path.” On the other hand, those of us who have been around for a while have seen thousands fall by the wayside because they just couldn’t let go of their own ideas and do as they were told by people who knew what they were talking about.
Good luck to you, and to your daughter. You have a long hard row to hoe, both of you, but there are plenty of folks willing to help if you will seek them out.
If I can be of further help, please feel free to contact me via the “Contact” tab at the top of the page. Be sure to include your email address, as I have deleted it from this posting of your comment.
Bill
Pingback: Post Accute Withdrawl Syndrome - PAWS - What do we know so far? - SoberRecovery : Alcoholism Drug Addiction Help and Information
Pingback: SoberRecovery : Alcoholism Drug Addiction Help and Information
I am writing about paws because the article is all over my condition like white on rice. I have been on heroin, methadone,and valiums every day for over 31 yrs. and drank whiskey every day for about 22 yrs. on top of all of those. I quit alcohol, methadone and heroin all at the same time and had very rude awaking for quite a while, but nothing compared to the valium withdrawal i’ve been going through for the last 16 months. I literally thought i was going to lose my mind, for almost a year it was like a bad acid trip. Non stop. My tension was so great it felt like my eyes were going to pop, like a band was strapped around my head, the muscles in my face were very tight and most of the time I was breathing very heavy and my heart about to jump out of my chest. I was having trouble distinguishing between fantasy and reality. I thought that everybody could see the way I felt by only looking at me. This started to go away for minutes at a time, then hours, then days and weeks at a time. I know it would get very overwhelming and feel like lightening ran up my spine when something stressfull came up. I stayed at home for a year after being in the rehab for three months. I didn’t know how to walk,talk, took an hour to get dressed and so on. I went to an AA meeting about seven months and had to get up and leave after about 5 minutes. Enough rambling, it still gets pretty scary sometimes and I went back to work and and on my 9th step with my sponser in AA. I figure that therapy and time will heal as much as possible but I may deal with episodes off and on the rest of my life ,the problem is you never know when they are coming. I am blessed to be alive, in descent physical condition and have a good family who quit enabling me long ago but still care about me. thanks for having a place that i could vent. Mark
Sounds like a tough trip, Mark. Perhaps some of the tools here will be of help. Sure hope so. You deserve some success after all that.
The following comment was presented for post today. In the process of doing so, I inadvertently lost it. I’m presenting the email notification version below, with all identifying data removed.
THANK YOU -THANK YOU_THANK YOU!
I am grateful that I went on the internet to search “recovering addict symptoms” tonight and found out about PAWS! I have been going through ALL the symptoms, extreme mood swings, emotional breakdowns, can’t deal with stress, anhedonia, etc. I’ve been sober 55 days and the last 4 have been “bad days” or a PAWS fit per say. I’ve read how the 30/60/90 6 month/ year -and incriments like that tend to be the worst for these symptoms. I WISH that councelors, psychologists, and people in recovery would spread the word! I know now that I am suffering from PAWS and that is NOT a reason to relapse! I’ve been to a number of professionals, treatments, meetings and never heard of this- but now I feel much better about my recovery. I need to cut the caffeine intake too!
WOW! And I just thought I had used so much that my punishment was to be crazy throughout my clean time.
Someone at my home group mentioned PAWS and I poo-poo’d it. Then I was sharing some of my feelings with my sponsor and he mentioned it. So I thought I would look it up and came across your website
I couldn’t believe how text book I am. Especially the muddled thoughts. I just cannot concentrate on anything for any length of time. Most days, I feel like I’m just able to put one foot in front of the other and try to finish what is in front of me and not think about what else there is to do.
I am holding on and know that “this too shall pass”. I cannot express how pivotal it is for me to be attending regular meetings and sharing openly about what crazy thoughts and dreams I’ve been experiencing.
If all goes well, through the grace of the universe, I will pick up a six months key tag on the 15th. That is the longest I have ever been clean in 21 years of using and, I believe, a testament to the power of surrendering to the moment.
Thank you for you site.
Namaste
You’re most welcome, Chas, and namasté right back atcha.
This article has gotten more comments, here and elsewhere, than anything else I’ve written by a wide margin. Apparently there are a lot of folks in the same boat as yourself. Been there myself, in fact. Come the 14th, Bog willing, I’ll pick up a black tag, and a 20-year medallion from the “other” fellowship.
Keep on keepin’ on. As they say, it’s mostly a matter of don’t use and don’t die.
Bill
Thank you so much for providing this information. My therapist told me about P.A.W.S. just yesterday, and we started to discuss HALT and tactics for my life. However, in a one hour therapy session it’s a lot of information to process and try to figure out how to make viable. I am so grateful to have this website as a resource!
The past six months I really felt like I was losing it, and that was AFTER the sobriety. I thought I was permanently high or something, and that I had some serious brain damage! It’s good to know that there is a real syndrome I am experiencing and that so many others have experienced and been able to work through P.A.W.S. I’m sad to realize that I really have caused such siginificant damage to my central nervous system, but I am glad there is hope.
With a little hope and a little faith I think anyone can battle addiction and have a chance of making it alive. At least that’s the theory I’m running with — Thanks again for the insightful information.
Dear Courtney,
It’s good that you are seeing a therapist. We have many little twists in our thinking that need an opportunity for straightening. Talking to someone who will make sure we stay on track is the surest way to take care of that.
I hope that you are also taking advantage of what the 12-step programs have to offer. They are not the be-all and end-all of recovery, but we need the association with and understanding of those who have also been down our road, and the structure of the program is quite complementary to the help that you are getting in therapy.
Keep on keepin’ on. I, and many others, are living, happy proof of what can happen when we surrender and realize that we can’t live our lives alone in a bottle.
Best wishes,
Bill
Pingback: Uncertain times... - SoberRecovery : Alcoholism Drug Addiction Help and Information
Pingback: Short Attention Span - SoberRecovery : Alcoholism Drug Addiction Help and Information
Pingback: A Comment From the PAWS Article « Digital Dharma
Bill -
You most certainly may use my comments – excerpted or in their entirety. Your message is vital to those of us who have encountered speed bumps on the Recovery Highway!
All The Best -
Dan in Las Vegas
I succumbed to the Madison-Avenue hyperbole spewed by a storefront Suboxone-peddling physician. This doc assured me that my years of opiate abuse/dependency would dissipate in a mere two weeks with this wonder drug. Granted, while on Suboxone I felt wonderfully well; afterwards, however, my spirits crumbled as I began to feel worse than I had during the peak of cold-turkey withdrawal. Of course, he dutifully advised me that I was experiencing PAWS – and for an additional $800 in cash I could enjoy another two to four weeks of Subox. I gallantly and charmingly declined.
My relapse was all but inevitable. Eights months later (after a literal drive-by intervention) I entered a medical detox facility and then was assigned to an intensive outpatient program three times per week, three hours per day for 24 sessions – attached thereafter to a one-year aftercare program. This process has been life-changing for me. And right now we are “working” on the skills and strategies to understand and soberly cope with PAWS. Who woulda thunk? The group’s facilitator is an LADC who focuses a huge amount of therapy time on helping her clients understand PAWS and its propensity for leading to relapse. Not only does she make us dig deeply to uncover our original motives for “using,” she guides us and prompts us to do the work necessary to cope during recovery.
There is hope out there. To all who now suffer, understand the pain – instead of trying to cover it. In so doing, you improve greatly the chances that your tomorrows will be improvements upon your “today.” Indeed, this, too, shall pass.
My Most Positive Thoughts to All –
Dan
Dear Dan,
Thanks so much for your well-written and pointed comment. The Suboxone racket is the biggest scam to hit the recovery world since Methadone, or worse, because just any licensed physician can prescribe it, with no expertise at all. Both can produce nearly miraculous results when used properly — Suboxone the better choice — but as they are being purveyed (I almost used another word beginning with “p”) they do the vast majority of their recipients a gross disservice. Put simply, there is no…NO…substitute for education and skilled therapy, or at least a support group.
With your permission I would love to post this on the front page. Please get back to me if that’s OK, with caveats, if any.
And congratulations on both your good sense and your recovery.
Bill
Great artical, I am going to show this to my Dr. I am currently on Subutex and xanax, I want off, but find it almost impossible to get off of the subutex. I was dependent on pain meds for a short time, under 6months and now have been on subutex for over 2 years. Was put on the xanax the last time, I tried to free myself from subutex. Its an awful drug to get off of.
Thanks for the great info,
C
Dear Clever,
Please assure your doctor that, despite my frequent comments about most doctors not knowing enough about addiction and detox, I emphatically do not have it in for GP’s and other family physicians. My own dear personal GP doesn’t know squat about it, admits it, and listens to me when I explain to him why certain courses of treatment are not options for me.
Addiction is as complex a field as any of the other neurosciences. No one can be expected to understand everything about medicine, and much of the confusion with family practitioners is the fault of pharmaceutical companies that are more interested in leading them down the garden path than in providing them with good, solid information about the medications they are being peddled. A physician who is seeing twenty or more patients a day cannot be expected to deal with all their aches, pains and misconceptions and at the same time stay up-to-the-minute about every area in the field of medicine.
Physicians receive, for practical purposes, no training in addiction while in medical school. Even psychiatric residencies are way behind the curve in treatment theory and protocols. The fact is, no one who is not devoting the lion’s share of her practice to addiction study and treatment is able to stay on top of the field. In a way, it is amazing that so many do as well as they do.
Best wishes to you, and to your doctor, and the best possible luck (and skill) in your recovery…
Bill
I’m a physician, 25 months into recovery from alcohol addiction. I would like to pass on my congratulations to you for a well written, understandable, explanation of post acute withdrawal syndrome, and your well thought out responses to the questions or comments made by people visiting the site.
This has been one of the most useful site I’ve come across in my web searching of sites on addictions.
Dear Dr. Karen,
Thank you so much for your kind remarks.
I journal, and have done so for many years. Thus I have not only my own memories and those of my close supports, but my jottings to jog my memory. When I was writing PAWS as a handout for a lecture series (and, again, I must give Terry Gorski credit for much of the basics), I tried to address the things that had puzzled me and caused me trouble in my own recovery — as well as the issues I had seen confronted by people in the treatment centers where I worked. It seems to be useful to some folks, and is by far the most-read bit of material on this and my other sites.
Congratulations on your own recovery. I’m sure it is difficult for a physician to face her own infirmities, and it takes a lot of guts to admit a problem and address it as you have done. I hope that you allow it to illuminate your practice, when you return to it, and that you will become one of those rare creatures that I refer to so often in the comments above: a physician who understands both the reality and the most effective protocols for treating addiction.
Regards,
Bill
I have been off suboxone now for 45 days with no clinical observation and have believe I am going through PAWS for sure. I am 26 years old and come off other drugs, some like Klonipin were monitored while others like oxycontin were not. However none of these have caused the same long term withdrawl period or PAWS which I am experiencing now. I read the whole article and believe I need to change my diet. The part of hypoglycemia is especially intriging to me as I have noticed I feel far worse after eating to much sugar or drinking coffee (even worse when using both together, IE a white chocolate mocha from Starbucks).
What worried me is when you wrote, “We really need to get this thing under control! Hunger produces stress. Blood sugar swings produce stress. Stress aggravates PAWS and, as we have seen, is deadly when combined with hypoglycemia—which is caused by poor eating habits, especially by too much sugar and caffeine. Are we beginning to see a trend here?”
Exactly what do you mean by deadly here? I constantly worry about my health because of PAWS and when I read this my anxiety shot through the roof. Is it deadly because it could cause us to relapse or because the combination itself is deadly in some way?
Dear Chris,
The “deadly” remark was meant to be figurative (unless a person is diabetic, in which case it could be literal over time). And of course relapse can be deadly as well.
You are the first person to bring the possible confusion to my attention, and I thank you for that. I will change it forthwith. If you misinterpreted it — or found it ambiguous — then others could as well. Thank you.
I hope you’re going to meetings and getting some support. It makes it much easier. However, if you are having emotional swings related to sugar and stimulants, I can almost guarantee that following the protocol I outlined will also alleviate a lot of your stress.
Remember two things: relapse=stress=relapse, and that stress is not always from unpleasant things. One of the most stressful things, for example, is getting married. When things get exciting, we need to be especially on our guard. New relationships are another pitfall, because they are not only stressful, they tend to make us defocus from our recovery priorities.
Thanks so much for writing. I will change that wording instantly.
I just found your blog on the google search engine and saw a few of your other posts that you had done . I just added you to my Google News Reader. Keep up the great work. i will Look forward to reading more from you again.
Very nice information. Thanks for this.its great to see someone with a like mind.
I received a response on my personal e mail today. It was helpful and I appreciate it. It’s perfectly OK to respond to me via the site here. It may help someone else.
I am 90 days sober, attend meetings twice a week, am 64 yrs old. I am using 2 – 1.5 mgs clonazipan daily to help my withdrawal. Am I substituting one drug for another? Or as my physician claims can I back off the clonaz easily by reducing dosage gradually. Thank You
First of all, Rod, let me say that there is no such thing as “backing off the clonaz easily.” Clonazepam is a powerful anticonvulsant, and the withdrawal syndrome can include life-threatening seizures, along with other less-serious issues. It is not recommended for use beyond nine weeks even as a seizure or panic disorder treatment without close monitoring, and is normally prescribed for alcohol detox for only a few days to get past the danger of seizures (and that is “off label” use).
You are far beyond the therapeutic use of the drug in alcohol detox.
Detox should be monitored by a physician with experience in detoxification from anticonvulsants. Try to find a doctor or nurse practitioner who is associated with a treatment center and familiar with the detox protocol for Klonopin.
As to your underlying question, that is not for me to say. My personal feeling is that at 90 days the exercise, fellowship, good diet, vitamins, blood sugar control and working the 12 steps should deal with the withdrawal. We can’t argue with success — you are 90 days sober. However, if I were your sponsor I would suggest getting off the tranquilizers cautiously but expeditiously. If for no other reason, should you have a medical emergency the Klonopin could complicate your other treatment.
Finally, congratulations! I too am 64, and enjoying wonderful health and a great life because of my 12-step program and the benefits it has given me. I spent my 45th birthday in treatment, so I’ve been sober for a while and I can tell you that it does keep getting better if you work a good program and let life happen.
Namasté
I’m an alcoholic/addict with 2 years sobriety, from a long line of alcoholics. I wish I had known about PAWS while I was going through it. My sponsor thought I had ADD and need medication. I just stayed close to my program worked my step etc. and made it through
. My question is about my oldest sister, age 62. While she is not an alcoholic addict in the classic sense, she does have all of the “isms” 20 years ago following a devastating divorce went on prozac, then an ever widening array of psych “meds” , getting farther and farther off the deep end. Last year her medicine cabinet was an addicts jackpot Long story short she decided to, medically supervised , wean off of all her prescriptions. Now at 9 months clean, she can’t sleep, can’t think, has anxiety attacks and now fears that she is bipolar. She is not mentally ill and 20 years ago as this nightmare began she had damn good reasons to be depressed. She had no tools to deal with her pain other than her doctor. The saddest thing about her story is that she is muddling through all of this virtually alone because she doesn’t see herself as an addict. So I guess what I want to ask is can prozac detox cause PAWS?
thanks
Terri K.
You have said that your sister’s medicine cabinet was an “addict’s jackpot,” and that she had to “wean herself” off all the prescriptions. To me, that indicates that she may be an addict experiencing PAWS. I don’t know that the Prozac even has to be considered in the mix, although there can certainly be a rebound from that, as well.
Her physical and neurolochemical balance has clearly been scrambled, and after 20 years of it, it is hard to say what her condition might be. One does not recover from 20 years of immersing their brain in drugs without some long-term problems, regardless of the source of the drugs and whether or not they were “legal.” If this were a member of my family, I would encourage her to see a doctor who is truly expert in addiction and psychopharmacology. They are not, unfortunately, thick on the ground. You might ask a few of your friends in the program if they know of anyone — just collect recommendations, and ignore the advice — and do a bit of research. Then all you can do is suggest a visit, and hope for the best.
It sounds as though she is ready for some help, but it is extremely important that she get the right kind. If she finds some doctor who is willing to accept her self-diagnoses, she could end up back on the same bandwagon.
I am an alcoholic and have been in recovery for 5 months (serious drinking for 20 years – 40yr old Female). I went to a 30 day inpatient facility and just finished my intensive outpatient therapy.
There are good days and bad days, then there are good weeks and bad weeks. I have an AA sponsor and attend 3 – 4 meetings a week.
I have been on the relapse threshold for the past few days. I know the mental part of relapse is as bad as the physical. I have not picked up but have been tempted to so I could escape. Escapism, one of the many ism’s in an addicts life.
Even with the education, treatment and the support system I have there are still many occasions where I feel like I am going crazy. Asking when will this obcession, craving STOP.
When I get like this I research, I read and get as much information as I can. I do not have the strength to start over if I relapsed, so relapse is not an option.
My point to this post is I am very well versed with PAWS and normally when I start having the symptoms I recognize it. I did not this time and was probably the closest to relapse I have been YET. I found this article, read it and was able to take a deep breath and sigh of relief. I am with the writer above where I did not get sober to be miserable. As long as I know or can some what can explain what is happening I can continue. I know with PAWS my brain chemistry is trying to restore itself from all of the years of abuse. This I can live with because I know that it is progress.
I thank you for this article as you have restored my sanilty for the moment. I can now use the old AA adage’s of this too will past and one day at a time.
This article is like the one sentence at a meeting that you hear out of all the words spoken that can get you through to another day. Thanks very much for this and the hope
and guidance you are sharing with those in need.
- Tammy
“The Power of the Mind can Defeat anything there is.”
I can’t tell you how much it pleases me to get this sort of comment. My wife, who is a detox therapist, also teaches PAWS and gets the same kinds of responses. Clearly, the insistence of some folks in the rooms that all you need is the Steps is misguided. Information is what scares away the bogyman, not some crochety old-timer like me.
Your note humbles me, and it is good for me to feel humble. It’s rare enough.
THANK YOU SO MUCH FOR TAKING THE TIME TO WRITE THIS ARTICLE AND THROW IT OUT TO THE PUBLIC! I will always rememeber reading this and you will be in my prayers of meditation and in the far future when I look back on how absurd drug addiction (not caring about it and just doing “sh@t”) truely is.
Many mandalas to you sir!
-Tim
And good luck and life to you, sir!
Namasté
I have been off tramadol for 60 days I was taking 400mg for two years for abdo pain drs pxn before I realisd the tramadol was actually causing the abdo pain. I detoxed on a programme where I tapered methadone for 5 days then they sent me home–after I got home it was hell but I persevered. However 60 days later I still only sleep 3 nights ot of 4 have stomach cramps regularly feel tingly all over often and have restless legs most nights. It is consderably better than it was but I would really like to go back to feeling normal. Do you have any idea how long it will take? I have never taken any other drugs and take only buscopan occasionally for stomach cramps now. If I have a glass of wine or a coffee it seems to make it worse–is this possible? Your advice or experience would be much appreciated. Thank you.
Sixty days seems long to be having even sub-acute withdrawal from tramadol. Although several of the symptoms you have described are part of the normal withdrawal syndrome, they can also be indicators of other conditions, including diabetes.
I would suggest a complete workup and physical from a competent physician — not the one who kept you on an addictive drug that failed for two years to alleviate the symptoms it was prescribed for. If for some reason you cannot afford a full workup, at least get a good blood panel including a fasting blood sugar.
You’ve come a long way. Hang in there.
I enjoyed this article immensely…. I do have a few questions though. Most of the information that I have been reading about PAWS, says that “long term users,” or, “heavy users,” will be affected. I am curious as to what is classified as a “heavy user” or long term user.”
I have been drinking for several years. I sobered up a 2 times for over a year each time. The last year or so I have been drinking, until extremely intoxicated, about 2 or 3 times a week, give or take. I was sober for about three weeks. I fell off the wagon a couple of days ago.
Do you think I culd be a good candidate for this syndrome. I have all of the symptoms. (but then again I have all the symptoms of half of the diseases on the net!) HE HE!
Dear Diane,
This definitely qualifies as both heavy and long term, especially since I imagine you have been maintenance drinking in between the frequent binges. That most likely means that your system has seldom if ever been free of alcohol for the last year “or so” — and possibly more.
Obviously, the longer we drink the more we damage our bodies and the longer it takes them to recover, if they ever do recover completely. However, the issue is not how long we have been drinking, nor for that matter even how much we drank. Rather it is whether or not our bodies had the opportunity to change in the ways that cause us to require alcohol in order to feel normal. Once we have reached that point, we are fully addicted.
It is not up to me to call you an addict or alcoholic, especially since I do not know you. But you described a series of events that conform to the pattern of a person who is addicted to alcohol, including the attempt to quit and the failure to remain abstinent.
You have shown that you were able to go “cold turkey” at least once without severe withdrawal symptoms. That does not mean that it will happen the next time. I suggest a medically-supervised detox, but that is entirely up to you. Be aware that alcohol detox, sans medication, can lead to severe seizures and/or blood pressure spikes that can be fatal. Ethically, I must mention that.
I also suggest inpatient treatment, but that may not be an option in your case. If it is, I would take advantage of it.
By whatever means, get to some AA meetings. We need the support of people who have been there and done that. Open up to them if you can. There are probably women’s meetings someplace in your area if you would feel more comfortable, but if you live in rural Canada you may have to settle for what you can get. When it comes to recovery, any AA is 100% better than none. If you will go to meetings and do as they suggest, and also follow the outline in the article, you will have an excellent chance of success in your search for sobriety.
Namasté
HELP!!!!!!! Eight years ago my husband injured his back… numerous docs prescribed pain meds (began with Ibuprofen 800 then escalated to Narcotics!). For years he had been taking Ultram (Tramadol) thinking it was “innocent”.. however was up to 20-30 50mg pills a day when the MAX dose was 300mg/day! He claimed docs said it was his “tolerance” he had developed to this drug – which made sense to me. He is also a 6’2″ 200lb man! Innocently, I went on accepting that his doctors said it was “ok” for him to get it on the internet because our insurance wouldn’t pay for the large prescription.
IDIOT ME!
After the amount of money he was spending to get this medicine really stressed our pocket book to the point of us not having $ to feed our four kids, I had to do something! I had let it go too far, by trusting he had this under control. I would question why he wasn’t getting it from his doctor etc… he always had a good reason why and I fell for it. Then I started to do research on this drug… found out how bad it was and that people were getting addicted. Tramadol is a non-narcotic and my husband had me convinced that it wasn’t hurting him. How could it? I would research and find things and present them to him and he wouldn’t listen. Finally got to the point of telling him I was going to start going to the doctor with him. He would say that was fine, but then when it came down to it, he would change the appointment or lie to me about going or say he couldn’t go etc… or even coming to me saying he was afraid that I would embarrass him in front of the doctor by bringing my concerns about the meds from the internet and that I would be “telling” the doctor how to do his job. After a while, I realized this was not right! I tried to get my husband to talk to me, but he just kept feeding me lies and I kept giving him the benefit of the doubt… I guess I was in a bubble thinking he would never lie to me or hurt me.
So one day, I was DONE! I marched myself and our 3 month old baby into the doctors office after leaving 20 messages trying to talk to the doc about this… first it was HIPPA, then my husband said he signed a release to talk to me, then they “lost it”, etc… excuse after excuse! That day changed my entire life…. that day I found out not only was my husband ordering excessive amounts of Tramadol from then internet (hiding it, lying, picking it up from fed ex, having it sent other places…) he was also taking NORCO!!!!!!!!!!!! In his chart he had informed the doctor that he had been taking Vicodin/Norco/etc… for the past 8 years!!!!!!!! Hmmm! So he told ME he was on Tramadol and told his docs he needed a narcotic! TAKING BOTH AT THE SAME TIME!!!! IN EXCESSIVE AMOUNTS! He would go see numerous docs to get Rx’s and get different types of drugs so that insurance would cover them… but I had NO IDEA!
Anyway… told him get help. We went round and round about this…. he kept saying he would, then I would find out he bought more drugs etc…. until it came down to me giving him an ultamatum (sp) —- get help either in-patient, out-patient, psychiatrist, or GET OUT! This was negativly affecting our four young children and I was not going to stand for the lying, manipulation, emotional mess any longer! I had to protect our children!!
He refused to go to detox — so we agreed on a compromise — Suboxone therapy. He seems to be doing “OK” on this.. as far as I know, he has been just on the Suboxone… but he gets wierd about it too… counting pills, hoarding pills…. I am reading posts and freaking out about this! Few reasons —–
He has been on Suboxone for 4 months now — 16-20mg/day. Scared about the “replace one drug for another thing”… but we were assured by the doc that it would not be the same thing….
Also — BIG ONE! He seems to have PAWS to the EXTREME CASE!!!!!!!! With 4 kids, me working part time from home and attending NURSING SCHOOL FULL TIME, he has pushed me over the edge! The moodyness, the emotions, the attitude, the overreaction etc… etc… I can NOT handle it! I was told when I started nursing school — if you can, move back home with your parents, but you all need to quit working if you want to be successful in this program! UM… yeah, I am 33, married with 4 kids… I am not moving back to my parents (are you insane!!!!!) and I can’t quit work!!! Unrealisitic! He has become worse than all 4 kids combined… the needyness, the drama — example — a few weeks ago, he had a very small cut above his lip… I would say maybe 2 MILLIMETERS if that! His face was smooth like he had just shaved that morning… I assumed he nicked himself shaving and didn’t mention it. He blew up, flew off the handle, told me I was completely insensitive, I didn’t care about anyone but myself, etc…. because I wasn’t concerned enough to ask what happened! First thing you should be able to tell by my personality… 4 children and I have wanted to be a nurse my whole life — those kinds of people are not insensitive! You can not be a nurse or a mom successfully and be insensitive! That is just ONE of MANY MANY instances!!!!
So my question — after the novel — is this…. anyone have any clue what I am supposed to do here?? I have let my husband trick me into believing that I am the one with the problem, I am the one who needs to get therapy and I have agreed!!!! Only issue is that I have no time to even pee, where will I find time to see a psychiatrist???? I guess I could spare one of my 3-4 hours of sleep I ONLY get each night, if I am lucky! Now I am concerned with the Suboxone … if my husband is having PAWS and STILL taking Suboxone… how much worse will it get when he is weaned from Suboxone???? If PAWS can last up to 18 months… will he have s/s of it while taking Suboxone and then even worse when he is weaned off???
Any advice… I am willing to listen/try!
Dear Karin,
It sounds like you find yourself caught between the proverbial rock and hard place — not unusual, in fact quite the contrary, for codependents.
The bottom line, once we sift through all the addict-speak and concerns is simple.
You need to take several steps:
Finally, ignore any promises, protestations, prostrations, pathetic pleas and all the other manipulative letters of the alphabet from your husband. He is terrified of getting off the drugs. He has no doubt already experienced the terror of withdrawal, and he cannot be blamed. He will do and say whatever he needs to avoid that, which is his greatest fear. Those of us who have been addicted understand and sympathize with him, but his instincts have been warped to the extent that he will do whatever he can to protect the status quo. Ignore his preferences. Find out what you need to do, and do it.
Bless you for being strong and faithful. Now it’s time for the hard part — the part that seems so unfaithful, but is so essential. It is his only hope — and yours — if you want to get back to normal.
Namasté
i have been feeling “foggy” and not myself, i have been 11 months sober… could this be related to PAWS?
It is certainly possible. I suggest discussing it with your sponsor and at a few meetings. Give your sponsor a copy of the article. Following the suggestions listed, even if it’s not PAWS, can never hurt. Finally, if you begin to feel depressed or otherwise unable to function normally, please see a physician who is trained in dealing with recovering people.
Finally, approaching anniveersaries are notoriously a time of relapse, and relapse occurs before we pick up. Redouble your efforts in the rooms. Get active. Help another drunk or addict. Do some service work. Start going to a new meeting to kick start some new aspects of recovery.
Good luck!
is there such a thing as paws from SSRI’s?
Thanks.
Dear JAS,
SSRIs are usually prescribed for specific neurological disorders involving imbalances in brain chemistry. I would think there would be a rebound effect of some kind that would be detectable, but I have no specific knowledge about that. Since the effect of SSRIs is to increase the supply of serotonin, I wouldn’t be at all surprised if sudden cessation couldn’t lead to depression, among other things.
If someone you know has ceased taking medication, they should be under the care of a physician who is knowledgeable about these things. If they are doing it on their own, or under the supervision of only a family physician, I suggest they speak with a doctor who has received special training, such as a specialist in psychopharmacology, or at least with a pharmacist.
Good luck.
I would like to say that I used Suboxone very short term to come off opiates. First, I would like to say that I began taking opiates “innocently”. I have a Masters Degree, I am married to a very successful attorney, I don’t smoke or drink!! At the age of 30, I had a damaged nerve, began seeing a neurologist and was prescribed Oxycodone. From the very first time that I took opiates, I knew there was the possibility for trouble. I felt wonderful and euphoric. I had all the energy in the world. But as most of you know, things changed rapidly!!! I began abusing the pills, taking them when I wasn’t in pain. Taking much more than was prescribed, etc. The next thing I knew I was lying to my doctor to get my prescription filled early. Frequently visiting urgent care centers and faking injuries. Calling my dentist and claiming that I had tooth pain. Fortunately, I never ended up buying them on the streets from dealers but believe me I wasn’t far from trying!! I made several attempts at cold turkey and was so ill that I couldn’t even lift my head off my pillow. I too am a professional and can’t miss work. So to me, cold turkey wasn’t an option at the time. Fortunately, I have several friends in the medical field that introduced me to a Suboxone doctor. I went in and saw him, and on my first visit I had to be in full blown withdraw!! Man did that stink!! I had to run in the bathroom during my initial interview to have diarrhea, it was very embarrassing. The doctor reassured me and administered the first Suboxone pill and within 20 minutes, all withdrawal symptoms stopped. However, I did a very rapid detox from Suboxone. I was only on it for 2 weeks!! That is the key with Suboxone and I believe where people are going wrong with it!! I started with 4 mgs my first day and rapidly went from 2 to 1 to 0.5 to literally tiny pieces of the pill and came off completely!! Its been 16 months and Im clean and sober!! Yes, I have my bad days where I feel tired or depressed but I just think about the horrendous life that I had while I was using and understand that I would never go back there!! Ever!! I went from 200 mg a day of Oxycodone to Suboxone for 2 weeks and then off. The only withdrawal that I had when I completely stopped the Suboxone was a little diarrhea but I have IBS so that could have just been my condition. I strongly recommend Suboxone for SHORT TERM USE ONLY!!! It can be addicting like any other opiate and why trade one addiction for the next?? I am not a doctor and this is only my opinion, so please don’t be angry with me if you don’t feel the same!! I just wanted to tell my story with the hope that it would help somebody else that is suffering from this horrible addiction!!!
I agree with you absolutely. Thank you for sharing your experience and pointing out the benefits of Suboxone when used in a skilled manner by a conscientious physician. It is unfortunate that many of the physicians doing “office detox” do not fall into those categories. Those of use who have worked in detox settings have seen more and more instances of full-blown Suboxone addiction, due to the ministrations of storefront detox clinics (and a Suboxone detox is just as bad as a heroin detox, only it lasts longer).
It is even more unfortunate that this drug which, used properly, could end replacement therapy, is instead now being touted as a “better” replacement drug than Dolophine (Methadone).
hi
i have every symptom you have listed above they all started about 3 weeks after i quit i had a withdrawl first that lasted about 2.5 weeks i then started to feel better , then all of sudden i just clicked into this weird state racing repetitive thinking thoughts going around and around no concentration i i could not focus on anything i thought i was going mad i had never exprienced anything remotely like this in my life before as i said i have had every listed symptom but it has got slightly better over time . the drug i was addicted to was cannabis ! have you ever heard of someone getting paws from cannabis addiction ? i have searched the net trying to find someone who has had paws from weed but i have found nothing . it makes me wounder if i have paws , but i tick every box in terms of symptoms and everthing else . also i am wondering if it will ever go away i have had it for 6 months now help!
Thanks for writing, Brian.
There is a lot of discussion over whether or not cannabis causes withdrawal per se. I think the entire discussion is beside the point.
Whenever we change our brain chemistry over prolonged periods there is going to be a period of adjustment after we stop, during which our emotional state will generally be the opposite of however the drug made us feel. Since THC leaves one relaxed and drowsy, we can expect a period of manic feelings and behavior for some time afterward. Generally, the period is longer the longer we have been using. You did not mention how long nor how much you were using, but I suspect quite a while and quite a bit. Sometimes this is simply our perception of the real world when we’re not “slowed down,” and sometimes it is an actual physical readjustment of brain chemistry, or a combination of both.
I cannot begin to diagnose your problem since, first of all, I am not a physician and, secondly, even a physician who is trained in chemical dependency could not make an accurate and ethical diagnosis without interviewing a patient and perhaps running some tests.
So understand that these are layman’s remarks. Having said that, two things come to mind: first of all, I wonder if your initial attraction to cannabis might have been related to self-medication of a condition undiagnosed — and perhaps unrecognized even by you. If there was a pre-existing condition, and if you were self-medicating, the condition may have worsened during your heavy use, and may now be manifesting more strongly.
The other thing is, how well are you taking care of yourself physically? Recovery from any addiction takes a big toll on the mind and body, creating stress which in turn takes an even greater toll.
I suggest that you follow as many of the guidelines in the article as your are able to. In addition to that, I suggest that if the symptoms do not begin to improve soon, you need to see a physician who has training in substance abuse, who can perhaps help you piece together your medical condition and see if there is something that needs attention.
With regard to the suggestions, pay particular attention to nutrition, exercise, and getting enough rest. I also strongly suggest a 12-step program like NA, if you are not already attending. These things are much easier to bear when you have the support of folks who have been there too.
Good luck, and remember that as uncomfortable as you are now, you have already gone through the worst of it. Keep on keepin’ on!
Bill
My husband is tappering off of subutex. He is very scared of the PAWS. I have read the article and stress will make the PAWS worse. Are there any vitamins other that the multi vit. to help with the PAWS. Can he get throught this? Have you heard of Low dose Naltrezone. I hear I helps with natural endophins production.
Please help. Thank for your article I know this will help.
lisa
PAWS occurs after detox. Acute withdrawal, when possible, should always be monitored by a skilled physician.
Withdrawal from buprenorphine, a synthetic opioid, is similar to that from any other opiate, except that (like methadone) its longer half-life tends to make withdrawal less severe unless it has been heavily abused. That doesn’t mean it is fun. Hopefully your husband is under the care of a physician who is competent to supervise detoxing patients.
Following the steps outlined in the article — even if it’s the last thing he feels like doing — and toughing out the several days after he takes his last dose is probably the safest course medically (although, I hasten to add, I am not a medical doctor and this is therefore a layman’s opinion that is worth exactly what you’re paying for it). This is one of those situations for which there is no magic elixer. The body is readjusting from a condition it has been in for a long time, and it takes quite a while for it to repair itself and get back to something like normal. He could double up on the multis, being always sure to take them with meals. Vitamins are food, and they are not absorbed properly unless taken with other food.
Addicts, of course (and I include myself), are people who, almost by definition, think it isn’t OK to feel bad. We have trouble getting the idea that everyone hurts, from time to time, and that we usually get over it. We want the answers NOW. Trouble is, apart from the above, I don’t have any. I realize this isn’t what you were looking for, but I do not bullshit about things I don’t understand, and I’ve told you all I know.
Good luck to you and your husband. I hope you’re hitting some NarAnon meetings and that he is attending NA. It helps.
Namasté
Thank you so much for taking the time to read through my thoughts ….it seems like this subject tends to shut people down- the wall goes up before the first sentence is even spoke. We take a stance and try not to waver, but we never really HEAR someone else’s reality. I am as guilty as some of the people I have accused of this!
Thanks again.
(ps-I agree completely on your take of faith based treatment)
I will never understand why the phrase “insanity is…” (we all know the rest..doing something over and over and expecting different results) …..is used so often in MAINSTREAM addiction treatment…..and then it’s applied to EVERYTHING in our lives EXCEPT the “treatment” which is offered. How many is TOO MANY times at “treatment” before it’s insanity as well?
If PAWS seemed endless to us the FIRST time we tried the “traditional” treatments, why on EARTH would we expect it to be better the next time around? And the next…….
I am sure my posts seem argumentative. However, that is truly not the case. I just keep hoping that some DAY I will post something like this, and someone out there who works with addicts (or is one) will understand the point I am trying to make about what we offer as “treatment”. We tell addicts that they are sick and they have a problem with brain chemistry…they are JUST AS SICK as someone with epilepsy or cancer (as your posts prove by showing what happens PHYSICALLY to an addicted person who’s brain chemistry is now forever altered)–and then we prescribe a treatment we would NEVER consider “real” treatment for ANY other type of disease.
I worked for much of my adult life in a substance abuse counseling. While there I watched the revolving door of addicts who showed up time and time again begging for relief from their “affliction” (which was PAWS in the rawest of all forms) and time and time again I watched as the SAME thing was offered to them as “treatment”….”your sick, but your sick because your selfish, spirtually weak or just plain weak.” or “you have to WANT it more” or “your brain is changed forever, but all you have to do is come to this meeting and be as honest as you can be about what a bad person you are and you will be magically healed”…….
Time and time again I watched them become homeless, jailed or die…..because why stop using drugs if you feel just as miserable OFF them as you do ON them?
Thanks for listening.
I believe that you are absolutely right. What seems to have been misunderstood about my remarks, which may have been phrased unskillfully, is that I meant only to refer to the practice of using opiate maintenance as a substitute for impatient treatment, support, and psych meds if needed, thus prolonging the dependency and keeping patients in close association with people who are questionable supports. There are drugs far better suited for opiate detox in a clinical setting, which is how I believe the issue should be addressed.
It is also my contention that many physicians who position themselves as addiction specialists know virtually nothing about addiction, and about as much about mood-altering drugs and psychopharmacology. This is almost universally true of family physicians, and of many psychiatrists and psychotherapists as well. I have seen far too many patients and clients who took 96 hours to detox from their drugs of choice and weeks to do so from drugs prescribed by physicians who do not understand that the first step in stabilizing brain chemistry is to safely remove all chemicals, if possible, to create a baseline. The protocol of piling one drug on top of another is another of my pet peeves, and a practice all too common in the medical industry. This is an area where incompetent help may be worse than none at all, regardless of the source. Witness the current plethora of storefront “outpatient” detoxes using Suboxone.
That said, I am (as was Bill Wilson) 100% in favor of “outside help” when it is needed. In fact, I once made my living being outside help. I do not, however, believe medication and/or therapy are enough. That’s where the support and assistance in rebuilding a life and relationships that is found in the 12-step programs comes in, and support of that kind is absolutely essential, whether or not it is obtained in the 12-step rooms or elsewhere, in my less-than-humble opinion.
The point of my insistence on 12-step recovery is that after looking at a great many programs I have yet to find another platform that offers (a) support that is based on an inside understanding of addiction; (b) has worked for so many people; and (c) is non-religious. They may exist, but since the purpose of these pages is to direct people in directions that I know to work from my own personal and professional experience, it would be just as irresponsible for me to speak to those as it would be for me to be pontificating about addiction if I were not a recovering addict. (I am also a firm believer in the concept of addicts making the best counselors, although I have known brilliant exceptions to that rule.)
I am not anti-religion, either, although I am personally agnostic. My position on religious treatment programs is that most of the religions with drug and alcohol outreach are proselytizing faiths, and I don’t care for the ethics of pushing specific beliefs on people who are emotionally needy and vulnerable to subtle coercion. As a practicing Buddhist, I consider that sort of thing not only unethical, but to be distracting people from the reality that they need so desperately to embrace in lieu of the addictive dreamland. There is plenty of time after they have their feet firmly on the ground for them to seek out organized religion on their own.
Thus, I suspect that we are mostly on the same pages (except, perhaps, regarding the methadone). Thanks very much for your input.
Dear Kerry,
There are too many possible reasons for your malaise for me to be able to answer your question. In addition, everyone’s brain chemistry is slightly different, and that complicates diagnosis and treatment at a distance. It would not be ethical, nor to your benefit, for me to speculate.
Having said that, if you have no physical disabilities that prevent it, a good multivitamin morning and evening, combined with a good diet as outlined in the article and some light exercise, like walking, might help. It would also help to go to a few meetings, get a sponsor, and begin helping others. Finally, if all of those things seem impossibly difficult, there is a good chance that you are suffering from depression and you might consider seeing a doctor who is familiar with recovering people and their problems. No doubt the detox that you attended could supply information about that.
Congratulations on your success so far! Methadone is the devil’s drug, as you certainly know, and methadone maintenance is society’s way of saying “we don’t really give a …. about those addicts.” Stick with the people in your 12-step program, and with the suggestions of your physician (provided, as stated above, he understands addiction and psychopharmacology; most family physicians and many psychiatrists do not). If you don’t have a program, call NA and ask for help.
Keep on keepin’ on…you can do it. I did.
Bill
Hi, I am 4 weeks from my last dose of methadone. I was weaned off it in a detox centre. I am still in so much paws, and have abosolutely NO energy at all. I am wondering how much longer this no energy will last. I have to push myself to just get up and go to the bathroom. I am a 50 year old woman… I just want to feel somewhat normal again! Thanks.
Thanks so much. I have been sober for eight weeks and for the last week and a half (after going back to work) I have had pain and shakes and headaches and depression. I haven’t started working the program but am starting IOP today (I know I am late). I am so glad I came across this site because I was beginning to think was experiencing something out of the ordinary. Now I know that this is common and there are things I can do to ease my discomfort and help me stay sober.
Thanks alot
I was on Klonopin l.5 mg daily for 7 month. Was side stepped to valium for a 6 1/2 month taper (dr. assisted) I was also on cipralex l0 mg and was taken off that after the benzo withdrawal. Felt wonderful for four months during which time we moved but then BAM in January I felt like hell – all the symptoms of PAWS and have had very few days where I feel ok. I long for my life as it was several years ago before my breakdown. I am 56 years old and otherwise healthy. I don’t know why I am experiencing this now. The taper was realatively easy. My gp has put me on l0 mg of cipralex to help with the anxiety. I have been on for 6 weeks with little relief. Please help before I go crazy. I don’t drink or smoke and as I say, have been healthy except for the last year of benzo hell. Thank you so much. Lynn
Dear Lynn,
I am neither a physician nor a psychopharmacologist, but my guess is that the crux of your problem, in addition to your obvious physical and emotional turmoil, is the expression “gp.” The bare fact of the matter is that general practitioners are not trained to deal with emotional problems and psych meds. There is a great deal more to it than a few seminars, reading medical journals and package inserts.
I realize this is not the sort of help you believe you needed, but it is the best help that I can offer. Psych drugs are for psychological and psychiatric conditions, and general practitioners are not qualified to treat them. Bottom line.
Your county medical society should be able to put you in touch with a physician who is qualified to treat your condition. Please don’t wait too long to look for additional help.
As to why, who knows? Our neurochemistry changes as we age, and exposure to psych meds works its own changes.
Please see a specialist.
Best of luck,
Bill
Thank you so much, icredibly well written. I am in recovery from alcohol – almost three months now. I was ready for the depression, that passed as I worked the steps in AA, but I’ve had alot of anger lately that has been threatening my sobriety. You’ve helped me understand much of what is happening – and made me think about ways to be a little more pro-active about stress levels at my job. Stress levels are going to remain high, I need to manage myself and my tasks better- I tend to procrastinate then its a stressball (I learned to do this from my boss, he’s the king of it). Cutting back the coffee would also be good.
Thank you! Makes it all worthwhile.
Good fortune in your sobriety. Remember that adage: “Anything I put ahead of my sobriety I will lose.” It’s too, too true.
bw
Thank you for the much needed advice. I’ve been off of suboxone for four weeks now after being on for a year and a half. I could have stayed on it for life – my doctor was fine with it. I wanted off as soon as possible. Now I feel lousy. I’m so tired I can barely get up in the mornings, much less function throughout the day.
I found my way to addiction though doctor’s advice (pain pills for headaches), and now I fear I’m in for another rough ride through this “PAWS.” My doctor has prescribed adderal to get me through the work day. I work 70 hour weeks and am not sure how else to get through. I will certainly give some time and attention to what you’ve suggested.
It’s too bad suboxone is billed as such a “miracle.”
Thank you -
You are most welcome.
Suboxone, used properly in a clinical detox setting by specialists trained in its use is, indeed, a miracle drug. Like methadone, however, when used by unskilled practitioners or as a political tool instead of a clinical aid, it carries with it its own set of problems as serious, or nearly so, as the drugs it replaces.
Please know that Adderall, an amphetamine similar to methamphetamine, is not approved for giving people enough pep to get through the day when recovering from addiction to another drug. First of all, Adderall is indicated in cases of adult ADD and narcolepsy, not low energy. Second, it is a highly-addictive drug in its own right, when used improperly. Thirdly, it is a highly dangerous addition to an addict’s brain chemistry because — odd as it seems — it keeps activated many of the same neural pathways that are involved in addiction to depressants, including opiates and alcohol, thus increasing the length of time necessary for the neurological response to return to something like normal.
Most people newly off opiates or other pain medications find that reduced stress, exercise, support from others and treatment for the depression that often follows secondary withdrawal — by experts — is the most effective way to avoid the worst problems with PAWS. The 70-hour work week is a highly dangerous situation, but I’m sure that you see no way to reduce your efforts to human levels.
I suggest a physician whose specialty is treatment of recovering addicts; one with a strong background in psychopharmacology, combined with a 12-step support group and a program of nutrition and exercise.
However, I am not a medical doctor.
I am at ten months and am feeling paw symptoms. How long does this last at ten months?
Hi Rebecca,
Thanks for your comment. PAWS varies with every individual. It depends on individual brain chemistry, our physical condition, how much and what we used, the stress we’re under, whether we’re eating properly, going to meetings, making sincere attempts to get our lives back in order, improving our self-esteem, and so forth. Following the suggestions in the article will help, especially the blood sugar, exercise and vitamins.
A good sponsor and a good home group, along with working the steps will give us support through the hard times. We didn’t get addicted overnight, and we don’t get well overnight, but it does keep getting better. Not every day, but on average, if we stick with our program of recovery it gets better.
Hang in there.
–
Bill
Wow, what brilliant information! My sister is a recovering drug addict, I think is still using some Suboxone, and I know she is going through PAWS as she is almost 50 days clean. This helps explain why she is experiencing all of these symptoms around my family and I right now. I will make sure and pass this along to the rest of my family, and maybe even her! Thank you so much!!
Suboxone is a synthetic opioid, similar to heroin and other opioids, except that it also includes nalxone HCL, a narcotic antagonist that prevents people who take it intravenously from getting high. When it is used to reduce cravings for heroin or other opioid drugs, the user must be tapered off slowly — preferably in a clinical setting — and once clean can begin an active program of recovery.
Your sister needs your support, and your encouragement to attend 12-step meetings. Perhaps you could be a good example by attending a few NarAnon or Al-Anon meetings yourself.
Absolutely awesome information! I was unaware that PAWS can last so long. I am nine months off of Suboxone, a horrible drug, and still feel lousy much of the time! I didn’t have any idea that how I feel currently had anything to do with PAWS as I didn’t know that it’s duration was so extensive. I suffer from almost every symptom you mentioned. I actually thought I had a health problem totally unrelated to recovery. Not knowing what you suffer from can be a horrible nightmare and just adds to stress levels. I am also in the middle of a bankruptcy and house foreclosure which, based upon your explanations, just adds to the problem. Thanks again for the extremely enlightening article as it alone has uplifted my spirits! It’s nice to know that there is a reason for the way I have been feeling!
WOW! Thank you so much for this enlightening article. I have almost 6 months off of alcohol, opiates, and benzos, and I related to everything you said. EVERYTHING.
The first few articles I read online about PAWS were very clinical and just stupid. But you “know your stuff”. Thank you for this service. Like you said, just knowing why I am feeling so crazy helps immensely.
-Kathryn
P.S. – I am going out at lunch to shop for healthy food because I see now how much my diet (mostly cereal, caffeine, and breakfast muffins) has contributed to my mood swings and just my general weirdness. I doubt I will never be un-weird, but I can try.