Post Acute Withdrawal Syndrome (PAWS)

Hi Guys and welcome once again to my blog about opiate addition. The topic I would like to talk about today is an aspect of addiction that usually follows the period of physical withdrawals once we stop taking opiates. What I am referring to is Post Acute Withdrawal Syndrome, commonly referred to as PAWS. Making the decision to get off opiates can often be a pretty difficult step to take, not to mention dealing with the nearly inevitable physical withdrawals that follow. When trying to quit their first time (myself included), most addicts say to themselves "ok, so I basically got to put up with a week or two of feeling like crap than voila, after that its all about keeping cravings at bay and learning to live sober." Unfortunately, it is rarely that easy.

The physical withdrawals are without a doubt one of the most challenging and painstakingly parts of overcoming addiction. However, the period that follows the initial physical withdrawals is far too often overlooked or underestimated. Remember that saying "Getting clean is easy, staying clean is the hard part?" Well, there's a reason that saying is so popular and commonly used within the addiction community. The reason being of course; PAWS.

What Exactly Is PAWS & What Causes It?

Post Acute Withdrawal Syndrome, or PAWS, is defined as a "set of traits and impairments that occur following cessation of some drug or medication". PAWS, for the most part, deal with the emotional and psychological feelings one experiences after they stop taking or abusing opiates. Some common elements of PAWS are depression, boredom, anxiety, mood swings, panic attacks, insomnia, intense cravings/urges to use again, suicidal thoughts/feelings, increased stress, tiredness, inability to concentrate, and lack motivation to get out and do things.

Just like the physical withdrawals, PAWS do eventually get better and go away but are often harder to understand and cope with than traditional physical withdrawals. It is important to note that it is important to monitor PAWS and to seek help/advice from your doctor(s), counselor(s), and members of your support network as PAWS can be just as or even more dangerous than the physical withdrawals one experiences while detoxing off opiates. Just like how the cold sweats, restless legs, or stomach cramps are very real when experiencing opiate withdrawal, so are the feelings of depression, stress, and anxiety as well.

The cause of PAWs can be best described in the passage below in the blue font (courtesy of Wikipedia):

"The syndrome may be in part due to persisting physiological adaptions in the central nervous system manifested in the form of continuing but slowly reversible tolerance, disturbances in neurotransmitters and resultant hyper-excitability of neuronal pathways. Stressful situations arise in early recovery, and the symptoms of post acute withdrawal syndrome produce further distress. It is important to avoid or to deal with the triggers that make post acute withdrawal syndrome worse. The types of symptomology and impairments in severity, frequency, and duration associated with the condition vary depending on the drug of use."

In other words, PAWS mainly occur as a result of our minds and bodies learning how to live and cope without our drug of choice. As I have covered before (click HERE), the reward system in our brains is greatly altered and affected during the time we abuse opiates. Opiates have such a powerful impact on the way our brains and bodies function, that over time it begins to rely on these opiates to produce endorphins, which are the neurotransmitters in our brains that provide us with the opportunity to experience pleasure, happiness, enjoyment, and feelings of being content. Opiates provide the brain with the ability to produce a vast arrange of strong endorphins, providing us with these feelings as a direct result of getting high. Continued use of opiates results in the mind relying on opiates to produce endorphins, eventually resulting in the brain having difficulty in creating its own naturally.

A lot of addicts state how they feel a sense of emptiness after they stop using opiates. Some express how they feel like their minds will never be satisfied or content while they are sober, which can be quite heartbreaking to hear. However, over time, it will and does get better. Unfortunately it can take several months or even years for one to feel totally normal. Recovering from months or years of opiate abuse takes much time and effort so it is important to remain positive and patient through thick and thin. Now, I'm not saying you will be hurting and depressed for months and months, but rather that one should expect that the road to once again living a life without having the thought of opiates present in the back of the one's mind will have its bumps and take time to travel. Remember, you didn't become an addict overnight so don't expect an addiction to go away overnight.

 

Some Good Information About PAWS

Here are some links to a few websites that I found particularly helpful in regards to PAWS:

http://www.addictionsandrecovery.org/post-acute-withdrawal.htm

http://whatmesober.com/personal-writing-about-addiction-and-recovery/early-recovery/paws/

http://www.arctreatment.com/post-acute-withdrawal-symptoms/

http://www.michaelshouse.com/opiate-rehab/why-are-opiates-so-addictive/

Dealing With PAWS

 

While PAWS can most defiantly be an obstacle in one's road to recovery, it is certainly an obstacle that one can overcome and learn to deal with. The most important step to take when dealing with PAWS is to identify what kind of symptom's of PAWS you are experiencing and to ask yourself why you are experiencing these symptoms. Besides the obvious answer of "I'm feeling like this because I love opiates so much and am now withdrawing", an addict must learn what led them to become an addict in the first place. 

 

Every addict has their own background, set of experiences, and reasons that can explain what lead one to use drugs in the first place and to eventually become to addicted to them. As I always say, everyone is different so don't expect your reasons to be the same as someone else's reasons. Some common reasons behind one's decision to try using a drug and to eventually become addicted to it are as follows:

 

• Stress
• Peer Pressure
• Disease or Health-Related Issues
• Mental Illness
• Pain
• Death of Loved One
• Difficult Childhood/Upbringing
• Loneliness

 

Were you using your drug of choice(s) because of stress from work, school, or simply life in general was beginning to be just too much to deal with? Or do you have a chronic disease that is sometimes painful or difficult to live with? Do you ever feel a sense of loneliness or helplessness? These are all questions an addict must address when coming to terms with their addiction and are ones that are often quite challenging to consider and answer honestly. More often than not, there is an underlying reason or root cause for why we got addicted to opiates in the first place.

 

 

The reasoning behind why it is so important to address and answer these questions is because (1) they most likely influenced one's decision to use drugs to some extent and (2) they are things that will most not likely not just disappear when one gets sober and can be difficult to handle without having drugs to ease or dull the pains of the stress and nuisances of life. If you give this an honest approach, you'll most likely find that there isn't just one, but rather a few, factors that lead to one getting involved in opiates. For example, I have to come to terms with my addiction and believe that the root cause of my addiction was a variety of factors such as:

 

1. Living with a chronic disease that can sometimes be painful and difficult to manage/live with
2. Being someone who is somewhat of a loner that enjoys being one's own company 
3. Stress from school, work, and relationships
4. Trouble sleeping
5. Difficulty of talking to others about my feelings or problems and instead just bottling them up

 

The good news is that you don't have to ask and answer these questions by yourself or all at once suddenly. Rather, try to talking about your addiction with your spouse, family members, or close friends. If you are fortunate enough to afford it, try speaking with a counselor, therapist, or psychologist. You'll be surprised just how helpful and beneficial it can be expressing yourselves and your problems with someone willing to listen rather than just keeping them inside you and trying to deal with them alone. It took me awhile to realize this myself as I was somewhat of a skeptic when it came to counseling and therapy. I always figured I became addicted to opiates because I simply loved to get high and it was an something to do with my friends (it's sad that I saw getting high as a form of entertainment and fun). Well, I wasn't looking deep and hard enough at my situation and what brought me to it until I made the decision to get sober and off opiates once and for all.

 

As most of you may already know, I decided to do something about my addiction to Oxycodone and got on Suboxone, which requires me to meet with a counselor at least twice a month for an hour each visit. I'm not going to lie, it took awhile for me to feel comfortable enough to express myself and talk about my struggle with my Oxycodone addiction to total stranger but it definitely got better and easier over time. I learned that I struggled to deal with my chronic illness, sleeping difficulties, and stress management. With therapy, I learned to better manage my time to help minimize stress and to not stress about things that are out of my hands. Rather than just complain and moan about my sleeping habits, I spoke to my doctor about my sleep difficulties and obtained a prescription to something that helps tremendously with achieving sleep. Learning to cope with my chronic disease hasn't been easy but I do feel a sense of relief being able to talk about it with someone. Flash forward to today and it has now been close to year of being on Suboxone and meeting regularly with my counselor and I feel that I have made much progress in my attempt to get and remain sober from opiates.

 

Many addicts probably cringe at the thought of speaking with someone about their addiction. I know I certainly did. However, it really is one of the most important aspects of recovery. After all, who are you going to go to or talk to if you feel overwhelmed or like using during your recovery when you are the only person who knows of your addiction. Believe it or not, speaking with someone about your struggles isn't as hard as it may initially seem and this is coming from someone who is quite shy and who preferred to keep their addiction in the closet next to a few other skeletons. A therapist or counselor won't force you to say anything, allowing you to say as little or as much as you would like. It is not uncommon for most patients to not begin talking about their addiction or causes of it until several meetings later. Everything that goes on in the room between you and the therapist/counselor stays in the room between the two of you. Most people who are in this kind of profession provide patients with a laid back, quiet, and easygoing atmosphere. These people can really help so please don't be afraid to use them when possible.

 

 

Another therapeutic-like session can be found at AA and NA meetings. These meetings are filled with addicts, some just a few days clean and others with decades of sobriety under their belts. AA and NA programs allow addicts to hear the stories, emotions, and experiences of other addicts that many can often relate to in one way or another. These meetings are also a great place to learn tips and coping mechanisms from other addicts who are fighting the same war as you; addiction. One can meet and befriend various people at these establishments which can aid in building one's sober support network. For more information on AA/NA meetings, check out my post about the topic by clicking HERE.

 

It is also important to discuss how you feel with your doctor(s). Some people experience conditions such as depression and anxiety after they quit opiates, making staying sober that much harder. By talking with your doctor(s), you may be able to find ways to deal with conditions such as these through things such as therapy or medication. Sometimes, these conditions may have been present before one started using drugs and are one of possibly many factors that could be a reason for a person's dependency on drugs. Discussing your situation and how you feel with your doctor is critical as conditions such as depression or anxiety can be dangerous and can get worse over time, especially after experiencing something as exhausting as detoxing from opiates.

 

By identifying and learning how to deal with the root causes of our addictions, it allows us to better ourselves and to learn how to deal with life without needing to get high. My point is, there are medications and other ways to help one cope with PAWS. Sometimes just simply talking with others about our problems is all we need. Whenever I was stressed after a long day of work and school, I would simply go out and get some Oxycodone to relieve myself and settle down. Only I wasn't dealing with my problems but was rather finding ways to mask them. It took me awhile to learn this but it is something that has played a pivotal role my recovery.

 

Most Common Types of Therapy to Deal with PAWS

 

In addition to medication, there are several kinds of therapy methods that can help one deal with PAWS and their addiction. It can be very difficult trying to overcome addiction alone so it is important to learn the available tools and people that can help one in his or her recovery. As I mentioned earlier, simply talking with someone about your personal problems, thoughts, concerns, feelings, emotions, and experiences can be extremely beneficial in one's road to sobriety. The following 3 methods are commonly used by those within the addiction community when dealing with people looking to get and stay clean. These methods, courtesy of the Authentic Recovery Center, are:

• Integrated Group Therapy (IGT): is a recent addition to the preexisting therapies designed to tackle dual diagnosed individuals. Using the group setting, this style of therapy targets people suffering from bipolar disorder and drug addiction.

 

• Exposure Therapy (ET): is a behavioral model that had proven useful in assisting addicts also suffering from phobias or anxiety disorders. Frequently with people suffering from anxiety disorders, they find themselves triggered by specific stimuli, which in turn triggers a craving for a drug. Like Cognitive Behavioral Therapy, Exposure Therapy seeks to unlearn these responses, and to establish in their place more rational, less destructive responses. This style of treatment has promise assisting individuals who experience anxiety and are also addicted to cocaine.

 

• Dialectic Behavioral Therapy (DBT):  specifically seeks to lessen behaviors that cause self-harm, such as cutting or mutilation. It is also used to treat individuals with a history of suicidal ideation or suicide attempts, and has proven helpful treating individuals who are diagnosed with borderline personality disorder.

 Conclusion

 



Well Guys, as you can see, physical withdrawals are only part of the difficult journey towards sobriety. PAWS are far too often overlooked and underestimated as everyone tends to focus on and worry about the physical withdrawals simply because it is what usually comes first when detoxing off opiates and because they are things that you can actually feel physically.

 

When dealing with PAWS, it is important to remember that it will get better over time and that recovery is a long process. This is where the skills you have learned to help cope with the physical and mental aspects of detox are critical. It is not unusual to feel depressed, fatigued, bored, or just "off" for some time after you say goodbye to opiates. Therefore, it is important to keep busy and active, seek sober support, and to truly learn and understand your addiction and what lead to it. 

I invite all of you guys to comment in the comment section about any other information you have about Post Acute Withdrawal Syndrome. Please feel free to ask any questions you have about the matter or to share your own experience(s).

As always, thanks Guys for taking the time to read my blog. Keep seeing the light!

-Seeingthelight