early recovery

A Reader Writes About Her PAWS Experience

I got this letter a few days ago. It so closely parallels the article on the Sunrise Detox blog about sugar addiction, and has such a clear outline of the lady’s experiences in early sobriety, that I thought it would be good to publish it here, along with my response. Perhaps some of you folks will be able to relate. The letter is edited for readability and to preserve anonymity, and is being published with the permission of the writer.

I had absolutely no acute withdrawal symptoms when I stopping drinking. In fact, quitting was so easy I never lasted more than 3 months before. I used to do these “stop drinking” bouts twice a year for the last 5 years to cleanse but admittedly, looking back it was because I had a problem with alcohol. It's been over 100 days now. I quit on January 1st.

I'm 46 and I have been drinking since 17. I was a heavy drinker who was always sensitive to alcohol. I could handle booze until I was 40, when I started drinking a bottle of wine nightly. For me, who was small, that was way too much. No one thought I was having a problem because I was drinking alone, hiding at home.

I had no withdrawal but I seem to now have classic PAWS. [Post-Acute Withdrawal Syndrome – Ed.] Where I used to have mental acuity and a really fast mind, I'm now super confused and tired. My first month was complete rage. I was so bloody angry, where did it come from? I seemed to be intolerant and have no censure about telling people off. It's almost comical.

In a sense it relieves me, I can finally not be polite. I used to be so polite and sweet and nice but chronically depressed as a drunk. I'm now angry, which in my book is better than depression. (Can you believe it, I was sure booze didn't create depression because when I stopped for a month before, I was not less depressed. But now that I’ve accumulated over 4 months and am no longer depressed, I SEE that it was alcohol. I just so wish I had got that realisation sooner…so many years wasted!)

Thankfully, the rage has subsided. I deal with frequent headaches, but my most annoying PAWS symptom is sugar craving. I was on a NO CARBS diet for 8 weeks and it helped, but it was too austere to be a happy place (I'm all about extremes) so I'm back to a good diet, meditate daily, do yoga, I'm doing wonderfully except for the sugar cravings. When I feel like drinking like mad, I allow myself the sugar rush. I guzzle a spoonful of molasses or maple syrup, and you know what? It helps me greatly. My only question is, will it ever diminish? It's a sugar craving exactly like when I have PMS — the exact same urge to have sugar with immediate brain POW relief. So since I don't abuse sugar at all except a daily dose of dark chocolate (1 square) or a tablespoon of maple syrup, i think it can't harm me that much. Better than alcohol.

I don't mind that PAWS takes time. In a way it makes me grateful, it reminds me that I'm weaned from my poison. I'm just happy it's not 1 year for 1 year of booze because I would be in pain for the next 25 years.

Thank you so much for your kind presence. I find that you are very present to us. In spirit, in listening.

“Ruth”

Hi Ruth,

Don't worry about the sugar for now. Next time you go to your doc, request that she order an A1C test to evaluate the way your body is handling glucose. For the time being, stick with the method you've found. You might try smaller amounts of sugar or — perhaps better — some more complex carbs to see how that works. I'm concerned about blood sugar spikes and bottoms, especially in connection with the rage.

Ah, the rage. Hardly surprising that it has surfaced now that the booze is gone. Booze helps us stuff all manner of things, powerful feelings first among them. At some point you'll be ready to take a good look at things in the past that are causing it, perhaps via a 4th and 5th Step, or with a good therapist. For now, don't sweat it, but you will need to explore those issues eventually. (If that caused any kind of reaction besides, “Oh, okay,” it's proof of the premise. Denial ain't just a river in Africa.) If things get too tough, buy an aluminum baseball bat, find some poor undeserving surface, and whale away at it for a bit. Good upper body exercise, too.

How much we drank has less to do with PAWS than how long we drank and how our tolerance for alcohol developed. Along with tolerance came changes in our brain, as our bodies attempted to adapt to the altered levels of neurotransmitters (NT's) caused by the stimulation of the alcohol and/or other drugs. These are permanent changes that involve receptor sites and other minutia. As a small woman, you got the full treatment. Because women produce less of the enzyme that metabolizes alcohol (ethanol dehydrogenase), it stays in your bodies longer, at higher levels than it does in men. Being small merely exaggerated that. More effects for the money is about the only benefit there.

Put simply, PAWS is the symptoms our body experiences during the period when the brain and other bodily systems are returning to an approximation of normal. They include all the things that you mentioned, some others that you didn't, and sometimes depression. Not everyone expresses the same syndrome, but your list fits right in.

PAWS usually lasts for from 8-10 months to two years, depending on a broad range of variables. There is no way to avoid it, but following the suggestions in the article can ameliorate many of the effects, and just knowing that it will gradually get better is a morale booster, too. Expect some swings: good days and worse days, with the good slowly increasing. It's frustrating for us addicts, because we're used to mood changes on demand, but this is better.

Trust me.

Follow the hypoglycemic diet suggested, and stay away from fad and “cleansing” diets. They have no real validity, regardless of how artful the presentation. Remember that those folks are trying to sell things; there's no profit in simple, good nutrition. Recovery is about reality, and there's some for you right there.

Keep on keepin' on!

Bill

Questions In Early Sobriety

I want to share a letter I recently received from a guy in early sobriety, along with the response I gave.  The letter is SO typical of the cares and worries of people in early sobriety that I think most folks will be able to relate.  I edited a bit for brevity, believe it or not.  So…

Hey Bill,

I talked with you once before  when I was about 43 days clean. 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, but 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 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.

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 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 my life would I ever think I would be sitting behind 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.

Peace, love and happiness. Take care.

Joe

Hi Joe,

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 sobriety. 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 the depressed feelings get worse than just feeling blue, you need to take them 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, there are plenty of non-addictive alternatives. Mainly, though, you need to keep to your program of healthy living and meetings.  In most cases the anxiety will ease off as you begin to feel more comfortable in your recovery.

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.  That said, as long as you're working a program and doing what you need to do, you needn't worry.  Just remember that recovery is a process, not an event.  It's a sliding scale, and sometimes it's more slippery than others.

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, Joe. 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 (Post-Acute Withdrawal Syndrome) is — the period of healing. It takes time, but it does get better.

Hang in there, and

Keep on keepin’ on!

Bill

Sorry to tell you this, but time takes time.

We addicts love our instant gratification, and one of the places it really shows up is in our seeming conviction that we ought to get better right away.

(c) DigitalZen — used with permission

Let’s face it: with virtually no exceptions, we spent months (at the least) and years (far more likely) using alcohol and other drugs. We took all that time to mess up our brains and bodies to the point that we were miserable enough to decide to do something about it. Then we got clean, and suddenly we were amazed that we still felt like crap, and that our minds were still running off in all directions at once.

For goodness sake, why wouldn’t they be? We aren’t addicted to substances, per se, we’re addicted to the changes they make in our brains. Doesn’t it make sense that those changes, created over months or years, should take a while to repair themselves? Of course we continue to think about our drugs. Of course we feel like crap. Of course our bodies — suffering from malnutrition and who knows what other problems — take six months to a year to get back to something like normal. If we took a bulldozer to our house  we wouldn't expect to put it back together into livable condition right away, with minimal effort and attention, would we?

We think in the short term: how long until the next chance to have a drink, shoot up, meet with the guy on the corner, pop that pill. We’re used to doing our thing and feeling more or less instant results. Changing that way of thinking around, accepting that not everything we want comes exactly when we want it, takes time.  Time takes time.

Left to our own devices, we’ll try to find short-term solutions. There aren’t any. Recovery is physical and mental healing, and doesn’t happen overnight. If we don’t take our time and put in the work, if we give in to that short-term addict thinking again, we’re not going to make it.

That’s why we need programs, folks. That’s why we need the guidance of others. We’re in no condition to figure these things out for ourselves.

Smoking Reduces The Chance Of Successful Early Recovery

Given the number of us who are also addicted to nicotine, this could be huge.  It reinforces the rapidly-spreading practice of rehabs prohibiting smoking (during primary treatment, not detox).

…smoking while kicking the alcohol habit impairs memory, learning and other cognitive skills–ultimately making it more difficult to weather the long storm of sobriety.

http://www.sciencedaily.com/releases/2012/10/121012141838.htm

 

Permanent post:

Newly Sober? PAWS Still Has You In Its Claws!

Early recovery can have its rough spots. If you've been having more bad days than good, you might want to take a look at this article. It could make things a lot easier. (Hint: You're not going nuts!)

 

Newly Sober? PAWS Still Has You In Its Claws!

We all know that most relapses occur in the first few months after we get clean and sober.  Many of them are related to Post-acute Withdrawal Syndrome.  We talked about PAWS in a previous post, but I wanted to go into it more specifically here.

Although there are differences in the way they act, all addictive drugs function by either stimulating or imitating the chemicals of the brain's reward system — giving us too much of a good thing.

In an attempt to return our brain chemistry to normal (homeostasis), the brain builds more receptor sites for those particular neurotransmitters.  This allows it to deal with the higher-than-normal levels, leading to tolerance: the need for more drugs to fill up the additional receptors so that we can continue to get high.

When we get clean and sober, those extra receptors clamoring to be filled up are what causes withdrawal: acute withdrawal while the drug is clearing out of our system, and post-acute withdrawal during the period when the brain is deactivating the extra receptor sites and returning to normal.  Some authorities believe that it never normalizes entirely, which may be why any use usually leads back to full-blown addiction.

There is a double-whammy effect, too. When the drug is removed, there is a “rebound.” We begin to experience many feelings and physical symptoms that are the opposite of the way the drugs made us feel.  Removal of the drugs' stimulation causes the production of the reward chemicals to drop to below normal, and they return to their pre-addiction levels slowly. During this period we may be antsy, anxious, depressed, manic, or combinations of those feelings. We may feel as though our recovery is hopeless, and that we might as well use.

That's PAWS.  The duration  varies depending on the drug(s) used and individual physical differences.  It can — but usually does not — last for up to two years.  Ordinarily it will peak and then slowly subside within the first few months.  During that period (and in most cases for the rest of our lives), use of addictive drugs can put us back on the merry-go-round quickly.  It will also prolong the period of PAWS.  It can even set us back completely, because it interferes with the brain's repairs.

So, in early recovery we need to be prepared for a prolonged period of slowly feeling better, with setbacks when our bodies need that additional bit of natural feel-good and don't get enough, usually when we are under stress.  Stress aggravates PAWS symptoms because the natural “drugs” that help us to cope aren't back to full strength yet.

The good news: it always gets better, slowly but surely.

The best medicine for Post-acute Withdrawal Syndrome is time, aided by mild exercise, good nutrition, rest, stress avoidance, and distractions.  We need to have some fun.  We need the support of people who know where we're coming from, and who know how to deal with people in early recovery.

That's why we recommend meetings, fellowship, halfway houses, long-term treatment, and some time away from the old grind and the old stresses.  They help us deal with PAWS, while we're getting into the habits that lead to long-term recovery.

As George Carlin used to say, “Just because the monkey is off your back, it doesn't mean the circus has left town.”

If you've had your own experiences with PAWS, how about sharing in the comments?  Questions?  Feel free!

In Recovery, How Do I Get People To Treat Me Normally?

How do we keep our family and friends from treating us like patients, or walking on eggshells around us, especially around times of celebrations?

First of all, we need to understand that they are doing it because they love us, and are trying to protect us.  It does seem as though they’re attempting to control us in subtle ways, and because we’re feeling something like normal for the first time in years, we want to be treated that way.

However, we need to remember that, to a great degree, we are responsible for those eggshells.  It is probably going to be a while before we can expect to be treated like a normal person.  We need to earn trust and respect by being trustworthy and respectable; we are not entitled to them just because we’ve been sober for a few weeks, or even months.  As the AA saying goes, “Don't expect a medal just because you're finally doing what you should have been doing.”

On their part, our families need to understand that hearing eggshells cracking all the time is irritating, and that the best thing they can do for us in early recovery is to try to treat us as normally as possible — apart from putting temptation in front of us.

That may be hard for them, though.  Remember that for however long we were using, they got used to treating us in certain ways.  Nowadays, our total reality has been turned inside-out, but theirs hasn’t changed much at all.  Change takes time, understanding and trust. Because they do love us and want us to succeed in our recovery, they naturally feel awkward around us because they don’t know what to do.  While that can be really annoying, it’s generally not all that hard to deal with.

We need to sit down with them, discuss our recovery, and honestly let them know how we feel.  If we’re not able to do that yet, we can write them a respectful letter.  If we're seeing a counselor, we can try to arrange a family session.  We need to tell them that while we appreciate their concern, we’d like them to try to relax and be themselves.  They need to know that we’re not going to head for the street or a bar just because someone mentions drinking, or refers to things that might remind us of the past.

We need to let them know that we don’t want to “forget the past, nor wish to shut the door on it,” and that we’ll be bringing it up ourselves from time to time.  They need to know that we don’t expect them to change their lives to accommodate us.

One of the things we can do is ask them to read this article.  Regarding the celebration issue, we can refer them to this article about parties that I publish every year around the Winter Holidays.  Finally, in the case of those who were most affected by our using, we can suggest that they consider a few Al-Anon or NarAnon meetings to learn a little more about living with people in recovery.

Most of all, we need to remember that these people love us.  They want to trust us.  They want us back in their lives.  They want what’s best for us.  They always have.  If we remember these things, and that they’re just doing the best they can — the same as us — it makes getting along a lot easier.