Dear Readers,

   One of the disadvantages of having a popular website is the attraction of deadbeats who want to use it for their own purposes.
    Those folks have finally compromised my contact link, so we’ll fix them!  From now on, if you want to reach me, send email direct to “bill(at)whatmesober(dot)com”  (not a link).  Thanks.


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. Many 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 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 that period they cause a variety of problems known as Post Acute Withdrawal Syndrome (PAWS).

All of us addicts and alcoholics suffered 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 f..ing clear!”

Recovery causes a great deal of stress. Many addicts and alcoholics can’t learn to manage stress without alcohol or drug use, or do so only after many attempts at sobriety.  Our ability to deal with stress 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 can require from six months to two years with a healthy program of recovery.  (The time varies greatly, depending on years of use, kinds of drugs and individual body chemistry.)  During this period, PAWS is the cause of most relapse.  We are well-advised to learn what we can about it.

Symptoms of PAWS

PAWS symptoms reach a peak from three to six months after we get clean. Use of drugs or alcohol, even in small quantities or for a short time, will eliminate much of the 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

Six things contribute to this: trouble thinking clearly, emotional overreaction, memory problems, sleep disturbances, physical coordination problems and difficulty managing stress.

Inability to solve problems leads to lowered self-esteem. We feel embarrassed, incompetent, and “not okay.” Diminished self-esteem and fear of failure lead to living and working problems. These all add to our stress, and the stress further exaggerates the other problems.  

Inability to think clearly

Sometimes our head just feels fuzzy because of the changes that occurred in our brains while we were using. Our brain seems to work properly only part of the time. These changes take time to improve.  In addiction to PAWS, they are 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.  Talking to someone else about our issues helps, because communicating forces us to organize our thinking.

Memory problems

We may hear something, understand it, and 2 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 compensate by “shutting down” our feelings. 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

Sleep deprivation stresses the body, prevents our minds from working well, and generally exaggerates any other difficulties we may be experiencing.  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. 

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.  It is important that we be consistent in our attempts to make changes.  It takes about a week to adjust our sleeping, so keeping a weekend schedule that mirrors our weekday pattern is critical to those adjustments.


Stress is the natural reaction of our bodies to situations that may our subconscious identifies as threatening or requiring immediate action.  Unresolved problems and issues also contribute, if we dwell on them.  Stress comes in all flavors: arguments with family, interactions with co-workers and employers, physically demanding situations, and even pleasant things, like preparations for a wedding, anticipation of a hot date, and so forth.  

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 of all kinds 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 great.  Some of our triggers work best in such situations.


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 psychopharmacology. This specifically includes herbal and so-called “natural” 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 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 means of controlling it when our stress levels are low, in order to be able to prevent the symptoms or be able to recognize and manage them if they occur.

Stabilizing our episodes of PAWS

When we begin to experience PAWS, we need to bring it under control as soon as possible. Here are five steps that can help.


We need to talk about what’s happening, to people who will listen, understand and not criticize us. In addition to badly needed support, it helps us to clarify our feelings, look at them more realistically, and helps us recognize our symptoms.  When we are in our own heads, our thoughts just go around and around.  When we force ourselves to tell someone else, we often find that it puts them into order and they begin to make sense.


We need to express as much as we can about what we are feeling, even if we think it sounds dumb or irrational.

Get a reality check!

We need to ask someone if we are making sense — not just in what we’re saying, but also our behavior. We must be sure our perception of what is happening matches up with reality.

Set a goal

What can we do right now to improve our situation? Taking action and changing things is our choice.

Think back…

…over what has happened. How did the episode start? What triggered us? What could we have done to reverse it sooner? Were there other options that might have worked better?

Self Defense

We are responsible for protecting ourselves from anything that threatens our sobriety, including anything that triggers post acute withdrawal symptoms. No one else can do it, because no one else can feel the warning signals. Learning about addictive disease, working a program of recovery, finding out more about PAWS—all of these things reduce the guilt, confusion and stress that intensify the symptoms and lead us to relapse. If we learn to do these things, we will begin to accept our own needs, and learn to be firm about not 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 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 lifetime…who knows?)  If we find ourselves walking past the beer cooler too often in the store, or discover that driving past a certain street corner makes us edgy, we need to recognize that and change our routes through the store and the neighborhood.  We also need to talk about these things with people who are not involved with the situation, so that we can get unbiased feedback.


Here are some things that will help us avoid PAWS, or control it when it sneaks up (which it will). They may be the most important things we will learn in the first few months of our sobriety. They are so important that we encourage you to print out this article, and to share it with others who may need it too.


With our organ systems damaged by alcohol and drugs, we were not—and may still not be—able to absorb nutrients properly. This, combined with our inattention to diet, has created deficiencies that we must deal with.  All active alcoholics (and most other addicts) suffer from malnutrition to one degree or another, and we may continue to feel the effects for months after adopting a healthier lifestyle. Malnutrition contributes to poor health, and poor health contributes to stress. Unless we consciously improve our diets and properly supply our nutritional needs, the poor eating habits that have carried over from our using days guarantee that we will continue to fail at getting the nutrients needed to recover.  Our bodies are repairing themselves, and they need the proper materials to do so effectively.

It isn’t necessary to load up on stuff from the health food store. It is much better to spend all that money on good healthy food at the market (although they’ll never tell you that at the health food store).  However, we should take a good multivitamin every morning with breakfast.  Yes, you will be eating breakfast.

Hypoglycemia – the secret demon of relapse (H.A.L.T.)

We’re tired and hungry. It’s been a long day, and we won’t be able to have dinner for a couple of hours. A candy bar is just what we need to pick us up and get us through. Forty-five minutes after eating the candy we are angry at our boss, arguing with our co-workers, suffering with tense muscles and a nasty headache, and life sucks again. We’re thinking about using.

Has this ever happened to you? Then you already know something about hypoglycemia.

Our brains use glucose, a kind of sugar, for fuel. If our brains are completely deprived of glucose, we will die just as quickly as we would if our air were shut off. Fortunately, our blood carries glucose to our brain, and as long as our heart is beating we don’t usually have to worry about its fuel supply.


Usually, glucose is manufactured by our bodies from the carbohydrates that we eat. (There are exceptions to this, but they involve special conditions that should be no concern of people in early recovery.)  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.  Eating sugars makes us feel good, energized, vital.  (Yes, sugar is a mood-altering substance.)

However, problems arise when we are in need of food and our bodies get a big jolt of sugar (the candy bar). That 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 — one of the prerequisites for addiction, as it happens.)

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 because it is overstimulated 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. We are 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.  


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 balanced meals every day
  • Three nutritious snacks every day, between meals and at bedtime
  • Avoid Sugar and Caffeine!  (Caffeine stimulates the production of adrenaline, which burns more glucose.)

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 a doughnut, or bowl of cereal, and a cup of coffee for breakfast, a sandwich and another cup of coffee for lunch, and one huge meal in the evening. Since this doesn’t spread the fuel around too well, we fill in the low spots with candy bars and some more coffee. Our poor pancreas! 

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?  We really need to get this thing under control! 

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 — fats, and dairy products. A nutritionist can be a great help in the beginning

The US Department of Agriculture’s Choose My Plate page is a good place to begin, and there are many 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.

Scheduling and Snacks

We should try to plan our schedules so that we do not skip meals—ever—and so that we can have nutritious snacks between meals.

  • We must not snack on candy, donuts, soft drinks, (incredibly high in sugar,) potato chips, or other high calorie, low nutrient foods.
  • We should carry raw vegetables, wheat crackers, a half sandwich (peanut butter and jelly on whole wheat is excellent; easy on the jelly), nuts, or even a package of cheese and crackers.
  • These, along with a glass of water or milk, will keep our blood sugar steady and our moods elevated until time for the next meal. Having a nutritious snack before we begin to feel hungry will prevent our craving for sweets, as well.

It’s a good idea to actually schedule our snacks, halfway between meals and about ½ hour before bedtime.  We must not miss breakfast!

Losing Weight While Eating Six Times A Day

These eating habits are not inconsistent with meal planning for weight loss. Competent dietitians and honest diet doctors know that several smaller meals are more conducive to weight loss than three larger meals, since the body more easily uses the smaller quantities of food, and is less likely to store it as fat.  Properly planned meals will contribute to our health, energy and feelings of well-being, and make it easier for us to engage in exercise, (the real secret to weight control.)  Our hunter-gatherer ancestors ate fruits and berries during the day, and gorged on game when they could kill something.  Metabolically, we aren’t very far from those folks.  The big difference between us and them?


Exercise helps our bodies to rebuild themselves and maintain proper functioning. It also helps control our metabolism and prevent unnecessary weight gain. (Weight gain due to increased muscle mass may precede any loss due to burning fat.) Exercise produces chemicals in our brains that act as natural tranquilizers and relieve pain, anxiety and tension.  It greatly improves our chances of getting a good night’s sleep.

Our ancestors lived together in small tribes of no more than twenty or so adults and a few children. They walked from place to place, following the food supply, eating whatever they could find. They carried everything they owned with them.

This lifestyle, during the eons preceding the beginnings of agriculture, is the lifestyle for which our bodies are best suited.  Humans—like the herds we have followed since the beginning of our history—walk.

So, how much should we walk? Simple. We should walk fast enough and far enough to work up a sweat, and continue walking for at least 20 minutes thereafter, followed by a slower cool-down of 5 to 10 minutes. We should do that at least three times a week—preferably every other day.

We can walk at the mall; walk to the store; walk to the park. We can walk with a friend. When we’re walking we can chat, unlike most other forms of exercise. All we need is decent shoes and, if we’re over 50 or under a doctor’s care, our physician’s permission. And while we do it, we’re continuing a tradition that goes back thousands of years. How about that, sports fans?

Relaxation Equals Stress Reduction

Playing and relaxation are absolutely essential to 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, 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 we have to work at it—it isn’t play.

Other ways of relaxing include bubble baths, our walk (by ourselves or with a friend), a massage, a swim, and watching children and animals at play. Whatever we do, if we don’t feel better after doing it, it was the wrong choice.


Meditation is part of the 11th Step: “Sought, through prayer and meditation, to improve our conscious contact with god as we understood him, praying only for knowledge of his will for us and the power to carry that out.”

Regardless of how we feel about god, we need to meditate.  We need to learn to calm our minds and allow our subconscious to help us solve problems by serving up whatever it may have processed during the rest of the day.  The only way to do that is to meditate in one form or another.

Think that’s too hard to learn?  You already do it.  Daydreaming is meditation.  All we need to do is apply the skills we already know, whenever we want to.

One of the best relaxation exercises is also one the simplest. We find a comfortable sitting position. We move our bodies until our weight is centered, so that we can nearly go limp without changing position. We begin counting our breaths in our mind. We count up to ten, and then start over. We think only about breathing. In comes the fresh air and we…relax…and breathe the tension out. If other thoughts come in, we don’t fight them, we just recognize that they are there, and go back to counting breaths, always silently.

This is one of the oldest and most-used relaxation techniques in the world. It goes back at least 3500 years. We can do it for five minutes, then ten, working up to thirty minutes or more. It might be a good idea to set an alarm, in case we fall asleep sitting up. It happens.


Spirituality is an active relationship with a power greater than us, which gives our lives meaning and purpose. When we work a spiritual program, we consciously try to become a part of something bigger, greater and more powerful than we are, whether that be a 12-step group, our family, other humans generally, or that “god as we understood him.”

Trust in a higher power gives us a peace of mind and serenity that comes from awareness that there is something that is not restricted by our own weaknesses and limitations. Through spiritual development, we develop new confidence in our own abilities and develop a sense of hope. Through a spiritual program we can reach toward the future with hope and a positive attitude.

Spiritual discipline is uncomfortable for many recovering people.

We have lived lives of immediate gratification, and discipline is the reverse of that. Many of us have trouble with the concept of a higher power, as well. We may have been brought up as atheists or agnostics. Perhaps the god of our childhood was a vengeful god whom we cannot even begin to contemplate in the light of some of our past behavior.

This is why we say that our higher power can be god, as we understand god, or our recovery group, or the great outdoors — whatever.  Recognizing a higher power is simply admitting that we aren’t perfect and don’t know everything.  We let all those grandiose feelings go, substituting a bit of humility instead, and becoming willing to listen to the ideas and advice of others.  In a sense, it is not so much recognizing the presence of a god as it is the realization that we aren’t one.

Spiritual discipline should always include meditation, fellowship, and regular inventory of spiritual growth. It is about our relationship with the human spirit. It is not about someone else’s idea of a relationship we should have with a god.  That is religion. While religion may be an important part of our recovery, it cannot take the place of spirituality.

In working on our spirituality, it is important that we use the principles of our 12-step programs. They provide guidelines for “increasing our conscious contact with god” (as we understand god). We do not have to have any particular image of, or belief in, a god to increase our conscious contact. We have only to be willing to recognize the possibility of a “higher” power, — be willing to experiment at listening, and opening ourselves up to others and their ideas.

Many people joke about having a tree as your higher power. The writer had that sort of relationship with a majestic Casurina tree for some time. He used it to remind himself that he was not nearly as good at taking care of himself—yet—as that beautiful tree. Did it work? Who knows? At the time of this writing, he is 20 years clean and sober. Something did.

Peace and Contemplation

It is important that we structure our lives in such a way as to spend time alone each day. We need to examine our values, and look within ourselves to determine whether our lives are in harmony with those values.  Perhaps we can combine this with our meditation, contemplating life issues and then meditating to let our subconscious come up with some answers.


We strongly recommend keeping a journal, and writing in it every day without fail—even if we only write the date. Forcing ourselves to organize our thoughts and put them on paper clears our minds. Reading what we wrote some years later can be highly instructive, and lets us see how we have grown in our recovery.

Balanced Living–the aim of recovery

Balanced living means that we are healthy physically and psychologically, and that we have healthy relationships with others and, more importantly, with ourselves. It means that we are spiritually whole. It means that we are no longer focused on just one aspect of our lives. That is no longer necessary. It means we are living responsibly, giving ourselves time for our jobs, our families, our friends, and time for our own growth and recovery. It means allowing a higher power to work in our lives, even if that is only the influence of people around us.  With balanced living, we addicts and alcoholics give up immediate gratification as a lifestyle, in order to attain fulfilling and meaningful lives.

It means a balance between work and play, between fulfilling our responsibilities to other people and our own need for self-fulfillment. It means functioning at our optimum stress level: maintaining enough stress to keep us functioning in a healthy way, but not overloading ourselves so that it becomes a problem.

Stress, in and of itself, is not necessarily bad. It can be the tension that keeps life interesting. But stress is unsafe for us until our new found ways of dealing with it are second nature. Until then, when it arises we run the risk of returning to our old ways of stress management.

Balanced living requires loving ourselves and taking care of ourselves. Nutrition, rest and exercise all receive the proper focus in our lives to provide energy, manage stress, allow freedom from illness and pain, fight fatigue, and rebuild our damaged bodies.

If we are under a physician’s care, and have been told to take certain medications, we do so. We do not stop taking them without consulting the physician. We communicate with our physicians regarding the effects that we perceive, the ways that we feel, and function as partners with her/him in our own treatment. We do not take the advice of amateurs, in the rooms of recovery or out of them, in place of the counsel of doctors with twenty-plus years of education. That’s just plain dumb. However…

We always tell our health providers that we are in recovery, and always double-check their suggestions regarding medications with a person knowledgeable about their effects on recovering people. Doctors are not pharmacists.  They do not have time to study drugs and the details of their action.  A good relationship with a pharmacist has saved the butt of many an addict/alcoholic.


Freedom from physical distress allows psychological growth. When we feel good, it is easier to do the work we need to do, eliminate denial, guilt and anger, and move on to self-confidence, self-esteem and learning to feel good about ourselves.

Balanced living requires a strong social network that nurtures us and encourages a healthy, recovery-oriented lifestyle. This network provides a sense of belonging. It includes relationships in which we are a valuable part of a whole: immediate family members, friends, relatives, co-workers, counselors, therapists, employers, 12-step group members, and sponsors.

Recovery is not about quitting alcohol and drugs. It is about learning to live a life that does not require mood-altering chemicals to be worth living.

Click HERE for more What…Me Sober? goodness.

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    © William E. Webb 2008-2015. All Rights Are Reserved except as noted above.

424 thoughts on “P.A.W.S.

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  13. Bill Post author

    Hi Geoff,

    You’re most welcome; I’m just passing on what I got from others. You can do the same.

    It’s really hard for me to give you much insight into the school issue. While it’s entirely possible that your difficulties are simply a matter of poor timing, it’s also possible that there are other issues, such as depression. Take this test, and if it seems advisable you might speak with your physician about getting on an antidepressant temporarily. Good luck, and

    Keep on keepin’ on!



  14. geoffb398

    Hey Bill,

    I’ve been following your blog for a while now and wanted to thank you for all of your insight. I have been sober for 7 months now after using and abusing for a good 8 years. I realize it is going to take some time before I can start fully functioning with a normal healthy brain. I enrolled in school this quarter and I’ve been having a really difficult time with being able to focus in class/reading and staying motivated. Sometimes it seems impossible to find the least bit of interest in my studies. I’m curious on your take on maybe if I am jumping into school too soon? I have a feeling that if I give my body some more time sober and have more patience that things will start to become clearer and my motivation will come back. Anything will help.



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  20. Bill Post author

    Congratulations on your decision to start a new life. Please hit a few Narcotics Anonymous meetings and make some new friends who understand where you’re coming from. You will find that there are NA meetings on (or just off) campus wherever you are in school, in addition to near home. Recovery groups are a necessity for successful re-entry into life and society. We are social creatures, and having wisely distanced yourself from your using buddies, you will benefit greatly from the new friends you’ll make at meetings and other sober activities. Don’t miss a chance to avail yourself of the opportunity for love and guidance from a lot of good people.


  21. brianafaithh

    I know this post was made a while ago but I am very happy I stumbled upon it. I have had addiction with marijuana/opiates for a little and just recently decided to get sober (I was noticing changes in my social behavior and was ready to quit cold turkey and get healthy again). This summer has been quite the experience for me, after having horrendous disturbing nightmares, panic attacks, shaking, balance issues, and a whole rack of other symptoms this post have me faith. I’ve been doing things to keep me busy and healthy, like starting this blog and working hour daily. Some weeks seem better than others but I can tell I am getting better. I forget things all the time and feel so dumb but I try not to fall into self pity because that leads to depression. I just hope these feelings will go away soon. I start college again in September and I am confident I can handle it but just nervous; a new place to live, away from home, meeting new friends who don’t do drugs with me. There will be a lot of changes in my life and I was just wandering if you had any advice for my new move am starting basically a new life sober? I’ve distanced myself from a lot of people I used to hangout with because all they do is get high. Just nervous about the transition I guess and if it will make my PAWS symptoms worse


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  28. Bill Post author


    As you know, I replied to your contact letter via email. Still, I’m repeating my reassurance that these are normal feelings for where you are in your recovery, for the benefit of others who may read your letter.

    Keep on keepin’ on!



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  31. bob (@BCplanes)

    Hi bill,
    I used to drink 6-8 beers every night and 10-12 on the weekends each day and this went on for about 3 or 4 years and quit in august 2013…9 days after quitting drinking I had my first ever panic attack in 33 years which felt like a heart attack….not knowing about withdrawal or even PAWS my doc prescribed me .25 mg Xanax which I stopped taking in November but wasn’t taking it everyday either….now 7 months after quitting drinking I’m still getting brain fog and anxiety..did taking the Xanax maybe a total of 60 .25 mg pills over a 4 month period set my recovery back that far??


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  43. Jennifer Matesa (@Guinevere64)

    Bill, I don’t know how I missed this wonderful piece you’ve put together about PAWS. It’s a thoughtful and reliable guide to getting through post-acute withdrawal. I’m going to feature it on both my blogs. Thank you. all best /G


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  56. Bill Post author

    Hi Kenny,

    While I don’t recommend doing anything as permanent as a tat during early recovery, I know of no problems with the alcohol in the ink. Most of it would be carried away from the bloodstream by bleeding at the site, and in any case the quantities involved wouldn’t be sufficient to trigger your addiction.

    Good luck,



  57. kenny

    Hi Bill,

    I am currently going through PAWS from alcohol addiction. I am thinking about getting a tattoo, but recently read online that the tattoo ink commonly includes alcohol as a carrier. Therefore, I am scared that getting a tattoo will reverse my progress with PAWS and healing as I read online that even the smallest amount of alcohol can set you back to zero. If you could let me know your thoughts, as you seem the only one knowledgeable about PAWS that I have encountered, that would be greatly appreciated. Thanks!



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  59. Bill Post author

    Go to wordpress.com and start following directions. That’s how I learned. A little basic HTML will help in setting up some of the widgets and with some of the trickier formatting, but it’s totally unnecessary for a successful page.


  60. natural remedies

    Hi there! This is kind of off topic but I need some help from an established blog.

    Is it very hard to set up your own blog? I’m not very techincal but I can figure things out pretty fast. I’m thinking about setting up my own but I’m not sure where to begin. Do you have any points or suggestions? Appreciate it


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  62. Bill Post author

    Hi Zack,

    I’m sorry I didn’t get back to you sooner, but sometimes life just happens.

    You are experiencing the pain of acute withdrawal from alcohol. It’s entirely typical. PAWS comes later. It’s not as miserable. Too bad you had to go through it cold turkey, though. If you ever need to again, try to get to a medical detox. It can make things much easier (and safer — alcohol detox can be dangerous), and while you’re there you can get a little education about addiction.

    The best thing you can do for yourself right now is get to an AA or NA meeting. It’s going to take a while for you to get past the worst of this, and you need the support from people who understand what you’re going through.

    Your social discomfort and other issues are probably related to the weed and alcohol, if you were “normal” before you started using. It’s going to take a while for your brain to recover from the changes that the drugs caused. Addiction occurs because of physical changes in the brain that make us feel like shit when we aren’t using. In order to feel good again, the brain has to repair itself. That takes time. Things get better, little by little, the same as how they got bad. Using and drinking were fun at first, then not so much, then…well, you know. The recovery process is the same, but support and suggestions from people who’ve been there help a lot.

    Please get to some meetings. It’s the best possible thing you can do for yourself!

    AA Meeting Lists

    NA Meeting Lists

    Hang in there, stay in touch, and

    Keep on keepin’ on!


    p.s. Drinking again or blowing weed will start the misery up all over again. No sense in going back to square one!


  63. Zackary

    Hey bill i know i depend on alcohol to make me feel better in any situation i have to be drunk to socialize with anyone or this anxiety and depression messes me up im pretty sure i have this PAWS disorder or it might be bipolar depression i dont know i just want to go back to the man i usto be when i was happy and positive and could get along with people now since i had panick attacks from smoking weed its like it changed who i am now i just drink and im getting to much of a tolerance and addicted to it even though i like drinking and wish i can drink it like other people without feeling anxeity and depression i cant i know il have to quit for a long time why cant i be normal like other people what should i do bill when will i feel better? I been sober from everything for like a week now and it feels like im going crazy im mad depressed and cant talk to no one without feeling anxious and depressed i have really low self esteem and just dont feel right can you help me please


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  71. Bill Post author

    Actually, Ryan, if we pay attention to what we eat and where we eat it, it’s not really a problem. I’ve been asking waiters, cooks and chefs about the alcohol content of food they prepare for over 20 years. Some may have slipped by, but not much. I’ve also spit out both food and drink on occasion — although rarely. Mostly being careful is enough.

    There is alcohol all over the environment. It’s in fresh bread and many other foods in small quantities, and our intestinal bacteria even produce a little bit. It’s impossible to avoid it completely, but you can avoid it in any quantity by being careful. The small quantities that we ingest without knowing it will not normally cause problems. We simply don’t ingest it intentionally. Doing it intentionally indicates a preexisting problem — a problem of attitude. The main thing is that we make every effort to avoid it. In this case, “It’s the thought that counts,” means a great deal more than simply a polite remark.

    What it comes down to is, all you can do is all you can do. But if we have the right attitude towards sobriety and recovery, it’s enough.

    Keep on keepin’ on!



  72. Ryan

    hey bill i know drinking any alcohol while your going through post acute withdrawal disorder can affect any of your chances of recovery but you know when some peoplle cook they use alcohol to put in the food can eating that affect you recover cause you never know what foods you eat the person that cooked used wine or alcohol to cook the food in you know?


  73. Bill Post author

    Hi Marie,

    Congratulations on making it for 100 days and (at least) 200 nights!

    It will get better. Your body is recovering from a biochemical firestorm, most likely aggravated by malnutrition. It’s going to take a while, but if you watch your diet, stay clean, listen to your sponsor and start on the steps when you’re ready, things will slowly improve. Don’t forget light, aerobic exercise, like walking. No workouts for you.

    You’ll be back in grad school someday if you really want to be there. Sometimes when we get clean and sober and begin to perceive a new reality, we change our plans — and that’s just fine. It is, after all, your life. You can’t live it for someone else. They had their shot.

    I hope you’re getting some therapy in addition to NA. They complement each other. It’s possible to get by, but both are better than just one. You can fool a therapist, but it’s damn near impossible to fool a roomful of players.

    Please stay in touch if you like, and hang in there! And, of course,

    Keep on keepin’ on!



  74. Marie

    Wow, I am so relieved to have found this. I have literally been experiencing everything talked about here. I am 100 days clean tomorrow and I am also in recovery from an eating disorder (anorexia), which I found the information on nutrition to be very helpful in explaining why my symptoms are SO much more pronounced than other people I have talked to. I went to treatment for both my drug addiction and anorexia at the same time so now I understand why my sponsor is so on top of me about eating. I have been going crazy feeling like I can’t think, I can’t function—I have been so scared that I am never going to be able to function in society again (and I just turned 24 today!) I was in grad school, working full-time, before I ended up having to go to treatment at the end of last year and now I am not working or in school as I just got out of treatment–and I feel like I don’t even know how to live. I feel like I’m not a human being most of the time and it’s so scary. I feel paralyzed in so many different ways–it’s hard to even hold conversations with people. I just feel so crazy. But I’m glad to see that perhaps what I’m going through is normal and will hopefully get better in time?


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  76. Bill Post author


    Most physicians know little or nothing about addiction, but think they know a lot. Doctors who wouldn’t think of messing around in someone else’s specialty (neurology, for example) are perfectly comfortable prescribing and making recommendations for addicts, who require care every bit as specialized as paraplegics do. It’s just the way things are. Doctors are “raised” in a culture where you’re encouraged to show confidence even when it’s unwarranted, and the results are predictable in many cases.

    In any case, you can whip this thing. You need a few days of medical detox, or at least medically-monitored detox, followed by some education, therapy and Narcotics Anonymous. At the very least, go to a few NA meetings and vent. You need the support of people who understand addicts, and that’s a guaranteed place to find them.

    Feel free to stay in touch, and

    Keep on keepin’ on!



  77. dough

    Aaaaaaggggghhhhh……I am my own worst enemy rite now!!! But after reading this, I feel a lot better. (For now)
    I am a 30+ yr old young lady, with a whole bunch of dreams And aspirations suddenly swallowed up
    by addiction- coated nightmares.
    My doctor gave me my first hit, and like any other dope dealer tryin to make a Buck, he neglected to tell me the life long side affects this drug would have. I treat everyonsame, immense amount of anger that I nevertook an opiate to get high. My first hit, givin to me back way of my primary care physician,


  78. Bill Post author

    Hi Beppy,

    Sorry to take so long to get back to you, but as I mentioned in the email, I wanted to consult with my wife, who is an addiction therapist, about this since this particular area of addiction is not one with which I’m especially familiar. Between the two of us, we came up with some ideas that we think will be helpful.

    You didn’t ask for this. It became part of your life when your brain was still developing, and was no more your choice than your alcoholism was, so you need to forgive yourself. Don’t beat yourself up. Remember that you are on your side, you’re not the enemy! Sugar is highly addictive to some of us, especially recovering alcoholics, and substitute addictions are common. Think of it as an allergy, as we do with alcohol. Combined with your previous history with sweets, it would be fairly amazing if you weren’t having some problems.

    You can do this! You’re well into your Third Step already, just doing what you’ve done. You understand your powerlessness, and you’ve found the courage to reach out, ask for, and accept help.

    The first thing you need to do is find a meeting of Food Addicts Anonymous if there is one in your area. If there isn’t, there are online and phone meetings listed on the website. FAA addresses issues like sugar and other foods rather differently than OA, and would most likely be best for you. Overeaters Anonymous, of course, is a great program. Don’t get the idea that I’m saying one is better than the other. It’s just that FAA’s focus would seem to fit best in your case.

    Second, try immediately to address substituting something else for the sugar when you have cravings for alcohol. Peanut butter and whole grain crackers are good, as they have protein and fats that will help assuage your hunger and that will not cause blood sugar swings that affect appetite.

    Watch how you eat in general. Avoid getting hungry. Eat small, well-balanced meals and snacks of whole grain breads, proteins, beans, nuts, bananas and so forth. If you balance things properly, you can probably get by eating less than you are now, because you’ll avoid getting really famished that way. See the section in the PAWS article on diet and hypoglycemia for more information about that.

    Avoid white flour whenever possible. There is great similarity between it and sugar as far as the body is concerned, and it will only prolong and increase your cravings. Try to stick with fruits and high-protein snacks. Check ingredients carefully for their sugar content.

    It is most important that you see your doctor for a checkup and lab work. There are metabolic issues that can affect cravings for both sugar and alcohol. If there, they need to be addressed.

    Know that you will fall off the wagon and into the sugar bowl occasionally in the beginning. You are going to be learning how to manage your eating in a whole new way. Relapse is a symptom of addiction, and it’s going to happen in this case because it’s impossible to eat perfectly regardless of how hard you try. If you “slip,” be thankful that it isn’t as deadly as drinking would be, and decide that you will do better. Don’t think of yourself as weak, or strong. It’s about powerlessness. It’s also about reality. Don’t expect yourself to be perfect. Just decide to do better. Be good to yourself.

    Buddhists talk about “skillful” and “unskillful” behavior. In recovery, we want to become more skillful in our ways of living. When we’re learning, we’re apt to make occasional mistakes. That’s human, not weakness. Keep moving toward skillful. Forget perfection — that way lies more addiction.

    At some point down the line, you might want to work with a therapist on any issues from the past that might act as triggers. Your association of your sugar consumption with your childhood leads both Michele and I to think that there could be some important information there for you to explore.

    Thanks for your letter. Chances are good that there are other folks out there who will benefit from this answer — perhaps some who need to know they’re not the only ones fighting this battle. You’ve done a good thing here. Please stay in touch, and

    Keep on keepin’ on!



  79. Beppy

    Very good reading. I have a serious, serious problem with sugar addiction(like alot of people) but I am clueless as to how to fix it. I honestly think quitting alcohol would be easier than attempting to quit sugar.(ive been sober 2 months)
    It is so bad. It’s like I go into this shady foggy place when I crave sugar and I will scarf/swallow down whatever I can find to get my fix.
    I quit buying the “really” bad stuff, and started to buy hard candy. Well now I just eat like 10 pieces in a sitting.
    And this is really embarassing, but if I dont have any candy in the house I will take spoonfuls of plain sugar or brown sugar. Or I will just add milk to powdered sugar and eat the frosting by the bowl.
    I feel so helpless. Ive had this sugar issue forEVER. I was obsessed with candy when I was little, and when I was alone (starting at age 10) I would steal and stash bowls of white sugar in my room and secretly eat them. Surely this cant be normal. And now I think it is contributing(if not causing) my severe moodswings and irritability. I dont have a clue how to stop. How am I supposed to stop when it is so easily accessible?? I feel like I need to be hypnotized!?!?
    ANY advice would be wonderful!
    Thank You


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  82. Russ Hudson

    This is one of the most comprehensive and honest assessments of PAWS that I’ve yet seen – thank you for publishing this. It’s shocking that so few are aware of this condition – including people who work in the treatment industry. Usually I find that most of the symptoms can be managed via diet and exercise, and you list quite a few excellent tips in this regard. I also found this well-researched article about diet to prevent PAWS symptoms and relapse: http://www.postacutewithdrawal.org/a-healthy-diet-to-prevent-drug-relapse/ I’m sure these types of concepts won’t be well-received in many recovery communities: requiring recovering addicts to put down the cigarettes and coffee? Yeah right! But it could mean the difference between a relapse and just a bad day.


  83. Bill Post author

    Hi Cheyenne,

    Congratulations on your 3-1/2 months clean. The worst part is behind you.

    The Prozac should help some with the more difficult symptoms. DON’T stop taking it without careful medical supervision! The rebound effect can be profound, and you don’t need an episode of deep clinical depression adding to your problems at this point or any other.

    Addiction occurs because of changes that take place in our brains, causing us to need the presence of the drug to feel and function somewhere close to “normally.” I can’t say whether or not you are an alcoholic, nor addict for that matter, but it certainly sounds as if you have a problem with drugs: arrest, violation of probation, concerns about relapse, and association with people who are still using drugs and drinking. Sounds like a problem. (Incidentally, I use “drugs” as a catch-all; there is absolutely no difference between alcohol and any other drug, except that it’s one of the least benign. If we discovered it today, it would be available by prescription only, and there would be no good reason to prescribe it.)

    There are a variety of things that lead to addiction: genetic predisposition (any addicts or drunks in the family?), length of total exposure, period of heavy use, physical condition, gender and individual brain chemistry. Women become addicted to alcohol far more quickly than most men, because of their lighter body weight and the unfortunate fact that they produce far less of the enzyme ethanol dehydrogenase, which is responsible for metabolizing alcohol and getting it eliminated from the body via the kidneys. Thus, ladies get drunk on less, and it stays in your bodies longer than with us guys.

    Some of us cross the line into addiction more easily than others. I drank like an alcoholic the first time I had unrestricted access to booze, and continued to do so most every time I drank — although the periods were in the beginning separated by weeks, even months of abstinence. At some point, abstinence was no longer an option (in the opinion of my “reptilian” brain), and drinking became a subconscious survival issue. That’s the way it happens for most of us, with variations: eventually we drink enough, long enough, to cause those changes in the brain, and then we’re hooked. Exactly the same process holds with other drugs, and I had my share of problems with those too, although alcohol remained my drug of choice.

    Whatever the details, it’s pretty clear that you need to stop drinking and drugging. The symptoms you are feeling are definitely PAWS, which occurs during the period when the brain is repairing itself. It can take from several months to a couple of years, depending on a variety of factors that are fairly unpredictable. It has nothing to do with behavior; it’s directly related to biochemistry. What is predictable is that one gradually begins to feel better, the better periods slowly supercede the bad ones, and eventually things get pretty much back to normal — as long as we remain abstinent. One binge will set us back to square one, and we get to do the whole PAWS thing over again if we survive the binge and manage to get sober afterward.

    I’ll guarantee one thing: if you aren’t attending AA meetings your chances are poor. You need the influence of sober people in your life, and while you may or may not recognize yourself as being one of “those people,” you have made no statements that lead me to believe that you aren’t. Sober people who do not get involved in a program of recovery relapse at astonishing rates. The choice is yours. If you haven’t been (and if it wasn’t a stipulation of your probation, the judge was an idiot), go. If you have been and stopped, go. If you are going, get a sponsor, work the steps, and learn how to live without booze and other drugs.

    Otherwise, the odds are better than 9:1 that you will use again. I’m not trying to scare you. I don’t have to make this stuff up. Wish I did.

    Please stay in touch, and

    Keep on keepin’ on!


    p.s. I would add that the fact that you stopped drinking in order to concentrate on college would seem to indicate that even then you realized that it was an issue of sorts. Just a thought.


  84. Bill Post author

    Hello Ty,

    We used to see kids who started cannabis at around 12; now more and more they report starting as early as eight — often influenced by a peer. Back in my drugging days it was essentially impossible to get addicted to pot. About all you could do consistently was get stupid. Nowadays, with the THC content increased by hybridizing and scientific growing methods, addiction is a very real and growing problem.

    Obviously, in referring to your son I’m really speaking in generalities since I don’t know him personally. However, his behavior seems normal for someone who began using at such a young age. Generally speaking, our emotional development pretty much shuts down when we start using mood-altering drugs, which interfere with both the emotions themselves and the development of the connections in the brain that lead to higher-level executive activity. A bit of adolescent or even pre-adolescent behavior is almost to be expected in a recovering person like your son.

    The good news is that the connections are still developing in a 19-20 year old. If he remains clean and sober, he has a good chance of regaining some of the ground he’s lost in terms of brain development. If he begins using, however, especially in the near term, he may have cognitive and emotional impairment that will remain even if he gets clean later. Right now it’s a toss-up; later on, essentially a sure thing.

    Encourage him to hit meetings. Don’t push too hard or he’s liable to rebel (remember that adolescent thinking). If he’s willing, a therapy group made up of other young addicts would likely do him a world of good, as well. Keep firmly in mind that he MUST WANT to do these things. It is literally impossible to force sobriety on someone. Finally, if he relapses again, throw him out and refuse all aid. He has eventually to learn the consequences of his decisions, and the only way that will happen is for him to experience them full force. You can assure him that you love him and will be there for him when he’s clean, but that your love extends all the way to doing the right thing no matter how much it hurts both of you in the short term.

    Also, please hit some Nar-Anon meetings. You most certainly need the understanding and support of others who have been where you have, are, and could be again.

    Keep on keepin’ on!



  85. Ty

    Hi Bill,
    I have a 19 year old son soon to be 20. He has had a marijuana addiction sense he was 8, and has been to 8 different treatment centers. The last center I had him in was out patient called Center for behavioral Health, which dealt with addiction and behavioral issues. He has also had DBT Therapy, at another place, and both places said he was emotionally younger He was doing good at home for the most part but a couple of months after turned 18 he moved out, and was back to his old habits, now almost a year latter hes back home, doing great has a job, and 3 months clean, but the only problem I have now with him is every once in awhie he has an attitude problem like a younger teenager, what do i do, or is that just part of PAWS?


  86. Cheyenne

    Hello Bill,

    I wasn’t ever really a heavy drinker or anything like that. I started when I was 18, but it was only occasionally, the random house party here and there during high school, and once I entered college, I didn’t take up drinking until I was 20, and stopped at 22. After that I spent two years without drinking in order to focus on my last few years of college, but when it was over I never really drank. It was never really part of the culture of the circles I was with, or at least never at the center of them – drugs and alcohol were always around, but I never felt a need to participate. It wasn’t until summer of 2011 when I met my now-boyfriend and starting hanging out with his circle that I was active in a culture of alcohol, and unfortunately got wound up in it. My drinking got really bad about May or June of 2012, and culminated with me being arrested in September and subsequently violating probation in December. I’ve been sober since then, so about 3 1/2 months now, and I think I’m starting to feel the effects of PAWS now (if I haven’t been already.)

    I guess I want to know that, if I never displayed “addictive” behavior or that I wasn’t abusing (misusing) alcohol for a long while, will this last a long time? I’ve got a bunch of the symptoms – mood swings, anxiety, irritability, concentration and memory disturbances, tired and sleeping all the time – but I’d been chalking it up to my anxiety until I started Prozac recently. Will taking an antidepressant help alleviate some of the symptoms or help them dissipate sooner? I’m just afraid of relapsing because it wouldn’t be just drinking again for me, mostly because I don’t want to go to jail at this point of time.

    Thanks for any help you can give.


  87. Bill Post author

    Hi Liam,

    I’m going to answer your question twice.

    1. No, cigarettes or an occasional cigar won’t affect your PAWS that much, although if you become a chronic smoker you may have to experience the post-acute withdrawal from that.

    2. You question “im just wondering say if i wanted to smoke ciggaretes ocassionaly or smoke a cigar” implies that you haven’t been doing so. If that’s the case, why in God’s name would you want to take a chance on re-activating an addiction to one of the three most addictive drugs known to medical science?

    Tobacco products are the number one cause of preventable death in the world.

    What else would you like to know?

    Congratulations on your three months, Dude. If you’re clean and sober from nicotine too, even more congrats! You could talk to your doctor about gabapentin (Neurontin) for the anxiety and depression. If you do so, DO NOT stop taking it without a physician’s guidance. It is not addictive, but there can be some dangerous backlash if it isn’t tapered off carefully. As for the low self-esteem, go to some meetings, find a good sponsor and work the steps. Your self-esteem will prosper, and so will the rest of your recovery.

    Whatever you do, don’t use, and go to meetings. ;-)

    And keep on keepin’ on!



  88. Liam

    hi bill im 3 months sober from alcohol and some weed going through some heavy PAWS symptoms Still alot of anxiety and depression and low self esteem and feeeling always tired.. im just wondering say if i wanted to smoke ciggaretes ocassionaly or smoke a cigar will that affect the paws will i have to start all over again? from the 3 months i put in staying sober?


  89. Bill Post author

    Hi again, Debbie,

    Frankly, it all depends on your daughter and how well she may have dealt with her underlying issues in treatment. All addicts have issues accumulated over the years of use. Along with that, your daughter most likely has some stemming from her early life with an addict, and quite possibly from her time in foster care as well. If she received guidance on dealing with those things while in treatment, and was able to do so with some success, her chances will be greater than if she simply blows the whole thing off. The same is true of her attitude toward meetings and support in recovery. Resistance to those things is a really bad sign insofar as long-term sobriety goes.

    Your most important duty is to yourself. Please attend some Nar-Anon or AlAnon meetings — and by “some meetings” I mean several at minimum. It takes most of us that long to get over the awkward feelings and begin to “get” what they’re about. Loving an addict has given you some issues of your own that need some attention if you are to be able to take the long view about things. Relapse is a common phenomenon among newcomers — indeed, it is one of the symptoms of addiction — and you need some perspective about that, which will also help you to consider your relationship with your grandchild. Don’t ignore this valuable resource. I can’t overemphasize the importance.

    Again, please stay in touch. And, as always,

    Keep on keepin’ on!



  90. Bill Post author

    Hi John,

    Congrats on the 90 days and 180 nights! Good to hear that things are improving for you.

    Lexapro is harmless to addicts but quite useful for mild depression. Ambien and Xanax are both absolutely out of the question, however. A word: be careful about that redemptive stuff. I understand where you’re coming from, but suffering for its own sake (if that’s what you meant) is just a bit medieval, don’t you think? Stress aggravates PAWS, and PAWS-related stress is a major cause of relapse. We want to keep our primary goal carefully in mind here, and not get too far off into the mystical mists. There are other ways to “redeem” ourselves, like passing on what we have learned to others in the rooms. Just sayin’.

    I had some trouble with reflux, not immediately after I got sober, but two or three years down the road. I watched my diet, avoided fatty and spicy foods, didn’t eat in quantity before bedtime, slept propped up for a while (what a pain in the ass that is!) and generally followed all the directions. They helped some, but not entirely. I finally traced the problem to hot food (as in temperature, not capsicum). Apparently my enjoyment of piping hot foods and beverages was causing minor scalding of the pyloric valve, which was then sufficiently irritated that even the smallest amount of acid reflux caused misery. I began to watch that carefully, and the problem disappeared immediately. The only time it comes back (and it’s been about 18 years) is if I forget and swallow something that’s too hot. This, for what it’s worth.

    It was good to hear from you. Please stay in touch, and

    Keep on keepin’ on!



  91. John

    Hey Bill, I wanted to check in with you again. Today is the 90 day mark for me! I’m happy to report that I’ve been feeling better and for longer periods of time which is quite a relief. I still slip into periods of anxiety/depression, but they seem more short lived and I feel like I can manage them. I’ve been back to some of the normal day to day stuff that I enjoy which makes me so happy. I’ve noticed that when stressful events happen I tend to slip into a bad place mentally and also have what my psychologist calls “somatic” symptoms. I never took any of the medication (Xanax, Ambien or Lexapro) as my belief is that what I’m going through is a natural part of my recovery from addiction to alcohol and even though I’ve been in dark place, for me there is a redemptive element to facing tough emotions and learning to accept them without drugs.

    One of the somatic symptoms I have that seems to relate to stress is acid reflux. Not heartburn, but acid coming up at night and burning my throat. It just adds to the disturbed sleep. I’ve never had issues with this prior to getting sober and am wondering if it is somehow linked to quitting? I know alcohol can wreak havoc on the digestive system, but I’m wondering if quitting can somehow trigger it? Like an over-correction or something? Might be a stretch i know, but all these problems all seem to have come crashing down on me since I quit. And Bill huge thank you. Your insights have really helped me in a tough time. you rock.


  92. Debbie


    Thanks for your quick reply and advice. I adopted her from foster care when she was 10 years old and her mother was an addict also. Will this have any bearing on her chances of staying sober long term. I just worry because all the statistics I read about relapses are high for people in first time rehab. The courts are only making her attend na and AA meetings for a couple of months after rehab, if she quits going after that I worry also. Thanks


  93. Bill Post author

    Hi Debbie,

    I understand your concern. It’s hard to say how it will go for her. Ninety days is a decent length of treatment, and if she uses the five weeks to get a local support group in NA or CA, go to meetings and do the things she needs to do, she could be ready to resume her duties as a mom in another few weeks. How the stress of taking care of an infant will affect her is something else.

    Okay. You asked for advice.

    1. Do not bug her about meetings or her recovery. It won’t do any good. You’ve been bugging her about related things for half her life, and going back to the old way of relating to her will do neither of you any good. You BADLY need to get to some Nar-Anon meetings to help you with that. She needs your support, but it must be the right kind of support, and the folks at Nar-Anon have invaluable experiences to share that will help you find your own way into a healthy relationship with your daughter. I admit that I’m making some assumptions about your prior relationship, but they’re definitely educated guesses. You need Nar-Anon for yourself, in any case.

    2. Help out with the things that count. She’ll need some time to get to meetings and associate with her sober friends. Great. Do what you can to help. Spend time with her and the baby. Let them both know that you love them. However, she does not need time to socialize with her old friends, date, and do the things that she was doing before and may want to take up again. Explain gently that her concentration has to be on her recovery and that you will do what you can to help her do that, but that you will do nothing to facilitate any social life out of NA. Explain this once — only if it comes up — and then don’t argue about it. Just stick to your guns, quietly.

    3. Keep firmly in mind that you have absolutely no control over anyone but yourself. You cannot influence your daughter to stay clean and sober. She is thirty years old, and any choices that she makes will be hers alone, including whether or not she goes back to using drugs. There is nothing that you can do about that. Be supportive, but know that what she does is not dependent on your taking care of her. It won’t help. The whole thrust of recovery is learning to live life on life’s terms, and the only way we do that is to do it — not have it done for us.

    I wouldn’t worry too much about the baby. If she uses again, a quick call to Child Protective Services will take care of the baby issue. Just keep an eye on things, and do what you have to do if you have to do it. Again, as dispassionately as possible. I know this sounds cold, but getting into a fight with her will help neither of you. Being loving is not the same as being an enabler. For more on that, check out my article here: http://sunrisedetox.com/blog/2011/03/08/enabling-addict-alcoholic-detox-codependency/

    Please get back to me if you have any more questions.



  94. Debbie

    I need some advice. I have a 30 year old daughter that has been using cocaine since she was about 15. She used during her recent pregnany and the child was taken into foster care. She has been in a inpatieint rehab center for 90 days. THe courts are going to give her the baby back five weeks after she gets out. How likly is it that she will relapse? I am afraid for the baby since I think they are giving the baby back too soon.


  95. Bill Post author

    Hi Mez,

    Congratulations on your determination to take control of your life.

    One remark: If it’s too rough, don’t hesitate to get back onto .05 every third day for a couple of weeks. It’s better to take a little longer than to be miserable. Recovery isn’t about misery…quite the opposite. However, once done, flush the rest.

    Stay in touch, and

    Keep on keepin’ on!



  96. mez

    everyone is so encouraging on this site!!! I’m starting my journey soon. down to .05 every other of Suboxone.On it too long 7 yrs….. tried twice before to withdrawal with Dr.’s help…..3rd time’s a charm…(please Lord)…..will be completely off @april 8th


  97. Bill Post author

    Juan, I’d love to help, but I am not a medical doctor. Generally Ativan is useful for anxiety, but it isn’t recommended for addicts since it acts in ways similar to many other drugs, and is itself highly addictive. You could suggest that your doctor consider Neurontin (gabapentin). It can be useful in those areas.

    I can’t comment on why the treatment didn’t work, but it could be because you had expectations that couldn’t be met. Recovery can be tough. We messed our brains up for years, and we can’t expect them to return to normal quickly, or without some discomfort. The suggestions in my previous answer still stand.

    Hang in there, and

    Keep on keepin’ on!



  98. Juan Puente

    well what medication would appropiately be good for anxiety or panick attacks that give me the most,,, depression is not a problem anxiety and panick attacks are? please so i can advise my doctor i already went to a mental center for 2 weeks but wont work ,,


  99. Bill Post author

    I can’t really advise you on this, Juan. I don’t know what resources you have available to you, and it would be unethical for me to suggest what treatment you need. Your doctor is doing what he/she can, but Ativan is not the best choice for you at this time. I suggest finding a treatment facility that will accept you. Call your local Mental Health Association for referrals, or check here. Otherwise, go to the ER and explain the situation. If there is a local mental health facility, it might also be an option.

    I will tell you this: depression is nothing to mess with. It can worsen in a hurry, and there may at that time seem to be only one way out. If you are thinking about self-harm or suicide, call your Crisis Line immediately.


  100. Juan Puente

    can you please reply quick i dont know whats wrong with me im really depressed and feel so bad i really need your help bill i would appreciate it please


  101. Bill Post author

    Hi Juan,

    I’ll need to consult with someone else, as this is a bit outside my area. I’ll get back to you as soon as I can.

    Hang in there,



  102. Juan Puente

    what can i do im 19 and i have serious anxiety and moods and insomnia also panick atacks i cant control my anger please help me im 1mont and 2 weeks sober from marijuana and taking ativan prescribed but i feel worse i need help bill pplease


  103. Bill Post author

    Hi Chris,

    Yes, yes, yes and no.

    The symptoms are typical. However, I’m not going to tell you that it’s only going to take you six months to “feel better.” I will say that you ought to begin feeling somewhat better around six months, but PAWS from both alcohol and weed can last much longer than that, depending on body chemistry, amounts drunk/smoked, and any underlying conditions that may have been masked by the drugs.

    That’s the bad news. The good news is that it does get better, and there are non-addictive medications that can help with the depression, feeling tired (which is probably a result of the depression) and anxiety.

    First of all, when you say “bad depression,” just how bad are we talking about? If you are just feeling blue, that’s one thing. If you are feeling worthless and no good, or contemplating harm to yourself, that’s another thing entirely. In the first case, Neurontin (gabapentin) will probably help. If you are thinking about self-harm, or feel that life isn’t worth living, you need to talk to a doctor immediately about getting on a full-blown antidepressant. They do not interfere with recovery, and may well save your life. DO NOT WAIT. Depression can worsen very rapidly, and it’s not long until you reach a point where even going to the doc is too much trouble, or you aren’t worth it, or whatever’s happening in your head. Under those conditions, suicide is a real danger.

    Second: When you’re on medication for depression (and this includes Neurontin) you DO NOT go off it without a doctor’s guidance. It needs to be tapered or replaced with another drug in order to avoid a rebound effect that can cause profound depression quickly. You can tell what concerns me here. Depression’s nothing to mess with. I lost a beautiful 19-year-old step-granddaughter to it. Stopped taking her meds…which were working well for her.

    Talk to a physician about my suggestions here. You don’t need to feel lousy.

    As far as PAWS is concerned, it lasts until your brain has repaired the damage from the drugs, but it does get better gradually, with good times gradually increasing and bad decreasing. It does get better. Hang on to that.

    Stay in touch, and

    Keep on keepin’ on!



  104. Chris

    hi bill… is bad depression and anxiety and feeling tired all the time a normal common symtom involved in the post acute withdrawal from weed and alcohol? and it should take about approximatley 6 months being sober untill i feel better right?


  105. Bill Post author

    Hey John,

    Addiction is a medical specialty and many practitioners, including many psychiatrists and psychiatric nurse practitioners, are not well-educated about it.

    As for PAWS, I have been lecturing and writing about it for over fifteen years, and constantly run across people who have been in long-term treatment facilities where they never heard a word about it (or not enough to remember). The lack of knowledge about it among professionals is appalling, which is why I run this site. Although there are pages about other aspects of recovery, I set it up specifically to host the PAWS articles and comments, which were popular on another site despite its being about something other than addiction. This is not new stuff, but you’d think it was.

    PAWS or not, your practitioner knows about depression and how to treat it. Lexapro will not affect your recovery, and will most likely enhance it by making your life more pleasant in general.

    However, as with all antidepressants you need to know a couple of things:

    It will probably not help immediately. AD’s work by modifying brain chemistry, and can take up to a month or six weeks to do their job. Many people stop taking them in disgust, because us addicts think medicine should work instantly, like our drugs did.

    Antidepressants should NEVER be discontinued without medical guidance. That is especially true of those that also have anti-seizure qualities, as Lexapro and many others do. There is danger of a rebound effect that can send one into deep depression if the drug isn’t withdrawn properly. The same is true of seizures, although the risk is lower with Lexapro than with some others.

    Quite rarely in adults, but somewhat more often in teens, antidepressants seem to trigger depression. If you find yourself becoming more depressed, especially if you find yourself feeling worthless or considering self-harm, call your practitioner or another mental health professional immediately. This is no joke.

    As far as the overall diagnosis of generalized anxiety disorder goes, it’s extremely difficult to diagnose anyone’s underlying problems in early PAWS. I wouldn’t worry too much about that. She could be right, or not. Just go to meetings, work the steps, take your other medicine and

    Keep on keepin’ on!



  106. John

    Hey Bill, I just had an interesting meeting with a Adult Psychiatric-Mental Health Clinical Nurse Specialist (PMHCNS-BC). It was a little discouraging as she had never heard of PAWS and basically just said I needed to take Lexapro 10mg daily to get over the bad feelings (anxiety/depression/super emotional) I’ve been having lately. She said that my drinking was used to self-medicate the generalized anxiety disorder I already had and that it is probably genetic. It felt a little presumptuous for her to say all that in the hour we met. I don’t think I’m going to get the prescription filled yet – I just feel like I need more time to figure out where this new me is really going. I kind of feel like things are starting to get better. Do people with PAWS commonly get on Lexapro?


  107. Bill Post author

    Hi Mark,

    Congratulations on deciding to change your life.

    You can expect fluctuations in appetite, ability to sleep and digestive comfort for a while. The best way to deal with the stomach issue is to make yourself eat small meals regularly, whether you want to or not. Try to keep a regular schedule, so that your body can adjust.

    The dreams are normal. As long as you’re sleeping, don’t worry about them too much. Your brain has just been deprived of stimulation that it has been used to for more than three years, and it is going to take it some time to get used to that and repair itself. Until that is completed, you will have intermittent symptoms, although they should moderate as time passes. Expect at least a year of physical recovery, perhaps more. Opiates, especially Oxycontin and Suboxone, have one of the longer lasting syndromes.

    For future reference, Suboxone works best for short detox periods of less than 10 days. It is not a good maintenance drug, despite what some doctors think. As long as you are on it, Methadone, or any other mood-altering drug (think “fun” drug), your brain and body can’t recover. Replacement therapy is just that: replacing one addiction with another. Healing doesn’t begin until we are clean.

    A further note: Antidepressants won’t affect your recovery. If you find yourself feeling depressed — and you most likely will — see a physician if it’s bad, especially if you’re feeling worthless or thinking about self harm. Better to take a pill for a while than to kill yourself, or even to simply be miserable.

    The best exercise is a brisk walk for at least 1/2 hour a day. Do not lift weights or do strenuous exercise, especially anaerobic exercises. Muscle-building exercises stress the body, and you don’t need any more stress. I don’t recommend competitive sports for a while for the same reason. Stress. Try to make your recreation fun, not competition, until you are feeling reasonably normal, then EASE back into whatever sports you were doing.

    Apart from that, I’d suggest that you read the PAWS article carefully and follow those suggestions.

    Be sure to ask any questions you might have, Catch some NA meetings, and

    Keep on keepin’ on!



  108. mark

    hi bill.
    i recently stopped taking suboxone after being on it for over a year and a half. i have been taking between 2-4mg sub a day. Previous to that i was taking oxycontin 80mg-160mg a day for about a year and a half. i have been off everything for 7 days now, as i just completely stopped last week as i realized i was in a very dark place in my life. i did have some withdrawls but nothing like when i cold turkeyed off oxy a few years ago. I am feeling pretty decent but my stomach and appetite are not doing very well. i also seem to have these endless crazy dreams every time i sleep although no real problems being able to sleep through the night. Is there anything that will help with the appetite problem and stomach pain problem? Also what is the best routine to get into to make my body fix itself? will these dreams stop? also like everyone else i feel sluggish and without much energy? is the best thing to do exercise? ie take a walk or lift some weights? please let me know what you think as i would greatly appreciate any advice you may have for me? thanks


  109. Bill Post author

    Hi Susan,

    Boy, I remember that fuzzy head!

    I wish I could tell you that you will be over the symptoms soon, but I’d be lying. You have some months ahead of you, and there’s not much you can do to change that. Our bodies can repair the damage only so fast. Good food, rest, moderate exercise (walking is best) and having some fun in our lives are the best remedies. And time.

    Things will get better, but you have to be patient. Hit some support group meetings. Those folks know how it is. We need the understanding of people who have been there, and who won’t judge us when we talk about our issues, whether present or past. Write any time, and

    Keep on keepin’ on!



  110. Bill Post author

    Hi Dave,

    Thanks for writing, and that’s a good question.

    I take a conservative viewpoint on vitamins. Most experts not connected with the vitamin industry agree that there is no point in over-supplementing unless blood tests have indicated an insufficiency of a particular vitamin, such as vitamin D. Of course, those who do have an ax to grind, either because of ties to the industry or their own endeavors (books, websites, health food stores, etc.) take an entirely different view. I once heard a nutritionist sum it up: “Americans have the most expensive urine in the world.” We require vitamins in tiny quantities, and what isn’t absorbed goes down the drain — literally.

    That said, there is no question that many, if not most, addicts suffer from malnutrition, including 100% of alcoholics. Alcohol prevents the small intestine from absorbing nutrients properly, and also interferes with the intestinal flora that produce many of the nutrients we need. As a general rule, I believe that absent a doctor’s recommendation most of us do fine with a multivitamin every day with a meal (I take mine with breakfast). Because I have also been diagnosed with a vitamin D deficiency, I take supplements of that as well. In the case of early recovery, no harm can come from taking one in the morning and one in the evening — always with a meal. Vitamins are food, not medicine, and must be digested with food in order to be properly absorbed.

    As addicts, we love the idea of some magical pill that will make us all better. It doesn’t exist. The repairs necessary in the body to recover from addiction will take place with a good diet, exercise, rest, and — important to a remarkable degree — fun. And time. We’re used to getting results fast. It’s no accident that the drugs that are most rapidly addictive are the ones that work the fastest. We don’t like to wait. Nonetheless, it takes months for our bodies to get back to something approaching normal. Good nutrition, exercise and so forth take attention and work, and there’s no instant payoff. That’s our biggest hangup in recovery: wanting the magic pill.

    My personal opinion is that people who eat properly, get a bit of sunshine and some exercise probably don’t require more than a multi a day, and perhaps a mineral supplement if the multivitamin doesn’t provide them.

    Thanks for writing, and thanks for posing a question somewhat different from the usual.

    Keep on keepin’ on!



  111. Susan

    Wow – thanks so much for putting this info out there. I’ve been off painkillers for about 3 weeks, and now I know why I’m feeling and acting this way. You have explained it so clearly. I’d write more, but my head is too muddled. Thanks again.


  112. Dave

    Hi Bill,

    Great article and advice. I have a general question regarding vitamin deficiencies and PAWS. To what extent do you think this plays a role in PAWS symptoms that we may experience? It sounds like the body is super busy repairing itself and was curious how often this has shown as a significant issue in all of your years of significance?


  113. Bill Post author

    Hi Matt,

    Simple answer: You’re addicted; they aren’t (or they’re lying to themselves).

    Whether or not we become addicted depends on a lot of personal factors, not just on how much or what we use, or for how long. Some folks have a genetic predisposition to alcoholism, so it hits us faster than other drinkers who don’t. Some of them will become addicted if they keep on long enough; some may not.

    That’s not important. What’s important is that OUR brains changed in the presence of alcohol and other drugs. Actual physical modifications took place that allowed us to use more, and tolerate more. Over time, the changes reached a point where we had to have the drug(s) in our system in order to feel normal. At that point, we were addicted.

    The symptoms that you feel when you stop using are because your brain needs time to get used to the lack of stimulation from the drugs. The recovery time can be from six months to two years, depending on the drugs. In the case of marijuana, you can expect symptoms to last for at least a year. You won’t be able to tell if they are from boo or booze, so don’t worry about that, either. Take care of yourself physically, go to some NA meetings, and wait for time to do its thing on your brain. Taking care of yourself in the mean time and avoiding all mood-altering drugs will help.

    Read the article and follow the directions. It’s worked for a lot of folks. Feel free to contact me at any time, and

    Keep on keepin’ on (or get started),



  114. Matt

    hi bill i have a question how come people i know can smoke weed everyday and drink everyday without having anything wrong with them like no depression or anxiety but when i smoke weed it usto make me feel good then after a while it made me have panic attacks and have anxiety and feel messed up and drinking it makes me feel good the day after and for a while i feel depressed with all the paws symptoms so my question is how come other people can drink as much as they want and feel okay and even if they do quit they dont go through the PAWS withdrawal symptoms but i do?


  115. Bill Post author

    Hi Peter,

    Everyone’s brain chemistry is different. With over 1000 chemicals bathing the brain in various regions, it could hardly be otherwise. Generally speaking, PAWS symptoms ameliorate within the first year. However, some folks get lucky with earlier recovery, and some take longer. Medications such as benzodiazepines (Xanax, Valium and Klonopin, to name only three of a couple dozen) taken while we were drinking AND afterward can prolong things, as can use of marijuana and some other drugs. That’s in addition to our own chemistry.

    So there’s no one answer for anyone. I’d not worry about the PAWS. The increasing incidence of memory problems and confusion, however, are worrisome. Those usually improve in the first few months. It might be a good idea to see your physician, and perhaps consider a referral to a specialist for some tests, just to ease your own mind about it. Even if the news is not great, the sooner these things are addressed the better for long term treatment. Be sure to tell any physician you consult your entire story about alcohol use, along with use of any other drugs. I wouldn’t wait that out, because there is also the possibility of cardiovascular issues that could lead to the same symptoms.

    Let me know how things go, and for goodness’ sake

    Keep on keepin’ on!



  116. Bill Post author

    Hi John,

    Good to hear from you again. Congrats on your 70 days. That’s the hard part. Hope you’re hitting some AA meetings. It makes things so much easier.

    Do not under any circumstances take Xanax. Period. A doctor who prescribes a benzodiazepine drug to an alcoholic does not understand addiction. That’s not putting your physician down. I doubt he knows that much about brain surgery, either. They are specialties, and not many doctors get more than superficial coverage in med school.

    As far as the ambien is concerned, I’d avoid it. It can be habit-forming, and since it binds GABA-A receptors at the same location as benzodiazepines, I suspect it could have the effect of interfering with the normalization of brain chemistry that is a part of recovery, just as benzos do. Also, it tends to leave people drowsy after waking, and can interfere with short-term memory. Recovering alcoholics don’t need any help with that.

    Insomnia is a normal part of recovery, and will gradually decrease over time. You didn’t say what kind of exercise you’re doing, or when you’re doing it. If you are doing anaerobic exercises or heavy jogging, I’d cut them way back and stick to yoga and walking for a while. Your body is still in the process of repairing itself, and heavy exercise that puts more stress on the body can interfere with the process. Moderate exercise, on the other hand, both increases your body’s efficiency and tires you out without causing aches and pains, which can help with the insomnia. Mild aerobic exercise is much better in early recovery then lifting weights or equivalent endeavors. Swimming is excellent. It exercises the whole body without straining anything. An hour of hoops is good, if done several hours before bedtime.

    If I were experiencing insomnia, I would (1) eat a high-protein snack just before bedtime, (2) take 2 mg of melatonin about 30 minutes before bedtime (the sub-lingual kind that dissolves under the tongue) and (3) go to bed and try to go to sleep. Don’t read or watch TV in bed. If you simply can’t get to sleep after an hour, get up and do something that isn’t too stimulating. When you feel drowsy, try it again. If you lie in bed too much unable to sleep, your body stops associating bedtime with sleeping and it becomes harder to drop off. Finally, pick a bedtime and stick with it. Go to bed at that time every night. If you can’t sleep, OK (see above), but your body will never settle down if you keep jerking it around.

    Chamomile tea before bedtime might help. Drop a pinch of powdered ginger in, to help settle your stomach.

    The main thing is, be consistent. Don’t worry if things don’t work the first night, or the second, or the seventh. Any sleep specialist will tell you that consistency is half the battle. Your body has to know what to expect. Oh, and NEVER exercise less than three hours before bedtime.

    Hang in there. Things will get better, slowly. We can’t expect our bodies to return to normal in a few weeks after years and years of accustoming them to abnormal conditions.

    And keep on keepin’ on!



  117. Bill Post author

    Hi Sasha,

    Naturally there is a tendency to want to use our old tools to solve the old problems. We spent years doing that. Recovery isn’t about not drinking or drugging, it’s about learning to live without it. Going out drinking with our buddies seemed to work in the past, but all we were doing was masking the stress with alcohol, not relieving it as it seemed. Because we numbed our brains we even reduced our ability to get it together and resolve stress-related issues in other ways.

    Stress of one kind or another is the number one cause of relapse. Exercise, good nutrition, proper rest (when possible) and meditation are the best stress relievers. So are distractions. Go out and have some sober fun. Read a book. Go to a movie. Call a sober friend and go for some sort of outing…anything to relieve the monotony. If you don’t have any sober friends yet, hit a few AA meetings. You should be doing that anyway. Alcohol abusers who avoid AA are like diabetics who refuse to take medication. You can survive for a long time that way if you are very careful, but it’s a lot easier when you have the support. Practically all of my friends are recovering — not because I don’t hang out with drinkers, but because people who are sober tend to be more interesting. After we’ve been sober for a while, most of us find that being around people who are drinking is annoying. Hit some meetings. They greatly increase your chances of staying sober, and of enjoying life in the long run.

    I doubt that lemon balm extract would be harmful, as long as it doesn’t contain alcohol. Lemon balm is a member of the mint family, and recommended by some doctors for relieving anxiety. Whether that would apply to stress as well, I don’t know. They’re not the same thing. Probably couldn’t hurt. What is important is to look for the sources of the stress and eliminate them to the extent possible. It is impossible to eliminate all stress from our lives (even pleasant events are stressful), but there is a lot that can be done to change the way we deal with issues, and to clean up some of the old issues that are making things difficult for us in the present.

    Good luck, stay in touch, and

    Keep on keepin’ on!



  118. Peter

    Hello Bill,

    I would like some advice again.

    I am 59. I drank about 100 units a week between ages 20 and 32, then probably between 50 and 100 until 56 years gradually reducing over time. I then cut down to a binge every now and then. Gradually decreasing until I stopped completely in July 2012 – so between 7 and 8 months of sobriety with no slips.

    I read that recovery from PAWS symptoms is normally over 12 months with months 3 to 6 the worst, then gradual improvement over months 6 to 12.

    My experience is at the moment of the symptoms getting worse, particularly memory problems, confusion, and inability to pronounce words sometimes. I am even considering going to the doctor to see if it is some kind of dementia.

    My question is: given the long period of abuse – off and on 40 years – do you think that my symptoms are to be expected and I should just wait it out. If so, any ideas how long for? Most of the advice I have read is about 10 or 20 years abuse, but often the weekly amounts are much more than mine have been. What is the advice for fairly large amounts but for a long period, and how does that pattern of addiction affect recovery experiences and duration?.



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  120. John

    Hi Bill, Wanted to check back in with you. I’ve been sober for 70 days now. No way am I going back to drinking now. I’ve seen my psychologist twice and it is looking like I’m suffering from anxiety and depression problems. Next Wednesday I am also going to see a nurse practitioner that specializes in psychiatric medicine. Basically she is going to consult me on the options for medication. I’ve made a ton of lifestyle changes like eating only very healthy meals on schedule and exercising quite a bit and doing yoga classes almost everyday. I feel this has helped some and I haven’t had a really bad episode with anxiety and depression for about 6 days, However, I feel the symptoms mildly almost all the time. Sleeping is the most difficult thing as I have nightmares and wake up feeling anxious. I cannot get a good night sleep which really puts stress on me during the daytime and exasperate everything. My physician wrote me prescriptions for Ambien and Xanax but I’m not taking them as I don’t want to jeopardize my recovery process.

    I’d like you opinion as it seems I’m at a crossroads now about taking medication. Sometimes I think I can do this on my own and other times I get low and frustrated and think I need medication. Given your experience what is your opinion on that and if I was to get on meds, which ones?

    Thanks Bill


  121. Sasha

    Question: I have heard Lemon Balm Extract is a natural stress reliever–that it mimics Valium. However, is this safe for someone in recovery?

    Also, I have been 7 weeks sober, with a few headaches and fatigue here and there–however, my symptoms have not been as severe as I am reading on here (I was a binge drinker for 16 years). I am wondering however, if thinking and wanting to drink (say with friends, when stressed) is a sign of relapse at this point or a normal part of recovering?


  122. Bill Post author

    Hi Sasha,

    The general opinion among people in the treatment field is that there is more benefit from caffeine than harm. I agree. Several recent studies have even indicated that it is good for us in reasonable quantities, and the other ingredients in coffee and tea have their own benefits. Don’t worry about it. Keep yourself at four cups of coffee (or six of tea) per day, and enjoy. The more comfortable you are, the easier your recovery.

    Hit some AA meetings. They make lousy coffee, but it’s still good for what ails you.

    Keep on keepin’ on,



  123. Bill Post author

    Hi James,

    Take a look at what you just wrote. You essentially hate your life, and you’re thinking about drinking again, but after putting all that garbage into your system for so many years, NOW you don’t want to take medication. There are a variety of medications (Neurontin is one) that will reduce your depression and anxiety and make your PAWS symptoms far more bearable. And they will do so without harming your recovery.

    Using alcohol (and whatever other drugs you used) caused physical changes in your brain. Until your body repairs itself, you will have problems. That could take another few months, or even longer depending on how much weed you used and for how long. You can do it the easy way, or the hard way — and remember that the hard way involves an extremely high risk of relapse.

    If you’re miserable and worried about how much longer this is going to go on, then do something about it. I guarantee if you use (you’re already in relapse if you’re thinking about drinking) you will feel a lot worse, and then when you decide to stop again you’ll have to go through the first two months all over again — just to get back to where you are now. You admit that your mind is all messed up, and yet you still think you know what’s best for you. That’s alcoholic thinking, Dude.

    Talk to a doctor. See about trying Neurontin for a short time. If it helps, fine. If not, OK too. Try something else. Just stay away from benzodiazepines (Ativan, Xanax, Valium and so forth), which will harm your recovery, and are often prescribed for anxiety. Your doc may not know much about addiction, so check with your pharmacist, or get back to me if you need more information. If the doc prescribes an antidepressant (and it sound as if you could use one), remember that you have to take them for at least a month to get the effects. Don’t give up on it until you’ve gone two months with no improvement. Even then, don’t quit without a doctor’s guidance.

    You don’t need to punish yourself. Recovery is about getting to feel better, not making yourself miserable.

    Oh, by the way, if you’re not hitting AA meetings, you’re REALLY shooting yourself in the foot.

    Best of luck, stay in touch, and

    Keep on keepin’ on!



  124. Sasha

    Hi–Does caffeine effect your brain chemistry/neurotoxicity while getting clean? I haven’t had alcohol for 7 weeks now–but noticing I get headaches, mild shooting pains in my brain–and really want to heal my brain from the 16 years of binge drinking I did. I have been drinking tea in the morning the last few days and felt fatigued and tired. I don’t drink coffee (hurts my stomach) and don’t drink tea everyday (so don’t think I am addicted to it all). Can I mess up all of my effort and recovery by having too much caffeine? It is a drug and it is an stimulant.


  125. James

    Hi.. i have been sober for 2 months now and still dont feel really any better i usto use alcohol daily where ever i went to make me feel good and about myself and depend on it to get rid of the depression and anxiety syptomps i be facing daily from a panick attack that happened a few years ago either from the weed or alcohol but either way drinking would make me feel good about myself just the day after and for the rest of the week the symptoms would be way worse unctrolable type thing.. so im tryin to stay sober to turn back to my old personaity before the weed or alcohol messed me up but its been 2 months now and i dont really notice a different my mind and body is always mad tired i sleep random times of the day i think thats a paws symptoms im going through, and i still have mad anxiety and depression where its hard for me to connect and talk to people good im always worried and i got enough bad negative thoughts its turnin me to start hatin myself its like i cant enjoy life and i dont got a personality no more like it hard for me to talk to people i cant feel emotions how many more months will it be till i start feelin better about myself and actually bein able to enjoy life without this depression and anxiety or wat ever im going through and i dont want to take meedication thats not a option not trying to depend on medication to get me better.. im gonna start doing excercising soon cause i heard that makes you feel good im just wondering how much longer till i notice a different usually im pretty sure this is PAWS im going through like being sober for 2 months already and still not feeling good its making me think like i should just be drinking alcohol all this time cause at the end of the day id still feel the same as i am now even with the hang over for a day or week but thanks tho for taking your time to read all of this..


  126. Bill Post author

    Hi Jen,

    That’s a tough row you’ve got to hoe, there, and it’s probably going to get worse. You are at a point where you have to decide whether to become part of the solution, or part of the problem. I sympathize.

    I wish there was an easy answer to your dilemma, but anything short of your husband going to detox and then treatment would probably not be effective. It is clear that he has passed the point of being able to be honest with you or with himself.

    Rather than reinventing the wheel, I’ll direct you to several articles I’ve written about codependency, enabling and similar issues. Please read them, and then contact me again if you have questions. If the articles seem repetitive in some respects, it is because there are really very few answers.





    Hang in there. There are solutions, but they will seem counter-intuitive. Doing the right thing in these sorts of situations is hard. However, they occur all the time. It’s not new, and the alternatives are well-tested.

    Keep on keepin’ on,



  127. Bill Post author

    Hi Tommy,

    Sometimes you have to do what you have to do. That said, it is never good for an addict to be taking opioid drugs. I would say that as long as you’re on them you can assume that your recovery has been suspended, so far as the physical aspects go. You also run a terrific risk of re-activating your active addiction, if you haven’t already. I’d personally do all I could to get off the opiates immediately if I were in your position. If it is impossible to control the pain, you can always go back to the current meds. Be certain, however, that you really do need to go back and that you are not making excuses to yourself in order to use.

    Tough spot. Talk to your sponsor about it, too.




  128. tammygodfirnon

    Hi I am a recovering heroin addict who has been clean for a few months now. I had back surgery a while back and I am taking an opiate based pain killer for pain as needed which is on average about once or twice a week. I was wondering if it is still possible to recover mentally and progress through PAWS while still taking an opiate based prescription because from what I have learned your mind will never heal as long as you are using any form of drugs in any amount. If this is going to hinder me from regaining my mental faculties I would like to know so I can have my Dr. switch me to a non narcotic medication. thank you


  129. tammygodfirnon

    I have a question, I am a recovering heroin addict for a few months now. My predicament is that I have had back surgury in the past and chronic back pain. I have a prescription for an opiate based narcotic pain medicine which I only take as needed which averages about once or twice a week. I am wondering if my mind will still be able to heal its self in regards the the PAWS as long as I am actively taking an opiate?? I know there are alteratives to opiate based pain medicines but they are the most effective and I do not want to switch unless absolutely necesarry.


  130. Jen

    Wow, what a great site. My husband is the addict and I’m so worried about him. He got hooked on pain meds and was taking them for years, he recently told me about it(thinking I had no idea what was going on) and started to try and get clean. He was doing great! Yesterday marked 15 days of having that particular drug out of his body. Even though he switched to anxiety and depressions meds, I keep thinking baby steps…lately I’ve noticed him acting a little strange, I found his google searches and asked him about it and of course he denied that he was looking up pills he found laying around at work. This is where I’m really hurt, I went out with a friend to talk last night-she works with my husband. She told me that he was trying to get her to find him “just one last pill” just to help cure the withdrawals. She said it got to the point that she almost started crying, she has never seen him in that state before. When I found out I asked him about it. Let him know we care about him and love him. He’s erasing text messages and that was the number one rule we promised not to do. And now he’s so angry at her for telling me. He said he didn’t tell me about it because he didn’t go through with it. I’m scared, worried and don’t know what to do anymore! I love him so much and want to help him but he’s pushing me away, what do I do?


  131. Bill Post author

    Hi Chad,

    No one knows what any given package of “bath salts” or “incense” contains, because the bastards who formulate them are constantly changing the chemistry to stay ahead of prohibitive laws. Therefore, I can’t give you a really accurate answer to your question. I’m going to take an educated guess and say that you won’t revert completely to the pre-PAWS state on one use. I would be more concerned about the use triggering old cravings for your drugs of choice. Regardless, it does count as relapse. Relapse occurs before we use.

    Get this thoroughly into your head, Chad: If you have ever heard of a drug or other mixture being used recreationally, DO NOT USE IT. I don’t care if you get it at the gas station, on the street corner, in a liquor store, or from a physician. If you’ve ever heard that it’s fun, don’t take it.

    We take drugs because (to begin with) they make us feel good. All feel-good drugs work on the same sections of the brain, although in different ways. However, the net result is that the portion of our brains that make us feel good — the “reward center” — is physically changed so that we need the additional stimulation in order to function. If we don’t have it, we feel like shit. That’s addiction. PAWS is the period during which the brain is in the process of returning to normal after all drugs are out of our system. If we re-introduce drugs, they interfere with, stop, or even reverse the repair process. Ergo, recovery = no drugs.

    Keep going to meetings (Oh, you weren’t? Start!), get a sponsor, help other addicts, work the steps, and get on with your life. Certainly it’s disheartening to think that you might go back to square one — so DON’T USE. It’s pretty simple. Recovery isn’t easy, but it’s not at all complicated. We just make it that way because we think like addicts. Essentially, recovery is learning how to stop thinking and behaving that way.

    Hang in there, and

    Keep on keepin’ on!



  132. Bill Post author

    Hi Dan,

    You have got to get off all mood-altering drugs and stay off them. Find a doctor who knows something about addiction. It’s clear that you haven’t so far, although the nurse practitioner seems to have had the basic idea.

    You didn’t say how long you took the Wellbutrin. It takes up to a month to have its full effects, like most antidepressants. One of the major problems people (especially addicts, who think things have to happen right now) have with antidepressants is that they go off them, thinking they don’t work, long before they’ve had a chance to do so. That’s just parenthetical, however.

    It sounds to me like the episode on holiday with your mates was a panic attack. You should not have been going through alcoholic withdrawal at that time, having just had the beers. Of course you would have by the time you finally saw the doc, but that’s immaterial to the original issue. The chances are good that some, and maybe all, of your problems are from PAWS, but the anxiety and depression need attention.

    Find a psychiatrist or internist who understands addiction. You need some long-term support from a physician who knows what’s good for addicts and what isn’t. Clearly your way isn’t working for you. If you can afford it, I’d suggest primary treatment for alcoholism at a good treatment center. Remember, insanity is doing the same thing over and over and expecting different results.

    It is extremely unlikely — although not impossible — that a person your age would have enough brain damage to be suffering from W-K Syndrome. It is, however, quite possible to mix alcohol and other drugs like tranquilizers and stimulants and so scramble your brain chemistry that it takes a long time to normalize, and in the meantime you can have some pretty wild rides.

    Get a good neuro-psychiatric workup and stop the hit or miss doctor’s visits. This needs a good, prolonged look by someone who know what they’re doing. Most doctors know little or nothing about addiction, although many of them think they do. It’s a specialized field like any other specialty, but physicians who wouldn’t dream of doing open-heart surgery are perfectly willing to tackle other specialties in which they’re inadequately trained. Go figure.

    You haven’t been 5-6 months sober (physiologically) if you’ve been taking tranquilizers. Benzodiazepines like Ativan prevent the brain from making the changes needed to return to normal brain chemistry. There are other anti-anxiety agents that do not mess with the brain’s reward system, such as Neurontin. Generally speaking you should not be taking any drug that you’ve ever heard can be used recreationally.

    I realize this may not seem to be too helpful. However, I couldn’t treat you via email even if I were the kind of specialist you need. Go to the SAMHSA site here and find someone in your area who can help.

    Good luck, and

    Keep on keepin’ on!



  133. Chad Warwick

    Hello bill I noticed you were doing a Q&A in this feed and I have a question. Let me start by saying I was clean from a meth and cocaine addiction of 14 years for about 6 months when I convinced myself that the “bath salts” sold at my local gas station would be an alright alternative. Needless to say I was very mistaken they were as powerful and seemed just as poisonous as the street versions. My “PAWS” during those 6 months clean were horrendous and I was just starting to notice at that 5-6 month mark I was feeling better with clearer thoughts and clearer happier emotion. My question is does my post accute withdrawal truely restart from day one with this single use. I bought one vial of the bath salts and dosed with it twice in an hour period. It is very depressing and anti-motivating to think I will have to relive the past 6 months especially considering all the work I put into it. I have found a home group, sponser and worked the first 5 steps during this period. Thank you for this website and deticating your time to those of us fighting for our lives.


  134. Dan

    Hey Bill,

    I meant to include this in the short novel I had written (I will keep it short this time I promise!)

    When I went through my withdrawal from alcohol in August 2012 the doctor gave me B-1 supplements to take. I tend to read a lot especially on things I don’t understand and found that it is used to prevent Wernicke–Korsakoff syndrome. He gave me an oral dose of 250mg a day. Reading further I found that after going through the bodies process, including passing through the blood brain barrier, only a very very small amount of B-1 is actually reaching the brain. Certain article I read suggest that in a case like mine it should have been administered differently to get more to the brain faster. Is it possible to have a mild form of Wernicke–Korsakoff syndrome from not getting B-1 fast enough? (I took my first dose of B-1 250mg two days after I stopped drinking and took it everyday for 2 weeks)

    And finally, I have been 6.5 months sober so about 6 months into PAWS. Can someone with my drinking history have it for up to two years in your opinion? (I have read that it can last for up to two years in some cases)

    Again, thank you for your time, and sorry for making it so long. Also, sorry for the spelling mistakes I just noticed!

    Have a great day,



  135. Dan

    Hello Bill,

    First I would like to say that it is inspiring what you do on here taking the time to answer people’s questions. Just plain awesome!

    I am 30 years old, and have been drinking heavily since I was 18. In the beginning it was usually on weekends, at parties or with friends. As I got older and the bar scene came into play I was drinking 4-5 nights a week. And when I drank, I drank. I would go home very very buzzed, sometimes blacked out. As the hangovers got for frequent I was introduced to the idea of just waking up and drinking. Hangover gone! SoI started to do that. As my life moved on and I got older I moved to Las Vegas (not a great place for someone like me). Being a somewhat intelligent person I realized that I could not continue drinking at this rate but I loved it so much. So what I did was drink heavily for a month or so, then take a month of. Then drink heavily again. This lasted for years. I typically go home to Massachusetts for the summer from July til October and have that entire period off from work. So I drank. That was my time to drink. Every day and night. I might take one day off a week. Anyway, this past summer of 2012 after about 2 weeks of hard drinking I want to the bathroom and noticed blood in my stool. I freaked. I stopped drinking for a week figuring that would cure it. The next weekend I went away with friends to a remote cabin in Maine and drank heavily. Probably 1.5L of vodka and several beers. The next day I woke up, had 2-3 beers while hanging outside with a friend. At that moment my life changed. All of the sudden nothing made sense to me. This feeling of uncontrollable fear came over me for no apparent reason. The trees started to move and dark spirit looking figures were coming out of them. I personally don’t remember the next few minutes, but I woke up next to my friends truck in the driveway with everyone standing around me. I was told after that I fell to the ground, started making noise and having what looked like a seizure. I stayed in bed the rest of that day with a resting heart rate of 140. I felt like I was dying. The next day I made a friend leave with me and we drove back home to Massachusetts and I immediately when to my doctor. He told me I was going through alcohol withdrawal and gave me ativan. He then recommended that I attend detox right then, after explaining to me what had happened and what was going to happen. I refused to go (I am Irish and stubborn) and told him I would do it on my own at my house. And I did it. It was the most terrible experience of my life. Just a note, for some reason sleeping on my bedroom floor calmed me down and I was actually able to sleep. Anyway, on to current events…

    I have read a lot about PAWS and have a good understand of what they are and why they occur. This is where my question to you comes in. My episode happened in the first week of August 2012. I did not drink again. I came back to Las Vegas, started working out, eating better. Everything was good. I rarely had any anxiety but when I did it was mild and I was able to control it. I used to occasionally smoke cigars but during this time I was smoking 2-3 a day. I think it helped calm me down. Anyway, things were going as I planned. I came back to Mass for Christmas and New Years. I drank on New Years for the first time in August. I had 5 beers. No anxiety the next day but then the rest of that week it was terrible. (Having read everything you wrote I now realize that was very stupid of me and I am not going to have another drink no matter what the occasion) So I came back to Vegas again and jumped back into my routine and things got better. I had good days and bad but definitely more good. I managed the bad days on my own. And again the nicotine seemed to help me somehow even though I know it is very bad for me. Now, within the last 4 weeks. I had to fly to Boston for a funeral, I flew from there to Seattle to see a friend. From Seattle I went to Tampa with my family and then back on to Boston for a few days before coming home to Vegas. While in Boston the anxiety seemed to be acting up a lot more than normal for some reason. My head seemed to be floating in water and I had trouble thinking and everything seemed fuzzy. Since these feelings had left me in previous months I went to my doctor to see what he thought. He was not in and I ended up seeing a different guy who was a nurse-practitioner. He said it is anxiety, here is Wellbutrin. I took it that Friday, was ok. Saturday was pretty tough. I left Sunday and it was terrible especially with the flight and all. I finally got back to vegas. I stayed on the Wellbutrin but things seemed to be getting worse. I play poker frequently and was out playing one day. While there I rodered a decaf coffee (I have cut caffeine out of my life completely). The waitress accidentally brought me a regular coffee and I drank the whole thing before I realized. Then I started flipping out. Somehow I was able to manage to bring myself back to earth and convince myself I was not going to die. The entire week this week I stayed with the Wellbutrin. I was having some crazy thoughts. I am not a suicidal person in the least but the thought started crossing my mind and my disease seemed helpless. I was convinced it was something more and that my wet-brain was actually cancer. Yesterday my throat started to close and my resting heartbeat was 130 so I went to the ER. The doc there gave me 1mg of ativan, told me that he thinks i have allergies (to explain the head issues) and that Wellbutrin may have intensified all of these feelings in me. He gave me 15 1mg ativan and 30 10mg Zycan for allergies. I went home last night and was fine (I was on ativan). Today I never left the house and at about 7pm while watching TV it just came on me. Rapid heart beat over 120, my chest and throat tightening. I wanted to make it through the day without taking an ativan (having read they are addictive and I dont want to need drugs to live) but I ended up taking one right before I wrote this. My anxiety last 3-4 hours before I took the ativan.

    I’m sorry this has been so long-winded but I just wanted to give you a clear story of my history. My question is can my anxiety still be from PAWS or a part of PAWS? I have been sober now for 6.5 months. Is it possible my brain chemistry is still messed up even after all this time?

    Again, thank you for what you do, your an awesome guy.

    Thanks for listening,



  136. rb

    Sami…I know what you mean. I look at it “for however bad it has felt it can feel that good”. You may be on the verge of a life beyond your wildest dreams. Get some help and just do a little to help yourself everyday. Trust me….I could write many things that have happened to me but figure out what matters and makes you happy. I’m right at the beginning of my journey also.


  137. Bill Post author

    Hi Sami,

    Your depression could be related to the Lyrica, but at this point it doesn’t matter.

    PLEASE SEE A DOCTOR IMMEDIATELY AND DESCRIBE YOUR FEELINGS COMPLETELY! There is no time to waste. The fact that you have considered suicide is a HUGE warning sign!

    Depression is serious, and can be fatal. You must get help right now. If you cannot afford a physician, call 1-800-SUICIDE or 1-800-273-TALK immediately.

    Feelings of self-harm do not mean you are crazy, and no professional would judge you for it. It simply means that your brain chemistry needs some adjustment. Depression is treatable.

    Please don’t delay! Call a doctor or the numbers listed above immediately!

    Also, stay in touch here if you feel like it. Don’t consider me a primary support, though, because I am frequently not available.

    Call. Now.



  138. Sami

    Hello Bill…

    In the past 3 months.. I’ve been suffering with a lot of problems mental & physical.. and im guessing it’s because after new year’s.. for fun I took two sheets of “Lyrica” ..it’s suposed to be an anti epilepsy pill.. and I was so stupid for doing that.. I was slightly depressed before all of this.. and i’ve been mis-treated by many people around me.. to a level that I can’t trust anyone.. so I was looking for anything that could take me out of this realm.. and i overdosed two times only but then I took the rest of the pills on a regular basis just for the hell of it which was dumb.. total pills taken is 14.. 75mg each… so now before two weeks I woke up with this horrific depression and i don’t feel in control of my brain anymore.. I don’t feel anything.. everything is like a chore.. I feel like I can’t be happy or excited anymore.. I feel like im living in an infinite cycle of a steady pace living.. it doesnt make a difference if i eat or sleep or workout.. im depressed all the time and sometimes i get so depressed to a level i have never experienced before.. thought a billion time of killing myself.. somehow everytime something sweeps it away at the end but i don’t think i can risk it again ive started to meditate and workout just for the sake of being better.. but i still feel like shit.. please help with any advice bill.. i’ll appreciate it… so much


  139. Bill Post author

    Hi again, Kam,

    I hope today is going better for you.

    In order:

    1. Everyone’s brain chemistry is different. With over 1000 chemicals bathing the brain, it could hardly be otherwise. Therefore, “normal” is relative. In addition to that, some ethnic groups (of one of which I suspect you may be a member) have more difficulty with nicotine addiction than others.

    2. My reason for suggesting the Zyban (or Wellbutrin) is that it may help with the depression and anxiety. Obviously, it isn’t “necessary,” in the sense that you can’t survive without it. However, your symptoms at this late date could indicate that you were self-medicating a pre-existing condition with nicotine. If that was the case, the bupropion could help normalize things and allow you to sort that out with the help of a doctor who is familiar with neuro-physiological conditions. I am most concerned about the depression. Profound depression is life-threatening, and should be addressed. However, it was only a suggestion. You are not my client, and it would be unethical for me to treat you by this route even if you were.

    3. You will not have the anxiety forever, unless there was an underlying condition. It should improve slowly, as should the depression. The fact that it is remaining for so long makes me think there may be more to it, as outlined above.

    4. Propranolol can be effective for anxiety, but it has a number of potentially serious side effects. Gabapentin is a better choice for most addicts, since we can’t take benzodiazepines which are the drug of choice for short-term anxiety suppression. That said, your physician may have reasons for prescribing that drug. Here is a link to the NIH page on propranolol. Read it and see what may apply to you. In all honesty, your physician’s prescription of clonazepam leads me to think that he or she doesn’t understand addiction. You might take that into account.

    Regarding friendcs, Kam, there are a lot of folks out there who would be happy to become friends of a sort. Check this forum, and participate if you feel comfortable. I think you will find friends and support in that community. http://forums.about.com/n/pfx/forum.aspx?webtag=ab-quitsmoking&nav=messages

    Things will get better, so

    Keep on keepin’ on!



  140. Bill Post author

    Hi Chad,

    A really good question! I don’t think anyone has put it that way before.

    “The medication” cannot repair your brain. That must be done by your body, using its normal processes. The purpose of the medication is to support you until that can happen. Using alcohol and other drugs suppresses the production of various neurotransmitters as the body tries to adjust the higher levels caused by the drugs. When we stop using, there is a sudden deficit that causes the symptoms that, taken together, we call post-acute withdrawal syndrome (a syndrome is a collection of symptoms).

    No, we don’t have to take the medication to heal. However, depending on the severity of symptoms, one may need the support in order to remain abstinent — and to have a decent quality of life during early recovery. There is a philosophy in the recovery community — to which I do not subscribe — that using medication is somehow cheating. I think that’s dumb, and I know it can be dangerous. It’s like saying you should cling to a log instead of using a life preserver. Recovery is like after a shipwreck. Smart people use all the tools at their disposal, not just logs.

    I hope I’ve answered your question adequately. This hard-nosed attitude on the part of some folks in recovery is not in line with good science, and has been responsible for a lot of relapses. I feel strongly about it. We have to remember that few of us addicts are experts on addiction, though we are good supports for each other in our recovery.

    Keep on keepin’ on!



  141. Kam

    Dear Bill
    Thank you very much for your answer .

    My questions is :
    -is it normal to be such depressed and have anxiety even after 56 days that i stopped ?
    -is it necessary to take zyban after 56 days ? i mean does it still have its effects on me ? ( after this period )?
    -and my worry is how many days should i be like this ? i feel like im gonna have this anxiety with me forever
    because there is no sign to decrease . is it normal for quitters ( nicotine ) to experience this terrible feelings
    even after 2 months ?
    -and the last thing is what about propranolol ? does it work as a good anti-anxiety ?

    Bill i feel you are my only friend among these few billions of people out there .. i am grateful .


  142. Chad

    do you have to take the medication to repair yourself and brain or can the anxiety and depression go away wiithout taking medication just staying sober for the year or two untill the paws symptoms is over with??/ and will u be able to be happy and get your old personality and social skills back once your brain is healed in the year or two it takes??


  143. Bill Post author

    Hi Kam,

    Don’t worry about your English. Communication is far more important than style.

    I’d try bupropion (Zyban, Wellbutrin) before the drugs you mentioned. Nicotine’s action in the body is extremely complex, but bupropion has been found useful both in decreasing craving and in supporting recovery. Since it is also an effective antidepressant, it should help with that as well.

    Stay away from the clonazepam (Klonopin). Benzodiazepines are extremely addictive, and you don’t need another problem. If the anxiety continues, gabapentin (Neurontin) has effective antianxiety properties and is not addictive. There are no reported interaction issues between it and bupropion.

    NOTE: It is important that people taking Neurontin (gabapentin) do not stop taking it suddenly. It should be tapered off slowly when no longer needed to avoid a return of anxiety due to backlash, and also to avoid a possibility of seizures. It is a safe drug, but like all drugs must be used according to good practice.

    Beyond that, long walks if weather permits and remaining socially active will do you a world of good. Also pay attention to what you eat. Read the PAWS article for some nutrition tips.

    You can lick this thing. I did.

    Keep on keepin on!


    P.S. Think of the medications as help with your problems, not just “taking pills.” You will be able to stop taking them in a few months at most, and in the meantime you are simply supplementing your brain while it repairs itself.


  144. Kam

    Dear bill
    in advance excuse me for my poor english .

    Actually today is the 55th day that i stopped smoking ciggarettes after 12 years of smoking 1 pocket a day .

    i feel extreme anxiety and i feel more depressed than before . what should i do ?
    i talked to a psychoterapist and she prescribed me ASENTRA + PROPRANOL + CLONAZEPAM …

    but i dont take them yet because i think they are too much for me plus im really frightening of their side effects
    … please help me bill .. what should i do ?

    i do exercising every day .. i eat a lot of fruits and vegetables … i am trying to be healthy … but i am really suffering from Anxiety
    and Depression ? how many more days should i wait ? will it be gone one day ? or i should take pills ?

    I am waiting for your answer … it can saves me .

    have a nice day .


  145. Bill Post author

    Hi, Sasha,

    Ah so. I read the rat study last month. Hopefully it will prove useful. Regardless of how you improve your health, it can’t be bad. I hope your experiment works out.



  146. Sasha

    Hi Bill,
    Here is an article on the diabetes and binge drinking. This is coming from a new study that was completed.

    Thus, if this is truly the case–I want to rebuild my brain chemistry and repair my body–and then lead a normal healthy life with a drink here and there. I have a strong will-power and am pretty self-disciplined. I feel because it was “normal” to party with friends every weekend, I didn’t think much of it. Also, I talked to doctors about my drinking, and they said I was fine, because my bloodwork was fine. (???). I really wished they would have talked about such things as pancreatic caner etc.

    I don’t believe everyone that over drinks becomes a raging alcoholic–and HAS to abstain. I’m sure there are people out there that self-correct and begin to drink moderately. I have a strong will power once I understand the dangers to my health. In fact, I’ve never done any other drug due to the drug education warnings I got in school–I was freaked out and never did it. Just for some reason, alcohol was not discussed in the same manner.

    Thanks for responding!!


  147. Bill Post author

    Hi Sasha,

    The first thing that comes to mind when reading your remarks is why, if you are happier abstaining, feel better, and know that drinking is bad for you, would you ever want to start again? That alone tells us a lot about the trickiness of addiction.

    The nature of the changes that alcohol causes in the brain makes it very likely that within a very short time of resuming alcohol, you would be back in exactly the same place you were when you quit. Your choice. Sometimes we need to do more research before accepting a thesis, regardless of the extent to which it has already been validated.

    I can’t answer your “back to normal” question. Too much depends on individual brain chemistry, the amounts of alcohol consumed, general health, and a variety of other factors. I’d say you ought to be feeling pretty good by six to eight months, but that’s only a wild guess — and only if your diabetes is controlled as well.

    I’m diabetic, and have never heard of “neurotoxicity” of the brain being a contributing factor. Reduced efficiency of the liver and pancreas due to alcohol are the most common relationships. Whatever the case, alcohol is extremely hard on the pancreas, and is a really bad idea for diabetics. It also increases your chances at the grand prize: pancreatic cancer.

    What you do is entirely up to you, of course. I’m not going to preach about AA, recovery and all that, because it doesn’t sound like you’re ready to hear it. I hope things go well for you.



  148. Sasha

    Hi Bill–I have really enjoyed reading all of these comments–it’s nice to hear about everyone’s various experiences.
    However, I’m having a hard time relating to some of the posts, and then relate to a few.

    My history–I started to weekend binge drink in college, and then post college I continued that same habit. I never craved alcohol in the morning and was never a “hair of the dog person”…as I went through my 20s, I started to use alcohol to to relax and de-stress from work and relationships. It seems like a societal norm to go out, binge drink, have a hangover, take a day to recover and then go on with your life. I’m 35 now–and the party schedule is no longer that interesting to me. I feel I have wasted 16 years of my life “socializing” and what I think happened to me, abusing alcohol.

    So I decided to stop drinking for a while. I’ve abstained for 38 days with no problems. I did do through some severe headaches–but I am sleeping well (and dreaming more), was sensitive to loud sounds and did feel some social anxiety when going out with friends who normally see me as fun and life of the party when we go out. However, I have been just fine going out without alcohol, and am learning how to be social without. AND–I seem to be more happier–naturally! I love it! I also love not having to constantly recover from hangovers.

    I read recently that due to neurotoxicity of the brain, diabetes can occur after heaving drinking. This happened to me my last year in college (I was already genetically dispositioned to have it though with both my parents being diabetic)–and THAT really got me thinking about brain damage. NOW I really want to abstain for a while to get my brain set back to normal.

    My question: Given my history (16 years of binge drinking), how long will it take me to get back to normal? I am absolutely willing to do this if it will make me healthier. And, when can I go back to moderate drinking (a glass of wine with dinner, a glass of champagne at weddings, etc).

    Thanks, your insights into this is really appreciated.


  149. Bill Post author

    Hi Rick,

    In order, more or less.

    We normally suggest that physicians wait about three months after cessation of drinking before they attempt to diagnose psych disorders, including major depression. However, since you are being treated for it already, I assume that your doctor felt it necessary and you most definitely don’t want to change your meds at this point. One thing about depression: It’s always best to err on the side of caution, and you shouldn’t take the above remarks as criticism of your doc. Regarding antidepressants in general, most of them take weeks to begin to have an effect, so don’t give up on them for a couple of months. At that time, you might ask the doc to try something else. WHATEVER YOU DO, don’t stop taking an antidepressant like Paxil or antipsychotic like Seroquel without medical approval and supervision. It can be fatal.

    The dopamine receptor issue is a function of the degree of changes in your brain and your own physiology. It can take as long as two years for things to return as close to normal as they are going to get, but you should feel improvement long before that. Typically there will be periods of feeling great, then dips into depression and (sometimes) craving, followed by feeling better again. There is no way to predict the results individually. Continue to hit your meetings, get a sponsor, get to know him, and go on with your life. If you wait until you feel good it will simply mean you’re dwelling on your problems, and that’s a quick route to relapse.

    Emotional development takes a while. It’s a process, not an event, and not something that you can control directly. I suggest the 12 Steps as a beginning. If you are honest with yourself and your sponsor, you will gain a lot. You might also find a therapist who is accustomed to working with alcoholics. Ask questions: are you in recovery? Have you ever worked exclusively in the field? How do you feel about the disease concept of addiction? What methods do you use? Are you certified in EMDR? There is an excellent chance that you will need some work on childhood trauma and perhaps other issues. Don’t think of yourself as emotionally crippled. Think of it as an opportunity to become happier and better adjusted. We all need a little help with that from time to time.

    Relationships: Dude, we’re talking about having a relationship with yourself. Once that’s improves, then think about a relationship with someone else. They say one year for a good reason. Anything you get into before that is simply a distraction from your recovery — and as you know, there’s nothing like a new relationship to take over your head.

    Stay in touch, and

    Keep on keepin’ on!



  150. Bill Post author

    Hi Rick,

    In order, more or less.

    We normally suggest that physicians wait about three months after cessation of drinking before they attempt to diagnose psych disorders, including major depression. However, since you are being treated for it already, I assume that your doctor felt it necessary and you most definitely don’t want to change your meds at this point. One thing about depression: It’s always best to err on the side of caution, and you shouldn’t take the above remarks as criticism of your doc. Regarding antidepressants in general, most of them take weeks to begin to have an effect, so don’t give up on them for a couple of months. At that time, you might ask the doc to try something else. WHATEVER YOU DO, don’t stop taking an antidepressant like Paxil or antipsychotic like Seroquel without medical approval and supervision. It can be fatal.

    The dopamine receptor issue is a function of the degree of changes in your brain and your own physiology. It can take as long as two years for things to return as close to normal as they are going to get, but you should feel improvement long before that. Typically there will be periods of feeling great, then dips into depression and (sometimes) craving, followed by feeling better again. There is no way to predict the results individually. Continue to hit your meetings, get a sponsor, get to know him, and go on with your life. If you wait until you feel good it will simply mean you’re dwelling on your problems, and that’s a quick route to relapse.

    Emotional development takes a while. It’s a process, not an event, and not something that you can control directly. I suggest the 12 Steps as a beginning. If you are honest with yourself and your sponsor, you will gain a lot. You might also find a therapist who is accustomed to working with alcoholics. Ask questions: are you in recovery? Have you ever worked exclusively in the field? How do you feel about the disease concept of addiction? What methods do you use? Are you certified in EMDR? There is an excellent chance that you will need some work on childhood trauma and perhaps other issues. Don’t think of yourself as emotionally crippled. Think of it as an opportunity to become happier and better adjusted. We all need a little help with that from time to time.

    Stay in touch, and

    Keep on keepin’ on!



  151. Bill Post author

    Hi Jeremy,

    Being unaware of the Asperger, I may have been more abrupt than I should have. I never consider these answers a waste of time; it’s what I do. However, I sometimes do get short with folks who seem less than dedicated to the concept of sobriety. Your further remarks clarify the situation. I can be a little short on empathy on occasion, and sometimes think I’m a bit aspie myself. Incidentally, I am one of those folks who believe that ASDs are not necessarily disorders. I’ve known aspies who are highly successful in their chosen fields.

    First of all, if you are on medical cannabis by doctor’s orders, I would check with my physician before changing that. You can stop drinking first. Since you drink “socially” (whatever that means) that should be less of an issue for you. I base the abstinence from alcohol on your statement that you want to be clean and sober. To me, that means complete abstinence from mood-altering substances, but in your case, given the medical issues, it might not actually be the best thing. Talk to your doctor. I am not qualified to give advice in your situation.

    Neither can I tell you how long it will take for the anxiety and other issues to disappear if you do cease the cannabis. I can’t even say for sure that they will, although I would expect the effects to ameliorate somewhat. I don’t know the medical rationale behind the marijuana, and in any case I am not a psychiatrist.

    Withdrawal from pot can cause issues like you describe — usually in folks who have been extremely heavy users but, again, you may not fit the profile and I’m not making any guesses. Ordinarily, the post-acute withdrawal will last for months, sometimes as long as two years. The symptoms gradually get better over time, but it takes a long time for the brain to return itself to normal. There are physical changes in the brain when we become addicted, and it is up to our bodies how long it takes to change them back. However, again, I don’t know how much you smoke or how the other factors might affect it.

    You might discuss the sleep issues with your doctor, too. It may be that you are taking too much melatonin. If that is the case, you could taper down to a smaller dose and it might help. I take 2.5 mg a night to help me sleep (due to weird hours, not an actual physical condition), and that works for me. I’m not suggesting that you are taking too much, I’m saying it’s possible.

    I suggest good nutrition, moderate exercise (walking seems to work best, and doesn’t require interaction), and sticking close to any support system that you have in place. You could try some NA meetings. I don’t know how you’d fare there, but if you do go, and if you decide to share, be sure not only to mention the Asperger, but also to share briefly how it affects you as an individual so that the other people will understand that you’re not going to fit their mold perfectly.

    Please feel free to write any time. If I seem abrupt, it is because of my ability to communicate and not about my opinion of you. All addicts are my brothers, but some need a kick in the butt sometimes, and I tend to be blunt.

    Keep on keepin’ on,



  152. Jeremy

    In case of misunderstanding,
    I take medication prescribed by my psychiatrist for a legitimate disorder. I have apergers.

    On weed all I need is the dose I’m prescribed and melatonin and I sleep fine.

    My goal is full sobriety, even from psych meds but the first thing I am trying to drop is weed.

    I thought you might help me by sharing how long it takes potheads like me to be able to sleep normally again after putting down the pipe.

    Thank you so much,


  153. Jeremy


    I apologize if it seems as though I am wasting your time however I do appreciate you taking the time to respond nonetheless.

    Weed is my main problem because when I smoke nightly I only take my anxiety prescription as supplied and only social drinking.

    Its only when I stop the weed that I turn to other things.

    Its only when I stop the weed that I wake up in cold sweats and become irritable.

    If thats not withdrawal I suppose my cold sweats when I quit must be from the lack of the calming presence of a bong in my closet (no offense intended)

    It would be very encouraging if you would be so kind as to share how long my severe insomnia problems are likely to persist after quitting weed.

    I am determined to be sober and this is by my own will. Nobody is imposing this on me but myself.

    Sincere thanks,

    ps. I am also an aspie who does not have the best communication skills so I’m sorry if something I said sounds offensive


  154. rb

    Thanks Bill…I’ve been using your site on my phone since I found it but I wish I found it months ago because it’s what I’ve been looking for.

    You’re spot on…I’m taking Paxil and Seroquel along with the Neurontin (started that when at detox). I’ve heard antidepressants don’t work while drinking alcohol…how long after stop drinking before they work again? How long before dopamine receptors go away? I guess expect episodes of hopelessness for the next 3 months? Is 3-6 months the hardest? Need to find therapy that is educated in addition.

    The emotional development…any specific suggestions? Never thought of it that way. It explains a lot (relationships, interaction etc.). I guess reading though the literature again that I have from the 6 week therapy would help. I lost my job 3 months ago after working since 13. The last 2 jobs…1 for 16 years and 1 for 3 years with nothing but praise until I exploded…hostile anger/rage. I guess God is giving me the time off to recover. Just weird not working. I also have custody of my 11 year old autistic son. I always could do “everything” for him but the frame of mind is better now. One other thing…AA suggest 1 year before dating/relationships…I guess since my emotional delay maybe educate there too?

    Sorry for so much…it was just flowing out. Thank you so much for your advice.



  155. Bill Post author

    Hi Rick,

    Depression is a normal part of PAWS. Your body is in the process of repairing 27 years worth of damage, and it’s going to take a while longer.

    For many years you have been messing around with your brain’s reward system. We drink because we find that when we do, we feel good. End of story. Even when it no longer makes us feel good, it keeps us from feeling worse. It does that by simulating the action of dopamine, the brain’s feel-good chemical. Over time, two things happen. The first is that our bodies, “realizing” that there is already too much stimulation, stop their natural production of dopamine. We don’t notice that, of course, because the alcohol’s action substitutes for it. As far as our brains are concerned, there’s still too much dopamine. So, the second thing it does is produce more dopamine receptors in order to handle the extra load. This is what creates tolerance, and we have to keep drinking in order to avoid withdrawal.

    So, we quit drinking. Now we have all those extra receptors, no alcohol to stimulate them, and no natural dopamine either. Of course we don’t feel so good. Our bodies need time to deactivate the extra receptors, and also to resume the production of dopamine. In the case of heavy, prolonged drinking, it takes a while.

    I can’t say how long it will take for you to be happy. For that matter, I can’t say that you ever will, but I can tell you that you will feel better than you do now. I would suggest staying close to your friends in AA, working with your sponsor, and if you have access to therapy I’d make use of that as well. You have a lot of work to do, but there is no reason to think that you can’t get through the next few months. You’ve already done three of them, and they were the hard ones, but you have a lot to learn. You stopped your emotional development at age 13, so you have some growing up to do. The Steps will help.

    I’d suggest cutting down on the exercise. Light aerobic exercise is much better for you than heavier workouts. I’d convert that two hours a day to one hour of brisk walking, and let the bodybuilding or whatever wait. Guaranteed it will help if you keep it up long enough. Heavy exercise breaks down your body and it takes resources that you can’t spare right now to build it back up. The sleeping is probably due to depression. The walking should help, if not…

    If you continue to have the feelings of hopelessness, see a doctor about an antidepressant. Antidepressants won’t affect your recovery. Stay away from benzodiazepine drugs like Valium, Ativan and Xanax though. Some doctors thing they help, but they’re poison for us drunks. They are too similar to alcohol in their action on the brain. If you need antianxiety medication, ask the doc for something like Neurontin (gabapentin). It often works wonders, and won’t trigger your addiction.

    Feel free to stay in touch and ask questions. And

    Keep on keepin’ on!



  156. rb

    Oh yeah…last sat (day 83) all day I had the same feelings of that hopelessness, what have I done all those years. I guess that’s expected, part of the healing process and will be replaced with normal feelings? After being under the influence from 17-40 years old I don’t know what normal is. I might be worth a crap and never knew it. Haha.


  157. rb

    Hello Bill…this article and someone like you to ask things is what I needed. I’m.40 and have drank since 13. From 17-37 mostly a lot of beer and a lot of weed but exercised a lot. From 37-40 a lot of crown royal and a lot of “cush”. Kept good jobs until recently. Been clean about 90 days and have made that many aa meetings. Had to detox and then 6 weeks outpatient therapy. Have been exercising for about 2 hours a day and eating right. I’ve never really been happy. How many months before I can expect to “love” life? From 60-90 days I have been sleeping 10+ hours a night like my body needs it…does it? Anything else I can do to help my mind heal? Have been attending church wed and sun and look forward to it btw. Enough for now. I’m looking forward to soberity and will ask more later. Staying intoxicated it hard work.


  158. Bill Post author

    Hi Jeremy,

    I don’t want to seem unfeeling, but I don’t b.s. my correspondents. I recognize that you’re uncomfortable and want to do something about it, but you’re just playing at it. When you decide to get clean and sober (that is, abstinent from all drugs), check back with me and maybe I can help.

    You’re not in withdrawal. Your neurotransmitters are totally scrambled from mixing drugs and bouncing back and forth. You get withdrawal when you are abstinent from drugs. As it is, you’re wasting your time fooling around, and making yourself unnecessarily uncomfortable. Either use or don’t use. You can’t have it both ways.



  159. Jeremy

    I was happy to find this and very appreciative.

    I’m 24 and been smoking weed daily for a couple years infrequently starting 17.

    My problem is sleeping sober. I decided not to smoke tonight and I want to see how long I go but I took 2mg clonazepam instead of the 0.5 I’m supposed to take at night and 12mg of melatonin.

    I feel guilty and unsettled and mild intoxication is like a must for me at that quiet period before falling asleep.

    Even when I sleep I have nightmares when I don’t have weed in my system. The melatonin increases bad dreams sometimes but its the only thing besides weed that works and I’ve tried just about everything for my insomnia

    Then by day 11-14 I get so irritable I become belligerent and usually decide I’m better off just smoking but I really want to go the full 12 weeks just to see what happens if nothing else.

    My question is how long do these cannabis withdrawal effects last from your experiences? Just fyi I get much worse than average WDs including fits of rage, waking up multiple times a night soaked in sweat, and terrible nightmares (though it only is this bad at its worst.)

    I hope this made sense as my mind feels scattered and I might even have a beer if I can’t shut off my mind.

    You seem to have very much experience in withdrawal effects so I figured if anyone could answer how long these more severe symptoms persist you might. :)

    Thank you so much,


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  162. Bill Post author

    Hi again, John,

    One of the things that we learn in recovery is that your pain is your own, and no one can judge it. The trick in AA is to relate, not compare war stories. Hit some meetings. A shrink who understands addiction can help you work wonders (my wife is one), but the day-to-day support of people in the rooms is absolutely invaluable. Besides, you need some sobriety buddies to replace your drinking buddies.

    Keep on keepin’ on!



  163. John

    Bill, Thank you for the reply. I think this must be the case too. I had a panic attack last Friday at about 4:30-5 – coincided with my weekly happy hour that I would always get drunk at. In the past I remember my heart rate and adrenaline ebb upwards leading up to meeting friends for drinks. So it would make sense that without all the alcohol to equalize me my body wouldn’t know what to do with itself. It really helps to know where some of these feelings are coming from as I have been terrified as to what is wrong. Knowing what’s going on really helps me face these difficulties. I’m going to a psychologist this week and this is the foremost topic we will discuss. I may start to go to AA meetings. I guess I felt stupid and that my experience isn’t bad enough and I wouldn’t fit in. I’m sure that’s not the case.


  164. Bill Post author

    Hi John,

    PAWS occurs while the brain is returning to normal after the changes that were forced upon it by alcohol and/or other drugs. The changes take place with chronic exposure to the drug, and are more a function of time than quantity. Acute withdrawal, on the other hand, is related to quantity. The hangover we get after drinking a few too many is withdrawal. If we remain intoxicated long enough, the withdrawal becomes more severe. In the case of chronic alcoholics, it is life-threatening.

    I would not expect acute withdrawal to amount to much, given your sporadic consumption. However, I would be very much surprised if you were not suffering some post-acute withdrawal. You can expect it to continue for possibly several months, but the symptoms should be less severe with time.

    Congratulations on deciding to get clean and sober. If you find yourself having problems, hit some AA meetings. Don’t wait until it gets too rough. Those folks know what you’re going through, and will be happy to tell you how they did it.

    Keep on keepin’ on!



  165. John

    Hi I’ve found this post very interesting. Is it possible to have PAWS without having the initial alcohol withdrawal? I quit drinking 52 days ago and never had any kid of acute withdrawal. I was probably drunk on 4-6 beers 1-2 times a week for 15 years. I’m putting that life behind me, but am now having some PAWS like symptoms such as anxiety/panic, clouded thoughts and overly emotional states. Thank you for what you do!


  166. Bill Post author

    Hi Alex,

    Congratulations on your six months. I hope you make it this time.

    Keep in mind that sobriety involves more than simply abstinence. As the old saying goes, “If you keep on doing what you used to do, you’ll keep on getting what you used to get.” I hope you’re getting to some meetings and preparing to “work” the 12 Steps. It’s the surest path to true sobriety that I know of.

    Feel free to stay in touch, ask questions, etc., and

    Keep on keepin’ on!



  167. alex

    Hi Bill,
    Hello from Dublin, Ireland.
    I came across your site last night. Great to read it. The past 18 years it’s been-booze daily, weed/hash daily, weekend coke & pills, promiscuity etc. This is my third stab at sobriety- 6months clean.
    Thanks for you article, It has shed much light on hypoglycemia and PAWS.
    Best, Alex


  168. Bill Post author

    Hi Edd,

    No question is irrelevant if it’s about sobriety (however, I don’t do marriage counseling). ;-)

    If coffee’s a problem, then several million people in AA and NA are in deep doo-doo! Yes, it is technically a drug and mood-altering; in fact, it’s the most popular drug in the world. Fortunately for us caffeine freaks it seems to have no ill effects on sobriety, and may in fact help to alleviate depression to a degree. If it is not affecting your sleep, have at it.

    That said, “moderation in all things.” If you’re drinking eight cups a day, you might want to taper down to about half that or less. At that extreme, you’re certainly flirting with sleep disturbances and there’s a definite addiction happening. We don’t want to be pinned to any substance to the extent that we’re uncomfortable without it (some medications excepted).

    [Edit] That most definitely includes energy drinks, which contain substances that are untested and may have undesirable effects. Also, as long as I’m at it, Kava is definitely a no-no. Not only is it possibly addictive, there seems to be some relationship to relapse — although that may be simply the frame of mind of the user. Relapse, as you’ll read here many times, occurs before using; it’s a process, not an event.

    Keep on keepin’ on!



  169. Edd

    Hey Bill,
    I know this may sound a bit irrelevant or not serious but I was wondering does coffee affect your brain’s attempt at rehealing itself. Does it in any way hinder your sobriety at any level? Please respond because I can’t find this information anywhere. The reason i I ask is because caffeine is considered a drug and in a way it does boot your awareness and gives you that quick jumpstart. Would this be considered mind altering since you were not in the same state before and after you consumed that one cup of coffee. I am going strong with my sobriety and am just wondering if it’s okay to drink it. Thanks a lot and I hope I hear back from you. Take care and Nemo is coming tomorrow!


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  171. Bill Post author

    Hi JWH,

    I thought I answered this a couple of days ago, but I think I was on my phone and it may have gone into drafts. Sorry about that.

    Most people are pretty much recovered from PAWS by a year to eighteen months. Methadone users and people who were long-time benzo addicts sometimes take as long as two years. Typically, most people feel pretty good by about one year. Some of the damage done to our brains is sometimes irreversible, but that is extremely uncommon. I think you can stop worrying about that. However, because of your length of addiction and the relatively complex action of tramadol on the brain, it is possible that your recovery may take a bit longer than average. Tramadol is a nasty, nasty drug.

    Find a simple job to do that will keep you occupied and pay the rent for a few months until you feel better. And don’t feel ashamed of having screwed up. It would be surprising if you hadn’t had some similar episodes. It was the fact that you were attempting something that is, for the time being, more complex and dangerous than advisable that caused the big problems. If you’d been, say, waiting tables, and dropped a tray of glassware, you wouldn’t have thought that much of it.

    Your brain is trying to repair itself, and right now you need to keep it simple and let that happen. The time to return to your old jobs is when you are back at the top of your game. In the meantime, a simple job is better than causing more problems for yourself.

    Get some NA under your belt. If you’d had some guidance early on, you may not have gotten into this mess. We don’t think clearly in early recovery. We need support and counsel from others who know what we’re going through, and who can tell us how they managed it.

    Please stay in touch, and

    Keep on keepin’ on!



  172. Bill Post author

    Hi Nicole,

    When we are in the REM phase of sleep, the portion where dreaming occurs, the brain inactivates our motor neurons — causes muscle paralysis. This keeps us from acting out our dreams and perhaps hurting ourselves. It also prevents us from making physical motions that could disturb this most important phase of sleep. Sleep paralysis occurs when the cognitive portion of our brain wakes up, but our body is still in the atonic state. It can also include hallucinations, panic attacks, and cycles where one falls back asleep, dreams, then awakes.

    The exact cause is unknown, but one or more of several factors are usually involved:

    Sleeping in a face upwards or supine position
    Irregular sleeping schedules; naps, sleeping in, sleep deprivation
    Increased stress
    Sudden environmental/lifestyle changes
    A lucid dream that immediately precedes the episode.

    The early stages of recovery obviously qualify. Sleep paralysis is one of the less common symptoms of PAWS; but it does occur, especially in the case of opioid drug users. Many users, in fact, experience it when they are nodding, as do some users of sleep aids that disturb the REM cycle.

    I have heard of it continuing as long as six months into recovery, but that report was anecdotal and most incidents are in the first two to three months. The two most common treatments are .5 mg of clonazepam (Klonopin) at bedtime, or Ritalin during the day to normalize sleep patters. Neither of these are recommended for recovering addicts because they retard the brain’s process of recovery and are themselves addictive. Some people report that consciously trying to move the facial muscles can help bring a sense of control and end an eipsode. Again, these are anecdotal reports (not from medical studies), but it is certainly worth trying if one can remember to do so.

    It is important to remember that sleep paralysis occurs in people with no history of drug use as well. Also, that apart from the fear it causes, it is harmless. The important thing to avoid is resistance to sleep because of the fear that it will occur. In this respect, knowledge is your best weapon. Knowing that it’s harmless, happens to others, is a fairly common symptom of disturbed sleep patterns, etc., can help you weather the storm until the episodes subside. If there is a sleep clinic near you, you could contact them to see if they have further suggestions, but stay away from the drug approach. And remember that most doctors don’t know jack about addiction even when they think they do.

    It must be difficult for you if your boyfriend is still using (“trying” to stop). I strongly suggest that you get involved in NA, and perhaps Nar-Anon as well. You — and he, when he gets serious — will need the support of folks who have been there and know what you are going through.

    Please stay in touch, and

    Keep on keepin’ on!



  173. Nicolee

    Hiya, I am so glad to find this website (: to sum up my question quickly I have been off herion for a little over a month now, and being completely addicted for maybe 2 years.. since ive quit I have been having a numbness when i fall asleep where I cannot move or speak and it is pretty terrifying. I read about sleep paralysis and it sounds like whats happening to me but nothing really links it to my withdrawls.. do you know why this is happening? or if it will continue? I didnt think it was really related to my drug problem because of the fact that it was so terrifying almost like being possesed, but the same thing has happened to my boyfriend for the last few weeks that he has been trying to clean up as well. I hope i made sense and thank you for your time (:


  174. John Wesley Hardin

    I thought I was losing my mind until I read about PAWS. I have been addicted to large doses of Tramadol for 15 years and have been clean now for about 5 months. Since getting clean I have had two bog standard jobs driving trucks and have lost them both due to my memory loss and lack of coordination. Whilst driving a low loader I forgot to put the ramps down and reversed a car off the back of the truck crashing it onto the road. Messed up all the paperwork and could not follow simple instructions also misplacing the keys to vehicles I had in my possession. The guilt and shame has made my PAWS worst and I feel guilty for the damage I did to the vehicles and truck and worst of all feel a looser and useless. Before my addiction I could have took these jobs in my stride. I can only hope this gets better my head feels numb and I get depressed most of the time. I feel a little better believing I am not really stupid it’s the PAWS that is causing my problems but I just hope I don’t have this for all of my life. I am determined to stay clean now because if I don’t I will end up a vegetable if I knew about PAWS I would have stopped the Tramadol years ago and then I wouldn’t be in this mess.


  175. Bill Post author

    Hi Erin,

    For a small number of people, PAWS-like symptoms can be extremely long-lasting. It is, however, impossible to say whether they were caused by the addiction itself or other factors such as adulterants in street drugs. Whether or not PAWS itself is permanent is debatable, although unquestionably in some people some symptoms do remain. All of this information, however, is anecdotal. We also have to consider the possibility that some are due to preexisting conditions that were masked by drug use. In some cases, people may have been using combinations of drugs, etc., etc., etc.

    In your case, however, worrying about it will simply add to your anxiety. Your symptoms are totally on schedule. They will diminish with time, but you can expect to enjoy little reminders of why you don’t want to use again for at least a year, perhaps longer.

    Your condition is by no means hopeless. The likelihood of your being totally symptom-free two years from today approaches 100%. I repeat, your symptoms are absolutely typical for someone three months clean. Since we’re addicts, accustomed to instant relief from discomfort by using our drugs, we have to re-learn the truth that some things just take more time. When you think about it, it is not unreasonable that brain changes that took place (and were cemented in place) by five years of drugs use might take more than three months to reverse completely.

    Relax. Enjoy the good days, accept that there will be some bad ones but that they will pass, and begin to revel in your sobriety instead of worrying about phantoms.

    Stay in touch if you like, and

    Keep on keepin’ on!


    P.S. Hit some meetings. The support of others who have been there is invaluable. It’s hard to recover alone. THAT is worth worrying about.


  176. Erin

    Great site first of all. I’m 37 years old and am 3 months clean from a 5 year opiate addiction. I was at the point in my addiction that there were really only two options for me, getting clean or death. Death would of been better than continuing to use quite frankly. Anyways, I find myself struggling with PAWS now and have episodes where I feel like I’m in full out withdrawl again ( sleeplesness, anxiety, etc..) These episodes usually last a few days, I can tuff this out though, i’ve been thru much worse. However, I find myself constantly worrying that this PAWS is permenant and won’t ever go away, and some of the reading i’ve done indicates that for some this is a real possiblity. I’m having HUGE problems dealing with the fact this may never go away. Just looking for thoughts on to cope with these thoughts and the hopelessness I’m feeling.


  177. Bill Post author

    Celexa is a selective serotonin reuptake inhibitor (SSRI), which means that it increases the amount of serotonin in the brain. That tends to make you speedy until you become accustomed to it. Several other similar drugs such as bupropion (Wellbutrin) have the same effect and are often prescribed in time release form for that reason.


  178. Robert Perry

    Bill, thank you!!! I ended up taking one before I read your post. I took it at night instead of in the morning like the doctor told me and I was up all night. I went to see the doc today again and she said to take it in the morning and only take half of what I took last night.

    Anxiety was rough all night and this morning. I have been dealing with bad anxiety every morning but not at night. Obviously had it last night because I couldn’t sleep.

    Feel pretty good right now.

    Thank you again Bill!!!


  179. Bill Post author

    Hi Shelly,

    (Wow! You’re the second Shelly in two days. And I’m married to another. How ’bout that?)

    Thanks for the good words. You are dead on about the importance of PAWS. It is, without question, the major cause of relapse for people who are actually working a program. It’s so discouraging, if you don’t understand what’s happening.

    Good luck in your career. Don’t forget to go to meetings. Even if you’re not an addict, you can go to open meetings, and you’ll learn just as much about addiction there as you will out of books. Quite possibly more. The key to treating addicts is knowing how they (we, in my case) think, and non-addicts need a lot of exposure to the process in order to “get” it. Listening to their stories in a non-therapeutic atmosphere will teach you a lot.

    Keep on keepin’ on!



  180. Bill Post author

    Thanks for the compliment, Edd. However, there are a lot more good people out there. I just happen to have a higher soapbox.




  181. Shelly Nagy Woycitzky

    Thank you for having this important puzzle peice available. Being in recovery myself, I know how difficult maintaining sobriety can be. When we have tools to assist the process, it makes life much easier. PAWS is a silent relapse trigger for many people and as I transition into my professional career as a addictions counselor, I vow to educate those in recovery about it! Thank You, I have attached a link to my Facebook page to help those in my personal life understand how important PAWS is!


  182. Robert Perry

    Hey Bill, sitting here staring at a bottle of Celexa that my doctor prescribed to me last night. Afraid to take it in fear that things could get worse.

    The Anxiety has seem to calm down a little. I still have it but not as bad. At least today. What I now have been faced with the past 4 days is depression. Not wanting to do the thing i normally would. Hopelessness. Fear that this is going to last forever. I guess I really have had those feelings since this started but I thought it was only because of the high anxiety feeling I was having. Now that that feeling is not so bad, it is scary just to have the depression.

    It seems to be really bad in the morning, then it gets slowly better and around 3 o’clock I feel almost normal. The problem is getting to 3 o’clock, it is REALLY HARD!

    I think if this happens again tomorrow, I will have to take the Celexa. I know it can take a while to work.

    Please, anyone who might respond to this. At this point in my life, I feel that this Celexa might be the only thing that can help me get through this, so please don’t tell me how it made you crazy.

    Thank you!


  183. Edd

    Hey Bill,
    Thanks for your quick response to my question, I appreciate it. Your advice is helping me to keep going and am thankful for that. Patience is a virtue so I will wait out the process and see how change occurs. Nothing great is achieved over night and like you said before abuse over prolonged period will take some time to correct. I will stay in touch with you so keep up the great work you are doing. There is still hope for humanity if there are people like you that are willing to give some of their time to help others in need. So much for now, take care!


  184. lindsay

    thank you bill. im a week sober and already went to my new church twice and they hold meetings there rgularly. For the first time I am realizing I have to forgive myself and get to know myself again aside from the user. your info is great…Keep helpin us!


  185. Bill Post author

    Hi Edd,

    Good to hear from you again, and congratulations on the 68 days and 136 nights! Sorry you’re having trouble sleeping, but that’s pretty normal in early recovery. You feel draggy, but rest assured that no one ever died from lack of sleep…at least not when they’re able to “sleep like a hibernating person” once they fall off. It sounds like you’re suffering as much from a disturbance in your sleep pattern as from actual lack of sleep. Try limiting heavy exercise and caffeine to mid-afternoon at the latest. That may help. Also, never force yourself to stay awake. If you get sleepy during the evening, forget about TV or that book. Go to bed. Sometimes a little discipline on the waking side is all it takes. If you can’t sleep, get back up and do something: eat a light meal or snack, low on carbs with a bit of fat and protein (peanut butter on crackers works well for many) and then read or do something non-stimulating until you think you can sleep again. Lying in bed awake just accustoms you to lying in bed awake.

    Your mood swings, likewise, are pretty typical. As long as the depression doesn’t become severe, or last for more than a day or so at a time, I wouldn’t be too concerned. Your brain is adjusting to an entirely new balance of neurotransmitters, and your dopamine production is almost certainly still below normal. As long as you’re not having thoughts of worthlessness, life not worth living, etc., you’re likely just going through normal swings. They will become less severe over time, as your brain chemistry slowly returns to normal. HOWEVER, if it gets worse than just feeling blue, you need to take it seriously and talk to a doctor. You might need an antidepressant for a while. Antidepressants won’t interfere with your recovery.

    On the other hand, watch out for antianxiety drugs. The most popular ones are benzodiazepines (Ativan, etc.) and they are poison for recovering addicts. They will prevent your brain from recovering properly, and are highly addictive in themselves (regardless of what your doctor may think). Trust me…I spent three weeks in medical detox for benzos. If you need medication for anxiety, Neurontin is a good place to start. Mainly, though, you need to keep to your program of healthy living and meetings.

    Your friends are right: overconfidence has killed many an addict. Relapse is a recognized symptom of addiction, and it can happen to anyone, even us old-timers. I know plenty of people with 10+ years who have relapsed — almost always because they got overconfident and stopped doing the things that kept them sober to start with. Don’t get too confident; it leads to carelessness. The person who told you about emotional growth is correct as well. If our emotional development wasn’t interrupted by some sort of trauma before we started using, it was most certainly brought to a screeching halt when we began getting high regularly. Then when we get sober — and just when our nerves are at their most jangly — along come all those suppressed emotions that we haven’t learned to handle. It can be unnerving, to say the least. This, too, shall pass. Therapy helps, as do the steps of the program. So does experience living clean and sober.

    Recovery takes time, Edd. We spent years messing up our brains and (to a degree) our bodies. Because we’re addicts we expect immediate results when we stop using, just as we got them when we used, but it takes our bodies months to get back to something like normal. That’s what PAWS is…the period of healing. It takes time, but it does get better.

    Hang in there, and

    Keep on keepin’ on!



  186. Edd

    Hey Bill,
    I talked with you once before on this blog when I was about 43 days clean in my sobriety. By some odd chance today is day 68 and don’t get me wrong I am happy so far. I have been exercising quite often, mostly running and some weight lifting in the days past. I still have trouble sleeping at night; I have to wait till like 3 a.m to be able to fall asleep and then I would sleep like a hibernating person. At times anxiety comes and attacks me just as depression sets in. From what I have read and researched it seems to point to p.a.w.s. I just really want to be back to normal and never touch the stuff I used to. Even deep down inside I feel tremendous strength and confidence that I won’t go back to using, some people I know tell me not to be fooled by this deception. I know you have a lot of experience with your own sobriety so I am hoping things will eventually get better for me. Honestly every day that passes I realize how nice it is to just be alive in the moment even though I have lost everything I have ever owned to this drug. People I have known for ages have distanced themselves, acting as tho they have never known me. I will admit this fact does hurt but I try not to let it get to me. Someone once told me that the day we start being clean is the day we start growing emotionally. Never in life would I ever think I would be sitting behing the screen typing this and actually counting the days that go by. I count each and every day because it serves me as a reminder of the time I have dedicated towards fighting this disease. All I want to ask you Bill is if things will eventually get better because depression seems to always be around the corner. There are days when I am happy for most of the day and then there are those times when everything seems dull. Thanks for putting your effort to help those in need. Like always and forever, peace, love and happiness. Take care.


  187. Bill Post author

    Hi Lindz,

    Congratulations on your determination. You’re right about the relapse being part of the process; in fact, relapse is officially one of the symptoms of addiction. Don’t sweat it. We’ve all gone through it, even though we may not actually have picked up. Relapse occurs before we use, and the big trick of staying sober is learning to recognize when we are in relapse and how to change our behavior before we make it official.

    We hear the term “surrender” a lot in recovery. That doesn’t mean that we give in and give up. It means that in order to recover we need to admit to ourselves that our addiction has thoroughly kicked our ass, and that our strength and determination haven’t been worth much. Then we become teachable, and begin to absorb the information that allows us to progress in recovery. Humility and the ability to listen to others who have recovered successfully is one of the main keys.

    One of the most profound things that penetrated my hard head in early recovery was the phrase, “My best thinking got me here.” When I caught on to that, I became teachable myself. I managed to set aside just enough of the addict arrogance, for just long enough, to start “getting” the program. That arrogance is still an issue. One of the most important things for me to remember today is that just because I know a lot about addiction and recovery, it doesn’t mean I’m bulletproof. That crops up time and time again in most folks’ programs. I’ve seen professionals relapse because they figured they were safe; that it couldn’t happen to them. I’ve seen people with more than my 23 years fall by the wayside, as well. Humility is important. You’re on the right track.

    Go to meetings, share, find a sponsor, work the steps. It’s worked for millions of addicts — and failed millions more who thought they could do it their own way. I don’t suppose that’s impossible, but it seems to be pretty unlikely, based on my observation.

    Hang in there, do what you have to do, and

    Keep on keepin’ on!



  188. Bill Post author

    The theme is “2011,” a standard WordPress.com theme. The header is an image of my own, and the background is adjustable in the theme controls. Glad you like it.



  189. Bob

    I got both your replys Bill! Thank you very much, it really means the world to someone going through this!!!.


  190. Bill Post author

    Hi again, Bob,

    Got this out of sequence. Sorry. I did cover the Ativan and anxiety issue in my previous answer, so even if you don’t see this one you should have the info.

    I would suggest finding a doctor who specializes in addiction. A local treatment center should be able to help you. It sounds like the ones you’re talking to need some further education in that area. No doctor familiar with addiction would prescribe a benzo to a recovering addict of any kind for any purpose except short-term protection against seizures during detox.

    I’ll have to re-read the part about peaking in six months. I may need to re-write it. The symptoms should begin to subside substantially by six months. Things get better the longer you go without using. It’s just a matter of the brain repairing itself, which takes time. But things do get incrementally better.




  191. Bob

    Hello Bill,I have quit drinking after 35 years. I only drank on the weekends up until about 10 years ago when it turned into every night. I am going through withdrawal, it has been 23 days. I will have 3 good days and then bam, these feelings of Anxiety come on and they are very powerful. Nothing triggers it, it just feels like the chemicals in my body start flowing for no reason. Tingling in the arms and legs. Then the feeling of having to get up in front of 1000 people to give a speech comes on and that is when I really feel bad and scared.

    I went to the doctor in the begining and was prescribed ativan. I only took one and was afraid to take anymore in fear that it would mess up my recovery from these anxiety feelings. I have been back to two doctors and they keep telling me when I have these anxiety feelings, to take the ativan. I would love to but fear a setback! I never suffered from anxiety until now.

    Your statement that this will peak in 3 to 6 months really has me worried. I don’t know if I could handle this getting any worse. I thought I was getting better.

    For me the anxiety seems to come on as soon as I wake up. It’s like a wave comes over me. I am not even thinking of anything.. God I just want to get through this. I don’t even want a drink and will never drink again for fear that these feelings would come back.

    I walk sometimes twice a day and it helps and I eat right. Junk food does make it worse.

    I have been to two AA meetings but when these anxiety attacks happen it is hard for me to go sit in a room and try to deal with it.

    I guess my real fear is that this is gong to get worse or never go away.

    Any insite would really help me!

    Thank you!!!



  192. click here

    I absolutely love your website.. Excellent colors & theme.
    Did you create this site yourself? Please reply back as I’m looking to create my own personal site and would like to learn where you got this from or what the theme is named. Appreciate it!


  193. lindsay

    aghh. day 4 of a mild detox off of oxycodone after 5-6 years of off and on relapses promiseing myself a better life. It took every fiber of my being last time I really got sober to get past the withdrawal. The physical stuff sucked but the mental anguish was a nightmare. Then on top of it I was terrified because I developed extreme depersonalisation, which now i realize may hav been PAWS. But it felt like and feels like right now i am high on pot and I havent smoked pot since high school (im 28) I know last time, after a month this kind of diminished and I started feeling better, cognitively and emotionally. Now I realize the reason why I was not successful last year is bc I did not truly take responsibility for my actions and my pain that I was masking with the opiods. I am scared of relapse bc it seems that that was always inevitably what I did because i got cocky and thought “IM good…I can lick this” or “one wont hurt”. This time around I have takn into my recovery the fact that I cannot do this without getting therapy and going to meetings. I am still scared I wont be able to handle staying sober and will give into temptation “eventually” but this time around I am better prepared with knowing the root of my addiction and what I need to do to have sustainable recovery. I hate feeling like I don’t trust myself or have faith in myself. I just cant remember the last time I was actually chemically “normal” and now I know that obviously what i have been doing for this long hasnt been working for me. I have to , as most other people here, have to do the dirty, scary, hard work in order to maintain our sobriety and stay on track. I hate cravings, but if anything i think back to all the messed up shit i did when I was high. And hey if terrfying myself into never using again is a good tactic to keep me clean than so be it. After all, I could never see the point of spending all this time in recovery then throwing it all away one night only to have to start all over again.
    This forum has been so educational to me and even though I have been on this path before and failed, I cant live in the past and have to take my recovery one day at a time. The way I see it, the best things in life are worth suffering because we realize how strong we can be and how much hell we “dont” want to revisit by relapsing again. I know every time i relapsed I was in denial about my relapse and would justify it, but everytime i relapsed another piece of m would die from feeling like a failure yet “again”. IM learning now that I have to let go of that and believe god will help me move forward. A lot of times I have heard it takes a couple of times relapsing to really get it right, right now ….just like the last time i got clean, the feeling of being out of control of my vision, thoughts, and cognitive functions (like im high all the time) is enough to make me rethink any stupi cravings i may have in the future because this sucks. I feel on my 4th day sober like I did last year on my 10th day or second week sober…..at least i know what to expect. I happen to be one of those people that gets depersonalisation from PAWs. Bill have you ever heard of that before? Thanks so much for the reads.



  194. Bill Post author

    Hi M.M.,

    Each of us is different in our body chemistry, and the amount that we drink or otherwise use seems to have little to do with the effects on our bodies, or on our symptoms in acute and post-acute withdrawal. It is entirely possible that you are having less difficulties than your partner, even though, as a woman, you are far more susceptible to the effects of alcohol. (Women produce less of the enzyme that metabolizes alcohol, thus you get drunk faster and stay drunk longer.) Likewise, your drinking pattern doesn’t matter, nor whether you choose to call yourself an alcoholic. What matters is that drinking and/or using other drugs is messing up your life, and whether or not you can quit and stay clean.

    On the other hand, addicts are notorious whiners, so there is that… ;-)

    In any case, your job is to concentrate on you, not on him. Your recovery is not a joint effort. The likelihood is that your shared backgrounds are what brought you together in the first place (although you may not have been conscious of that), and the more you can separate insofar as your recovery is concerned the better off you’ll both be.

    The doctor was correct in prescribing Valium, but should have done so only under controlled conditions. Very short term (5 or 6 day) use of Valium is effective is staving off the blood pressure spikes that can lead to stroke — even in young people — and convulsions. Both are very real dangers in alcohol withdrawal, even when it seems to be going smoothly. However, giving an addict who is feeling bad unrestricted access to drugs is foolish, as your partner has demonstrated. He just did what addicts do.

    In any event, he needs to be off those benzodiazepines. Not only will continued use beyond a week or so increase his chances of relapse by keeping the neural pathways open, but all benzodiazepine drugs are highly addictive, and he needs to get clean, not add another chemical to his repertoire. That is true of yourself as well. Mood-altering drugs — apart from antidepressants — just prolong the addiction and/or lead to new ones.

    Only you can decide how to deal with your relationship issues. Ideally, the two of you would be separated for the first few months of sobriety, and then re-assess your situation. Having said that, my wife and I went through treatment and recovered together. However, we were highly motivated and had an excellent support group that included both people from the treatment center where we got sober and also many friends in our 12-step programs. From what you’ve written, I’d say your best course would be to cut your losses and get out of an uncomfortable relationship before the pressures of early sobriety make things even worse. That’s the sort of thing that leads to relapse.

    You both need AA and Al-anon meetings. Google both of them and you’ll find meetings in your area. Without support, your chances are poor.

    Keep on keepin’ on,



  195. Bill Post author

    Hi again, Shelley,

    I’m glad you recognize the danger you’re in. It’s hard to know exactly how to approach issues like that, so I usually just lay it all out and folks either get it or they don’t. The one thing we can’t do in this business is ignore suicidal ideation.

    BTW, I went back and removed your email address from these comments.

    Ten percent of the population has some sort of substance abuse issue, and that’s just as true of public personalities as any other group. There are support groups for attorneys, doctors, clergy and a variety of other folks who need to have careful control of their anonymity. It’s also true that many employers are most understanding, although I do understand that there are professions and positions where addiction could certainly be a deal-breaker.

    Perhaps there is some trusted person in your profession whom you could speak with. The number of people with similar experiences would probably astound you (I know it astounded me!) and there may well be options that you don’t know about. There is also the possibility of a leave of absence and treatment far away from your home territory. If you are concerned about confidentiality, you’re pretty safe unless you have paparazzi chasing you around. Breach of confidentiality in the case of people being treated for substance abuse is both a Federal crime and eminently addressable under civil law. Thus, treatment centers are doubly careful in that regard.

    If I can be of further help pointing you in useful directions, please don’t hesitate to ask. You can contact me via the contact form on the PAWS page if you need to interact more confidentially.

    Hang in there, and

    Keep on keepin’ on!



  196. Shelley

    Hey Bill
    Thank you for your response! You are spot on with your analyse of my situation. I work a very public and a very unforgiving job! I do absolutely love doing what I do and shame/embarrassment/unemployment, have lead to a part of all the secrecy my life entails. I have always managed to keep things together, even in the tough times. I completely understand what you are saying, about the secrets could kill me not the drugs. Like you, my plan to end it, is very detailed/planned and would be a 100 proof. I know now that this addiction is bigger then me and I do need outside help! Just writing to you was hard but it also came with a little relief/reality to my life. I hope to gain a little more courage to continue on and relieve myself of all the demons (drugs, secrecy, shame, embarrassment, ect…). I have given myself way to much credit in thinking I can handle this on my own! Your words have scared me and have also been a comfort to my thinking. I have felt so alone and I know that this is an extremely dangerous feeling right now!


  197. M.M.

    Bill; thank you!
    I found your site while doing some research. Myself and live-in boyfriend are detoxing from booze (day 4?). We have many other issues that our drug use (not only booze) has never helped, only hid, and especially now things are… uncomfortable. I am a child of alcoholics and he has addiction issues of his own. I sit here, crying from a combination (Im sure) of Paws and PMS. I just was feeling so lost. He went to the Dr and was prescribed Valium, which he ate quite a bit faster than the bottle prescribed…
    He seems to think he is an alcoholic and needs a Dr’s prescription pad to help him through. Fine. BUT; we had similar, if not the same, drinking patterns. he would always drink a bit more than me I think it evened out being that he out weighs me by almost 100lbs…
    I wouldn’t have even said I was an alcoholic, binge drinker sure, not denying that. He thinks he was so bad he would get the shakes and other symptoms, which I never observed. Could he be psyching himself into feeling worse? I think he may do this in many aspects of his life, but who’s to say. I try to give him the benefit of the doubt but his ailments/symptoms are all too often invisible.
    I have just been so frustrated and flabbergasted. He wants to play ‘poor me’ without even acknowledging that I may be having my own issues of the same and varying nature. I have been doing extra housework, biting my tongue over his messes and trying to excuse myself when him just existing is enough to make me snappy. I just feel like if we could both just step back and say ‘we are BOTH going through crap, how can we BOTH help EACH OTHER?’ this could be at least manageable.
    I really didn’t mean to write so much. I just wanted to say that not only writing something so helpful but also manning this message board and making yourself available to those of us that are wrecks is phenomenal work! TYTYTY for the good advice I have read to others as well as just letting me vent a bit. I don’t think I could ever go to AA but knowing what is going on and expected makes so much difference.
    Thank you, again and again.


  198. Bill Post author

    Dear Shelley,

    It sounds like your secrecy is well on the way to being the death of you. I have no suggestions that would involve maintaining it. The major outside contributor to PAWS is stress, and you have backed yourself into a corner that’s loaded with it for the foreseeable future. I don’t know what your reasons for all the secrecy are, and it really doesn’t matter. If you’re thinking about killing yourself, there is nothing that could be worse — for your loved ones, friends, co-workers, and especially for you.

    My own secrets nearly killed me. I was a prominent official in the town where I worked. I hid my addiction to alcohol and prescription drugs (I thought) until I too was considering suicide. I knew exactly how I would do it, and it would have worked perfectly. I had worked myself into a classic double bind: I knew I needed help, but thought if I got it I would lose my job and wouldn’t be able to afford the help. The flaws in that thinking are obvious now, but at the time I was tied in knots — damned if I did, and damned if I didn’t. The point is, the knots were in my own head. In fact I was sent to treatment by my employer, and my job was waiting for me when I returned.

    You need some support, and not just your husband. He doesn’t have the skills to give you what you need, and he’s too emotionally involved to be able to assess the situation clearly. And clear thinking is what you need most, right now. I strongly suggest that you consult a private therapist. Confidentiality laws will protect your secrets. Hopefully, she will be able to help you realize how your flawed thinking is contributing to your problems.

    I’d also suggest NA, and preferably treatment. However I would expect you to be resistant to that course. I do hope you get over that, because it has a very good possibility of killing you.

    Lying to others is rude. Lying to ourselves is often fatal.

    Best regards, and feel free to write any time.



  199. Shelley

    Hey Bill,
    I’ve lived in secrecy for over 2 years, so I could do opiates. I snapped about 6 months ago and started on a path that I would have never chose in my right mind. I have been married for almost 13 years, and started a toxic affair. After getting wrapped up in this toxic situation, I had a revelation to my life. It took about 2 weeks of going back and forth in my mind to decide that what I really wanted was sobriety. On December 10th I took my last pill but because no one knew or would ever even think that I was an addict, I had to start the detox in complete secrecy and keep myself together. My husband found out about the toxic affair (that I had ended) a couple weeks into my detox. I decided to come completely clean with everything, knowing that he would probably leave. He didn’t leave though, he wanted to stay and help me. I was completely prepared for the initial withdrawal, knowing I had to keep myself together because of the secrecy to my life. I was NOT prepared for this aftermath!! Not only am I dealing with the stress and guilt of engaging in an affair, I’m dealing with a huge amount of physical/mental pain from sobriety. I thought by this point I would be feeling so much better and thought I could get through all this. My mind feels crazy and I’ve even gotten to the point of making a plan to end all this. I’ve completely scared myself but have been able to pull it back together enough to just deal with my life. It has been so much harder doing this process only having 1 person, who knows what’s really going on. It’s always mind boggling how I was able to get away with my addiction, without even the close people in my life knowing. I was feeling pretty lonely and out of sorts, until I read this! Thank you


  200. Pingback: Joined Yesterday, 1st time addict HELP - Page 2 - SoberRecovery : Alcoholism Drug Addiction Help and Information

  201. Bill Post author

    Hi Tracy,

    I was traveling. Sorry to take so long to get back to you.

    I’m guessing that she is addicted to the opioid drugs — quite possible over several months; quite likely, in fact. The Ativan would have helped with the withdrawal, and was the proper prescription at the time. Valium would have been a better choice, but I’m not here to second-guess the people at the ER. You didn’t say how long she was on the benzos, but I don’t think that’s an issue in this case. Simply put, the detox was handled badly.

    Her symptoms are consistent with early post-acute withdrawal from opioids. Depending on how long she was on the benzodiazepine, there could be involvement there as well. A normal benzo detox is between two and three weeks. She needs to be seen by a physician who is skilled in treating addicted people. Clearly her primary is not familiar with the issues, or he would have dealt with them differently. Check with a local treatment center or medical detox facility for a specialist. Your local medical society may be able to point you in the right direction, as well.

    Good luck,



  202. Tracy

    Hello. I’m hoping to get your professional opinion. My mother has been on several drugs over that past six months (Vicodin, Percocet, attivan) in an attempt to get relief from her head pain. The last drug she was on was attivan given to her by the emergency room doctors. Her primary doctor did not approve of this drug, so he would not refill her script. Rather he gradually took her down over the next week. She has been free of all narcotics and benzos for 12 days now. However she is still having crazy withdrawal symptoms: high anxiety, pacing, sleep issues, memory loss, incoherent thoughts, body jerks. Is this type of reaction possible even after such short term use? Should I seek professional care to assist her with this process? I’m concerned that any assistance we receive from doctors will require that they put her on another kind of drug…and we’ve had such bad experiences w drugs we are very hesitant to do that. Any advice or suggestions would be appreciated.


  203. Shawn

    Hey bill thanks for taking the time out to type all of that out i appreciate that still like i been googling all these syptoms i have from what the drugs and shit did for a long time now and this blog and ur advice is the best i came across… im gonna take in what u said and try and do my best to stay sober for over the year and see if that helps to make me feel better… i been sober for a bit over a week so far and when i did go out with people to drink i went off with it like i could drink over 12 beers a night before i started to feel drunk lol i would always have to rely on drinking to make me like more social and feel good about myself while chillen with people i think its the weed that caused this depression and anxiety and changed my brain but like its messed up now that im this way even sober its hard for me to talk to anyone when im sober its all akward cuz of the anxiety and depression i cant feel any emotions and have really low self esteem and confidence ….like even if im gonna go chill with a girl its all akward unless i get drunk and then i feel good bout myself and can talk to her properly… but honestly im gonna stay sober and excercise then after a while il see if that makes a difference cause i hate bein sober now a days cause of this shit im always stressed and have like no personality anymore thats why i always needed to rely on the alcohol to make me feel good my brain feels like im going crazy

    but thanks for taking your time to read all this


  204. Bill Post author

    Actually, Ashley, this blog costs me about $25.00 a year (if you don’t count my work): $12.00 to GoDaddy for the domain name “whatmesober.com” and $13.00 to WordPress.com to map the domain to this site. The blog itself and the theme are free.

    Go to http://wordpress.com to get started, and have a blast. It’s dead easy.


    Actually, you can get your domain from WordPress too, so you don’t even have to involve an outside party.


  205. the migraine solution

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  206. Bill Post author

    Dear Shawn,

    This is one of those questions that I’d really like to be able to answer with sweetness and light. Unfortunately, I’d be lying.

    See, the thing is, you want to have your cake and eat it too. You want all the unpleasantness that was brought on by the pot and accelerated by the booze to go away, but you want to keep on living your life the way you’re living it, and doing things your own way. I’m afraid it doesn’t work like that.

    Using drugs (alcohol is a drug) causes physical changes in your brain. They make you feel good for a while, but then things start going south and eventually you can’t even feel good with the drugs helping. If you want your brain to change back to normal, you have to stop using the drugs. Then it takes quite a while (1 to 2 years) for your brain to return to however close to normal it’s going to get. That’s PAWS. Your depression and anxiety aren’t due to PAWS, they’re caused by the drug (alcohol) you’re still using on a regular basis.

    Here’s what you need to do. You haven’t said how much you’re drinking, but if you need it to feel good about yourself, my guess is that it’s a fair amount. Would five or six beers or drinks in an evening sound about right? Or should it be more? You need to:

    (1) Stop drinking and any other drugs that you’re using. If you are drinking heavily, or are taking benzodiazepines (Ativan, Xanax, and similar drugs) you need to be detoxed in a medical setting to avoid the possibility of convulsions and/or blood pressure spikes that can cause strokes. (Yes, you can have strokes when you’re 21.)

    (2) Go to AA. You will need the support of people who have been there and done that. It’s really difficult to stay sober without support. Practically no one succeeds at it. There are groups of young people in AA your own age. If you live in a city of any size, just look it up in the phone book or google “AA+your city”.

    I know the AA is about the last thing you want to do, but your buddies who are still drinking won’t be any support at all, and hanging with them will just put temptation in front of you every time you’re out with them. Realize, I’m not saying you are an alcoholic; I’m saying that your brain won’t repair itself while you’re drinking. Only you can decide if you’re an alcoholic. What I’m saying is, if you need alcohol to make you comfortable in certain situations, stay the hell away from those situations.

    I can’t say if you’ll be able to drink again. If I were as miserable as you say you are, and found out that not drinking made me feel better, I wouldn’t touch it with a 10-foot pole. That’s up to you. Would it be a good idea? No.

    Regarding your depression and anxiety, and medications for them: You can’t even be accurately diagnosed when you’re under the influence of drugs. Alcohol itself is a depressant, for one thing, and withdrawal from cannabis (which can last for many months) can cause both depression and anxiety. You need to get clean, then find a doctor who understands addiction. A local treatment center should be able to refer you, or ask around AA. If you can find one who’s personally in recovery, that’s even better.

    If you do those things then yes, you should feel gradually better and after a year or so you should be in pretty fair shape. I can’t guarantee how well you’ll recover, but I can tell you this: if you keep on using alcohol and other drugs, things will only get worse.

    Please stay in touch, and feel free to ask any questions you like. I don’t bullshit. You may not like what you hear, but it’s the straight stuff.



  207. Shawn

    Hey Bill.
    back a few years ago i was smoking weed with some of my friends it usto make me feel good id always be laughing and stuff then later on smokin it it started making me all paranoid and have anxiety and think negative stuff and depressed i thinkk… this one night i drank and smoked weed at the same time i think i had one of those panick attacks or anxiety attacks i felt like i was going crazy no lie… then ever since that day i swear i dont act the same ike my personality changed and im always depressed and have anxiety even wen sober its like i lost my social skills i cant joke aorund or talk to people good anymore i have to depend on alcohol to make me feel good about myself everywhere i go or to chill with people i have to drink so i can actually conversate with people and feel good about myself… i think what i have is depersonalization or it might be paws i dont know the question is… i quit weed for good and smoking i like to drink though if its just the weed that messed me up or if its the alcohol that messed me up if i stay sober like urr article says for a 6 months to 2 years will i get my oold personality back and feel good again without having to worry about this depression and anxiety??? and honestly i dont want to go on a medication for depression or anxiety or w.e i tried it for a bit time ago and it made me feel more emotionally numb to everything and it made me gain bare weight i want to be able to not depend on medication to make me feel better and beat it by being sober

    and say if it does go away being sober with excercising and getting good sleep later on in the road will i ever be able to drink? cause i dont want to stop drinking competley cause im only 21 years old and i want to be able to go to clubs and stuff you know??

    thanks for readin this and let me know


  208. Amit


    I used to be addicted on opium and its derivatives for 6 years, meanwhile I was also having alcohol regularly .from feb to may I have tried heroin and alcohol both.from may I have left every opium drug but I still have alcohol every 2 or 3 days.iam facing problem of continuous headache and numbness on left side of my head, and I won’t be able to concentrate and keep on thinking . There is numbness on my left leg also. Is this numbness could be some serious problem or just paws??


  209. Bill Post author

    If I cant do it on my own I will seek counseling!

    Think what that means, dude! If you “can’t do it by yourself,” then you relapse. Too late for counseling then. If you were an expert on your own head, you wouldn’t be seeking advice, would you? Your best thinking got you where you are now. Don’t be so darned stubborn.



  210. Michael

    Thanks for responding so soon! I was probably drinking more than what I said trying to cover it up in my head. I do have strong support form my girlfriend and parents which is great. If I cant do it on my own I will seek counseling! I no there are AA meetings in my area quite often.
    Thanks Again


  211. Bill Post author

    Hi Michael,

    Congratulations on your two weeks clean and sober. As you can tell from reading the article, you have a few months of fairly rough going ahead of you. It’s certainly up to you whether or not you go to AA, but you need to know that your chances of success are greatly improved by support from people who have been where you have, and know how things are with you. I don’t think I could have survived without it, and I went to one of the best treatment centers in the country.

    The amount that we drank is less important then why we drank. The fact that you experienced withdrawal for more than 24 hours (i.e., a hangover) indicates that you are addicted to alcohol. A six-pack every other day is about 1-1/2 times the suggested amount for an adult male, and I’m guessing that you weren’t especially happy during the off days. I’m also betting that you drank more than that, if you’re really honest with yourself. I know I minimized my drinking in my own head. It protected the drug that I subconsciously realized that I needed.

    I’ll give you the advice about smoking that I give every newcomer. If things get too rough, for heaven’s sake have a cigarette — DON’T DRINK! A few beers will set back your recovery to day one, and you don’t need to go through that again. You can quit smoking in a few months when you have your feet well underneath you in the booze department. In the meantime, the stress relief you get from nicotine could be helpful. The nicotine gum is also an option.

    On the other hand, if you feel as though you can make it without, by all means stay off the smokes. It’s just that relapse in that way is far preferable to the other.

    If you have questions, feel free to ask. Please stay in touch, and

    Keep on keepin’ on!



  212. Michael

    Wow! What great reading! I never new about PAW I’ve had a lot of problems with anxiety and dealing with it with alcohol. I went to the doctors awhile ago and he told me the reason for my anxiety and depression was because of my alcohol use and he felt I did not need to be on medication but needed to make life style changes like going to AA and exercising which I never did. I don’t drink daily but do so to mask my anxiety which ive done for 30 plus years I am currently 49 yrs old. I probably drank a six pack everyother day. I recently two weeks ago stopped smoking cigarettes and drinking because I felt in my mind that it was time. The withdrawals have really sucked but I am dealing with it because it will be better in the long run. Just reading about the PAWS and what I am feeling makes me feel like I’m not alone and the feelings will pass.


  213. Bill Post author

    Two things, then I’m going to watch the Dolphins beat New England. (ha)

    NA will help even if you don’t open your mouth. Get to a meeting, then keep going — especially when you don’t want to. At this point, NOTHING in your recovery is more important apart from not using. If you don’t like one meeting, go to another. And another. And another. Keep going.

    Stay away from people who are still using. You need friends who aren’t using. That’s one of the things NA will give you. If you keep on hanging around people who use, you’re spinning the cylinder of that revolver…with five chambers loaded instead of one.

    Do it!



  214. Bill Post author

    Hi David,

    You’re welcome. I’m just doing what was done for me, according to my abilities. It’s what we do to stay sober.

    Keep close track of your blood pressure and let someone monitor you for any signs of convulsions. Don’t be alone for the next couple of days. Ideally, get to a medical detox unit. Alcohol detox can be really nasty, depending on the individual. As a last resort, if things start to go south, have ONE drink and get to an ER. I’m not trying to scare you, but you need to know this.

    And get to some AA meetings. NOW! Those people are your best defense against both relapse and problems in early recovery. Don’t try to do this by yourself. Your odds are much better with support from people who understand. http://www.aa.org/lang/en/meeting_finder.cfm

    Doctors deal with things that can be measured and controlled, like all other scientists. Many mental health professionals do know about PAWS, but for some reason it isn’t covered nearly well enough in primary and outpatient treatment. I was lecturing about it in a rehab where I worked nearly fifteen years ago; it’s not new stuff. In fact, most of that article goes back about 10 years, although I update periodically. Go figure. I don’t know.

    Stay in touch, and

    Keep on keepin’ on!



  215. edd mahone

    Hey Bill,
    Thanks for the quick reply and for answering some of my questions. It helps me realize that even if I do H just one more time it would set me back from the beginning. Truthfully I don’t want to go through that pain again because it was hell in the first place. Thanks for your support and even simple words sometimes push my drive to keep on fighting. I don’t go to NA at the moment but I will look into that. You are so right about the slim chances of beating this addiction on one’s own terms without the help of others. I have to learn how to let others near me and allow them to be a part of my life even if I feel I have nothing to offer at the moment. I still have friends that still use H on a daily basis and they came to see me sometimes. All I hear from them is that , “This is the last time I will do it and never again!” I used to say the same thing but I was just fooling myself. It’s either now or never. If I don’t fight it fully now I will just keep on extending the date of my sobriety. I don’t want to extend it my whole life. Thanks again for all the advice and take care!


  216. David Burgess

    Hi Bill,
    Can I just thank you for writing such a brilliant article. One that has not only opened my eyes but feel will probably save my life. I’ve been abusing alcohol, cannabis, cocaine, Ecstasy and Ketamine for about 10 years now. Although I have never been out of work I’ve been in denial. Last time I quit everything I lasted a month and thought “The damage is done. I’m always going to be like this” and relapsed. Been abstinent from drugs for 2 weeks now and alcohol 2 days. Last night I was close to tears and about to relapse and found this article. Just understanding the process has really made me see it from a different perspective. I will be sure to come here and re-read everytime I am tempted. Even reading the other stories and comments I finally feel like I can cope with the symptoms – as I can EXPLAIN them rather than just ‘accepting’ that I am going to be a mess for the rest of my life.

    You are truly an inspiration. I cannot believe doctors/professionals/therapists or anyone has never mentioned this lengthy process to me and actually explained it in such a way that MAKES SENSE. I know it will be tough but not as tough as it would have been without reading this.

    Thank you. I will definitely keep on keepin’ on :)

    Happy New Year to you also



  217. Bill Post author

    Hi Edd,

    Thank goodness you came across the site when you did. I sure hope it helped keep you from relapsing. Hang in there. It will get better, although it’s going to take quite some time. The only thing using heroin now will do is set you back 46 days. (Congratulations on that, it’s the hardest part…really.) Eventually you’re going to have to quit or die, and it might as well be now since you’ve already done the hard part.

    If you’ve read anything on the site, then one thing you should have realized is that I do. not. bullshit. So I hope you will take to heart what further I have to say.

    First of all, you were hooked when you were taking the pills. The heroin was just a logical extension of the addiction. Chemically, there’s not much difference in painkillers, whether they come in little orange bottles with labels or in little bags. In fact, heroin was first developed and used as a painkiller, and it’s a very good one. Unfortunately, like all opioid drugs, it doesn’t let go very easily.

    It doesn’t really matter how long you mainlined. What matters now is how long you’ve been clean — and staying clean. You mentioned that your family doesn’t understand you, and that you have some pretty tough stuff to live down with them, but mostly with yourself. One of the things that makes recovery hard is trying to overcome all that guilt and shame by ourselves. You didn’t mention NA, so I assume you’re not going to meetings.

    You’ve got to get to meetings and get a program going. That is the only way you’re going to get the support and guidance you need to really beat this thing. You sound like you’re ready to surrender and start doing the right thing by yourself. Don’t throw a monkey wrench in the works by depriving yourself of the best support available. You need people who understand who you were, what you did, what you’re going through now, what you’ll be facing in the future, and who are able to tell you how they did it and help you do it too.

    Read this closely: Your chances of staying clean without NA are vanishingly small. You have as much chance by yourself as a big fat fly trying to swim across a stream filled with trout. There are people standing with their hands outstretched to help. Grab them before the H grabs you.

    Oh. One other thing. Go buy a pack of cigarettes. You don’t need that stress. You can quit that addiction later when you have your feet firmly under you.

    Stay in touch, and

    Keep on keepin’ on!

    And get to a f******g meeting! Now! Here’s a simple way to find one: http://na.org/index.php?ID=home-content-fm



  218. edd mahone

    Hi Bill,
    Just came across this site today as I contemplated selling some of my possessions so I could get money to buy some H. Prior to using H (true devil in disguise) I was a heavy painkiller abuser and would do all sorts of pills. When I moved to H it’s probably been 2 years and I started with boosting the drug. It’s funny because at beginning I thought I was immune. This is the first time in a long time that I have the strength to actually leave a response online. Today is day 46 clean for me and that’s the longest I’ve been clean from H. I’ve tried before and relapsed many times at the same time breaking multiple promises to those I loved the most. My good heart has turned into something not of this world. I admit that I stole money from those closest from me and played a lot of people along the way. Also I just quit cigarettes at the same time as H. The first 2 weeks have been hell with physical symptoms and I haven’t been able to sleep for the longest time. Those have subsided and now I feel like there is this black void trying to suck me back in and there is a battle between good and evil playing in my mind on repeat. I started running recently and I am running hard. I don’t know what to do anymore, life seems so boring at the moment, so many mistakes I have caused and now I have to face my past. My track marks remind me every morning that I have just started my road to recovery. Nobody in my family understands me and they feel that I am joking when I say that I feel depressed. I am a lover of life and I feel like there is so much to do and people to meet. All praise to you Bill for taking your time to respond to who you can. If you can respond it would be great but if not that is fine too. I am sensing all the hard work you are doing and I hope that the universe is smiling back at you for this. I just need to know if I should keep fighting this addiction from H and the question if things one day will be better. This is just a quick note for now but I truly hope that all those afflicted with addiction can find their light. Don’t forget that life itself is a precious gift, and the circumstances that it took for us to exist today are great. Thanks for this site and I hope you can get back to me…


  219. Bill Post author

    Hi Elizabeth,

    Congratulations on making it back, and on your 18 days. It sounds like you learned a valuable lesson about addiction, and I hope it stands you in good stead and helps you maintain continuous sobriety.

    Addiction is a disease, and one of the symptoms is relapse. We trained our brains to need alcohol (actually caused physical changes in them), changed our behavior to support that need, and then all of a sudden — BANG! — we stop drinking or whatever drug we were using. Naturally there’s a powerful impulse to use again, and until we have changed a lot of the behavior and old ways of thinking that went along with our alcohol or other drugs, relapse is a constant possibility — especially during the early stages of the 1 – 2 years duration of PAWS.

    That’s one of the main things that AA and the other fellowships do for us. They put us in contact with others who understand exactly where we’re coming from, and give us the support and guidance we need while we are learning to be sober. It is possible to get sober and stay that way without AA, but I don’t know many people who have been successful at it. Certainly it’s one heckuva lot easier than trying to change the entire focus of our lives without any help or understanding companionship along the way.

    Furthermore, part of recovery is giving back — paying forward, to use the currently fashionable phrase. And what better place to find folks who need our help than the 12-step programs? We can begin it just about as soon as we walk in the door. The next poor soul (of the same sex) who walks in looking scared out of their wits, we walk over and introduce ourselves, get them a seat and a cuppa, and let them know they’re welcome. Newcomers have trouble relating to us old-timers sometime, but they can get their heads around 18 days sober and realize that it’s possible for anyone to make it that far.

    In short: yes. I not only think you need AA as part of your program, I think it should be the major part, and that you’d be doing yourself a big disservice by ignoring the opportunity.

    Please stay in touch, and

    Keep on keepin’ on!


    p.s. I’m pretty sure that I would be dead without the help I got in AA.


  220. Elizabeth S

    I just found this article and the moods/feelings/attention span, ect. that I have been feeling are all making more sense. I had never heard of PAWS before this. I am 18 days sober today and taking antabuse to do it. I relapsed right after a 28 in treatment program for alcoholism right after Thanksgiving. I am beginning to try to focus on my physical health right now and exercise regularly and eat better. Everything is just so hard for me right now. I am in therapy weekly and have an appt with a new psychiatrist to see how my current meds may be affecting me. Should AA meetings be part of my recovery plan too?


  221. Bill Post author

    Hi JB,

    Congrats on your 46 days and 92 nights. I won’t lie to you; you have some rough times ahead, but I promise if you don’t use it WILL get better. Hang with the people who understand you, and it’s easier. If you’re not going to NA, start — and work the program. It increases your chances of making it immeasurably.

    Merry Christmas, and

    Keep on keepin’ on!



  222. Kristin


    Thank you for such a quick response!! And for the ice cold glass of water to the face!! Having grown up in an addiction filled household, of course I “know” these things, why it fails to register immediately, who knows?? Because I’m the “fixer” I guess. I’ve tried Al-Anon in the past but it was a long time ago, apparently I need to re-visit them and be reminded of my role, good and bad. Not been to an ACOA meeting but will look it up and see if it’s something I should look into. The articles you linked were great and exactly what I needed to hear, hard as that is to admit. I appreciate your straightforward answers more than I can say and I think my bf and I will both benefit from them.

    Thanks again and God Bless!!



  223. Bill Post author

    Hi Kristin,

    The symptoms he is experiencing during the week have nothing to do with PAWS. That comes after you get clean. He is still an active addict, suffering from acute alcohol withdrawal, which he then treats by drinking on the next weekend. He is fortunate that he has avoided seizures so far. Probably the fact that he is not using his drug continuously is the reason for that, but it could still happen. I would think that his blood pressure is spiking pretty high at some points, too. Read up on the symptoms of stroke. You might need to know that.

    As you said, there is nothing you can do for him until he is ready to get completely sober. In the meantime, anything you do to make his life easier is just making it possible for him to continue without making any substantive changes. There is little you could do to affect his health, in any case. Active alcoholics cannot absorb nutrients properly, even if supplemented, and we all suffered from malnutrition when we were drinking — not the kind that makes us look as though we’re from Ethiopia, but the sneaky kind that slowly breaks down our bodies’ systems without making a fuss. Alcohol, BTW, is the only drug of abuse that affects the entire body.

    The best things that you can do for him at this point are, (a.) read the articles that I have posted here and here; and (b.) get some Al-Anon meetings under your belt. You need support yourself. Some ACOA meetings would be helpful, too.

    Please feel free to contact me at any time. I usually get back to folks within 24 hours.

    Keep on keepin’ on — but take care of yourself first. Your alcoholic will need your support later.


    Please stay


  224. Kristin

    I stumbled upon this blog while Googling diet tips for addicts/recovering addicts and it has been a HUGE help…..I do have a couple of questions, though. My bf was a HEAVY drug and alcohol abuser until about 6 years ago. Since that time, he had one relapse with the drugs about 2 years ago but has been clean to date. However there’s still a problem with alcohol. He has stopped drinking during the week, which is great, but he starts as soon as he gets off work Friday afternoon and doesn’t stop until Sunday evening. I know this still fits the definition of an alcoholic and am not making any attempt to disguise it as anything other than that. Having dealt with alcoholics my entire life, I also know without a doubt that it needs to be their idea to get sober and stay that way. Nothing I say will influence that at all in the long run and I am well aware of it. So what I’m wondering is A. Is there anything I can do to help him physically stay as healthy as he can be until he gets to the point where he knows he has to abstain completely? Diet wise maybe? Supplements? We have had the conversation several times lately that it needs to happen and I think he’s more willing to think about it now that he has ever has been. He also knows I will not stick around much longer to deal with the consequences. My other question is B. Could he be suffering from PAWS during the week when he’s not drinking? The beginning of every week he’s extremely moody and tired, doesn’t want to eat, kind of withdrawn. Toward the end of the week he seems a little better but I think part of that could be because he knows Friday is closer and so is his next drink. Do you think having him read something like this article, especially about the sugar highs and lows and the caffeine might be an eye opener? Or more wishful thinking on my part?? I do love him and want to help in anyway I can, so if there’s any advice you could give I would be most appreciative!! Thank you so much!! Have a Merry Christmas and God Bless you!!


  225. Bill Post author

    Hi again, Steve,

    Kratom is derived from the leaf of a tree indigenous to Malaysia. It contains mood-altering alkaloids, and is known to be mildly addictive. I have not been able to find any indication that it interferes with recovery, but I would approach its use with extreme caution. As you are learning, the major obstacle to recovery is PAWS, and I have no way of knowing if Kraton will interfere with the process of healing. I’d not be inclined to recommend it. Too little is known about its effects.



  226. Steve

    Thanks for the reply I had been taking the steps as far as vitamins, and better living habits. I even. Have spurts of feeling normal at times like your article states. I did not want to take the subs because I was sure it would restart the process of the receptors heeling. A friend suggested smoking the plant to feel relaxed. I tired it a few nights but honestly did not enjoy it and stopped. Here’s a question for ya. Kratom an erbal remedy to help ease the paws? I haven’t taken it myself but my wife has. She’s with the kids all day and gets her as kicked I at least get alone time at work. She doesn’t intend on continuing with this erb, but im afraid that it’s affecting her nerves and only making it more drawn out and worse. Im gonma take this path alone it’s just kinda how I am when I’m done I’m done. I have my wife and kids as enough motivation as well as my own will to be a good man. I wouldn’t mind chatting with ya at times. It is nice to get an outsiders view on this. Hey thanks bill your doing a wonderful thing supporting us. I’m sure you remember the when will things be normal and what to expect feelings. Thank you


  227. Bill Post author

    Hi Steve,

    Don’t fool yourself that you’re not an addict. If you weren’t, you wouldn’t be having these issues. You need to look at your situation realistically or you have two strikes against you already.

    At this point there is no reason to go back on the Suboxone, and I would flush them. ANY further use of drugs will prolong your recovery. Your brain cannot normalize when you have them in your system. There is no reason to keep them if you have decided you definitely want to stay clean. If you don’t want to dump them, that should tell you a lot about your level of resolve.

    PAWS sucks. There’s no lying about it. There will be some rough times ahead, but you can be each other’s (partial) support, and that will help. I got clean and sober with my wife, but there were two things: we agreed that if either of us relapsed, he or she would move out immediately, and we had loads of support from AA, NA and a variety of recovering friends. That’s the solution to sitting around being miserable. You need to get involved with a program of recovery — separately. By that, I mean go to meetings separately, or together only occasionally. Each of you will have issues that you are unable to discuss with the other, and they are most likely the ones that need working through the most. Get some support.

    Beyond that, pay attention to the article. Get regular mild exercise, eat properly (even if you don’t feel like it), take a multivitamin with breakfast and dinner, and try to get enough sleep. I know that’s more easily said than done, but the exercise will help. Stick with mild exercise. Heavy workouts will interfere with your body’s repairs.

    And get to some meetings. Your chances without support are slim.

    Feel free to write any time. I usually answer within 24 hours, although no promises.

    Think about each other and your kids, love each other, and

    Keep on keepin’ on,



  228. Bill Post author

    Hi Chris,

    Your symptoms could be PAWS-related, and are probably complicated by going on and off the Xanax. Recovering addicts and alcoholics should not take benzodiazepine drugs, as they stimulate some of the same neural pathways and prevent the brain’s complete recovery. Your doctor should have known that. You might consider finding one who better understands addiction and recovery.

    You need to be on a non-addictive anti-anxiety agent. Cymbalta is a possibility, and some folks have good results from Neurontin. Be sure to tell both your physician and pharmacist what other medications you may be taking, including all over-the-counter medications. Talk to the pharmacist about possible drug interactions, as the doctor may not be familiar with the pharmacology of all the medications. In recovery, your pharmacist is your best resource on drug questions. Be sure she knows that you are in recovery.

    DO NOT take either Cymnbalta or Neurontin intermittently. Psych drugs act over a long period, and if they don’t have time to work they simply complicate the symptoms. By the same token, they need time to show an effect. Don’t give up. Keep in mind that some drugs can be dangerous if ceased suddenly. It’s best to go online and do some research on your own. You are your own best advocate. Physicians mean well, but they can’t keep up with all the details of all drugs as they are too busy trying to keep up with the medical aspects of their practice.

    Let me know how it goes, and

    Keep on keepin’ on!


    BTW, you were really lucky on that detox. Alcohol detox without medical support often leads to potentially fatal blood pressure spikes, and also seizures.


  229. Steve

    Thank you for allowing me to read this article. My name is Steve, Ill be 29 this dec the 29th. I have a beautiful wife who I enabled to get addicted ( but stopped with me) and 3 beautiful kids. I started taking 30’s about a year or two ago. It started as a weekend thing and over time got to 8 to 10 a day for the both of us. This wends at 3 am will be 14 days since I railed 3 blues…. I have no intention of going back but wow this is different. Having the kids makes the stress and finances do hard for me but I keep telling myself to push through. I may be foolish to say I wasn’t an addict more so then I just could and enjoyed doing them. But now I feel like I don’t know who i was a month ago. I have extra suboxone left over would taking a small piece help ease the tense feeling. I have found that if I stay busy I will simply forget about it and all is well. However once the kids are in bed which we can’t wait for all day we don’t have anything to look forward to and we kinda just sit in this blahhhh feeling. My will of quitong is strong I have 15 30’s right now and for the last weeks with not the slightest urge to do one. I just wish there was some kind of something that would kill that blah fuzzy feeling. Any advice will be much Appriciated


  230. kyle

    Hey Bill, I was a very heavy binge drinker for the last 8-10 years, meaning sometimes i would go on a binder for a week or two. Sometimes drinking 30 beers a day.. I just stopped all of this thursday. Tapered off a bit.. Now completely sober. I noticed in the mornings while binging, i would wake up with an awful dry mouth. Dry eyes. Shakiness. Major anxiety. Very uncoordinated. Nauseous. Insomnia. Blurred vision and much more. Well everything has died down for the most part.. The only thing, i still have this dry mouth, bothers me all day. Driving me crazy! Any thoughts? Have you experienced or has someone you known dealt with this? How long does it take to over come? I just found out about paws. I assumed it was binge, withdrawal, feel fine enough to drink again, repeat. Turns out, the paws may have been pulling me back in. Im taking a stand and have quit everything including cigarettes. Just need a little reassurance. Thanks!
    Also sent this in a pm. Didnt know which you check regularly.


  231. Chris

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


  232. Bill Post author

    Any time you like, George. However, given the issues with sleeplessness in early recovery, you might want to hold off until your sleep patterns have stabilized again.

    Sent from my Asus Nexus 7 using Dragon


  233. Pingback: af day wed 12 Dec - Page 4 - My Way Out Forums

  234. Bill Post author

    Hi Mike,

    The Xanax should help avoid seizures (far more dangerous during alcohol detox than anxiety), but you need to get off it within a couple of weeks. Benzodiazepine drugs stimulate the same neural pathways as alcohol, and your brain will not begin to repair itself while you are on alprazolam. The metoprolol (Lopressor) will help control the blood pressure spikes in acute withdrawal, which can also be dangerous. It sounds like your doctor knows what he is doing — by no means a common thing when it comes to addiction.

    Drink lots of diet coke or something else non-sugary while watching football. “Non-alcoholic” beer may contain up to 0.5% alcohol and still be labeled non-alcoholic. You cannot safely be exposed to any avoidable alcohol at this point, and frankly I don’t recommend it ever. It maintains old tastes and habit patterns, and is simply not part of the curriculum of learning to live differently. The technical term is mind-f**k.

    It’s good that you have a friend to help support you. Nonetheless, I STRONGLY suggest that you go to AA. It increases your chances of making it by a significant amount. I’m a “strong-willed” person, and in retrospect I’m convinced that I could not have gotten sober without AA, despite having been in one of the best treatment centers in the country. We need the support, the knowledge that others know where we’re coming from and understand us, and the commitment to sobriety that is strengthened by having others know of our progress and/or struggles. It’s also a good source of the new, sober friends that you’ll need to replace some of the heavy drinkers in your life.

    Go easy on the exercise for the first few months. Mild aerobic exercise like walking is much better support for your healing body than anaerobic stresses such as weights and machines. Your entire body has been compromised by the alcohol (it’s the only drug that affects every system in the body), and it needs time to heal along with your brain. There is also the danger of becoming addicted to the endorphins, and thus the exercise regimen itself. Trust me on this. I’ve seen it happen many times, just as I’ve watched many addicts get their “fix” of endorphins at tattoo parlors. Moderation is the secret to recovery.

    It’s great that you are doing this for yourself. I suggest that you have your wife read the PAWS article so that she will have an idea of what’s happening with you. Please stay in touch, and

    Keep on keepin’ on!



  235. mike

    Day one of no drinking was yesterday. I would typically drink anywhere from 200ml’s vodka on up to 375ml’s vodka every day for the last probably 3 years or more. I woke up yesterday and decided I need to stop. Things are not always great with my marriage and I have the most beautiful 2 year old boy. I think the alcohol has certainly had negative effects on my marriage and when I wake up with a bad hangover, I don’t function at the level I normally do at work. I have a pretty good job (I am a general manager at travel plaza). It pays very well, but in turn I deal with alot of stress. I used the excuse of a stressful job and nagging wife to convince myself I can drink. Anyways, my dr prescribed me metoprolol and lorazepam for anxiety and it is helping. I am keeping taking them to a minimum (only when I feel overly anxious). I know this is going to be a struggle – I even thought about trying to wean off it by only drinking a beer or 2 a night for a while. I have even read online that this can be effective, but I don’t know if it would be for me or not. I have gone a 2 or 3 day stretch without drinking and without symptoms from time to time, but I end up telling myself that I “Have been good” the last few days, so I owe myself a night of heavy drinking. Pretty ridiculous, I know. Anyways, I have a friend that went through a similar thing and I have confided in him and told him my plans. I am sure he is going to be a big help. I used to be a gym rat and I visited a gym near my house yesterday so I can finally get back into working out again. Twice when I looked at my son yesterday I cried and told myself that I have a beautiful son and I need to do this for him. I need to give this up and get healthy.

    Another big challenge is that I love football and on Sundays it has been a routine for me to watch football and drink all day. This Sunday will be tough. I have to wonder if drinking non-alcoholic beer could be a way to cope with the absence of regular beer?

    Well, I hope when my withdrawal symptoms begin, it is sure to be a struggle, but I know I can do it.


  236. Bill Post author

    Your higher weight when drinking may have been due to metabolic disturbance, and it is quite possible that the weight you lost was weight you didn’t need. If you are eating properly and physically active, your weight is probably not too low. Why not check a body mass index calculator and see what your ideal weight might be?


  237. George

    3 Months abstaining from alcohol. I weigh less than my normal by about 8kgs. will my weight come back, after how long?


  238. Bill Post author

    I have no answer for that question. Everyone’s brain chemistry is a bit different, as it would have to be with over 1000 chemicals bathing it. Given your description of your drinking, any PAWS should be ameliorating soon. If the symptoms continue, they are not PAWS and you need to see about anti-anxiety meds. Neurontin often works well, but if you take it don’t cease without a doctor’s care. It also has anti-seizure qualities, and a rebound with seizures is a possibility with rapid cessation. Avoid benzodiazepines. They are highly addictive — all of them: Valium, Xanax, Ativan and the rest. If your doctor thinks otherwise, he or she doesn’t know enough about addiction to be treating a potential addict.


  239. Jennifer

    When I say I drank about once a month with friends we did get drunk and usually smoked marijuana also. Sometimes twice a month I guess…I didn’t keep track. Then in March of this year I drank about a bottle of vodka every night by myself for about a week. I would wake up the next day feeling fine and so I did it again and again. Then I went to a friends house that weekend and drank a little but not much, and smoked a very little bit of marijuana. I had a full blown panic attack, which I have had before after a night of drinking and smoking, but this time it didn’t go away. It lasted for about 2 weeks. I had a very fast pounding heart, and severe anxiety and fear. When it finally did stop being constant, I would have panic attacks alot and the depersonalization didn’t go away until I started working out about three months ago. Like I said , my anxiety has gotten quite a bit better, but Im just wondering how long I will have to work so hard to feel normal.


  240. Bill Post author

    Dear Jennifer,

    I think that you are extremely lucky to have learned what you have so quickly, and with so few consequences (assuming, of course, that you have internalized the lesson). I’m sure you will continue to improve, and look forward to hearing from you again.

    Keep on keepin’ on!



  241. Jennifer

    This all started in March of this year. When I said I would go out about once a month with my friends and drink we did get drunk. Sometimes it was maybe twice a month. I March I drank about a bottle of vodka by myself for about six days. I drank one night and would wake up feeling fine without a hangover so I did it again and again and again. Then I went out that Saturday night with my friends and drank but not much, and than I smoked a little bit of Marijuana. I went into a full blown panic attack which I have experienced before after a night of drinking, but this time it didn’t go away. My fear, anxiety and rapid heart rate continued for a couple of weeks constant. When it finally did stop I was still freaked out and having panic attacks. This has been the worst thing that has ever happened to me. I never thought withdrawals would be this bad, but I also didn’t think I was dependent on alcohol. I thought it would go on forever until I read your site about paws. Knowing that it will go away eventually gave me some peace.


  242. Bill Post author

    P.S. Deep breathing exercises a few times a day and 30 minutes of exercise are excellent even when you’re feeling well. They virtually guarantee that you’ll feel even better.


  243. Bill Post author

    Hi again Jen,

    You can have withdrawal from one night of drinking: a hangover is withdrawal — short, but not so sweet.

    I wouldn’t expect much PAWS from a week of drinking, if any. PAWS is the period after acute withdrawal when the body is repairing the long-term damage from drinking: deactivating extra receptor sites in the brain, correcting conditions brought on in other systems by the constant exposure to alcohol, and building itself back up after suffering from prolonged malnutrition. (Alcohol affects the absorption of nutrients from food, so all alcoholics are malnourished even if they eat well and take supplements.)

    You didn’t say how long ago your spree occurred, but if it was less than a month ago I’d not worry about it. I doubt that the effects would last even that long, as a week isn’t time to cause many changes in the brain, and even less in the rest of the body. Nor did you state exactly what your symptoms are, so I can’t speak to them specifically.

    However, your period of heavy drinking does worry me. Non-alcoholics rarely go on long binges without a reason, and usually a big reason. Is it possible that you are suffering from depression related to whatever triggered the drinking spree? I’d keep an eye on that: feeling tired, at loose ends, unmotivated, useless, sleep disruptions (including sleeping more than usual, or at odd times), down for no reason, etc. If you have those symptoms and they don’t improve in the next couple of weeks, I’d talk to someone about it — sooner, if you begin feeling acutely depressed.

    In any case, I’m glad you’re feeling better. If I were you, I’d keep an eye on my drinking (assuming that you don’t simply stop after this experience). Not having a desire to drink does not speak to the possibility that you have a predisposition toward alcohol use. I didn’t drink a drop until I was a freshman in college, drank rarely for a couple of years, then things escalated. By my mid-twenties I was binge drinking (I drank seldom, but nearly always got drunk when I did) and by my mid-thirties I was off to the races. I had no family history of alcohol abuse (that I was able to learn about), but I certainly ran with it when I got my feet under me. Just be careful, is all.

    Take care, and keep on keepin’ on.



  244. Jennifer

    I used to drink occasionally (Patron) with some friends about once a month, but one week I drank alot of vodka everyday for six days straight and had withdrawals from it. I didn’t even think that was possible from just one week of drinking. Anyway, I was wondering how long do you think it will take for me to get through the PAWS stage. Dependency wasnt much the problem, and I have no desire to drink at all. I didn’t realize how poisoneous that stuff is. I just want to feel normal again. I feel alot better, but I have to excercise everyday for 1/2 hour, and deep breathing excercises several times throughout the day.


  245. Anatoliy

    Thank you again Bill!

    Today I visited 2 meetings in our area. I stopped visiting them more than year ago, when found the job. I was so afraid to loose the job, so was always stressed. And I stopped meditating, approximately half an year ago. Now after reading you article I see how stupid I acted. I put myself on the edge of breakdown, that’s why relapsed. There is no cure from addictions. There is no return to the former life. It could be a new life only, when I always remember that I have a dragon inside that can one day get over if I don’t calm it down putting to sleep by proper diet, exercises, relaxations. And learn to lead the new lifestyle, with knowledge about this dragon inside. Functions of alcohol has to be replaced, I see clearly now that it’s not enough to eliminate alcohol, new ways to relax and get an energy has to be learned instead.

    Thanks again!



  246. Bill Post author

    Hi again Anatoliy,

    Two years is an outside figure. You may well do better, and remember that it gets better even during PAWS, there are just periodic recurrences.

    You badly need AA. You need to go to meetings, and you need to have people to call who understand, and who will help you through the rough times. An alcoholic who fails to utilize AA is like a drowning man who decides he doesn’t really need a life preserver after all. And has about the same chance of survival.

    Google “Alcoholics Anomymous” for your city. There are bound to be some meetings nearby. Even if there are not, there are online groups where you can get support.

    Keep on keepin’ on,



  247. Anatoliy

    Thank you again Bill!
    Now I know what I am going through. I will need 2 more years now. I wish I knew at least a week before! I gave up using alcohol, but did not find replacement. It seems so easy now: to learn to relax without alcohol, or the body will want it when needs to relax! The first time I gave up drinking in 2008. 18 months after relapsed. Then again, almost 2 years did not drink. And the last week, when weather was changing, migraine started. And I suddenly found myself drinking. I knew I must not drink. But there was a thought that this time it will be different. Now I am sick, reading your replies, and periodically the thought comes, “Go to the store and buy a drink!” It is hard to stop after started… I am afraid to go to a walk because part of me still wants to drink, but I know I should not! I am afraid I will end up in the store nearby.


  248. Bill Post author

    One of the things that seems most often to escape people in early recovery is that we spent many years getting our bodies and brains into the condition that led us to decide to stop drinking and drugging — yet we seem to think that we should get better in 1/100th of the time without any real effort at repairing the damage. It’s no wonder there are so many relapses. The addict remains, though the substances are gone.


  249. Corina

    What a good read! And thank you for bringing up the important role diet plays in cultivating a sense of balance and well-being. I feel like this fact gets ignored a lot, maybe mostly for cultural reasons. Can a body full of healing tissues and nerves coming to life subsist numbly on soda and processed snacks as it has in the past? Probably not very happily…


  250. Bill Post author

    Hi Anatoliy,

    I’m so glad you finally did read it. It’s amazing how little is said about these issues, even in treatment centers. It’s not new information, either. I started lecturing on it more than ten years ago, and it wasn’t new then — just more or less ignored.

    You can help a lot of folks yourself by either directing them to the article or copying it for them to read. Thank goodness that some other sources are beginning to get the word out. PAWS symptoms are by far the greatest cause of relapse.


  251. Anatoliy

    Thabk you Bill!
    I wish I dead this before my relapses in several years! It could save so much pain to me and others!


  252. Barbara

    i feel blessed to have found this site i would like to share my story and ask some questions tomorrow cause right now im very low in energy..i really think this site is very helpful for people like us and will help us understand what we really are going through…bless u


  253. Bill Post author

    Hi Lucey,

    Recovery is about changing many things, but it doesn’t have to happen all at once. That’s why we say, “One day at a time.” When you decide to really change your life, things will get better.

    In the meantime, good luck and best wishes.



  254. Lucey

    I am 3 days clean, and after reading this. I feel totally hopeless and want to go blow my brains out. Exercising, eating healthy, none of that is me and will never happen. I give the fuck up.


  255. Bill Post author

    Hi Sim,

    Congratulations on kicking the H and dropping the booze. You’ve accomplished a lot, the hard way. It’s much easier (to the extent that any quitting is easy) to nail everything at once. The problem is, there’s no such thing as a little bit clean and sober. We either are, or we aren’t — as you’re discovering. Stopping individual drugs just prolongs the agony, because our brains don’t begin to repair themselves until everything is out of our systems.

    There’s a lot of myth surrounding pot, a couple of the main things being that it isn’t addictive or as harmful as other drugs. That may be true for non-addicts who use occasionally, but once we’re hooked on one drug the addiction transfers over to others. Don’t think of yourself as being “wrong” for using pot. We’re addicts, and it’s natural for us to use drugs. What’s unnatural is quitting when our brains and bodies are telling us how much we need the chemicals in order to feel halfway normal. Just consider weed the last obstacle you have to conquer on your way to sobriety.

    Now is the time to quit. It’s never going to be the perfect time, so just do it. Be aware that the worst period with marijuana detox usually begins three weeks or more after you quit, when the last of the chemical begins to leave the body.

    Remember that we aren’t addicted to specific drugs, we’re addicted to the changes they have made in our brains, and many of the changes are the same for most drugs. Until things change back, we’re in danger. And while the changes are taking place, we can get pretty nuts. I STRONGLY urge you to begin NA meetings. You need the support of other addicts who know what you’re going through. Kicking cannabis isn’t as rough as heroin and booze in the short term, but you can expect to be pretty crazy for several months afterward, and you need people to talk to who understand. Keep in mind, too, that once you quit, any using will just prolong the agony. It takes up to a year or more for our brains to return to normal after addiction to drugs of any kind, and further exposure to drugs — of any kind — just makes it take longer.

    I hope things go well for you. You can do this, and you owe it to yourself. You’ve come too far to stop now. Just be aware that you need support and that it won’t be a bed of roses for a while yet.

    Good luck, and

    Keep on keepin’ on!



  256. sim

    HI Ive been in Recovery from Herion for 9 years and also in Recovery from Alcohol of which i am in my 2nd year of. My emotions have been like a roller coaster. The thing is i still smoke Weed and i no im doing wrong in doing so but i contiune to do it as i tell myself it isnt that bad and it could be so much worse.. I am loving been Free of the Alcohol and Hard Drugs and this smoking of Weed feels like my last Addiction to Conquer. I am finding it hard to do and im scared of been Abstinence from everything as ive never really known that way of living for many years…


  257. Bill Post author

    Hi Dennis,

    We all went through it. The emotional highs and lows are part of the package. Be sure to share how you’re feeling at meetings. Everyone can relate, and you’ll likely hear some stories about their own experiences. I was insane for the better part of 18 months, so I know how you feel.

    Keep on keepin’ on!



  258. Dennis

    I am ten months sober and the last month has been very difficult. Emotions are all over the place and I can relate to pretty much everything in the PAW symptoms. It has been very tough but I am glad to know that this is normal.


  259. Bill Post author

    Hi ADJ,

    We all have to make our own decisions. Keep NA in mind, though. If things get rough, you may find you’re not as independent as you think.

    Best of luck, and keep in touch.



  260. Anonymous DJ

    Thank you for the response bill. The last couple of days I have had a pretty foggy mind. It has subsided and today I seem to be able to have normal thoughts but not like I would like. Still have a little bit of a headache but I will put up with this rather than my “I’m going crazy” stage. I went to my first NA meeting on Sunday but didn’t really feel it was for me. I don’t crave the drugs and the stories of people in there and seeing how they are still suffering only stressed me out even more. I am one of those people who like to move on buy don’t forget but to only be reminded about my past all the time I feel will only prolong my recovery. I am hoping my psychiatrist is well educated and will have good supporting advice.

    Trying to stay positive and looking forward to more better days. Currently I have been searching the Internet for people that have gone through paws with the substances I abused but have only been able to find benzos, opiates, etc nothing really much marijauana and e.

    Thanks for all the online support bill reading even the same article everyday knowing that I will get through this and feel normal again helps me get through the hours I am feeling down.


  261. lisa

    hank you so much for the reply I am feeling a lot more positive I made a right fool out of myself in front of some people in recovery but u know what it has reminded me where I don’t want to be I haven’t told my sponcer yet or any one at na but I have told my rEcovery friends and I onwards and upwards have gained a massive kick up the arse and a love for the programme again x


  262. Bill Post author

    Hi Lisa,

    Don’t kick yourself too hard about doing a bit more research. More of us relapse at least once than not, by a huge margin. The smart ones learn the lesson they needed to learn, and go on to successful recovery.

    Your use of cocaine and alcohol woke up the dormant receptor sites in your brain, in effect reactivating your addiction. Whether you call the symptoms acute or post-acute doesn’t really matter. The point is, using creates setbacks in the brain’s recovery process. That’s why abstinence is considered by most experts to be the only effective path out of addiction.

    The good news is, these symptoms will abate soon. The bad news: you’ve increased the length of the PAWS phase somewhat — how much is impossible to say. However, the important thing is that you are again abstinent. Hit lots of meetings, TALK ABOUT your little experiment (we’re as sick as our secrets), and get on with your recovery. No one in the rooms is going to look down on you. Relapse is common. Successful returns to sobriety are less so. Consider yourself lucky.

    Please stay in touch, and

    Keep on keepin’ on!



  263. lisa

    Hi I haVe been clean 6 months last week and ended up drinking and having some coke the other day I feel so bad about it and paranoid and have been ill and shaky for 4 days. Is the illness I am suffering related to PAWS


  264. Bill Post author

    Hi George,

    Sorry to take so long to get back to you. The page changed and I lost your comment.

    Honey is mostly sugar, and in excess it will have the same effect on your blood glucose. It depends on the individual, but if you will treat it the same as table sugar as to quantity and frequency, you should get comparable results.


  265. Bill Post author

    Hi Erin,

    Congratulations on getting clean, and welcome to the rest of your life. Truly, you have a lot to be thankful for this holiday.

    There are hundreds of thousands of us out here who know what you’re going through. Reach out to the women in NA. You need the support of people who have been there. The suggestions in the article will definitely help, but there’s nothing like an understanding shoulder when you need one.

    I don’t know about the ECT and recovery, although I seriously doubt that it would have any effect. You also need to know that depression is a normal part of opioid-related PAWS, and your physician and family should monitor you closely for signs of depressive relapse.

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

    Keep on keepin’ on!



  266. Erin

    Thank you for this post. I have been going through PAWS for about 3 months now, from opiates. It has been a crazy ride. I almost cried when I read this because I couldn’t believe someone knew what I was going through. I also had ECT treatments for depression during my first month of PAWS, I’ve had severe depression my whole life. I’m not sure if anyone knows, but do you think the ECT will affect my recovery?


  267. Bill Post author

    Hi Anonymous,

    Cannabinoids mess with our brains in strange ways. Until recently, it was assumed that cannabis was non-addictive, and thus that there was no withdrawal syndrome. Over the past decade we’ve come to realize that isn’t true at all. Heavy users do indeed suffer withdrawal and PAWS, but because the cannabinoids have such a long life in the body (due to their fat-solubility), the acute withdrawal stage is often almost unnoticeable since the elimination is so slow that it amounts to a tapered detox.

    Unfortunately, that is not true of the post-acute syndrome (PAWS). It can be severe and prolonged, and you are describing the symptoms precisely. I’m afraid you can expect them to continue for several months, but they should slowly reduce in severity and the good periods should become longer, the bad ones shorter over time.

    I would speak to my psychiatrist about an anti-anxiety medication. DO NOT ACCEPT A BENZODIAZEPINE, however. They are addictive themselves, and will interfere with the repairs taking place in your brain. Neurontin (gabapentin) often works well in these situations as an anti-anxiety agent and mood stabilizer. Keep in mind, however, that if you begin to take it, you must taper off under the care of a physician when you decide to stop. Failure to do so could involve seizures, as gabapentin has anti-seizure qualities (as do the benzos that are ordinarily used for anxiety.) Neurontin, however, will not interfere with your recovery from PAWS. Xanax and Ativan will. Buspar (buspirone) and seroquel are also safe, but seroquel can make you drowsy.

    As far as depression goes, none of the current antidepressant meds will trigger your addiction, and are relatively safe if your physician feels they are indicated. (Just remember not to cease them rapidly, either. The rebound can be acute and life-threatening.)

    Finally, yes, it’s PAWS. And yes, you will feel normal again as long as you stay away from mood-altering substances including alcohol. Try to follow the suggestions in the PAWS article. Re exercise: I would go easy on anaerobic exercise for the next couple of months. Stick to walks and the treadmill. Mild exercise is far more effective in relieving PAWS than exercise that causes the breakdown of muscle tissue. I’m not saying don’t do strengthening exercises, but keep them short and mild.

    You may find that your law enforcement hopes are not totally out of the question, but stay away from it until you’ve been entirely back to normal for some time. I was a police officer for many years, and I’m here to tell you that the job produces more addicts than it cures. Also, I found that the state of mind necessary to be a good cop wasn’t conducive to the serenity I needed in my life. I’ve never regretted leaving the profession, although I hasten to say that I have great respect for all officers who are in the work for the right reasons.

    The AA issue depends on the particular group. Some are more lenient than others. All 12-step groups have their own personalities on a local level. You can certainly attend open meetings, and sample others. Just say you “have a desire to stop drinking.” That is (or should be) true. You don’t have to identify yourself as an alcoholic. If you are in a large metropolitan area, you should be able to find support. Marijuana Anonymous is another possibility. However, don’t eliminate NA without trying a few different meetings first.

    Please stay in touch, and

    Keep on keepin’ on,



  268. Anonymous DJ

    Also I was wondering will AA support groups accept me and allow me to express myself? The guy I talked to said he liked AA groups better than NA groups but the little research I have done seems like AA is only for alcoholism


  269. Anonymous DJ

    Thank you so much for this article.

    I have been sober about just about 5 months now but just 2 weeks ago really felt like I was going crazy. I used ecstacy at least once a month and depending on the night between 3-8 pills per night. Some months I would use twice also between 3-8 for the past 3 years. I smoked marijuana just about everyday for the past 3 years. I will never go back to using. I wanted to get out but was stuck in with my friends until my current girlfriend came along. She was a user as well but we both wanted to get out and well she pretty much saved my life. Up until a few weeks ago I felt “normal” the past couple of months I would have some episodes of depression and little anxiety but nothing led me to believe it was because of my past drug use. I never really experienced withdrawals… At least until now…I think. So a couple of weeks ago I ate a couple cup cakes and started to feel a little weird, head was fuzzy, little panicky…just wasn’t feeling right. I went to the ER and they did my blood work, EKG and everything came back normal. 2 days after this incident I seriously thought I was losing my mind, to the point of thinking I was never going to be normal again. Severe anxiety, panic attacks, confusion, feeling of being lost/alone, felt my relationships were ending or that my relationships were the cause, over analyzing everything, paranoid delusions, very clouded mind, uncontrollably shaking from 1-3 hours, dry mouth, and the thought of suicide crossed my mind quite a bit. I freaked out because I didn’t know what was wrong with me just that I had finally lost it and would end up in a mental hospital for the rest of my life.

    Last week I finally began to feel “normal” again. I still have episodes of depression, worry, anxiety, and get the shakes (shakes have only happened twice only lasting for about 10-20 min in the last week).

    I went and saw my doctor and told her what was going on that I thought it was withdrawals. She didn’t think it was and referred me to see a psychiatrist. I have yet to see one but have an appointment set up with one that specializes in addiction and withdrawals next month. I have called someone from a sober help website and was lucky enough to speak with the person I did. He pretty much confirmed that I was going trough PAWS because he personally went through it but I have yet to have it confirmed by a medical professional.

    My girlfriend has been really supportive and we have signed up for gym memberships and are planning to go almost everyday. We walk all the time together and it really seems to help.

    My question is have you heard of anyone having my symptoms 5 months after being sober? From the time I stopped using til about a month ago I was running 4-5 times a day but just stopped about a month ago due to just no motivation. My diet has been pretty healthy, rarely eat junk food, candy, or soda. I use to drink socially about 1-2 times a month only a couple of drinks but since these recent episodes have given up anything that alters my body.
    I stress out because I don’t know what I want to do with my life. I am 24 years old and have always wanted to be in law enforcement but my past has pretty much screwed that for me. It’s all I have ever researched or trained for but I crossed paths with the wrong group of friends and just got sucked in. I worry everyday that I won’t find my place in life.

    Does this sound like PAWS to you and will I ever feel normal again?


  270. Bill Post author

    Hi again Martin,

    I’m glad you’re feeling better. You can expect to have good days and bad days for a while, but over time there will be more good than bad. See Jason’s comments and reply below — you’re not the only one. See especially the part about exercise.

    The amino acids won’t hurt. Whether or not it’s placebo effect, it’s working for you.

    Must rush. Keep on keepin’ on,



  271. Bill Post author

    Hi Jason,

    In haste. One of our sites is preparing for an accreditation inspection, and I have to go down and help out.

    It could well be that something about your nutritional or lifestyle changes had an effect on the hair loss — or perhaps Tramadol is responsible. I’m not discounting it, I simply don’t have an answer. Hope it works out for you (or comes in, to be more accurate).

    If you’ll replace fifteen minutes of pushups with half an hour a day of brisk walking, you’ll get even better results. Aerobic exercise that doesn’t break down muscle tissue is more beneficial to PAWS than anaerobic. Don’t cease the pushups, just do maybe half as much every other day. A suggestion.

    Keep on keepin’ on,



  272. Martin rasmussen

    Hi bill, as promissed an update, it has been 9days since i took my last pills, i am getting better for sure, but i do get really tired after a days work, kind of when you are about to get the flu i think, but i think its getting better couse in the first 5-6 days the tiredness came at 12, now i hammer the coach at 17-18 a clock so there are progress. In the weekend a hav a avfull feeling of what now, i used to get relaxed and enjoy myself with tramadol,so i feel a little empty, but i am convinced that it will go away in time (cant wait-wont to get better), thanks for listening, i hope everything works out for everybody in here, ps, i took some proteinpowder ,designed for bodybuilders i was aming on the aminos in it and i think it helped on my mood, or is it if you believ enough, i dont now,but it maked me feel better.
    Talk to you later bill in a few days


  273. Jason

    Thank you for your response. I haven’t been taking a specific dose uniformly during these two years. The doses differed from time to time. I started off 100 mg per day, but then gradually increased with time. However, I would say that generally, I was taking about 500 mg daily.

    Regarding the hairloss, hairloss does not run in my family and I have always had long, thick hair. Its ever since I started using that I started to experience excessive shedding. The same can be said about the impotence and lack of sexual drive. I’ve suffered from these symptoms even before the withdrawal period. This is why I’m under the impression that the symptoms are a direct result of the tramadol, and not something else. However, I still wanted to confirm this because as you’ve mentioned, there has been very little research about tramadol. In addition, even when I find information on tramadol it is usually confusing and contradictory. Different articles write different things. Some indicate that tramadol does not cause hairloss, while others say the exact opposite.

    On a more positive note, I must say that healthy nutrition and regular exercise are really helping me out during these difficult times. Ive been eating healthy meals and doing push-ups daily for about 15 minutes. Its amazing how just 15 minutes of exercise can you make feel so much better.


  274. Bill Post author

    Hi Jason,

    You are most welcome. I’m glad the article helped. You didn’t say how much Tramadol you were taking, but I expect that regardless of the amount, two years would be time to multiply the receptors and get a good addiction going. Sorry to take so long to answer, but I had oral surgery this AM and also needed to do a little research on your question.

    Tramadol is widely believed to be non- or only slightly addictive, but as you can attest, opinion and reality are often not the same thing. It stimulates the μ-opioid receptors and is also a serotonin (SRI) and norephenephrine reuptake inhibitor, which is to say that it is a moderately strong painkiller and has mild stimulating and anti-anxiety effects. It also makes you feel pretty good when you first use it.

    There isn’t a lot of information about PAWS from Tramadol, as it has been neglected in favor of the more potent opioids. Based on its action, however, I would guess the post-acute syndrome would include the usual opioid symptoms, among them nervousness, difficulty sleeping, depression, and anxiety. The anxiety and depression would likely be be exaggerated by the removal of the SRI and anti-anxiety characteristics of Tramadol. I don’t know that the impotence and lack of desire would necessarily be a direct result of the withdrawal, but it could easily be a symptom of depression.

    All-in-all, it sounds like your progress is in line with that, except for the hair-loss. It’s practically impossible to say what causes hair loss in a given individual, and I’ve found no definitive information that would indicate it should be expected with, or after use of, Tramadol. The material I’ve been able to dig up is mostly anecdotal and really tells us nothing, since a lot of people take Tramadol and a lot of people also lose hair. Causality is questionable at best. However, stress can certainly accelerate hair loss, and you’ve been under a lot of it. Whether or not it will cease is, frankly, anyone’s guess. If hair loss runs in your family, you may have to face its inevitability. All I can suggest is good nutrition and a healthy lifestyle including mild exercise and whatever fun you can manage.

    As to your progress, as is the case with PAWS in general I’m sure you can expect improvement with time. How long it might take depends too much on the individual and exact chemicals used to forecast accurately. I would expect relatively rapid improvement compared to the more powerful opioids, but frankly I’m guessing here. As I stated, there’s not much about Tramadol withdrawal in the literature, and there’s even less about its effect on PAWS, which is sorely neglected by the medical profession overall. Figure on the good periods getting longer, and the bad getting less severe. Nonetheless…

    Any time someone mentions depression it rings bells. If you find that you’re feeling more than just “blue,” have feelings of worthlessness, futility and/or suicidal ideation (not plans for suicide, but considering how you’d do it


    you did it), then get to a doctor and get on an antidepressant. If you do that, don’t go off the medication without a doctor’s care. Antidepressants will not trigger your addiction, but they are dangerous to quit suddenly because of an almost certain return of the depression that can be severe. That said, it’s unlikely that you would have to take them really long-term, and if you did it would certainly beat the alternative. Apart from that possibility, the exercise-nutrition-fun regime works wonders for depression too.

    And, of course, I recommend a support group. It helps to have friends who understand the problem from the same side as yourself. Pill Addicts Anonymous is a possibility, along with NA — among others. Google is your friend.

    Please stay in touch and let me know how things go. In addition to being interested in your progress, I’d like to know how the Tramadol thing works out. It’s sure to help someone else down the line.

    Keep on keepin’ on,



  275. Jason

    Hi Bill,

    First of all, I would like to thank you for posting this article. It has been really helpful and informative. I’ve been off tramadol now for 30 days after using for a period of 2 years. There are days where I feel absolutely fine and can function normally in my life, but other days where I feel extremely depressed and uninspired to do anything. So I just wanted to ask how long does PAWS usually last for Tramadol-addicts, and how severe is tramadol compared to other opiod drugs like heroin, codeine or vicodin. Also, during my withdrawal period, Ive been suffering from hairloss, impotence and lack of sexual desire. Is this normal? Are these symptoms related to PAWS? And are they permanent or can they eventually be reversed? These symptoms are making me feel really worried and distressed, so I would really appreciate your help and advice.


  276. Bill Post author

    Hi Lori,

    As regards your overall question, things will continue to get better. I have a suggestion below that may help.

    So many people have the idea that taking small amounts of opioids or “only what the doctor prescribed” affects the outcome. Unfortunately, addiction is addiction. Once the changes take place in the brain, it takes about the same length of time to repair them, regardless of how quickly or slowly they got there. Thirty milligrams of hydrocodone a day for four months is quite sufficient to produce an extended post-acute withdrawal. Unfortunately, most doctors know little about addiction or the addictive qualities of drugs. There are ways to manage chronic pain that don’t involve extended use of addictive drugs.

    That said, there is a time component. Most likely your symptoms won’t last as long as someone who was doing twice or three times as much, for much longer. Opioid PAWS can take up to two years. I doubt you’ll have to endure that.

    The nine-month mark is a critical time for addicts. No one is quite sure why, but the resurgence of PAWS at certain points has been noted since the beginnings of AA at least. It’s no accident that the coins and keytags are timed as they are. The rough spots seem to come at three-month intervals, although some folks skip them altogether.

    Don’t get carried away with the “doesn’t involve me taking any pills or medication” bit. That’s another idea that makes sense on the surface, but not when you think about it. If you used a bulldozer to wreck a house, you wouldn’t try to repair it with your bare hands. Just so, once we’ve wrecked our brains with drugs, we often need a bit of chemical assistance while cleaning up the mess. I suggest you speak to your physician about trying Neurontin (gabapentin). It is a relatively benign medication with anti-anxiety and anti-seizure qualities, and also acts as a mild antidepressant in many people. It will not trigger your addiction, and is not itself addictive. The side effects are generally tolerable. NOTE: As with all drugs that have anti-seizure qualities, gabapentin should not be discontinued without tapering under the guidance of a doctor. Don’t let the anti-seizure thing scare you. Xanax, Ativan and Valium (as well as alcohol) have the same effects, and they will trigger your addiction.

    I know things seem bleak at the moment, but they will get better. Have patience.

    And keep on keepin’ on!



  277. Lori

    Hello. I guess it’s better to just jump right in to it. I was taking vicodins 10mg 3 times a day for about 4-5 months. I slowly tapered off of them the last month. My last half a pill was December 31, 2011. I have been clean for almost a year now. Now to the questions. After about 6 months clean my PAWS symptoms went away and for about 3 months I had no PAWS at all. At the 9 month mark they came back. And ever since they have been off and on. Lasting about a week or two then stopping for a couple of weeks and then starting up again. Most of the time all i do is cry, but sometimes I have an anxiety attack. I’ll wake up with very painful anxiety. It feels almost like the first month of PAWS all over again. Is this normal? I was under the impression that because of the small amount I took per day and the short time that I took them for, my PAWS wouldn’t last long or be too severe. I never abused th pills. I only took them one pill every 5-6 hours like my doctor told me to. It wasn’t until after he took me off of them did I realize the extent of my addiction to them. I’ve been eating right and going to work and doing everything I can to cut out the stress in my life, which isn’t even that high and nothing I haven’t delt with before all of this. I’m trying so hard to stay on track. Because of this I have NO desire at all to do any pills ever again, but trying to hang in there and be strong is getting harder every day. What else can I do that doesn’t involve me taking any pills or medication. Is it normal to feel PAWS like this after almost a year. How much longer will I go through this? Please help.


  278. Bill Post author

    Hello again, Martin,

    While I applaud your resolve, let’s not mix science up with superstition. Not all pills are bad, and it’s dangerous to mess around with depression. If your depression gets worse, see a doc about some help. Don’t wait until it becomes severe, as it’s harder to deal with both personally and medically. The same goes for the anxiety.

    Let me know how things go, OK?



  279. Martin rasmussen

    Hi bill, thank you fot taking your time to help, however i wont have the pills near me ever again so i will stay on zero tramadol from now on, i have started to get better, i slept good this night and i went to work for 4hours i wasnt exactly happy but i was ok, now me and my wife are going for our daily walk, about 5 miles, it makes me sleep better i think. Once again than you
    Martin, denmark


  280. Bill Post author

    Hi Nas,

    Congratulations on deciding to turn your life around. There are very few problems in life that can’t be made worse by using drugs, and apparently you have realized that.

    Let me answer your last question first. You will almost certainly feel like your old self again. PAWS is rough, but millions of people (including yours truly) have made it through, and you can do it too. The big question is if you really want to feel exactly like your old self. Something caused you to turn to drugs to solve your problems, and you need to take a good look at that in order to keep it from happening again. I strongly recommend that you attend some support group meetings. If you will search for AA, NA in your area you will find meetings near you.

    Don’t get the idea that you can think your way out. Addiction occurs on the sub-cortical level, and is not amenable to logic. You need to come to terms with the things that are happening in your life and learn to handle the stress — because stress will always be with you in one way or another. It’s the human condition. Support groups will help. So will some individual therapy, if you can afford it. Make certain that you find a therapist who specializes in addiction — preferably one who is also a recovering addict.

    Your anxiety and depression can be treated with non-addictive drugs. Stay away from benzodiazepines — which includes most of the popular anti-anxiety drugs that doctors are prone to prescribe. They not only run the risk of triggering your addiction, they will certainly interfere with the reduction of your PAWS symptoms, and are themselves highly addictive. I can attest to that personally. Neurontin (gabapentin) is a good choice as a general anti-anxiety medication and mood elevator. As for the depression, you will have to try antidepressants until you find one that works. Keep in mind that most of them will not show results for several weeks. Don’t take them for a week and give up. It takes a while to re-balance your brain chemistry, especially when it has been scrambled by addiction.

    Antidepressants will not trigger your addiction, nor are they addictive themselves. HOWEVER

      , you must not cease taking them without a doctor’s supervision and instruction! There is a backlash effect from sudden cessation of antidepressants that can be extremely dangerous.

      You can expect PAWS to continue, with lessening symptoms, for up to two years. Most likely the major effects will subside well before that, but your brain must repair the alterations that took place when you became addicted, and that takes time.

      Follow the suggestions in the PAWS article, see a doctor about the gabapentin and an antidepressant, get to some meetings, and prepare for the rest of your life. You can do it.

      Keep on keepin’ on,



  281. Nas

    Hello Bill!

    First off I want to wholeheartedly thank you for this encouraging and elaborate work. Of everything I have read in regard to my situation, your piece has been the best info I have found.

    I don’t know why but I feel compelled to leave a, hopefully quick, comment. 24 years of age and 9 days clean. I partied normally the last few years never having an issue with anything. I have been self medicating with prescription pain killers for a year almost exactly. Everyday for the last 5-6 months of the year. It was a terrible and naive mistake as I did not know or respect the chemically changing properties of the substance. Regardless of will to wake up one day and say oh I’m over it, with no repercussions. Within the last 4 years my life took so many huge turns. My parents separating, facing a DUI with special circumstances, and as of late, having to leave a job I loved and dedicated to for 3 years, and finally being blessed to have a wonderful daughter this last year, when my use began. I never handled my stress well and was constantly so anxious through all these situations, possibly merited. I believe all these factors may have contributed to the appeal of the sedating feeling the medication offered. My physical symptoms have subsided and I definitely believe I am in the PAWS state you describe. I don’t have any desire to use again as I am a young and completely healthy guy, other than my situation. Just as well I can easily remember my life without them. However, I feel this PAWS is beating me. I know I’m only 9 days but feel I have come a great way already. I wake up extremely anxious and hopeless for no apparent reason which in turn causes my stomach to hurt and I feel like I’m constantly tense through my whole body all day fighting this second person in my head and winding up so exhausted in the evening that I could fall on my knees in defeat. All the while knowing I’m never going to put myself in this situation ever again. But still there’s this anxious, depressed feeling in my bones. It puts a frog in my throat. I’m amazed at what only a year of use has done to me.
    I just wish to ask, have I permanently ruined myself? Will I ever feel 100% again because I’m so ready to get back to work or will there always be a lingering anxious feeling in my soul? Is it a good idea to go see my doctor for possible medication for my underlying anxiety and depression which existed before the use? Will those medications help a possible chemical imbalance which might have made it harder for me to cope in stressful situations? I feel like my life is changing everyday in every possible way and it scares me. I apologize if I rambled or my thoughts are incoherent, I know this is a possible symptom. Also for so many questions at the end. Thank you for allowing me this space and for the help you’ve given.

    So much love and blessings to you!


  282. Bill Post author

    Dear Lauri,

    First, let me apologize for not getting back to you sooner. For some reason I stopped receiving notices of comments on this blog, and so I missed your note. I’ve corrected the problem (I think). Again, sorry.

    You are most likely suffering from depression, and an antidepressant could prove helpful for the next few months. PAWS from benzos in particular can last for quite a while, and depression is symptomatic for withdrawal from both them and opiates. Antidepressants will not trigger your addiction, and I suggest that you speak with a doctor who understands addiction and addicts. Possibly your treatment facility could refer you.

    ANY additional treatment will be helpful. Your friends are right, but AA alone may not give you all you need if you have a history of chronic relapse. Better a bit of overkill now than to end up having to go through the misery again.

    Please stay in touch, and

    Keep on keepin’ on!



  283. Bill Post author

    Hi Martin,

    No worries; your English is much better than my Danish.

    You are suffering from acute withdrawal, not PAWS. That comes later, and should not be as severe. It also gets better over time. You need a longer taper from the Dolol (tramadol). Go back to 150 and taper down 25 mg at a time for about three days at each reduction. That will give you a reasonably comfortable detox. If you can get medical support from a physician who understands addiction (which, clearly, does not include the doctor who kept you on tramadol for 8 years), such assistance would be helpful. There are medications that can help the anxiety and confusion, such as buspirone, gabapentin, seroquel and venlafaxine hydrochloride, among others.

    Unfortunately, after such a long period on the drug, your post-acute withdrawal is likely to be prolonged. Try to find a support group to help you recover. Rest assured, however, that PAWS will be nothing like you are presently experiencing.

    Good luck, and

    Keep on keepin’ on!



  284. Bill Post author

    Hi George,

    Wernicke-Korsakoff Syndrome, which includes Wernecke’s Encephalophy, is due to brain damage caused by a deficiency of thiamine (vitamin B1). According to the National Institutes of Health, the symptoms include
    Wernicke’s Encephalopathy: Confusion, loss of muscle coordination (ataxia), leg tremor, vision changes, abnormal eye movements (back and forth movements called nystagmus), double vision, and eyelid drooping.

    Symptoms of Korsakoff syndrome include inability to form new memories, loss of memory (can be severe), making up stories (confabulation), and seeing or hearing things that aren’t really there (hallucinations).

    Generally any similar symptoms in post-acute withdrawal are mild and transient, and subject to improvement. The damage from Werniecke’s is severe and usually permanent — at least in part.

    Congratulations on your 51 days, and don’t forget to vote!

    Keep on keepin’ on,


    Congrats on your


  285. Martin rasmussen

    Hibill, i has bin takng dolol for mayby 8 years at start about 150 mg and the last 2 year about 400-600 mg, last veek i went down to 150 mg and today i went to zero, i have defentley felt anciety confusion and lak of concentration, then i red about paws, and i got scared becouse of the long rehab, do you have any idea of wow long i can expect tobe in this horrible condition. I am sorry for my english, i am from denmark


  286. George

    Hi. 50th day sober and keeping on. thanks for your enlightenment. PAWS symptoms remarkably similar to Wernicke encephalopathy (wet brain)! is there any way to tell them apart?


  287. Lauri

    Hi Bill,
    I am 40 yrs old. I have been in and out out recovery for about 8 yrs. I started drinking when I was 13 and began using opiates at 23. At 32 I hit bottom with alcohol and began going to AA. My obsession with alcohol was lifted, but I have struggled with opiates and benzos ever since. I ended up in treatment on July 11 of this year. This was my first time in treatment. I detoxed off Suboxone and Xanax. I could only stay in treatment for 2 weeks because I have no insurance and I only had enough cash for 2 wks. Thankfully I am still sober today.
    I have a sponsor and a home group and a good support system. But I am struggling with having very low motivation and low energy. Somedays I think I’m depressed because I don’t want to get out of bed. When I was using I seemed to be able to get so much much more done in a day. I don’t want to use anymore. I just want to feel better. My friends who have been sober for multiple yrs say it will get better so I am trying to believe them. I am scared and I don’t want to go back to using.
    I never had any outpatient treatment only AA. I am wondering if I should seek some further treatment considering my past relapses on pills. I really want to stay sober but I am struggling so any advice you could give me would be greatly appreciated!
    Thank you so much for the great article. I have never heard of PAWS before. Your article was very informative.


  288. Bill Post author

    Hi Emily,

    Your addict’s symptoms could certainly be a part of early PAWS, however sweating doesn’t usually extend beyond the end of acute withdrawal, if at all. Neither do calls from dealers, texts and missing money. Perhaps you have heard of the duck theory of relapse: if it looks like a duck, walks like a duck, and talks like a duck, most likely it’s not a peacock. I’d have to say that it almost certainly applies in this case. All of the symptoms are there.

    The symptoms of recovery, on the other hand, include going to meetings, getting a sponsor, and working the steps…all those things that you are presumably doing in Al-anon. Words mean little. Action means everything.

    If you will go to sunrisedetox.com/blog and search for “codependency”, you will be taken to a series of articles I’ve written on helping addicts who are having problems getting clean. You may find them helpful in reinforcing some of the things you’ve been hearing at meetings.

    Keep on keepin’ on with your own recovery. Your loved one’s recovery is not your problem.



  289. Emily

    Thank you for this very helpful information. Do you know of any resources for family members to help us support loved ones through PAWS?

    I am in Al Anon but I am still looking for practical help for being patient and compassionate through PAWS. I am finding it especially difficult to be supportive when the PAWS symptoms are so similar to acute withdrawal (i.e. insomnia, back pain, sweating, stomach problems, lethargy).

    Sometimes I am suspicious that my loved one has been using (e.g. phone calls/texts from his dealer and cash missing) but he says he is not. I cannot know for sure whether he has used (oxycodone is his drug of choice) and regardless I am working on Letting Go and Letting God, regardless of whether his symptoms are from acute withdrawal or PAWS.

    But I could use some more help!


  290. Bill Post author

    Hi George,

    Alcoholic myopathy is far outside my area of expertise. If you truly believe that you’re experiencing it, you should consult a specialist. However, if you were extremely sedentary, as many of us were, you might think about a mild program of walking if you are able to do so. If you’re unable, again this is an excellent reason to see a specialist.

    I wish I could be of more help. However, I know far less about the subject than you would be able to find online. If you do seek more information there, I would stay at reputable sites like the Mayo Clinic and similar sources. They are far more likely to give you the straight poop than other sites, some of which have their own agendas.

    Good luck, hang in there, and keep on keepin’ on.



  291. George

    Thanks for your answer. tell us about alcoholic myopathy. am on my 40th day sober experiencing lower back, hip and rear muscle pains. these muscles seem to be wasting away. how long to recover, anything that can aid or speed up recovery? thanks again.


  292. Bill Post author

    Hi George,

    I wouldn’t expect any sugar to be a problem in reasonable quantities, taken with other food, unless one has been diagnosed insulin-resistant or diabetic. I’d avoid it on an empty stomach, unless I had a craving to drink or use other drugs. In that case, bringing up the blood sugar rapidly is a good idea, but we should eat soon afterward — within 30 minutes, if possible — to avoid the crash.

    I always recommend that recovering people get a glucose tolerance test or else an A1C (HbA1C) after they’ve been clean for a couple of months. Drugs can mask a lot of things. An A1C can be included in a routine blood test, and is a good indicator of potential problems.

    Thanks for your question. We don’t get many about blood sugar, and it’s an important issue in PAWS.

    Keep on keepin’ on,



  293. Bill Post author

    Hi Moe,

    First of all, let me congratulate you on your survival. It’s not unheard of for people to die when detoxing cold turkey from any of those drugs, and you managed to get away with it three times. Don’t push your luck again, though. You should never detox cold turkey from anything without the advice of a physician, which you obviously did not have.

    Your symptoms are consistent with acute withdrawal from benzodiazepines, and are likely to last for another couple of weeks. My suggestion would be to go back on the drug immediately, and then taper according to a physician’s advice. As for the Paxil, you weren’t on it long enough to experience any therapeutic effects, but it is quite possible that it was the cause of your urinary problems (which I’m assuming involved difficult urination, especially at night). That’s fairly typical.

    It sounds to me like you’re a person who assumes far more knowledge than he actually has. The “liver detox” is a case in point. It’s a quack concept that is promoted by health food distributors, and has no basis in medicine. You need to stop fooling around with your body. Taper off the meds, stop smoking, reduce or eliminate the caffeine, and let your body heal on its own. If anxiety or depression are factors, find a doctor who understands how to treat them, and follow his or her protocols. Messing around with these classes of drugs isn’t for beginners. You’re lucky you didn’t kill yourself.

    Good luck and best regards,



  294. Moe

    Hi bill

    I have been going through anxiety and its symptoms all year however this was brought on by using sports supplements. In may this year my gp had put me on oxezepam and I was on it for about 7 weeks and I began to become dependent on it. I quit cold turkey and experienced severe dizziness and loss of balance. This improved for 6 weeks and I soon began increasing my caffeine and nicotine usage and this brought back the anxiety symptoms such as light sensitivity and panic attacks. About a month ago my gp put me on paxil and I took Xanaz with this drug for a week and I experienced a whole lot off side effects!such as constant back pain and headaches that I initially had a few months ago. I quit the paxil cold turkey for a week now and my symptoms seem to have been intensified. I am currently trying to detox my liver as these medications has brought upon urinary problems as well

    Am I experiencing acute withdrawal again as I went back on benzos and an ssri? And does detoxing the liver cause more headaches?

    I will appreciate the feedback and keep up the great work

    Kind regards


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  296. Joy

    Bill: Dear Joy,

    Thanks so much for writing, and for your thoughtfulness in specifically making your letter available to others.

    Your letter is so long, and so chock-full of commentable (word?) material, that I’m departing from my usual format of simple Q&A and will address each paragraph or so as they come.

    Joy: Hi Bill,

    I’m a 38 year old female with a long history of being a drunk. I started drinking in college and it was often binge drinking. After college, I continued to drink, sometimes binging, but usually mostly on weekends. I was in a bad relationship for 2 years and drank more often than that. Then my relationship after that was better, but I still drank. This was still weekend binges and sometimes during the week as well. My next relationship was with a non drinker, so my drinking was cut way down, but that was only for a year. Then for the next 2 years (about age 26-28), I was more of the weekend binge drinker with sometimes some drinking during the week.

    Then from 28-38 (now), I’ve basically drank every night. My boyfriend of a decade is also a drinker. The first 5 years it was mostly beer (5-6 a night), with some hard liquor on the weekends. Some weekends I would drink more than 5-6 a night. Then I developed a wheat allergy (so bloated and horrible stomach and digestion problems, as well as infections), and switched to vodka about 5 years ago. I also have a history of bladder and yeast infections. I would have 6 or 7 shots a night, pretty much nightly (often mixed with club soda because it’s without calories). Sometimes I would take 1 or 2 days off and felt even worse, so started drinking again. I continued to have bad digestion and stomach problems, but not as bad and the bloating went away quite a bit. But I continued to have infections, and almost 4 years ago was sick with one for 2 months. They think it was my colon. No antibiotics worked and I got a yeast infection in my mouth. I should also mention I had infections even as a kid (ear and acne) and was frequently on antibiotics. So that history mixed with the booze equals disaster.

    Bill: Your progression down the road to alcoholism closely parallels my own, except that it took me about another five years to catch on to the fact that I had a problem. That’s not unusual, BTW. Alcohol damage progresses more rapidly in women, because you don’t produce as much of the enzyme that breaks down alcohol. Your BAC rises faster, and the drug stays in your system longer.

    Four things:

  297. Alcohol is alcohol. The body can’t tell the difference between beer, wine, spirits and pure ethyl alcohol (ETOH).
  298. One 12 oz. beer = 1 shot of 80-proof = 1 6-oz. glass of wine when it comes to alcohol content (we refer to each as one “unit” of ETOH).
  299. Five to six units of ETOH a night is about 5 times the recommended daily intake for females, and more than twice that recommended for males.
  300. Alcoholism compromises the immune system.  Your frequent infections could easily be connected.  The oral infection (Thrush) is a pretty sure sign of that.)
  301. Joy: After that infection almost 4 years ago, I mostly lost my sex drive. Then last October (2011), I detoxed after getting some questionable blood work back. My vitamin D was very low and my white and red blood cells were a bit low (not too crazy yet though), and there is booze in my bone marrow. MY GP WAS NOT CONCERNED. Really?! I think I am a bit anemic!

    Bill: Loss of sex drive isn’t unusual with advanced alcoholism, and the discomfort of the infection most likely didn’t encourage activity either. That will probably improve.

    I’m a bit concerned about your GP.  The bone marrow is connected to the circulatory system, and any time there is alcohol in our blood (within several hours of the last drink — longer, with heavy drinking), the blood marrow will test positive as well.  However, I’ve never heard of a blood test for that condition.  Your physician may have meant that the presence of alcohol in the marrow could have been the cause of the anemia, but more likely it’s your diet.  I hope she put you on Vitamin D supplements immediately, as low D can affect bone strength, especially in women, and is related to immune deficiency as well.  Oh, I see below that she did.  Did she tell you, also, to stop drinking or it wouldn’t help?

    Joy: All of this is reversible, right? So I detoxed and it was SO AWFUL. I was a complete mess for about 2 weeks and I thought I was going to die. My GP even sent me for tests because I had a bounding aortic pulse. That test turned out okay and they found no issues there. But when I withdraw, or even as a part of hangovers, I have some cardiovascular symptoms. My chest is tight and I can’t breathe really deeply. I feel anxious. I hope this is also reversible.

    Bill: Everyone has cardiovascular symptoms when they detox from alcohol.  That’s why we recommend that you never, EVER attempt it without close medical supervision.  Strokes and seizures are common, along with psychosis and hallucinations.  The rest of your symptoms are consistent, as well.  For more information on acute withdrawal, go here.  As to reversibility, that all depends on you.  First you must get and remain sober. 

    Joy: With my 2 month quitting of the booze last October-December 2011, my physical symptoms went away for the most part! My heart felt fine, I could breathe, and I was even able to lift groceries and walk without pain! I was feeling a bit manic without the booze though. I should mention I have a long history of what was called fibromyalgia, but I often wonder how much is the effects of alcoholism. I’ve been in full body pain for years, and weak and tired. I also have had tendonitis, plantar fasciitis, and stress fractures in my feet. And of course I am an emotional mess.

    Bill: All characteristic of early abstinence.  Regarding the body pain, weakness, musculo-skeletal and other problems: again nutrition may be the key.  All alcoholics suffer from malnutrition, because the presence of alcohol in the body inhibits the absorption of vitamins and minerals, and can even cause leaching of some.  Even supplements do not help, as they are not absorbed.  I suggest a complete nutritional workup after you have been abstinent for at least four months.  I’d consider consulting a specialist for that, if possible.  I’m a bit uncomfortable with your GP’s performance so far.

    If the pain continues after you are abstinent, Neurontin (gabapentin) may prove useful.  It will not trigger your addiction, and is especially effective against the kinds of pain your describe.  Its anti-seizure qualities can also be of help, but you must remember not to stop taking any seizure medication abruptly, for obvious reasons.  Do so only under a doctor’s supervision, and gradually.

    Joy: I started drinking again, and at first moderately (2-4 drinks once a week in general, sometimes more) from December-May. My parents visited in May and I fell off the wagon due to stress.  

    Bill: Stress is the principal cause of (and often excuse for) relapse.  However, if you were drinking at all prior to that, you were already off the wagon.  There’s no such thing as slightly sober for an alcoholic.

    Joy: I never worked my way up to daily drinking or keeping vodka in the house, but it got bad again. I lost 30 pounds in 3 months with the huge reduction in calories. I also wasn’t eating as much because my stomach didn’t feel irritated from drinking all the time. But in April 2012, I stopped getting my period! Could it be the shock of significant weight loss? I wasn’t overweight to begin with and am now 5’8″ and 130 pounds (I have since gained a few pounds back). I have a gyno appointment next week. Should I tell her of my drinking, or will she do the same tests to figure out what is causing the period loss whether or not she knows of my drinking history?

    Bill: If you don’t tell every physician in your life about your drinking — which is the biggest cause of avoidable health problems in this country after smoking — you needn’t even bother seeing them.  They can’t treat you effectively while you have alcohol in your system.  You can’t even be accurately diagnosed for some conditions until three or four abstinent months have passed, and many treatment protocols won’t work even with accurate diagnosis until you are alcohol free.  Your health has unquestionably been severely compromised, and there is no reason — so far — to ascribe it to anything but the booze.

    Joy: Also in October 2011, I did not have hepatitis and my liver function was okay (blood tests were done). I hope I am still hepatitis and liver issue free? The last time I drank was 8 days ago, and I had a mini-detox (nothing like October 2011). I’m actually still having one now, but it’s mostly cardiovascular (pounding heart and anxiety), See previous remarks about detox.  but it’s definitely improving. My whole abdomen felt like it was on fire, but that’s improving as well. I felt like my liver hurt, but everything else did as well, including a shooting colon pain that would get riled up with booze.

    So obviously I want to quit again, and this time longer than 2 months! Do you think I have any permanent damage? I’ve been walking and eating well and I have always taken a multi-vitamin. Also I have been supplementing with vitamin D since March. (See previous remarks about nutrition.) I’m worried I have a permanent heart issue, but when I didn’t drink for 2 months last year, all of the symptoms went away, so it might just be that I need to get over the PAWS, which I realize can last 1-2 years with the amount I drank for so long.

    Bill: I can’t say about the permanent damage.  I’m not your doctor — in fact, I’m not a doctor, period.  I can tell you that many chronic issues disappear when we stop drinking and using other drugs, but what might linger remains, at this point, a mystery to all.  You should be able to get more definitive answers at around six months sober.  I guarantee one thing, though:  a lot of the problems will be gone by then.

    Joy: I have a lot of the PAWS symptoms you describe and when I didn’t drink for 2 months last year, I was definitely more manic and felt bipolar at times, as my boyfriend has noticed as well. I have worked full time through all of this, and as an editor for more than half of it. My job requires a ton of very focused work and great attention to detail. It’s also very busy all the time and very stressful, which made me want to drink more.

    I definitely have problems concentrating, emotional overreaction, sleep disturbances, stress, problems making decisions, and rigid, repetitive thinking. I think some of this could describe me even in childhood, as well as low self-esteem. Being able to turn off my brain was a great draw to booze for me.

    Bill: Tell me about it!

    Joy: Thank you for reading this and your article about PAWS. I read everything, including all the comments and your comments. I’m planning on going to my first AA meeting on Saturday (a women’s group), and I hope to be able to meet someone in a similar situation for support. I probably also need referrals to sort out all my health concerns. My diet has actually been good through all my boozing, but I know the booze took away from what was actually absorbed by my body, so I don’t know how much I saved myself there. I used to do yoga, which I want to start again. I’ve also always been a writer and will continue my journaling.

    Thanks again!

    P.S. I am emailing you as well as posting this as a comment in case my situation may help someone else.

    Bill: It sounds like your heart is in the right place.  Here’s the key: we have to want to stay clean and sober more than we want anything else in our lives.  It is trite, but true, that we will eventually lose anything we put ahead of our sobriety.  Your drinking is already affecting your job and your health.  It probably hasn’t impacted your relationship so far, because your boyfriend is a drinker too.  (More will certainly be revealed about that!)  After a few days in treatment, I had to tell my wife of 9 years that I believed I would not be able to remain sober if she kept drinking and drugging, and that we would not be able to stay together.  Two weeks later, she came into treatment with me.  She is now clinical director of a detox center in Florida, and one of the best addiction therapists I know (and I know quite a few).

    The publishing industry is rife with drinkers, and anyone connected with administration has had ample exposure to the various alternatives.  I suggest that, in addition to your meetings, reading and journaling, you approach your EAP about possible treatment options.  You might be amazed at the possibilities that are open to you.  At a minimum, you should insure that you are under the care of a physician who is trained in the management of recovering addicts.

    It sounds as though you are getting serious about this.  Please stay in touch.  Pay attention to the suggestions in the article.  It’s the distilled wisdom of a lot of drunks and other experts.  (That was not an error in syntax; no one understands drunks like another drunk.)

    It’s one day at a time, Joy.  Anyone can stay sober for one more day.  Do it.

    And keep on keepin’ on!



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  304. Bill Post author

    Hi Peter,

    The good news is, it won’t take 40 years. The bad news — as you’ve already discovered — is that it doesn’t take 40 days and 40 nights, either.

    Just to reiterate a point for the benefit of others who might read this, whether or not you drank spirits is immaterial. Ethyl alcohol is the active agent in all alcoholic beverages, and it is the same chemical in all of them. The only difference among the various libations is the amount that we need to drink in order to get the effect we want. One beer, one glass of wine, and one ounce of 80 proof spirits are all roughly equal to one unit of alcohol.

    The adjustments that you are looking for are directly related to how long it takes the brain to recover from the changes that took place and caused the alcohol addiction. In most alcoholics, assuming that other drugs aren’t involved, there is gradual improvement that leads to relatively symptom-free conditions at about a year to 18 months. However, this is only an anecdotal measure. Some no doubt improve more rapidly, and some probably take longer. There is no fixed figure, because everyone’s brain chemistry is a bit different. With over 1,000 chemicals bathing the brain, it could hardly be otherwise. It is also true that, depending on the degree of damage to the brain and other systems, some folks never reach the point that they would have had they not used alcohol and/or other drugs at all.

    In my own case, I was able to function reasonably well after a year. In retrospect, I realize that I did not approach full capacity for about two years. The thing is, there is no way to rush the process. The changes in the brain take place as they will, absent complications like other drugs. Benzodiazepines (tranquilizer/anti-anxiety drugs) are especially to be avoided, as are all other mood-altering medications. I mention benzos specifically because many doctors, unaware of their similarity in action to alcohol, prescribe them to recovering addicts for various reasons.

    I would add that antidepressants do not fall into the dangerous category. If you experience signs of depression, which are common in PAWS, don’t hesitate to see your physician about some help.

    I realize this isn’t the definitive answer you would have liked. Unfortunately, there are no such answers. Expect gradual improvement is the best I can do. However, you CAN expect improvement. It does get better.

    It is also important that we deal with the effects of years of consumption on our spiritual, emotional and social lives. As always, I recommend AA for the best help with that. I honestly question whether it is possible to achieve the full benefits of sobriety without it or a similar program.

    Please stay in touch, and

    Keep on keepin’ on!



  305. Peter

    Hi Bill,

    I am 75 days sober and would like you to comment on how long you think PAWS, which is quite severe, might last. I am almost unable to do my job which requires mental acuity – thinking on your feet. I find that in recovery you can do something which is laid down and may require a certain amount of thought, but you can’t do things which require any real creativity. My head feels like a block of wood and i lack any energy.

    I started serious drinking around 19 and I’m 59 now, so 40 years of excess. I drank very heavily in my twenties, but after marriage at 32 my drinking was often excessive (say 15 – 18 units per day) but with gaps of several days of sobriety. Recently over the last two years I have reduced even more to drink maybe 10 units three times a week.

    When I finally gave up in July, I did not have acute withdrawal (as I had already tapered), but I sure as hell have Post Acute! The problem is therefore that I never drank bottles of spirits, but on and off I have drunk beer excessively for fourty years. As far as how long the PAWS will last, I suppose it is more about the duration of years of drinking rather than the intensity towards the end of my drinking career.

    What do you think? When do I get my brain Back? I am following you exercise, diet, meditation etc regime.


  306. Concerned

    Bill thank you so much for commenting back. I have done so much research on PAWS but didnt have anyone to talk with about it. You have answere all of my concerns. I will keep on keeping on…


  307. Bill Post author

    Hi Concerned,

    Your husband has some serious cojones if he got through methadone withdrawal cold turkey! Very, very few people manage that. He must really want to be clean. Congratulate him for me.

    He is most assuredly suffering from PAWS, and it is likely to continue for some time. All opioid drugs, and methadone especially, have a prolonged post-acute withdrawal syndrome that often lasts for a year or more.

    Addiction isn’t about drugs, per se. It’s about the changes that take place in the brain because of their presence. The drugs take the place of certain natural brain chemicals (neurotransmitters) that allow us to feel good and experience pleasure. Because they overload the system, the brain stops producing the natural drugs. In addition, it tries to correct the overload by making changes. In turn, these changes mean that it takes more of the drug(s) to get high. That’s called tolerance, and it is the first concrete sign of addiction. Eventually, the person needs the drug to even feel “normal,” and beyond that will likely reach a point where he never feels right, even with the drugs.

    When the drugs are out of the system, the addict gets hit with a triple whammy. First there is the acute detox, which I don’t need to describe to you. You’ve seen it firsthand. Second, the extra receptor sites that the brain built in order to adapt to the high levels of drugs need time to go dormant. Third, since the natural “feel good” chemicals won’t get the brain back to normal until their natural production has resumed, and there is a lot of depression, confusion and general inability to function well while the brain is returning to something like a normal state. This takes a lot of time.

    The good news is, the symptoms do gradually reduce in severity, and things gradually get better. The bad news is the “gradually” part. You can expect slow recovery…definite, as long as he stays clean, but slow. That isn’t his fault; it’s simply the way the human body works. In the meantime, he needs to follow the suggestions in the PAWS article, especially the parts about nutrition, exercise and connecting with a support group. I will tell you frankly that if he does not do those things, the likelihood of his relapsing approaches 100%. It is not his fault that he feels the way he does, but it is his responsibility to do what he can to change that.

    Keep in mind that he obviously wants to do the right thing or he wouldn’t have gone through the hell of detoxing cold turkey. He simply can’t handle life very well right now. Cut him a little slack, while letting him know that you expect him to do what he’s able to do for himself. He needs your support, but it’s not your job to prop him up. It’s his job, and the tools are available.

    I suggest NA or AA for him, and Nar-Anon or Alanon for you. See my series of articles here for more information on the need for both. You can google the names of the groups for information about locations, meetings, literature and so forth. If possible, he should also consult a physician who is completely familiar with treating addicts. A local treatment center should be able to hook you up with one.

    Hang in there. It’s rough being the loved one of an addict in early recovery — but not as rough as when he was using! Just don’t expect miracles — they happen, but they’re slow, and they only come if the people involved are willing to continue to work for them.

    Keep on keepin’ on!



  308. Bill Post author

    Hi Brit,

    So sorry to take so long to get to your question; it’s been a chaotic week here. All good, but totally chaotic. I simply missed the notice of your comment.

    Regarding your symptoms: at 20-1/2 months clean, you should just about be past any symptoms associated with PAWS. If I were you, I’d keep a log of my symptoms and discuss them with my physician. I’m not saying PAWS isn’t a factor, but rather that at this point I’d start looking for other answers if the symptoms continue.

    Yes, you definitely need to stay on the “sober route.” It is quite likely that any further experimentation with mood-altering drugs would cause more severe problems than those you have already. In fact, when you think about it, I’ll bet these don’t compare at all with those you had while drinking. I know mine didn’t.

    Let me know how things are going, and

    Keep on keepin’ on!



  309. Concerned

    My husband has been off of methadone, vicoden and cocaine for about 6 weeks now. He did it cold turkey. Know I believe he is suffering from PAWS. He cant consentrate on anything for very long, he over analyzes everything, he cant sit still, he doesnt sleep and he has severe mood swings. He forgets things and cant keep up with anything. He has no ambition and will not try to find a job, although I dont think he could mentally handle it yet. I have been with him for 15 years, and he has used on and off the whole time. Is it possible that this withdrawal called PAWS will never go away??? How long can this last….


  310. brit

    HI I’m going threw a year and 8 1/2 months clean. I can say that the major withdraws went away completely like the sickness the ever lasting migraines and the anxiety. but from time to time still have migraines not as bad at all as the first year but maybe once every 2 to 3 months. I still get a little sick, kinda like a mild flew symptoms, but just with my stomach, were some things make me nauseated and mild depression. I realized that i need to keep going on this sober route to continue to reap the the benefits. I drank and did a mixture of things like ecstacy, coke, but mostly alcohol for about 4 to 5 years. long enough to experience withdraws. I would like to know what to expect from here I know everyone is different? But does it get better to be honest and clear? thanks


  311. Cynthia

    Hi, well thank you for the vote of confidence. i needed it! my legs seem to be getting better…Slowly, but surely…Thank God cause between that, the fatigue, and night sweating I wasn’t sure I was going to make it. Today is three weeks and yesterday I actually noticed some pep in my step like I use to be before using…Congrats to you also!!! Question: How do you feel?? Are you over the moon at the fact that you no longer carry this monkey on your back? What about physically? I am not 100% yet, but I feel like I am improving which makes it a whole lot easier to continue…..Thanky you again for your support I needed it


  312. val

    Congrats Cynthia, I have been off oxy for 3 and a half months and let me tell you I know the pain you are feeling in your legs all too well. To be honest it took a good month or so for it to go away. Just take long baths with epsom salts, it seemed to get me through the worst of it. Keep at it though it will get better. All the best!


  313. Bill Post author

    Hi Cynthia,

    Congratulations! Welcome to the rest of your life. May it continue to improve. Hopefully the various symptoms will subside quickly.

    I’m sorry that you had to go through that experience. Apparently your physician failed to explain the issues involved. It is true that Suboxone is a nasty detox when done cold turkey, but it is not intended to be cut off suddenly. It is at its best when used to suppress acute withdrawal from other opioid drugs, then tapered off over a few days, rather than for prolonged maintenance. It is an extremely useful tool when administered properly by clinicians versed in its use, and the normal course of treatment is a couple of weeks, with most of that time used tapering off the Suboxone. The facilities with which I am affiliated have detoxed thousands of addicts successfully using that protocol, with entirely endurable levels of discomfort. No detox is easy, but used properly along with other medications, Suboxone can make it about as painless as it can be.

    I mention this, not to contradict your experience and reality, but rather to assure other addicts who may be considering detox that when used under skilled medical supervision it is an excellent choice.

    Keep on keepin’ on!



  314. Cynthia

    Hi, I find this article very helpful thank you…I was on Vic’s for 5 yrs. I then went on suboxone for a month and stopped. It is true this suboxone is much worse then drig I was taking and I believe should be outlawed. Anyway, I have 12 days today off of vicoden. My legs are aching like I can’t believe and I am fatiqued. Almost thought there was something else wrong with me , but it is the withdrawal..I am just learning about PAWS…I hope the leg thing will leave soon, but I do realize I walked into the forest for 5 yrs. and am not going to get out overnight…Thank you for all the knowledge and support….This stuff is nasty and I look forward to living a life free of vic’s as I feel like the devil himself has hold of me…God bless all of you keep fighting and beat this demon.


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  316. Bill Post author

    Hi Joe,

    Drugs and alcohol are metabolized by the liver, and “sweating it out” in the sauna does nothing more than make you dehydrated and add one more complication to withdrawal.

    As for IV Withdrawal (which I assume to be the same as the so-called 24-hour withdrawal), none of the addiction experts I know of recommend it. It involves general anesthesia, which is always problematic even when needed. Furthermore, it does nothing to equip the addict with tools or information that will be useful to him or her during PAWS, which can last for a year or more, and during which life can be pretty miserable if you don’t know how to take care of yourself. It’s really no more effective than shaking out and then hitting the streets, except that it isn’t as uncomfortable while you’re doing it. On the other hand, since general anesthesia always involves some risk (ask Michael Jackson’s doctor about that), it isn’t necessarily going to work out the way one would like.

    If that’s not what you mean, please explain and I’ll be glad to address it further.

    The most effective detox, recommended by all experts that I know of, is medically-monitored, inpatient treatment with buprenorphine and supporting medications if required, combined with some education and therapy during the process. Most folks who gain long-term sobriety have followed up with further treatment, also recommended.

    Keep on keepin’ on…



  317. So happy to be sober!

    Great article and a rare find even on the web!
    I’m almost 9 years with total sobriety after two decades of hard liquor nightly.
    A DUI set me on the clean path, thank God. Yes, the body and brain will heal. My liver was enlarged 33% and has returned to normal with natural, clean foods and much water. Exercise is imperative to relieve stress and promote healing. My Religion is very powerful, but it works, so don’t mess with it! My memory has returned, digestive system has healed (Bacardi 151 tears up the stomach and intestinal lining), and the incontinence due to enlarged prostate and bladder damage has subsided. I had to use Antabuse for a month to stop, but that’s no shame: whatever gets you through the DT’s is the key. I think the nervous system takes the longest to heal physically. Noticed a difference around the 5 year point. The psychological healing is being helped immensely by my Religion, so I can’t speak for those who are on their own, but emotions can be controlled and dangerous emotions like rage and anger can be eradicated at the source. Still need the lowest dose of Prozac and Clonazepam, but my M.D. and I are carefully working to reduce them even further.
    Around the 8 year point, I became overwhelmed with thankfulness about the sobriety and pure lifestyle. That thankfulness is growing exponentially and it displaces the negative emotions.
    The longer you are sober, the more you will enjoy it and the better you can cope with life’s inevitable problems. Except now you can really cope & solve with a clear mind and strong body.
    Best wishes to everyone on the journey!


  318. Bill Post author

    Hi TTB,

    I’m glad things are working out for you. Next time you see the doc, arrange for a fasting blood sugar test and “A1C”. With those swings, you need to rule out diabetic or pre-diabetic conditions. It sounds like you’re living a pretty healthy lifestyle (except for the donuts, which are loaded with cholesterol), so if you’re still having swings it needs looking at. Hopefully it’s nothing.

    Thanks for sharing your story and your strength and hope with us. Please stay in touch, and

    Keep on keepin’ on!


    Sent from my Nexus 1 by Asus


  319. ttb

    I’ve been wanting to leave this reply for quite some time. I’m just over 7 months sober (alcohol) after a good 10 year on/off heavy drinking spree. About 5 months ago (don’t remember exact day) I found this article. I was cranky, tired, desperate for information, and go figure, H.A.L.T. all the way. Anyway, I vividly remember how I read through most of the article, was incredibly hungry and annoyed (funny, I put off eating because I was compelled to read the article), got to the eating part of the article, broke down in tears for a brief moment, and immediately made myself a peanut butter and jelly sandwich. After I was done eating, I finished my hyper-focused reading.

    THANK YOU! I’ve been telling people for years, especially my husband, that my blood sugar never seems right and I was aware that I drank more when I was crashing from not eating or after a lot of physical activity (I’ve always been pretty active, including running 5k races). While going through early withdrawal this article was WHAT I NEEDED TO SEE. I think it’s what so many, if not all alcoholics need to see. It really helped me solidify what I had always suspected. It made me feel better about my bad and good choices.

    Since I read the article I do pay particular attention to my eating habits and my moods. I MAKE MYSELF stop and take time to sit down and eat. I try to keep snacks with me to prevent crashing and also to control the types of food I consume. I will go through a drive-thru, but only as a last resort. I figure a fast-food burger will do more good for me than crashing and wanting to pass out. Don’t get me wrong, I might eat fast-food 2 times a month (as long as that statement doesn’t include donuts..haha). Well, my metabolism, general eating, and physical activity level is probably much better than what’s considered average (I’m finally back in good shape and dropped many sizes), so I’m not worried about a few donuts and some cookies here and there. Not to mention they are a much better reward than the booze was!!!

    Besides the sugar crashes, the rest of the article is so true too. All of it. I’ve practiced yoga for several years and it has been especially helpful during the past several months. I do over-react emotionally speaking but I’m quicker at realizing I do it and also at preventing it (not to mention I’m bipolar).

    So, thank you again. I’m glad you, me, and others have found our path and stuck to it. We pull our strength and experiences and put up a hell of a fight. It’s the only way to do it.


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  323. Bill Post author

    Hi Steven,

    Congratulations on your approaching six months clean. It’s too bad that the physician who put you on Suboxone didn’t use it to detox you completely, rather than simply as a replacement drug. That’s its most effective use, although it obviously can be used for replacement as well.

    Although it’s certainly better to take maintenance doses of Suboxone than to use other meds, the big advantage is functionality, rather than recovery. It’s still an opioid drug, and the addiction is prolonged until all drugs are out of our systems. It, like Methadone, have a much more prolonged and usually unpleasant detox than the drugs they replace.

    Unfortunately, PAWS tends to be prolonged with both of them, as well. Your symptoms are typical. They will continue for some time, but should slowly moderate in intensity. Just believe that it will get better.

    I strongly urge you to get involved with some sort of support group. It’s much easier to go through PAWS with support from folks who have been there.

    Please stay in touch, and

    Keep on keepin’ on!



  324. St

    This PAWS thing is very interesting to me. I’m a prior user of pain medication for roughly 10 years. I wanted a change in my life so I sought out a doctor who put me on Suboxone. It was and is a miracle drug in some ways. I was taking 32 mg/s daily for 6 years, which is on the very high side. Coming off this drug is much worse and harder than the actual opiates I was taking. The end of January was my last time to take the Suboxone. I feel good some days and crappy the next. The sadness, depression and fatigue is my worst enemy. I have also gained almost 30 pounds, which is just mind boggling.

    Thanks for giving us a place to feel comfortable with.


  325. Bill Post author

    Hi Cathy,

    Ye make me old heart glad! Good to hear that it’s working so well for you. As far as “I still go to AA” is concerned, I still go, too. It’s a good place to meet good people, help others, and make friends. What’s not to like?

    “And I was addicted, I can see that now” may be the most valuable thought you’ve had in the past 10 weeks. Acceptance really is what makes the rest of the changes possible. It’s not just another word in a phrase bandied about by big book parrots. (Ever see one of those big yellow and blue macaws? That’s what they look like.) ;) My motto: if you can’t think of something original to say, don’t share. But I digress…

    Don’t forget the moderate exercise, too. It’s so easy to make excuses. We’re finding out more and more every day about how valuable even being non-sedentary is to health. They’ve recently discovered that ANY amount of exercise has measurable benefits. Half an hour of walking 4 times a week, says Dr. Bill.

    Thanks for the comment, stay in touch, and

    Keep on keepin’ on,



  326. Bill Post author

    I answered Andrew in an email, and I’m not going to reproduce it here. If you’ve read much in these comments, you’ve seen it all before.


  327. Cathy

    Bill, I wanted to say a big thanks to you. I posted back on 2 April asking for advice as was feeling tired and not functioning that well on a cognitive level. You gave me good advice about eating properly etc to get through PAWs. I took your advice (as well as your advice on staying sober). I’m still tired and up and down but I feel so much better (and I’m over 10 week’s sober). I make sure that I keep my blood sugar levels steady and it really helps me.

    I still go to AA, and I’m making sure I look after myself and follow your advice in the article. I’ve taken up mindfulness and considering doing a meditation retreat later in the year. I have some way to go, but at least I am now getting there. I’m no longer as depressed as I was which, for me, is fantastic.

    And I was addicted, I can see that now.

    Thanks again.


  328. andrew

    Went through a life changing experience 7 months ago and 6 months ago I quit sleeping pills and alcohol cold turkey. I was never a big drinker (2-3 beers a night or a glass of wine) and used perscription sleeping meds for the past 2 years on and off but mostly on. Began mixing the pills with my drinks and near the end would have a glass of wine or 2 with hycodan.I used several types of sleeping pills over the years including tylenol 3, temazepam and a few others I can’t remember. I never mixed pills but did use alcohol near the end to wash them down. 6 months ago I quit everything cold turkey and have not looked back, been clean the whole time. Went through crazy withdrawals the first month or 2 and then it tapered off. have had some pain in my head during the whole 6 months but did get a ct scan that came out clean. I did lose my job around the same time as I detoxed and am still searching for a new one. In the last week I have been extremly low and depressed and feelings of guilt and hoplessness are present and my head is dark. It almost seems I have regressed back to the days of initial withdrawal. I have cleaned up my life in all areas and am seeking couselling which is helpful but the pain continues. I am seeing a naturopath which has also helped. She first checked for adrenial fatigue which worked well and was able to raise my cortisol levels but still feeling down, now she wants to try Nevaton to help with the anxiety and depression. I don’t want to go back on any meds if possible and am fighting through the pain but not sure it will ever clear up. Is this a normal reaction and is there a chance for a full recovery. Never thought I would have gotten here but here I am.


  329. Wesley

    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?


  330. Wesley

    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


  331. Bill Post author

    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.



  332. Radha

    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.


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  334. Bill Post author

    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!



  335. Radha

    I have had a laparoscopic surgery to have my kidney stone removed last year (PCNL). I forgot to add that. Sorry.



  336. Radha

    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.



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  338. Bill Post author

    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.



  339. Eve

    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.


  340. Bill Post author

    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!



  341. Bill Post author

    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.



  342. Bill Post author

    Hi Sunrise,

    Good to hear from you. I know you’re not going to like hearing this, but you’re pretty-much on schedule for someone who drank as much as you. Not only was your consumption pretty high, but women don’t produce as much alcohol dehydrogenase, the liver enzyme that effects the metabolism of alcohol and helps clear it from the body. That means that, pound for pound, women get intoxicated faster, get more intoxicated, and stay that way longer than a man who drinks the same amounts. Thus, the brain is exposed to higher levels for longer times and makes corresponding changes in order to attempt to function normally. When the alcohol goes away, the brain cells that have been adapted to the large amounts of alcohol start screaming for their fix. This continues at slowly decreasing levels until the brain is as close to normal as it’s going to get. (Some authorities believe it never gets back to its natural state, and that this is what makes alcoholism progress so rapidly when we drink again.)

    So, having encouraged the changes in your brain for a number of years, is it especially surprising that it might take a year or so for things to settle down? Of course, all us addicts think in the short term: the next pill, the next drink, the next fix. We get out of the habit of accepting that sometimes we don’t feel OK, and that it’s not going to go away in a matter of minutes — or days, weeks, etc. — and that it’s OK not to feel OK.

    I understand that it seems like the crazies are lasting forever. Been there. Done that. Got the ragged, dirty t-shirt. The fact is that things will get better slowly, but they will continue to get better, just as they have been. In the meantime you might try some St. John’s Wort extract from the health food store. Take it as directed, and it may help stabilize your moods some. Valerian might help as well. HOWEVER, if you’re going to take them, do so at the same time every day, and don’t pop one during the day if your’re feeling out of sorts. You want to treat them as medicine instead of chasing the feeling. That’s addict behavior.

    Hang in there. It’s been getting better, and will continue to do so. In the meantime, let your family read this. It may help them to understand what’s happening with you. Fact is, you have a disease and it’s in remission, but you’re not back to your full health yet. It’s that simple.

    Stay in touch, and

    Keep on keepin’ on!



  343. sunrise

    Hi Bill,
    This is Sunrise, now nearly nine months sober!
    Have been doing well, taking care of myself and my recovery. I go to a counselor and have a strong support group around me. But I am still dealing with roller coaster emotions and snappiness. I happen to be “surfing” the web and found my old comment to you and I just happened to have a pretty hard night with my mood swings. Again, I was feeling so crappy about myself for not being able to control my moods around my family. I sense a weariness in them with me, and I feel I am pushing them away.

    I know it must be hard for them to live with someone in recovery, who is depressed sometimes , fine sometimes , and then over reacts sometimes. I am doing the best I can, I was just hoping to be “normal ” by now.

    I could really use some encouragement am feeling down in the dumps. I did go my doctor because I was feeling down after the holidays with no energy and mood swings and he diagnosed me as bi polar and prescribed medication which I politely refused knowing I was not bi polar.

    Does the amount and length of drinking affect the length of PAWS? I drank every night ( except during pregnancies and nursing), for 15 years , wine starting with 2-3 glasses a night for years and then in the last several years I was up to 4 – 5 glasses of wine a night.


  344. Eve

    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?


  345. Ted

    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.


  346. Bill Post author

    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!



  347. Eve Shaffer

    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.


  348. Bill Post author

    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!


  349. xa

    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.


  350. Bill Post author

    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!



  351. Cathy

    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.


  352. whatmesober

    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!



  353. maritzza

    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.


  354. Bill Post author

    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!


    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.


  355. sam

    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.


  356. Lynn

    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


  357. Bill Post author

    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,



  358. Opiatekicker

    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.


  359. Bill Post author

    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,



  360. Ivy

    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!


  361. Pingback: I was spiritual when I was drinking and drugging, why not now?

  362. Bill Post author

    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!



  363. Justin

    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


  364. Bill Post author

    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!



  365. Bill Post author

    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!



  366. adammcdonald98Adam

    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!


  367. Pingback: PAWS and the waiting game - Methadone Treatment Clinics

  368. Sebastian

    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.


  369. bobbi

    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)


  370. Lynn

    Thank you for sharing the reality of this disease Angela. I too spent time in Guelph this past summer! I cried going in because of fear of the unknown, and cried leaving for the same reasons… I’m doing good so far. Really good! I must always remember to be good to myself…

    That damn vino was my poison of choice as well.


  371. Bill Post author

    Hi Judy,

    Oxys are rough in the post acute phase for the first few months. You will experience lengthening periods of feeling better, interspersed with periods of feeling pretty ratty. We took years (two, in your case) to allow our bodies and brains to become used to drugs, and now our bodies are going to take a while to get “unused” to them.

    If you’ll follow the suggestions in the article regarding rest, exercise, nutrition and especially blood sugar, you’ll find that things improve much more rapidly. It’s also easier if you have support. Hit some Pill Addicts Anonymous meetings, or NA. At this point there’s probably even an Oxy-Anon fellowship. There’s a world of support out there, from people who have been where you’ve been, and who have felt (or are feeling) what you’re feeling. You don’t have to do it alone, and doing so is a guarantee of more discomfort than necessary.

    Please stay in touch, and

    Keep on keepin’ on!



  372. Judy

    I am at 79 days off of a 2 year Oxycontin addiction. I basically at the 3 month mark. I feel that PAWS is going to be the death of me as I refuse to ever use again. I know that it peaks from 3-6 months and could last for up to 2 years. One thing I haven’t been able to understand is will it always be this bad? Or can I look forward to feeling much better over the next 3 months? I seriously would rather die than ever use again. Looking for more info on this, thanks!


  373. Al K Hall

    Thanks so much for the advice about eating! i’ve been enjoying recovery in AA, just hit 9 months yesterday, but found myself feeling “woozy” after work but before a meeting and dinner. Your tips will really come in handy.


  374. whatmesober

    That’ll do it. Most doctors don’t know their knee from their elbow when it comes to drugs, especially addictive drugs. I once had a doc tell me, “You drink too much, take these instead,” and gave me Rx’s for Valium for the next three years. (Of course I didn’t stop drinking ,either.)


  375. whatmesober

    Good evening, Sunrise (how’s that for confusing?),

    Sunrise is a good omen; it’s the name of the company I write for on my “real job.” Lots of folks first get sober there.

    Let me point out a couple of things that you may not have thought of about early sobriety. What is alcohol? A depressant drug. What happens when we drink alcohol? It deadens the response of the central nervous system (CNS) in several different ways. Over time our brains adapt physically to the CNS depression and attempt to compensate for it. That causes us to need more alcohol, and so on and so forth.

    The key words are depression and physical adaptation. The presence of alcohol in our body produces actual structural changes in our brain cells that make it possible for them cope more easily with the presence of ever-greater amounts of alcohol. (I’m not saying they cope well, just more easily than they would without the changes.) Other changes occur throughout our bodies. Alcohol affects every cell in the body in one way or another (it’s the only drug that does).

    So, suddenly we stop drinking. Our bodies begin to react to the lack of alcohol. Over the first few days we react more or less violently to having it removed. However, after detox, the changes in our brains and bodies remain. It takes months for them to return to something like normal, and complete recovery — if it is possible, depending on the amount of damage — can take a couple of years.

    When we stop taking depressant drugs, the symptoms of withdrawal are the exact opposite: stimulation. Our brains and bodies rebound in a big way. We have the shakes, periods when we over-react to stimuli (including other people) and our feelings are all over the place. It’s no fun, but it’s perfectly normal. It’s just our body trying to adjust, with emotions and feelings and thoughts and physical activity and mental depression and manic phases sloshing around like water in a bucket. It takes quite a while for things to balance out and the water in the bucket to calm down. That’s where you are right now, and the hormonal changes of menopause are complicating the already complex readjustments.

    The good news: it always gets better if we don’t drink. It doesn’t necessarily get perfect. Sometimes we have to address physical and mental issues that were masked by the drug. Sometimes we need a bit of help in areas other than simply not drinking. But things always do get better if we stay dry and find caring people to help us with the issues that arise. That can be a doctor who is familiar with addiction and recovery, a therapist, or other specialists — but the most important thing that we can do for ourselves is attend AA meetings. There we will find people who have been there and done that. We’ll get a sponsor who will get to know us and guide us in our recovery. Those folks will help us weather the storm, and when the bucket calms down they will help us in repairing the relationships and other areas that were harmed by our drinking.

    I truly believe that it is nearly impossible for people to recover — really recover, in the sense of again becoming contributing members of society — without the support of a recovery program. The company that employs me deals mainly with the first month or so of clean time. I don’t work for AA. But I’ll tell you what: two weeks ago Wednesday I celebrated 22 years clean and sober.

    AA worked for me.

    Keep on keepin’ on,



  376. sunrise

    I am 2 1/2 months sober from alcohol. I found this article after sitting here at the computer, feeling horrible for my over reactions . I was sitting down crying feeling like a drink and scared I was actually going to go and get some wine. I was so shocked at my over reaction towards my husband being late taking my daughter to soccer practice , that I stood in stunned silence when they left the house. I prayed, and started to search the web and found this article about PAWS. I am a 44 year old women who is also dealing with early menopause, so I am not sure what is happening to me. my brain seams to be all jumbled and I cannot remember things. I get stressed over really anything extra in my life. So thank you for this article….I will continue to reread it and most importantly reach out to people and not isolate myself. I do not want to drink!
    I guess this must be my “peak” time between the 3-6 month period?
    thanks again


  377. Bill Post author

    Wow, Angela! I can hardly think of anything to write (practically unheard of for me).

    Wait! Yes I can! Why not give it another try? You know it worked the last time, and you know what mistakes you made. Sounds to me like you have a pretty good shot at it this time around. Remember that addiction is a disease of relapse. Far more of us have to make multiple efforts than manage to get it on the first go ’round.

    Thanks so much for your heartfelt story. You may have saved someone else from going through the same experience. I need to write something about changing old habits, even if they seem harmless. Thanks for that, too.

    Won’t you please try again?



  378. Angela

    A P.S.
    I didn’t want to make anyone think that they will fail. I wanted people to understand it is there for life and don’t be so confident as I was. It hides, but doesn’t go away. Just be careful. Remember me…I am a great example of someone who forgot they were an addict.


  379. Angela

    Hi. I went to a most wonderful rehabilitation in Guelph ,ON. Hospital setting in sense that real nurses, doctors, psychiatrist and wonderful therapist. But your accommodations mimiced a lovely hotel (well not quite)
    As I prepared to leave (8 years ago) the therapists and pyschiatrists repeatedly told me…you are too confident, you have to watch that confidence….it leaves you unprotected.
    Whatever I thought. I know I’m never going to drink again so if that’s too confident so be it.
    Bam PAWS. Add in I am a most sincere isolationist, and bi-polar things fell apart pretty quickly…a routine? I live alone…routine? Whatever.
    Whatever indeed. 3 years later I walked by the same LCBO I had walked by every day for 3 years and 50 paces on, I turned around and went to buy a bottle of wine. Out of nowhere. I maturely drank 1 glass that evening and no more for a week. Then I finished the bottle at lunch one day.
    It kills you. It really does. You know that beautiful life you had reclaimed has just ended. How much can someone hate themselves, be disgusted with themselves.
    5 years later….I am still drinking, fairly heavily. No, heavily.
    Be careful, be careful, be careful becareful.


  380. Bill Post author

    Good on yer. Keep up the good work. If you’ve made it three weeks, the worst has passed, but you can still expect some rough spots. As George Carlin said, “Just because the monkey’s off your back, it doesn’t mean the circus has left town.” (I love that quote!) Pay close attention to the article. There’s way too much information there to get in just one reading. Take some notes. This is life and death.

    Just as importantly, if you’re not hitting meetings, DO IT. Very few people manage to stay clean without the support of other addicts. It’s possible, but so is dying. Speaking of that, the tolerance to opiates drops rapidly. There are many ODs by people who have been clean for a few days or weeks, and then go back to using, thinking they can use the same amounts as before they stopped. Ain’t true. If you’re going to relapse, play it safe. I’m not trying to tell you to relapse, but those folks who do have a much better chance of making it back into recovery if they remember that little tidbit.

    Stay in touch, and keep on keepin’ on,



  381. TheTeller

    I really appreciate this article. I’ve been struggling with opiates since I was 15 years old. I am 19 now, and sometime in between that period of time I was sober for more than 8 months. It was great, then I hit my senior year of high school, and the partying began more than ever before. I was soon back on pain pills, but 5 times worse than ever before. Now I’m sometime in my 3rd week sober. It’s been such a long struggle, I’ve lost everything that meant something to me. Now I’m determined to get it back, and this article definitely helps me understand what I am up against. Thank you.


  382. Bill Post author

    Thanks for your note Aileen, and congratulations on the longest 32 days of your life. It will get better, but it may take a while for all the symptoms to go away. Considering your age, it is likely that there was some interference with the development of connections in your brain. You may have to concentrate on improving some areas later, but for now, be thankful that you’re clean and sober.

    Please stay in touch, and

    Keep on keepin’ on!



  383. Aileen

    Hi, Thank you so much for this. I am currently enrolled in an intesive outpatient program for alcohol dependency. I am 32 days sober today. PAWS is something I didn’t really have any understanding of. I thought after detoxing there wouldn’t be any other symtoms. Recently, my short term memory has been HORRIBLE. I will literally think of something important that I need to do, and then 2 minutes later I cannot for the life of me remember it. It’s rather un-nerving. (I’m only 22 years old, so memory loss is something I thought I wouldn’t be dealing with for a long time!!) I felt like I was going crazy!!

    This article is so informative and really sums it all up. You covered all the bases, and it makes me feel so better. I am going to recommend this to my councilors and maybe have them give it to other patients in my program. Thanks again!!!



  384. Bill Post author

    Hi Jim,

    Thanks for the kind words. Knowing I’ve helped someone the way folks helped me gives me a Iot of satisfaction.

    You didn’t say if you’re still fighting The Creature, or if you have finally managed to put the cork in the bottle. In either case, please stay in touch. Your comments, questions, experience, strength and hope are always welcome here.

    Keep on keepin’ on!


    Sent from my HTC Thunderbolt


  385. Anonymous

    I am a 50 year old who has struggled with alcoholism for 30 years. I dont think I have ever read anything so compelling, down to earth, common sensed, invigorating, spoken from a Heart. I can go on and on but Thank-You for such inspiration in words that have obviously touched some of the people who have read this. I am going to book mark this page to help me with my recovery.



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