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How do you deal with PAWS?

Cane2theLeft

Cane2theLeft

Bluelight Crew
Joined
Jun 21, 2008
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As many of you probably know from experience, Post-Acute Withdrawal Syndrome can be more of a barrier to sobriety than the torturous acute withdrawal and can plague substance users long after quitting their drug of choice.

Only recently has the treatment world started to recognize the role that managing PAWS plays in preventing relapse and have begun to offer some concrete suggestions on how to prevent and manage the symptoms as well as expedite resumption of normal functioning.

I'm hoping to learn more about what helped those of you who have experienced this but first a few basics... (Based on Terence Gorski's writing on the subject)

Some of the most common Post-Acute Withdrawal symptoms include-

  1. Inability to think clearly
  2. Memory problems
  3. Emotional overreactions or numbness
  4. Sleep disturbances
  5. Physical coordination problems
  6. Stress sensitivity

Some common-sense ways to treat PAWS include-

  1. Eating a balanced diet
  2. Avoiding caffeine and sugar
  3. Exercising
  4. Relaxation training
  5. Developing a support system
  6. Maintaining healthy relationships
Click to expand...

Everyone who experiences PAWS has unique triggers that catalyze their symptoms and its important to recognize what these are so you can address these when they occur. Having supportive people around you that you can discuss what you're experiencing with can certainly go a long way as well.

To all of you who have experienced PAWS, what helped you? Are there any specific dietary or lifestyle changes that you found beneficial? Conversely, what did you find harmful and necessary to avoid?

Thanks in advance to all who contribute!
 
With opiate WD's the most significant parts of PAWS seem to be the insomnia (and resulting fatigue) and the heightened effect of regular aches and pains.

Caffeine seems to be on the "no no" list, but I drink TONS of coffee in the weeks after kicking. Sometimes I'll even take up smoking. And when the insomnia gets particularly bad, I'll often take some valium.

But I do agree that exercise helps a lot. Especially weight/resistance training done in fairly high volume.
 
Lots of people consume tons of coffee and sugar when they're coming off various substances (especially opioids) but in the long-run its been said that this is detrimental for people experiencing PAWS.

You might feel better momentarily but then the crash will make you feel worse and these high and lows are more likely to both exacerbate and elongate the PAWS symptoms.

It seems to make sense that the addict brain is looking for the quick fix to alleviate the misery rather than weathering the storm and focusing on making healthy lifestyle decisions that will have more sustainable benefit.
 
I've made the mistake of immediately jumping into exercise and completely healthy living shortly after kicking.

IMO, once you get your appetite back and your GI issues have subsided, it may be worthwhile to "treat yourself" a bit. The most tempting way to treat yourself would be more opiates. And of course, that almost always ends in disaster. However, I don't really see any problems with pigging out on boxes of chocolate donuts and pots of coffee. I agree that your ultimate goal should be healthy diet and exercise, but I believe you should ease yourself into that, and shouldn't feel too bad about a bit of hedonism here and there.
 
^There certainly is truth in that!

If you impose too many rules, make it too rigid then just like a teenager with a 9pm curfew, you're going to want to rebel. I've found personally whether its with drugs, diet, exercise or whatever else; if I make it too rigid, I'm FAR more likely to just abandon the effort.

Its a fine line and of course moderation isn't the strength of junkies but if the pendulum swings too far the other way, chances are its just going to swing back.
 
I've always been *somewhat* good at getting out of the oven before things got too hot. I mean, I've been hunched over a toilet with a blanket and heater praying for death more times than I care to remember, but I've never carried on daily usage for more than four or five months at a time. But I'm no stranger to PAWS . Even after all the real "nastiness" is over, the sweating, general achiness, and inability to sleep for more than a couple hours at a time seems to drag on FOREVER (a month or two, actually, but still..).

I can't even fathom how bad it must be for someone who's carried on an addiction for years or decades. Even though that's beyond my experience, I fear that for some of those folks, nothing short of a lifelong methadone or suboxone script would help.
 
Binge_Artist said:
I can't even fathom how bad it must be for someone who's carried on an addiction for years or decades. Even though that's beyond my experience, I fear that for some of those folks, nothing short of a lifelong methadone or suboxone script would help.
Click to expand...

preaching to the choir brotherman
 
^I know that situation of Long Term addiction doesn't really apply to me, but I brought it up just because I wanted to hear Cane's thoughts on the subject. He's an extremely well spoken guy, and he's studdied addiction quite extensively, academically.

Also, even though I haven't been in the shit that deeply YET, it would be foolhardy of me to think it won't ever happen.
 
Let's start with things that don't work:

DXM - You would think any kind of anaesthetizing chemical would help, and DXM is over the counter, I mean, it couldn't hurt, right? It'll make you feel like your head is a helium balloon, and you'll still feel all of the negative effects of PAWS, plus more nausea. Bad idea. In desperation, I took 150mg, and it basically ruined half my day (as if it couldn't get any worse).

Recreational Stimulants - Ecstasy makes you feel worse. So does speed. I'm sure some people will tell you otherwise, but even if it did help temporarily, the crash will be magnified times a jillion. It's just not worth it. The bad feelings from PAWS don't go away. They just sit alongside all the stimulation and scatterbrain-ing.

---

Let's finish with what does work. This has been my regimen:

Naproxen (Aleve) - For muscle cramps, helps a little. Take two or three twice a day.

Ranitidine (Zantac) - This pill will help all your stomach related issues, save for vomiting. When I've withdrawn from tramadol, I get incredibly awful stomach cramps from stomach acid, bordering on peptic ulcer status. I was at work once during PAWS, and I was having trouble standing from the pain and cramps. I took two Zantac, and it made all the difference. I was pretty shocked.

Loperamide (Immodium) - I've never felt its peripheral opiate effects (they say it's supposed to help you feel a little better in general, supposedly), but it definitely helps with the diarrhea. I still take beyond the recommended dosage; I'd rather be constipated for a few days than having to run to the bathroom every thirty minutes. Does anyone know at what dosage it helps with peripheral withdrawal effects? I mean, I thought it might have helped a little at 10mg, but it might have just been placebo.

Benzodiazepines (Xanax, etc.) / Carisoprodol (Soma) - This is optional, but it really does negate a huge percentage of the dysphoric effects of PAWS, so it's really almost essential. It will help you sleep at night, and help you relax during the day. The worst of PAWS really only lasts two or three days; after that, you don't really need the benzos. It's not enough time to worry about addiction; you just have to remember to cut yourself off after a few days. If benzos aren't available, and for a lot of people they aren't, carisoprodol (Soma) is much more readily available (unscheduled in most places, available OTC in a few, and you can order it online pretty easily everywhere else) and it's not a bad substitute.

Ensure - Good healthy smoothies that substitute for meals. Good if you can't eat.

Gatorade - For fluids.

Some hilarious DVDs to watch - Comedy heals the soul.

Energy drinks - Usually okay after the first day or two; be careful drinking them too close to bed time, or you'll have a hell of a time getting any sleep. This isn't as big of an issue if you have benzos or Soma. In fact, the caffeine will negate some of the hypnotic effects of the depressants during the day, while leaving the anxiolytic effects (what you want primarily). DON'T go overboard. I only have used a lot of caffeine when I really cannot take off a few days and have work to do. If you can manage without caffeine, it's for the best.


If all else fails, I usually write the words "I'm okay!" along with a happy face on the palms of my hands with an indelible black marker the day before withdrawals. If things get bad, just look at your hands: it's your non-PAWS self reminding you that things will be better soon. I know it sounds a little silly, but to me, it's levitated me out of the worst of lows during PAWS.

As a side-note, I only have experience withdrawing from prescription opiates, primarily tramadol. So I can't speak for everyone with my post, but tramadol is known to have some of the worst withdrawals of all opiates, at least in terms of mental anguish, so I can speak with a modicum of experience behind me.
 
^I believe you were more thinking of acute withdrawals than post-acute withdrawal syndrome. PAWS is described as lingering effects people have AFTER the typical withdrawals end. These are often characterized by depression, clumsiness, cognitive deficits, stress and inability to cope with stress as well as many other symptoms.

PAWS can occur after cessation from many different types of drugs not limited to opioids and some of the worst PAWS can occur in people with large, long-term benzodiazepine habits.

While acute withdrawals can be torturous, psychologically they are manageable due to understanding they are time-limited. One of the reasons PAWS can be so difficult is that it can last months and in extreme cases, even years without an end in sight.

People plan for the acute withdrawal, stock up on the supplies you mentioned, get through the few days of utter sickness but then it still may take weeks, months or even longer until they start to feel right.

Despite lacking the intensity of acute withdrawals, many people say that PAWS is much worse and leads more people back to using due to the depression, anxiety and other symptoms.

Fortunately, more and more information is coming out on ways to manage the symptoms and even shorten the period that one experiences this and I was hoping, with this thread, for people to share what did and did not work for them.



_______________________________________
Regarding the question about loperamide- when I came off ~150mg oral morphine/day after 4+ years for pain, I started at 24mg and tapered from there. This stopped about 80% of the withdrawal symptoms and didn't cause any excess constipation or other problematic side effects.

B_A - thank you, that's very kind of you to say! I definitely appreciate your input here as well, brother.
 
^ its ok, at least your tangent was spot on for what you were talking about!
 
Cane2theLeft said:
Regarding the question about loperamide- when I came off ~150mg oral morphine/day after 4+ years for pain, I started at 24mg and tapered from there. This stopped about 80% of the withdrawal symptoms and didn't cause any excess constipation or other problematic side effects.
Click to expand...


IMO, loperamide during acute WD's puts you past the sickness, almost into a "precipitated PAWS" state.

Perhaps whatever works for PAWS plus loperamide would skirt any WD's whatsoever, huh?
 
the worst paws symptom that i dealt with after breaking a 5 year heroin addiction was fatigue.. i was constantly exhausted and i had no energy to function in daily life. after three or four weeks of that without any improvement, i went to see my physician and he put me on wellbutrin.. i was skeptical about taking an antidepressant but it turned out to be a godsend! not only did it help my energy levels get back on track, it really helped elevate my mood and diminish my cravings to use opiates again... anyone experiencing fatigue and depression from paws should definitely look into wellbutrin.
 
dealing with PAWS, for me, meant throwing myself into my trade . the more occupied i kept myself the easier it became to get back in the fucking human race and out of the life .
 
^that's an excellent suggestion. For most addicts, getting/preparing/using their drug takes up a substantial amount of your time so when you don't fill that time, you often just sit there thinking about using and it makes things worse. Productively occupying your time is very helpful.

Thanks for the input, .Lucid. Fatigue certainly is very common in PAWS and bupropion may certainly be beneficial for some who can not manage it in other ways.
 
Mostly I've had to accept the suffering and fucked up sleeping patterns that came with my protracted benzo WD. I've been lacking energy and enthusiasm so occupying myself has been made more difficult. I guess I'm just waiting to get better. But real important stuff:
1. Don't miss an oppurtunity to sleep and go home early so you can unwind and get some nighttime sleep. I found that if I miss any sleep at night by staying up late I don't make it up by sleeping later with this WD. Losing sleep heightens my WD's big time. No caffeine around bedtime either.
2. Don't be tempted to use another drug/herb/supplement to feel better. I tried Hydroxyzine for insomnia/WD anxiety and stayed awake for 3 days and worsened my WD's bad. Not even my old DOC, Cannabis, is the same while being mentally fucked on this WD.
3. Don't over-exert yourself -- even if you feel good.
4. No stress/arguments is good if you can be so lucky...
5. Really try to relax through relaxation techniques, I believe this builds non-drug pathways for reward and relaxation in the brain.

I even have urges to drink alcohol that I never had before now cause it relieves the physical agony, but it is definately not good. I've got some limited and decent effects from GABA supps. so they must cross my BBB a little and can't be too harmful as the don't interact with the BZD site. I luckily have no craving for benzos, in fact I'd like to bulldoze the factories that make these drugs. I would never touch one again. I just want out of the physical grip it put me in. I have nothing but hatred for this drug.

BTW cane2theleft, who is that on your avatar, he looks familiar I think?
 
Oh BTW, the last couple of times I used a benzo I had horrible paradoxical reactions, so that is why I CT'd and really have had no problems with wanting more because I'm terrified of getting another PR. I've even been held up at gunpoint by a real crazy fucker and that wasn't shit compared to the bad trip the benzo PRs took me on. I'll never be the same!
 
Chomsky rocks! I thought he looked familiar. I used to read some chomsky when I was in school.
 
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