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Help don't want relapse, PAWS is my prob

I

irwinr89

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Joined
Mar 31, 2012
Messages
15
Been on oxy 60mg day recreationally for past 5 years, have quit cold turkey several times only to relapse , easily thinking I could manage it. I have never exceeded that dose thou

Prob is I get it easily n free, but I put my foot down this time and I have been one month clean now, longest ever, and I would hate myself gone this far and relapsing like a fool.

Funny thing is the cold turkey is easy for me, I only feel a bit crappy for couple days and then am mostly ok, but now this time around for some reason the PAWS is kicking my butt on and off after a month, not cravings per say, just low energy and low motivation.
I have had mental health issues for over 10yrs, and for the record I've been on Lexapro, vyvanse and ability since then, I am a highly paid IT manager for large corp , have kids, married, etc.....I can't let this opioid crap get any further, it has to stop....But I can feel the ease of relapse...please help, need strength....I don't want any methadone or subx crap, I want clean, I need to beat this
 
Why don't you want to try something like buprenorphine? You would be a fairly ideal candidate given your history. There is nothing about taking a prescription medication appropriately that precludes one from being "clean" or sober.

Other than that, if you're dead set against it, what could you do differently than you have tried in the past? Do you have your mental health concerns under control (do you feel like they are)?

In terms of specifically dealing with PAWS, I have discovered basically three things. 1) Focusing on my overall health and making improving that (through nutrition, exercise, meditation, body work, sleep, etc) my priority really made PAWS more managible. 2) Appropriate medication for my mental health issues particularly for the first year off really helped. 3) Certain treatments, such as ketamine therapy and iboga, have been beyond helpful in helping me stabilize into and out of the PAWS ups and downs.

I should also note that I found the PAWS following ORT (in my case methadone in particular) to be far more managible than that following coming off a short acting opioid habit like oxycodone or heroin. I'm curious to hear why you are so against trying something like buprenorphine, as the idea of it just being "changing one addiction for another" is bullshit dogma.
 
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Just went through 3 months of paws... Sleep was the worst of it. It gets better though. Exercise helps alot. Those endorphins are little miracle workers .

R13
 
For me, staying connected to other people has been crucial to keep PAWS under control. If left to my own devices, I tend to isolate myself, and this invariably gets me feeling down, uninterested in life and interested in getting high. So I have to periodically force myself to reach out to people and make plans to hang out. In fact, I just did this yesterday after realizing I haven't hung out with anyone aside from my wife for a long time.

Upshot is: I really do recommend strengthening and relying on the social ties you have in your life.
 
Getting out of the house is crucial. When I get out of the house to go do something I don't think about shooting my suboxone at all (unless I'm starting to WD from it) but when I'm sitting on the couch watching TV I compulsively want to shoot my sub. Gotta keep the mind active. The only thing that keeps me from using more sub that I actually need is either:
A) getting out of the house and doing something (ANYTHING. Go to the bar I work at and chit chat with the bartender/employees while I very slowly nurse a beer, go out and play pool even if I'm just playing against myself, go slowly walk around the grocery store or various culture food markets and take in everything they have to give me ideas on something to cook, bookstore even though I never buy anything except comics, record store, etc.)
Or B) I start to run low on sub and have no way of getting more anytime soon.
Otherwise I will sit in the house and my needle addiction takes over. I try to pick up extra shifts at work just to keep me out of the house more often. When I am at the house I try to do something productive like working out or cooking something nice. Today I detailed my car and that took up 3 hours of my time and I didn't think about shooting up once and now my truck is sparkling inside and out.
With a wife and kids it shouldn't be too hard to find stuff to do for them to make them happy which I would assume will ultimately make you happy too.
 
You have my sympathies and understanding...
I consider PAWs to be by far the hardest stage of withdrawal and I don't believe I've managed to come through it completely.
After 4 months clean PAWs got the better of me and I recently relapsed. I can only suggest that holistic treatment and support is necessary and in practice you need to overhaul all aspects of your life and put in place distractions and coping mechanisms to boredom, depression and melancholy. I'm working up to another attempt but daunted by challenge and scared of withdrawal pain.
 
Speaking to my counselor really helps me work through my issues and get to the root cause.

In general, most my PAWs have simple solutions like being active, having regular sleeping habits, getting out of the house, socializing, going to meetings, avoiding stressors or people who I conflict with or if I can't stay away then learning how to deal with them. I know diet and exercise play a role but I've been slacking on them and some PAW symptoms seem to be getting worse as a result.

It's hard because there is no cut and dry answer or solution. They are usually a sign that there is some behavior that is not healthy or needs to be changed, but it is difficult to pinpoint exactly which one it is.
 
Mafioso, you speak a lot of sense. I support your advice. It's not easy but there is a way through. It's just hard and requires perseverance. Although as you say, the solutions are mostly simple.
 
Just to point out, PAWS proper (the clinical term) tends to refer to the period beginning around 90 days of abstience.

Recovery can be a rollercoaster. I strongly suggest exploring stress reduction techniques. They will probably do more than anything to help keep one grounded, particularly once one learn to integrate them into daily life. Stress reduction means a lot of stuff too, and it looks different given different types of stress and other circumstances.

The good news is that learning to cultivate this kind of lifestyle will set you on a course for success far down the road. I find thinking of the future to really activiate PAWS symptoms in most people.
 
Hi toothpastedog,
I wasn't aware PAWs is clinically recognised or is an official medical diagnosis.
Can I ask what you are referring to when describing the post '90 day' definition?
Perhaps you're referring to an index of recognised USA medical diagnoses...? the majority of clinicians I've spoken with in the UK are not aware of PAWs as a defined diagnosis.
PS
addiction.com refers to PAWs:
"Many people in early recovery will only have symptoms of PAWS in the first 90 days of abstinence."
 
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juansalar said:
Hi toothpastedog,
I wasn't aware PAWs is clinically recognised or is an official medical diagnosis.
Can I ask what you are referring to when describing the post '90 day' definition?
Perhaps you're referring to an index of recognised USA medical diagnoses...? the majority of clinicians I've spoken with in the UK are not aware of PAWs as a defined diagnosis.
PS
addiction.com refers to PAWs:
"Many people in early recovery will only have symptoms of PAWS in the first 90 days of abstinence."
Click to expand...

To the best of my knowledge, PAWS is a clinical term, but not a diagnosis per se. As its name implies (post-acute wd syndrome), it is a syndrome--a collection of symptoms. The first weeks of recovery (up to a couple of months) is usually still considered acute WD.

At the same time, because it's a slightly nebulous concept, many people use the term PAWS in various, sometimes conflicting ways. Personally, I wouldn't split hairs over the issue...the crucial thing to understand about PAWS is that it can drag on for a long time. Before 'PAWS' came into popular use in recovery circles, it was common to assume that getting through the ~7 days of physical discomfort (for fast-acting opioid use) was the main hurdle we faced. Hopefully now, it's more widely understood that people in recovery can face significant challenges for many months after quitting.
 
simco hit the nail on the head. A lot of what people often identify as PAWS is really more akin to a mish mash of symtpoms (like mood disorders) one experienced prior to self medicating/using opioids (or whatever substance) and the normal ups and downs and difficulties in everyday life that affect folks in recovery no less than others (these ups and downs can be more difficult for those of us in early recovery simply by virtue of our not having learned to manage them without our DOC, and then without their DOC having to learn to manage them anew).

Personally I don't like the idea of taking PAWS to seriously. IMHO there can be some psychological stuff that comes up, where there is a certain set of expectations that ends up coloring ones experience in ways the experience wouldn't otherwise be characterized by if the individual didn't identify so strongly with them.

Taking the attitude of "don't know mind" in regards to early recovery, especially acute withdrawal and PAWS is super helpful. This isn't to say one shouldn't do ones research. Getting an idea of the range of what others under similar circumstances have gone through is incredibly valuable. But one must realize that we are all different, and the invitation to "see for ones self" is a very powerful aid. As we probably all recognized by the point where we start using SL, expectations can be a PITA sometimes. Not getting to caught up in them and staying flexible in terms of being open to whatever will come is just so so so useful. It goes a long way to turning obstacles into challenges into oppertunities.

The mind, after all, can be an absolutely wonderful ally. It always makes me so sad when folks seem to have an antagonistic relationship with their thoughts patterns :( I'm like, "hey you've got a great brain - learn to use it for the best!" :)
 
Thanks for both of your responses to my question. I agree with your description of PAWs and acknowledge that this condition was previously thought of as an indistinct part of recovery i.e. the period before normal endorphin production resumes (if it does). Hence my question about the 90 day milestone, which I think you'll agree is arbitrary line in the sand which won't apply to everyone or indeed anyone. I haven't come across it before nor can I find reference to it: I don't believe it's a helpful guide, unlike the generally accepted guidelines of 2 weeks for acute withdrawal and 2 months for more substantial relief. Sorry if I appear to be making an issue of this... it's simply because - having been in this situation before - arbitrary milestones can lead to disappointment and loss of confidence when your own experience doesn't match the description.
 
I will need to look it up, but it seems like it takes about 90 days for the neuropsychology to return to a more "normal" equilibrium. Perhaps that is the bit about endorphins you mentioned. I haven't personally noticed a whole lot changing around the 90 day mark, but I've never noticed much happening in terms of PAWS either. It isn't to say my recovery has been super smooth simply after the acute detox, but I think it's generally been managible for me because I've put so much effort into being kind with myself and regularly practicing healthy lifestyle habits.

I'll ask one of my teachers who is knowledgeable on the subject to educate me a bit on it some more and report back (assuming they get back to me). Sorry I can't be of much help with this! And I most certainly don't take it as confrontational on your part - more like critical and curious (both of which habits are very healthy and useful) :)

There is certainly a lot of evidence to suggest certain milestones when it comes to changing any deeply entrenched habit behavior though, anecdotal or otherwise. But it is important to emphasize that each of our situations will unfold a little differently, given what we are specifically dealing with, the nature of our DOC(s) and character of our habit(s), both healthy and unhealthy.

I couldn't agree more that arbitrary milestones, or taking milestones generally to seriously in terms of our expectations, is very unhelpful and counterproductive. Flexibility is also a learned skill, and so incredibly useful. Much like resiliency.
 
I agree, expectations during recovery are a recipe for frustration and confusion. Especially since in those early stages were often really hurting for some tangible promise of relief.
 
Thanks again, very useful... and reassuring to know that I'm not deluded and I'm thinking about things in the right way.
 
Yes, it's a useful perspective IMO.

In large part recovery is about learning to think in new ways. We all have different assets when it. Ones hot how we reason, feel and imagine, so what may be useful given ones own character might not be the same as everyone else. But regardless of how we think, there are ways to work with what we bring to the table. I cannot suggest enough using our brains for the better :)
 
So after talking to someone very knowledgeable on the subject, the short answer is that it seems to take a minimum of 90 days to grow new neural pathways.

Speaks to how our brains are more "wet wired" rather than hard wired.

Keep in mind that is a neuroscience perspective. There are other ways of looking at things (such as a more psychological or behavioral perspectives), but they don't really contradict the neuroscience either.
 
OP here...thanks for the replies very helpful. Here is the deal, I got my supply as usual 2 days ago....and just having that gave me a good mood lift, sort of stress relief from knowing I have access, but honestly I feel strong repulsion towards using it and havent touched a single one, yet.
the mental reminder of the having to go thru WDs all over again if I relapse seems to be strong enough now, for some reason, to keep me from wanting it at all. I seem very clued in right now on that those fleeting good feelings are not real and come at a high price later.
So it makes me wonder how real or how strong was the PAWS, or was it more of not having something am used to have, seems a lot like a placebo effect of sorts.
Regardless I am concerned if this strenght will last and if I will eventually give in during a weak moment.....what to do then? If I discard them I fear I will lose that stress relief and get depressed again and PAWS like, or what have you....but if I keep them, well thats an obvious risk too...is a double edge knife....
 
You've hit the nail on the head with your dilemma. As well as the reference to the placebo effect, something that shouldn't ever be underestimate and can be used to ones advantage once one becomes aware of its dynamics.

In terms of your current dilemma, it's one you'll have to figure out for yourself. In my own case, just having opioids around tends to end up with me using them, sooner or later. It isn't the end of the world if that happens by any means, but it can create problems for obvious and not so obvious reasons.
 
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