For those of you who don’t know, I also write the blog for Sunrise Detoxification Centers (Sunrise Detox Blog). I think there’s some pretty good stuff there, so go to the blog and look around the categories if you’re interested.
If you have questions about PAWS or other aspects of addiction and alcoholism, PLEASE feel free to use the comments section of this page, or the contact link at the top of any page. I respond to all questions. If I don’t have an answer, I’m good at referrals.
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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.
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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.
More annoyed now this happens to me. My mind races, have severe anxiety, and im in fear. I recognize this, and i deal with it with meditation. Just relax in your own way. The only thing i hate my breathing seem so tight. But anxiety tightens everything up. You have been clean for a year and your still having bad symptoms? How often a month, and how many consecative days do you get this?
Just a note, Wes. It’s not uncommon for cannabis users to have prolonged post-acute symptoms.
Hey Radha.. i am experiencing the same thing with PAWS. I freak out there is something wrong with my body.. i know it’s anxiety trying to get the best of me. .this will go on for some time, around 10 days.. then subside for 3 to 5 weeks.. i have improved greatly from october.. and im hoping all i need is more time. Another thing is, i feel like im suffercating, my breathing is over analyzed.. like ocd. It’s a bit of rigid thinking. I have a bit of generalized anxiety, i don’t like being in public anymore during paws. I know this should subside, im still in early recovery.
I’ve hooked up ekg units at my university, and my heart is fine.. but i freak out something is going wrong. I am about the same age as you. My memory is still not perfect amongst other problems that deal with paws. So i know i have ways to go. Meditating works for me.. close your eyes and relax. Be around positive peopleved ones
Just as in bill states in his section. My paws hits me now, and im more annoyed my mind
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I have had a laparoscopic surgery to have my kidney stone removed last year (PCNL). I forgot to add that. Sorry.
Thanks.
Hi Radha,
I’m sorry to hear about your health problems. I know of no way that cannabis could have caused them, and your symptoms were certainly consistent with kidney problems. Congratulations on getting off the marijuana and hash. As you have discovered, the many statements to the effect that cannabis is harmless are pure baloney. I’ve seen too many people suffering prolonged PAWS after quitting to buy that.
Regarding your anxiety about your body: I am not prepared to say that it is not related to PAWS, but there could be other emotional issues involved as well. Therefore, all I can tell you is that if it is PAWS-related, the issue should slowly resolve itself. I suggest that if the anxiety continues to worsen you might want to consult a physician about it. Anxiety, when it is not drug-induced, tends to worsen rather than abating on its own. It could prove to be a real problem.
Overall, it sounds like you have a great attitude, and I would expect you to respond to treatment well. Regarding medication: some of the commonly-used antianxiety medications are addictive, principally the benzodiazepines (Ativan, Valium, Xanax, etc.). There are others that work well. I suggest discussing any medications with a pharmacist as well as your physician. Doctors mean well, but most of them know less about addiction than I know about high-energy physics.
Take care of yourself, stay in touch, and
Keep on keepin’ on!
Bill
Thanks for replying Bill. I have been meaning to ask you one more thing, is it also attributable to marijuana withdrawal and PAWS that I pms more and my hormones have gone haywire and I am hardly sexually aroused… Its getting better every month but do you think these things are related? And one last thing, is it normal to experience fatigue even after a year of quitting? I mean i am a lot less fatigued than before but still not as active as i was when i was still smoking the greens. Thanks a ton in advance for ur time and patience.
Hi again, Radha,
I’m no endocrinologist (heck, I can hardly even spell it), but there has been some mention in the literature of loss of sexual appetite. As far as I know, there is no connection with PMS nor with gross hormonal changes. The one could, of course, be aggravating the other in terms of symptoms. Certainly the depression associated with PAWS could affect both arousal and energy levels.
Some folks have found that capsules of soy extract seem to help with the discomfort of PMS. As always, check with your physician before using any so-called “natural” remedies if you are taking any prescription medications. It’s a good idea to research carefully anyway. Just because something is “natural” does not mean it is necessarily harmless — and there’s nothing natural about plant extracts anyway.
As long as things are getting better, I wouldn’t worry too much about it. Continue self-care, and try to have a bit of fun.
Bill
Dear Bill,
Greetings from India. So I have smoked Marijuana and Hashish on a regular basis for two years and then I was out of college and got myself a job and with a lot of determination I decided to cold turkey. I was off of it for a week and then on my birthday I smoked a joint and weirdly my ankles and face got swollen. I did not attribute it to the joint, I went and got an ultrasound instead and everything was fine except that I had a 1.2 cms big stone in my right kidney along with a really bad UTI.
I decided to quit for good and it has been over a year since I smoked my last joint. I have gone through the acute and yes I am still dealing with the post acute withdrawals. What started as anxiety trips have now transformed into a constant fear that something is wrong with my body. I get better and these thoughts vanish but when they do come I invariable end up feeling like I have cancer or something and rush to the hospital and touchwood I have all my systems working fine.
Anyway, I just wanted to let you know that I have come out of all of this without any help. I am much much saner than how I had started a year back. Although my question to you is, will I get completely better like how I used to be or this is how I will be? I mean I am not the chirpy bubbly girl I used to be before I started any of this. I am twenty five and very positive. And since I have come this far, I am hopeful to get like how I used to be.
Thanks
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Thanks for your reply, I had no idea where you were corresponding from, how could I.
I found your blog while trying to find info on PAWS. Your site is extremely informative and due to you experiencing addiction I trust what you have to say more than I do from someone who only knows about it through theory.
You were able to answer the questions I needed and couldn’t find anywhere in my own city of Toronto, Canada. It also helps to read that other people are experiencing it too.
I also take a benzo for sleep and have for 14 years, will this also keep the chemical pathways open like marijuana because I’m not planning on going through a withdrawal of that drug right now, if ever, after what I’ve been through the past 8 months. My last question for you is if I keep smoking marijuana will PAWS will not go away.
Because of you I did go to a NA meeting yesterday.
Thank you for this site, it has helped me a lot.
Hi Eve,
The PAWS will go away, but will likely return if and when you stop using marijuana. The same is true of the benzos.
The benzos concern me more, because (depending on the exact drug) their acute withdrawal can be life-threatening. That means if they were interrupted for some reason — say you were in an auto crash and your current medications were not accurately communicated — you could have a real problem. The manufacturer’s literature for every single benzodiazepine drug clearly states that they should not be taken for prolonged periods except for very specific circumstances involving specific drugs and conditions. Every doctor should know that. Very few seem to, or else they ignore it.
On the other hand, withdrawal from cannabis — apart from the depression that frequently accompanies its post-acute syndrome — is not life-threatening, although it can be prolonged and unpleasant. Ideally, neither would be an issue.
Parenthetically, I’d add that detox from benzos, done properly, does not have to be especially uncomfortable. I’ve been there, too. It’s the PAWS that can really suck (to use the technical term). My personal opinion is that you have to go through several months of PAWS once, if you’re getting off drugs, so you might as well do it all at once instead of repeating it for each drug.
Thanks for your compliments. They’re what keep me going on this thing. Good on yer for hitting NA. Give it a fair chance, and you won’t regret it.
Keep on, etc.
Bill
Hi Bill
Thanks for you websites and all of your responses. I’d like to get your advice about my situation even though I know what you are going to say because it’s all in your article. But I’d still like your advice because I’m still having a hard time even going on 14 months of sobriety. I smoked pot for 15 years and drank beer along with smoking cigarettes for that time also. I first gave up cigs, and then let the beer drinking go, and finally gave up the weed, which I thought I’d never quit. That was 13 months ago. When I sobered up I felt great and full of energy (after the initial withdrawals), but for the last eight months I have felt depressed and very low energy. I have been to the doc to get checked out and things are basically good. The part that I know you’ll say I need to improve is my nutrition because I eat out mostly and don’t get the nuts and fruits and greens that I should. But in the past I didn’t feel this down and tired eating worse, and I’m kind of hoping that it’s PAWS because that would be a nice easy answer, but I know it may be other things too. I have been doing AA for the last 4 months, and I have been playing half court basketball at the Y three or four times a week, which both really help. But the feeling of low energy and depression just keep hanging around. I don’t have the motivation to cook and eat right, and that puts me in a catch 22. Well let me know what you think, I appreciate any advice you may have.
Hi Ted,
I thought for a minute you were my brother, who pops up in my comments sections from time to time.
Depression is a normal part of early recovery. It will come and go for the next few months, and then most likely level out into normal living. If it doesn’t, there are medications that work pretty well. In the meantime, if you are not taking an antidepressant already, and if you are not taking anticoagulants such as Warfarin, try some St. John’s Wort extract. Take 500 to 600 mg. a day for the first two or three days, then if you don’t feel better double the dose. Don’t start at the higher dose. Some folks get dopy if they don’t give themselves a chance to become accustomed to the drug (and it is a drug, don’t kid yourself — just not a harmful one). For the best results, take it in the morning and then eat breakfast. Don’t bother popping caps throughout the day, because the herb doesn’t work in the short term.
Like prescription antidepressants, St. John’s takes time to build up and have an effect — although not usually as long as the prescription drugs. If you are on any other prescription drugs at present, ask your pharmacist if there might be a conflict, and take her advice. Your pharmacist is your friend. They’re drug experts. Doctors aren’t, and often know less than they might about the action of the drugs they routinely prescribe. This is a natural outcome of having to stay on top of a complex branch of science while still trying to run a practice and see patients. Talk to your pharmacist.
Ease off on the b-ball for a couple of weeks and take long walks a couple of times a week instead. The gentle exercise will give your body a chance to catch up, and it will likely help you sleep.
That’s about all I can tell you. Let me know how things go, and
Keep on keepin’ on!
Bill
I’ve been on opiates for the past 10 years for chronic pain due to fibromyalgia, arthritis and coccydynia. For the past 3 years I’ve been on Methadone (37.5mg tablet/daily). In August of 2011 I started a taper of 5mg every two weeks. On November 20/2011 I took my last dose of 2.5 mg. The past 8 months have been absolute hell, more specifically the past 20 weeks post Methadone, I completely understand why anyone could relapse. I haven’t slept more than 4 hours a night since October, the anxiety of withdrawal is like nothing I’ve ever experienced. My sleep doctor also works in rehab centres told me I am now suffering from PAWS. I can barely eat (I’ve lost 35lbs), sleep, everything smells and tastes awful, it’s the same feeling I had when I was pregnant. Also, after I eat within 30 minutes I fall asleep, the deepest sleep I’ve ever experienced and no doctor yet has been able to figure this out. I also have to get my stomach checked because my doctor is worried that the anxiety induced from the withdrawal from Methadone may have affected the lining of my stomach. I feel awful when I don’t eat and when I do, constant stomach cramping still.
I am not taking any pain relievers and I have a few chronic pain conditions so that has also left me feeling awful. I have started to walk which hurts but I do it anyway (you can only lie down for so many months) because I noticed my anxiety levels were better, but my sleep isn’t.
After reading about PAWS I’m extremely angry at the medical world for not letting everyone know what withdrawal really entails, it isn’t just the acute stage that’s difficult, the fact I’m now 20 weeks post Methadone and from what I’ve read I may never feel normal again. This has made me extremely angry at the medical/pharmaceutical world. Since this began the one question I’ve asked a few doctors is – when will this be over, every day I woke up and still felt awful having an answer for me I felt would keep me going, to date I have not received an answer to my question. For me, going through withdrawal has meant the complete loss of control over my being, it’s a very long waiting game that requires a lot of patience. Time seems to stand still during withdrawal.
The one good thing that has come out of this is that I will never take any pills again, I would rather be in pain from my conditions than ever have to endure what I have over the past 8 months and now I have learned that I will continue to endure.
Hi Eve,
I have bad news and good news.
The bad news is that the post-acute withdrawal from prolonged Methadone use (as opposed to detox, which works just fine) is worse than most of the other drugs. That’s just the way it is. The fact that you were on other opioid drugs for so long just adds to the problem. Then, of course, there’s the chronic pain, which surely isn’t made any easier by your state of mind.
The good news is, it won’t last forever. The PAWS will probably taper off more slowly than from some other drugs, but it will taper. There are some things you can do to help.
Number one, don’t harbor the idea that all pills are bad. In your case, you need to worry mostly about opioids, benzodiazepines, and alcohol. (Since you’re recovering from an actual addiction, I’d avoid marijuana (even medical) as well. You do not have to be concerned about OTC analgesics such as Tylenol (acetaminophen). You shouldn’t be taking non-steroidal anti-inflammatory drugs (NSAIDS) due to your stomach condition. NSAIDS reduce the production of mucous in the stomach lining, which makes it more vulnerable to its own acid, but Tylenol does not have that effect, and unless you have liver problems should not be detrimental. It’s a more powerful pain-reliever than people give it credit for, and could be of help.
Neurontin is also a good choice for several of the things that are plaguing you. It will help with mood stabilization (anxiety) and pain. It is not an addictive drug, and is commonly used to treat conditions such as you are experiencing. The one thing that you and your doctor need to be aware of is that since it has anti-seizure properties as well, it should be tapered off slowly — should you go off it — due to the risk of enhancing the possibility of seizures. This is a perfectly manageable situation, and should cause no concern. Talk it over with your doc. Considerable relief is available, and it is relatively safe and free from side effects.
The exercise is good. Do what you can, but do it. It is invaluable.
Keep in mind that your brain changed over the years that it was awash in chemicals, and that the changes back take time. PAWS will end, but it will take a while still. You don’t mention going to meetings. I strongly suggest NA or PAA (Pill Addicts Anonymous) for the support of others who have been where you are, and who will understand and be able to help you find ways to cope. Many people seem to think they have nothing in common with “those people.” We all have the important things in common, and probably 50% of those people were addicted to the same drugs, and most addicts don’t come from the streets. I was a mid-level police administrator in my “previous life.”
Be good to yourself. Find something to do for fun, even if you don’t want to. It will help your mood a lot. Fun has measurable positive effects on brain chemistry, and that’s the cause of your PAWS. Your body is recovering from a chronic disease. You write a coherent letter, so obviously some of your faculties are doing OK now. The rest will improve with time.
Please stay in touch, and
Keep on keepin’ on!
Bill
Thanks Bill for your reply, support and advice be it good news or bad. I notice you say PAWS will last a while still -any idea how long and how will I know when it’s over.
I live in Toronto, Ontario and I have my medical licence for marijuana and am curious why you say I shouldn’t smoke marijuana, which I have been doing for the stomach cramps and for sleep. I do not drink at all.
When I say I’m against pills, I mean the kind that involve any brutal withdrawal cycle. Many years ago my pain specialist prescribed Gabapentin for the pain, which I believe Neurontin is in the same family, but it didn’t do anything in regards to the pain. Advil does work for me but I’m not taking it due to my stomach issues. I don’t find Tylenol deals with the pain the way Advil does.
Any idea why I crash after I eat dinner, it is a very deep sleep and when it happens I sleep solidly for a few hours, but then unfortunately that is my sleep for the night so I’ve almost become afraid to eat due to the way I feel after I eat and I fall asleep.
Why did you suggest I attend NA meetings, am I considered an addict even though the drugs I’ve taken have been prescribed for a chronic pain condition and have not been abused in any way over the past 10 years.
[The bad news is that the post-acute withdrawal from prolonged Methadone use (as opposed to detox, which works just fine) is worse than most of the other drugs.] What’s the difference between me tapering and detox?
Hi Eve,
Detox is the process of removing the drug from your system to avoid withdrawal. Post-acute withdrawal occurs during the period between the time the drug leaves your system and when your brain has finished adjusting back to normal again. It usually takes several months, and depending on the amount of changes in the brain and the kind of drug involved, it can take a couple of years. That, and the fact that no two people have exactly the same brain chemistry, means that there is really no way to predict it individually. Also, there’s no way to tell when the brain has completely normalized, without thousands of dollars worth of tests that may not tell the full story anyway. Addiction science is evolving quickly, but there’s a lot we still don’t know for sure.
Marijuana keeps the brain from normalizing by keeping the chemical pathways open. It’s that simple. You will not recover completely until the THC is out of your system, and then the brain has to repair itself from that time onward. If you have to use cannabis, you have to. But you have my advice on it. I can’t make your decisions for you, any more than I can diagnose you as an addict. All I can tell you is what an addict is.
Addiction has nothing to do with how much of the drugs you took, nor why you took then, nor whether or not they were prescribed or bought on the street. Addiction is a condition of the body brought about by changes in the brain. You need the support of people who know how you feel and are able to tell you what worked for them. Corresponding with an addiction educator 3,200 KM a way is not the answer. Addiction is nothing to be ashamed of. You didn’t plan it, didn’t know it would happen, and couldn’t help it when it did happen because you didn’t know that, either.
I am an addict in recovery. My wife the psychotherapist is an addict in recovery. Most of my friends are addicts in recovery. (I include the alcoholics, because alcohol is just another drug, and alcoholism is an addiction like any other — one of the most serious, in fact.) None of us chose it, but we can choose how we deal with the results. Do yourself a favor. If I, as an active police administrator when I was in early recovery, could go to AA and NA meetings, you can too. Don’t let semantics and your pride keep you from availing yourself of the help and fellowship NA offers.
Read some of my responses to other people here on the site. There is a lot of information. You can trust what I say, but don’t expect me to pull punches. Addiction is a chronic disease that is fatal or at least shortens life markedly if it is not arrested, and it is possible to arrest it completely if we are willing to make the necessary changes. That’s serious business.
Please stay in touch, and
Keep on keepin’ on.
Bill
Really interesting article, I was pointed in this direction by someone.
Bill, what I’d like to know is if you can get these symptoms even if you didn’t drink a huge amount? I drank consistently, longest I went without a drink was 5 days in 20 years (I’ve now stopped for 10 days, I’d been stopping and starting over the last 6 weeks then realised I had to get to AA for the support).
I guess my average consumption was around 35-40 units for several years, but there were times when it could be 60 to 70 units e.g. Christmas. I was told even the lower levels were risky but one of the things that kept me out of AA was not thinking I was a “real” alcoholic, I can see now that I probably am. It could be that I’m so used to seeing large amounts of drinking as acceptable as I come from a family of alcoholics. I did also have rarer binges where I’d drink up to 20 units in one go.. which wasn’t great.
I didn’t get what I thought of standard withdrawal symptoms (sweating, shaking) but my memory and concentration is shot to pieces. I’m forgetting my keys, my purse (not saying I never do this but a couple of days in a row does not happen usually!). And I cannot concentrate. Work is difficult. Luckily, I’d planned this week off work to chill out and I decided I should stay quit as I’ve go the time off to deal with/do some research. I thought initially maybe it was anxiety that I’d medicated for years, but it seems to fit the above article. I’m also really tired.
Should I follow the advice above? I’m still clinging to coffee but figure that will have to go.
I have personally seen people with similar levels of alcohol use to what you are describing, and yes, they did go through withdrawl. If you aren’t feeling the shakes or sick you probably don’t require medical attention, but please remember that alcohol withdrawl is not to be taken lightly and can be dangerous. It’s better to be careful.
That being said, don’t panic, and don’t give up! Your body and mind need a chance to adjust, and it makes sense that it might feel weird at first.
Thanks for the article. I’ve been looking for good resources for PAWS to share with others, and this is probably the most thorough desription and plan that I’ve seen so far.
Thanks for your comment. It’s appalling that there isn’t more out there. I wrote this in desperation as a handout when I was doing didactic groups, and expanded on it here because I couldn’t find anything on the Web. I went to treatment at one of the best treatment centers in the country (at that time), and no one told me anything about it. Neither my wife nor I can remember anything about it in the CAP curriculum. Given that it’s the proximate cause of practically all relapse, no one should come out of any form of treatment without knowing about it and having resources to help them deal.
Keep up the good work!
i stopped using 80-100 mgs. of hydrocodone daily 7 days ago. went to detox for first three 3 days of withdrawal. they gave me methadone and many other pills to take. i finished detox and the physical withdrawal subsided after a few days. the last 3 days has been psychological hell for me. i thought i was loosing my mind but i can say it is getting a little bit better everyday. I really just wanted to know how much longer this will last please help.
Hi Sam,
Uncomfortable though it may be, it’s great to have that monkey off your back, isn’t it? Congratulations on deciding to live the rest of your life clean.
I wish I had better news about PAWS. Everyone is different, because everyone’s brain chemistry is a little bit different and our ability to repair the damage caused by the drugs varies as well. You can expect at least six months of post-acute withdrawal — perhaps up to a year. You will have good periods and bad periods that will slowly segue into longer good times.
You can best facilitate your recovery with light exercise (walking), watching your diet as outlined in the article, and getting support from other people in recovery. You need to know that relapse is least likely if you do those things. The farther you deviate, the more likely it is that PAWS will slap you down.
You also need to know that if you use, even a little bit (including alcohol or other drugs), you run the risk not only of complete reversion to your original level of addiction, but of setting your recovery back a substantial amount in terms of PAWS. Don’t use ANY mood-altering substances, including tranquilizers. Do go to meetings, take care of yourself physically, and know that it will get better, but that it will take time. We addicts are used to quick fixes. There aren’t any for PAWS, but there are both ways to make it easier on ourselves, and to make it worse.
Please stay in touch, and
Keep on keepin’ on!
Bill
PS: Keep in mind that most doctors know little or nothing about addiction. Get your information from the docs at your detox facility or a treatment center. That way you know it’s good information. Others mean well, but lack the experience.
I think I’m over the worst of it. Its been about 10 days clean (no suboxen this time) after a straight 6 yr heavy constant opiate addiction. Before that I never did drugs and my body felt good. But I, like Sam, am getting frusterated because I’m still practically bed ridden. Every time I stand up I get light headed and my heart beats fast. I’m so weak and thinking about cleaning my room feels like I’m deciding to run a marathon. I get a little better everyday. I notice the smallest improvements. I too just want to know when I’m going to feel like ok I feel good today? Ps. I really appreciate who ever wrote this web site. It is interesting to know some of the things I’m going through are just a process I have to wait through. But It’s also daunting that this can last for months. Please tell me that how I’m feeling now is not as much paws as much as this shit leaving my system and that I’ll feel better soon.
Hi Maritzza,
Congratulations on getting clean! I’d love to tell you that you’re going to feel great in no time, but the likelihood is that there will be a lot of ups and downs over the next year or so. More downs than ups to begin with, and then the good times will slowly begin to predominate. I can’t tell you much more than that, because everyone’s a bit different. However, after six years of heavy opiates, there’s no way you’re going to escape a good dose of PAWS.
You spent six years changing your brain so that it needed drugs to feel even anything like normal. When you remove the drugs, there are a whole bunch of opiate receptors that are no longer needed, but that are still active and needy. Until the brain is repaired and those extra receptors go dormant (they never go away, which is why we go down so fast when we relapse), there will be some tough times. We addicts are in the habit of thinking in the short term. We want to feel good — right now. Sadly, physical recovery from drugs — especially opiates — doesn’t work that way. I could b.s. you about this, but that would do you no good at all.
I suggest that you pay close attention to the nutrition and exercise portions of the article. I know you don’t feel like walking around much right now, let alone exercising, but once you’re on your feet, mild exercise is one of the most valuable aids to your physical recovery. Walking is best — for at least a half hour every other day. Every day is better. As far as your emotional and social recovery go, PLEASE start NA right away. You need the support of other recovering addicts, and you need not to isolate. Knowing you’re not alone in this is one of the most valuable things you can learn. Remember, recovery isn’t about getting clean. You’re already clean. Recovery is about staying clean, and learning to live a normal life after all those years of chasing the next fix. Your chances of doing it on your own are vanishingly small. The monkey may have left your back, but the circus will be in town for a long time yet.
Please stay in touch, get involved in NA, and
Keep on keepin’ on!
Bill
Hi Cathy,
Congratulations on your successful detox, and for getting involved in AA. After a few meetings you will see why I push it so much. We need to be able to talk to people who understand what’s happening with us, and you’ll meet some fine folks and make lifelong friends. It will also give you an opportunity to use your experience to help others. AA is quite fulfilling if you stick with it and take it seriously.
I’m not sure how much you were drinking, because I’m not sure we have the same understanding of “units” and you didn’t say over what time period you consumed them. Be that as it may, it doesn’t really matter whether you got blasted when you drank. Your family history and consistent drinking over a 20-year period, combined with your difficulty in stopping and your post-acute symptoms, makes the likelihood of addiction pretty high. Of course, whether or not you are an alcoholic is yours to decide and accept (or not). I’ll simply say that you’re doing the right thing and seeing the right people as far as I’m concerned.
Your symptoms are consistent with PAWS, which is as much dependent on the length of exposure (beyond a certain point) as it is the amount we drank. I wouldn’t expect your episodes to be especially extreme, but you can plan on some more of what you’re getting now. Twenty years’ exposure allows the brain to make some extensive changes in its functioning, and it takes quite a while for it to make repairs and get back to normal.
Stick with the information in the article and keep hitting those meetings and you’ll continue to improve slowly. I’d cut down on the caffeine some, but don’t try to quit now. Your body is confused enough as it is. If you can get it down to about three cups a day, nothing after 6:00 PM, it will help you with any sleep problems you may be having.
Stay away from ANY mood-altering drugs. Check them out on line. If it says “potential for abuse,” don’t do it. Even some over-the-counter drugs are problematic, especially outside the US.
It’s going to be OK, it’ll just take a while. Please stay in touch, and
Keep on keepin’ on!
Bill
Why is it, that AFTER you get clean (5 shitty days..) and you go get help from a clinic, because you just cant hang, they WANT you to fkng relapse?!?!?!?!? They WILL NOT take you if there is no opiates in your blood. F.M.L.
So now, after 12 years of pill and heroin abuse, I am *finally* pulling my head out of my ass and doing something about it. But, the help I need, seriously, NEED (I CAN NOT QUIT without it…tried 9 times in 10 months) requires me to relapse. What in gods name do I do about this? Im afraid if I go score, Ill just jump off this sobriety train, and F myself even harder! I FEEL LIKE I AM LOSING MY MIND!
Hi Ivy,
I could try to explain the hole in the treatment system, but that’s not what you need right now. You need to get to an NA meeting. Check here for meetings in your area: http://portaltools.na.org/portaltools/MeetingLoc/
After you line up some meetings, google “drug treatment in central California” (I think that’s where you are, based on your IP address) and see what you find. Start making calls, and keep it up. The NA people at the meeting may have ideas, too. Hold up your hand and tell them what’s happening with you. There’s help out there, but you have to ask for it.
Sorry I couldn’t get back to you sooner. I had no Internet access yesterday. Answered as soon as I saw your comment.
Feel free to write again, and keep on keepin’ on,
Bill
Ivy,
I could only spend the first 5 days in rehab before I had to get the hell out. Mainly because the place I stayed was a living hell. It really was a hole. In fact, my therapist won’t refer people there anymore and sends them 3 hours away due to what I went through. My point? It IS POSSIBLE to do without a center/clinic/rehab. Just make sure you see a doctor to make sure you’re medically stable to do it.
I have gone to a few meetings… they weren’t really for me. BUT they are EXTREMELY helpful for most people. I read a TON online and studied good educational websites. It was hard and it was, at times, very discouraging. But I promised myself that I would NEVER go back to that horrible place. Be strong, educate yourself and apply what you learn to your recovery. Talk to people whether it’s online or at a meeting. Stay away from triggers. Stay away from addictive substances. For example, I am an opiate kicker and still make myself avoid alcohol. I haven’t been within 50 feet of alcohol in 7 months. I also refuse to go out with people who I know have access to pills. Some are good family friends. But because they are true friends, they understand.
I am 7 months clean, as of yesterday, and I am absolutely amazed at the amount of healing my body has done. It’s so worth it. One day at a time. Think about how you’re going to get through just this one day. Then tomorrow, do it again.
Hi Opiatekicker,
Congratulations on your 7 months. I hope your program keeps working for you. You’re mostly through the worst part, so hang in there.
You’re absolutely right about the alcohol — or ANY mood altering substances. Mood altering substances, if they don’t trigger the old neural mechanisms directly, have the well-known ability to give us permission to do things that aren’t in our best interest, like pick up our drugs of choice “just this once.”
I would comment that just because meetings “aren’t for you,” it’s not a good idea to mention that to other newcomers. They might be for them, and you might be giving them permission to blow them off. Just sayin’.
Keep on keepin’ on,
Bill
Hi Ivy :) How are you doing? Its 10 days since your post…I just wanted to let you know that a lot of people die from heroin overdose or quinine allergy (cutting agent) but almost none die from the detox. Its only 2-3 days for acute detox and 10-14 days to gain general health from eating and sleeping properly. You dont need a medical detox if you are ready to quit all drugs. [But it can make things much easier. - Ed.] You do need support though i recommend NA or an outpatient rehab for individual counseling and group supports. Life is really better free from drugs. I got clean when i was 21 years old and just celebrated 21 years clean last week…Its a great life but i wouldnt have found a life i love and can cope with, without support from NA and counseling. If you just want to not do heroin and be a “maintenance person” i understand that too, but i hope you go for it all the way its worth it i promise. Lynn
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thank you so much for this information, I am 4 months clean now from a number of different things, suboxone, methamphetamine, mpvd, adderall, and just about anything else. I used suboxone as a maintenance drug for all the pills and heroin i was using. for the past month or so I have been thinking something was medically wrong with me because it wasn’t getting any better Its good to know what the problem actually is. Im just trying to have faith that it will get better, I remember being so capable on all those drugs, smart and creative. Now I just feel stupid. . I do think I will hang on to my sobriety, because as bad as it can get now, it is nowhere close to as bad as it got then. Thank you
Hi Justin,
Congrats on your four months. One speed freak to another, I know how you feel. That Superman feeling is hard to give up. Most of your PAWS is likely due to the Suboxone, which has a pretty long withdrawal syndrome, but the uppers haven’t helped. The good news is that it does get better.
Do hang on the sobriety. I guarantee it will get worse the next time around, and then you’ll have to do all the PAWS again anyway. Resist the temptation to take “just a taste.” It will set you back much farther than you’d think.
Please stay in touch, and
Keep on keepin’ on!
Bill
Thank you so much for this post. I am 49 days sober marching forward to the 90 days and 90 meetings with AA. After 30 years of hard drinking, I just assumed that everything would continually improve from day to day of not drinking – instead, I am challenged with mental and emotional behavior that I have never experienced before. It makes me feel a tad insane. But 2 days ago a friend brought me a partial article on PAWS. Man have my eyes been opened. Having the knowledge regarding what I may experience over the next year or two is a great advantage for my recovery. Thank you!
Congratulations on your 50 days, Adam. I thought the same thing when I got sober, and in fact I was pretty lucky to have so much support that it made things easier than they might have been. In retrospect, however, I realize that I was a long way from “normal” for a long time, and did some pretty bizarre things that seemed perfectly reasonable at the time. I was fortunate, in that I was in really good physical shape for a 45-year-old drunk. I’m sure that helped a lot, and walking miles on the beach every day and a lot of swimming helped, too. Still, I don’t claim to have been really sober for at least the first couple of years. Clean, yes.
I can’t overemphasize the importance of diet and exercise. They are as important to physical recovery as AA and the steps are to emotional and spiritual sobriety.
Please stay in touch, and
Keep on keepin’ on! Oh yes…and Happy New Year!
Bill
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I was addicted to Crystal Meth for a solid six months – That may not sound like much, but it only takes a little to hurt you. At the time it seemed like fun and just something to do but it was so much more then that. It consumed my entire life and turned me into someone/something I didn’t want to be. I would look at myself in the mirror and just hate the person looking back at me with every fiber of my being. I knew I needed to quit but I just couldn’t deal with the withdrawals. I reached my peak of use on October 27th of this year. I was celebrating my birthday with a few buddies and what went from a round of use turned into a 13 hour binge. It ended with me lying on the couch for the next 48 hours writhing in pain. I felt like my body was contorted; my heart was racing, everything looked off-balance, I couldn’t eat, I couldn’t sleep, and I literally felt like I was dying. And that was the last time I used. I’ve been clean ever since and it has been rough. A couple weeks after that PAWS started setting in and it has been hellish to say the least. I have my good days and my miserable ones, but I just keep looking at the future and remembering it will get better. And to top this all off… I’m only 19.
Bill, I started using pills when I was 22. I am about to turn 70 and I have battled this problem for nearly 50 years . I came into AA in 1974 and haven’t had a drink since. But the old pills have kept me from completle soberity. I learned abour PAWS ten years ago, my doctor who was also had 20 years sobriety put me on an antidepressent (my first time) and Gabapantine. I have taken the Gaba 300mgs 3-4 a day since. But I haven’t followed all the other things i knew i needed to do. I just when through a very bad experince. My doctor put me on ambien to help with the withdrawls, and when that made me crazy, he put me on Klonipin (same exact poison!) It’s only by the grace of God that i didn’t kill myself oe someone else. I mean, that stuff really made me CRAZY! I can not tell you how much it has meant to me to see and read what you have written about PAWS. It’s never to late to apply what you were taught nearly 40 years ago but didn’t use. Today is my first day of trying again. I plan to read your column everyday for as long as it takes to get this in my head. I already know I’m in for some rough days (months, years…if I live that long) but I feel I’ve finally reached my bottom. My hubby of 41 years was so worried and upset with the Ambien and Klonipin and I can’t do that to him anymore. (Although I know this is all being done for me first.) I might add that my pill of choice for the past 5 years has been Tramidol, and with the Gaba I’ve been able to control it and not go over the edge. But I kept needing more, my doctor wouldn’t allow me more than 6 a day and I had worked myself up to 15-20 a day. That’s when I knew I had to stop…then took the crazy pills, and now hopefully I’ve got all that worked out once again. Some times I’ve been a very slow learner. Thank you, thank you for the good work that you are doing. Already you have been such a blessing, and my God continue to use you to help others with these horrid diseases.
Bobbi (please no last name)
Dear Bobbi,
I am SO sorry that I missed this comment! Somehow it got into the “pending” file, and I overlooked it because I don’t believe in “pending,” preferring to answer posts immediately. My apologies.
The benzodiazepines (Klonipin/clonazepam) can make a real mess. In some respects they’re more dangerous than heroin. They have a longer PAWS period, as a rule, and can cause fatal complications during withdrawal. You’re fortunate to have been able to get off them without serious consequences. It’s really scandalous how physicians fail to understand the dangers of these drugs. (It’s also a testimony to the effectiveness with which they are marketed to doctors.)
Tramadol is a synthetic opioid drug that affects the body similar to other opioids such as heroin and oxycodone. It is highly addictive, tolerance increases rapidly, and reactions with other depressant drugs are possible and often severe. Your doctor was wise not to increase your dosage, but would have done better to get you into a medical detox facility so that you could get all the drugs out of your system at once with monitoring by addiction professionals. If you are still taking any of the drugs you mentioned, I strongly suggest a medical detox to get off them completely, as withdrawal can be problematic for a person your (and my) age. Your brain will not begin to recover to a normal state as long as you have mood-altering drugs in your system. (I am not referring to antidepressants. They are different drugs that act differently from those you have been taking.)
If you have further comments or questions, please write. I promise to get to you sooner next time.
Again, my apologies.
Happy New Year!
Bill