Znegative
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Post Acute Withdrawal
Megathread & FAQ
What are PAWS?
Megathread & FAQ
What are PAWS?
PAWS stands for "Post Acute Withdrawal Syndrome". PAWS is a serious of impairments that follow the acute phase of withdrawal from different psychoactive substances including opiates, benzodiazepines, ethanol, stimulants, anti-depressants and other drugs. The symptoms of PAWS vary depending on which type of substance was discontinued, and the severity and length of these post acute withdrawals are effected by how much of the substance was used and for how long, as well as certain factors such as the drug's half life.
What is the cause of Post Acute/Protracted Withdrawal Syndrome?
PAWS is a result of the chronic use of psychoactive substances which, over time causes changes in our brains, depleting or stopping the production of our own endogenous neurotransmitter's which directly relate to pleasure, focus and relaxation. Even after the acute withdrawal symptoms end, if the substance abuser has used heavily enough for an extended period of time, he/she will still suffer from a range of symptoms due to the chemical imbalance/deficiency caused by their drug use.
Below is a more detailed explanation for PAWS or 'Protracted Withdrawal'
Symptoms of PAWS/Protracted Withdrawal:
- Psychosocial dysfunction
- Anhedonia
- Depression
- Impaired interpersonal skills
- Obsessive-compulsive behaviour
- Feelings of guilt
- Autonomic disturbances
- Pessimistic thoughts
- Impaired concentration
- Lack of initiative
- Craving
- Inability to think clearly
- Memory problems
- Emotional overreactions or numbness
- Sleep disturbances
- Physical coordination problems
- Stress sensitivity
- Increased sensitivity to pain
- Panic disorder
- Generalised anxiety disorder
- Sleep Disorder
This list was taken from Wikipedia.
How long does this $h!T Last??
How long does this $h!T Last??
Unfortunately the duration of PAWS can change drastically depending on the individual. Some variables which can effect the length of protracted withdrawal are:
- The Length of Time a Drug is Used-This is fairly obvious, but the length of you experience Post Acute Withdrawal Symptoms is going to be partly determined on how long you used the substance in question. For example, someone who kicks a three month oxycodone habit is going to recover from PAWS faster than someone who has kicked a three year oxycodone habit.
- The Half-Life & Ammount of the Substance-The larger dose of a drug that is chronically used is going to cause a build up of the substance in your body, which will make both your acute and post acute withdrawals to last longer. Similarly, a very important factor in regards to the duration of PAWS relates to the half-life of the drug that was used.
As most people are aware, certain drugs are eliminated at slower rates than others. A drugs Half-Liferefers to the rate at which the drug is expelled. (I.E. Buprenorphine has a 36 hour half life, this means that every 36 hours, 1/2 of the drug is excreted from your system. So if you dose 16mg, after 36 hours, you'll have 8mg left, and after 72 hours, 4mg). Generally, the longer the half life, the longer the Post Acute Withdrawal Syndrome is going to last, which is why without proper tapers and maintaining healthy habits, the discontinuation of drugs like Methadone, Buprenorphine, Clonazepam, Diazepam, Methamphetamine etc, can be misserable and result in relapse.
Is there anyway to shorten or lessen the intensity of PAWS?
Yes. After getting through acute withdrawals it is important that you begin to maintain a healthy lifestyle. Though it may be difficult, and you may not feel like it, it is very important that you keep your appetite up (eating healthy foods, not fast food of lunchable's pizza<---I know, a real sacrifice). You also should try to be as active as possible. If you have the means to do so, join a gym. If that's not an option, try to find some sort of excersize you can do for around an hour each day. Exercise is crucial as it releases endogenous opiates (endorphins). Another must is sleep-try to get a good 8 hours of rest. This is very hard for some people, and it might not be possible for a while without the aid of medications.
Medications:
There are several medications that can sometimes be used during PAWS.
However, it should be noted that some of these medications can cause withdrawal
syndromes in their own right.
There are several medications that can sometimes be used during PAWS.
However, it should be noted that some of these medications can cause withdrawal
syndromes in their own right.
- Acamprosate-(Campral, Rx only) A drug used for the treatment of alchohol dependence. Acamprosate works by agonizing GABA receptors along with reducing Glutimate surges which activate N-Methyl-D-Aspartate receptors (which can cause tremors/seizures and delerium). Acamprosate also helps with withdrawal associated insomnia (source).
- Naltrexone-(Vivitrol, Revia, Depade Rx only)Naltrexone is actually an opiate antagonist closely related to opiate agonist Oxymorphone (though their effects are not at all alike, so don't confuse them!). Naltrexone's basic action is to block opiate receptors. Naltrexone is either given in the form of a shot (Vivitrol) or by taking tablets. It is used for the treatment of Opiate addiction and Alchohol addiction, though its efficacy (specifically with opiate users) is questionable at best. Many drug treatment centers IME try hard to push Vivitrol on patients with the claim that it helps to reduce cravings and PAWS. However, I have yet to read anything that supports either of these claims, I've only heard horror stories of people overdosing after attempting to override the naltrexone (which they were often coerced into taking) with heroin or another opiate. However, in regards to alcoholism, it is thought that naltrexone helps to deter the urge to drink by blocking opiate receptors. NOTE: Taking Naltrexone while on opiate pain medications will precipitate withdrawals.(source)
- Gabapentin/Pregabalin-[Gabapentin-Neurontin Rx only, Pregabalin- Lyrica Schedule V controlled Substance, Rx only) Neither of these drugs are prescribed for PAWS, but people do use them for this purpose as they are very effective anxiolytics and analgesics. Gabapentin and Pregabalin are both GABAergics, however they do not effect GABA-A or GABA-B directly. They work by decreasing neurotransmitter's such as glutimate. Both of these drugs can cause a physical Dependance similar to GHB and Benzodiazepine's if used in frequent and large dosages, making them most suitable for 'as needed' use. Another important note is that both Gabapentin and Pregabalin can produce euphoric effecfts of their own which increases a risk for a psychological addiction as well. On the flip side, the fact that they are not cross tolerant with Benzodiazepines, Alchohol, Z-Drugs, Barbiturates or any other GABAergics that agonize GABA receptors is a plus.
- Baclofen-(Kemstro, Lioresal, Liofen, Gablofen, and Beklo-Rx only) Baclofen is a GABA B agonist indicated for spasticity. However there have been several studies that seem to conclude it is effective for the treatment of alcoholism and cocaine treatment. It should be noted that as a GABA B agonist, Baclofen can cause dependence and withdrawal syndrome, though it curiously is known to not cause an increased build up of tolerance.(Source 1,source 2)
- Disulfiram-(Antabuse, Rx only) Disulfirum is not known to actually help prevent symptoms of PAWS, and is thought by many to be a cruel and antiquated form of treatment. Antabuse basically works by preventing the breakdown of Alchohol which causes intense nausea/vomiting and other unpleasant effects if even a small amount of Alchohol is consumed.(Source)
- Bupropion-(Wellbutrin, Zyban Rx only)Bupropion is one of the more commonly prescribed Antidepressants (in the U.S) and smoking cessation medications prescribed. Unlike most other Antidepressants, Bupropion is not an SSRI. Instead it is a Dopamine-Norepineohrine Reuptake Inhibitor and has shown some promising results in treating those with amphetamine or cocaine addictions.
Things to Avoid:
Recovering from dependency takes time and effort. There are several things you want to avoid during this period. Some may seem insignificant, but the key to getting through PAWS is to practice as much self-care as possible. Things not to do:
- Using your DOC-Im not preaching complete abstinence here, but after withdrawing from a certain type of substance (let's use opiates as an example), it is wise to try s hard as you can to refrain from slipping as it can possibly push back some of progress you have made (though that's not to say that if you use once after four months of abstinence, you will have to start all over). The more 'slips' you have, the longer the PAWS is going to be. It can be very frustrating as the anxiety and depression caused by PAWS is one of the main reasons that people return to using. However, from my personal experience, I can attest to the fact that if you do stick it out, this depression and anxiety will over time begin to fade away.
- Staying up late, Sleeping in late-Most of us know that sleep is difficult, sometimes even impossible during acute withdrawal, and even afterwards getting a solid eight hours of sleep is not really realistic. However, it's very important to try and stay in bed and try to rest. Even if you cannot fall asleep, close your eyes and try two meditate. It is also important that you not sleep in late, as this will further screw with your sleep rhythm. Eventually you will be able to sleep solidly.
- Junk Food-During PAWS it is also important to a avoid junk food and eat a balanced diet. Things to avoid are food high in sugar content, as well as caffeine. When recovering from a prolonged period of chronic drug use, it is important to cut out anything that can induce stress (such as coffee and say, gushers-though god damn I love how they explode in my mouth)
- Sitting on your Ass-You're depressed, tired, restless and anxious-even making a peanut butter sandwich seems unbarable (and that's without the jelly!). However, it is incredibly vital that you try to stay active and participate in drug free activities that you (used to) enjoy. While drawing (I'll use art as an example) might not seem at all like something you want to do when you're going through PAWS, you should get into the habit of forcing yourself to do this (or whatever other hobby you may like) for a designated ammount of time each day. While its not going to bring much joy or inspiration at first, if you stick to it, your brain will slowly start to recover and doing these hobbies will begin to bring you pleasure. Besides, it's important to keep yourself busy. The more time you devote to an activity which requires your concentration, the less time you have to spend thinking about using your drug of choice. So keep busy!!
Related/Helpful Links
- How do you deal with PAWS?
[*]Opiate PAWS Symptoms
[*]A Question about the 1-Week Initial Delay of PAWS
[*]Live with Eternal PAWS or Go Back to Opiates
[*]Gabapentin can reduce-eliminate Opiate WD and Cravinghttp://www.bluelight.ru/vb/threads/537238-Gabapentin-can-reduce-eliminate-opiate-WD-and-craving
This thread is intended to discuss Post Acute Withdrawal Syndrome (PAWS). All threads regarding this subject will be merged.
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