Help for Post Acute Withdrawal Syndrome (PAWS) after Opiate Withdrawal

[Richard_smoker]

Many people addicted to oxys, hydro, heroin, fentayl, or other opiates are concerned about what to expect AFTER the initial WITHDRAWAL period (~3-10 days, depends on the drug).

The reality of Recovering from Opiate addiction is that there is an initial "HELL" period (immediate withdrawal) that is followed by a much longer, much milder period of time while the body is fine-tuning the nervous system, and while the body's own endogenous opiate system (endorphin) is recuperating.

There are 2 basic stages of opiate withdrawal.

1. The Short-lived, Acute, intense, immediate withdrawal which occurs directly after stopping all opiates. "clucking", shakes, profuse sweating, chills, gooseflesh, body temperature instability, autonomic instability, "revved-up," diarrhea, cramping, bone pain, mental anguish, etc. (takes ~3 to 10 days depending on the half-life of the drug)
   
2. PAWS or "Post Acute Withdrawal Syndrome." This is the more drawn-out phase of withdrawal...as the body learns to cope without the drugs. includes boredom, insomnia, self-doubt, 'restless legs,' depression.
   

I believe from my own experience, combined with reports from recovering opiate addicts and the physiology involved that the initial withdrawal is the big, feared MONSTER associated with feelings of sickness and delirium, whereas PAWS can be extremely different for different people. PAWS seems to be more akin to a "waiting game" with fears of overwhelming boredom than an acute sickness. The most important thing to remember during PAWS is AWARENESS that PAWS IS ONLY TEMPORARY!

With time, PAWS will go away!! In fact, with few exceptions, it seems that with every passing week, PAWS symptoms can be demonstrated as improving--sometimes DRAMATICALLY compared to the weeks prior.

Some Reasons why PAWS takes several months to get over:

1. Behavioral changes are necessary in order to learn new and solid pathways for the brain's reward circuit, and
2. It takes MUCH LONGER for your effective neurotransmitter levels and nerve conduction parameters to return to normal, pre-addiction levels.
   

And depending on your expectations and how you approach these critical 're-building' and 're-organizing' phases, will go far in how well you'll feel during and after withdrawal.


What can be done to HELP your nerve conduction while re-equilibrating to life without opiates? (or--"How to Maximize Your Neuronal Signaling During Post Acute Withdrawal Syndrome.")

• Boost the deficient neurotransmitters.
• Maximize electrical conduction ALONG the nerve.

1. BOOSTING THE DEFICIENT NEUROTRANSMITTERS.
First, let's talk about boosting the neurotransmitters. For the opiate addict, this means SPECIFICALLY "ENDORPHIN"---short for "Endogenously Produced Morphine" aka "Endomorphine" aka "ENDORPHIN."

There are some things you should know about endorphins. They are the body's natural opiate. Endorphin is released naturally in response to pain, orgasm, exercise, laughter, positive thoughts, secondary messengers responsible for fevers & immune responses, and there are other potential triggers including prayer.

These tips may not seem like earth-shattering phenomena by themselves, but believe me, when these steps are clustered and performed regularly, THEY REALLY DO HELP!!!

Common activities known to boost endorphin levels/satisfy cravings:

• Chocolate. Chocolate has a mild effect on endorphins.
  
• Candy. Actually any kind of sugary candy boosts natural endorphin levels. Candy helps most with early stages of withdrawal. Lab mice experiments have shown sugary sweets appease craving after abruptly cessation of morphine. Swim practically LIVED on Reese's Pieces, sour candies, M&M's, and those 'tiny' Hershey Kisses for 8 TO 10 WEEKS! Note: he did not gain or lose weight during this time.
• Exercise. This is #1. Force yourself to walk out the front door. FORCE YOURSELF to walk 2-3 blocks from your front door…then you turn around and get 2-3 additional blocks in for good measure. I CANNOT STRESS THIS ENOUGH!!! The best exercise is running/jogging/spinning/anything aerobic. Second best is walking or yoga. Somewhere in-between the two is weight lifting. Weight lifting or resistance-training can be done in a fraction of the time and there is evidence to show that this kind of exercise might benefit the MOST at the late stages of withdrawal (i.e. insomnia from 'restless legs').
  

some medical professionals believe the positive feeling you get when you meet a physical challenge, rather than the exertion itself, is what stimulates the endorphin release....(how much endorphin-release you get) is all about intensity and duration.

*

• Accomplishment. That's right. Any kind of accomplishments. Small ones, big ones. Just be sure you're PLANNING and EXECUTING daily. Anything that fosters a feeling of self-accomplishment and PRIDE will cause your brain to squirt out some Endogenous Morphine.
• Sex. Orgasms release endorphins. You've probably already figured this one out… OR--more likely, you've noticed that your sex drive has gone down to almost NOTHING while on opiates. This is normal. I can explain the hormones of it later if you're interested. The point is, you've replaced the endorphin-rush of sex with one that requires no build-up, no mess, and no chance of rejection. Do not feel embarrassed if you become a masturbation machine. This is also a normal part of recovery. Eventually, the sex act itself will be overshadowed by the LOVE aspect.
• Love. Love is a complicated emotion. It's the fuel for poets, playwrights since recorded history and the need for it traces all the way back to the first man and woman. HOWEVER!! SEXUAL LOVE IS *NOT* WHAT I'M TALKING ABOUT HERE!!!! Ultimately, your most long-lasting, gratifying experiences outside of drugs will come from the experience of giving AND RECEIVING love. Get creative with this. Love your enemies. Remember people's names. Start remembering birthdays. Surprise someone with your generosity. Next time you mow the lawn, cut your neighbor's grass…and take his trash out to the street. Donate time to feeding the homeless. There's literally TENS OF THOUSANDS of small things you can do to put forth love out into the world. *THIS* is the true secret to learning how to live without opiates! And believe it or not, the rewards are MUCH GREATER than even the best heroin you'll ever do!!! But you've got to get up and DO SOMETHING!
• Sleep. Eventually---like in 4-6 months from now--your body's autonomic nervous system will stop being 'revved-up' all the time. Eventually, you will be able to sleep again without having to knock yourself in the head with a sledgehammer! When this day comes, BE PREPARED! Start going to bed as early as possible, to allow yourself a good 7 or 8 hours of restful sleep. Your endorphin levels will naturally increase from the circadian rhythm, plus you'll allow yourself the luxury of copious dreaming--not only endorphin-releasing, but overall will make your days more relaxing and give your psyche plenty of time to play.
• Eat a hot Chili Pepper. *

  The rush you get after holding one on your tongue is likely due to your body's protective response. "Chewing a hot pepper can release endorphins centrally and on the tongue," says Dr. Hirsch. Why? To reduce pain, of course.

• Think Positive Thoughts.* Placebos, prayer and positive thinking all trigger endorphin release according to Dr. Slotnick.
• Get Emotionally Moved *
  

  Dr. Fuhrman says that viewing beautiful art, watching a touching dramatic scene or even listening to an inspiring piece of music can produce endorphins. "A person who gets pleasure in life, from whatever source, will keep endorphins at a healthy level," he says.

• Undergo Acupuncture.*

  "Putting needles into the body is a release," says Dr. Fuhrman, "and it may trigger endorphin production." Also, acupuncture patients benefit from a placebo effect -- they believe that the process is working, so it really does, says Dr. Fuhrman. Talk about the brain's power.
  Endorphin factor: 3 (NOTE: HIGHEST LEVEL). People who use acupuncture tend to be positive thinkers, which adds to the effects.

• Be Afraid.*

  Whether you're watching a horror movie... or feeling a rush of wind in your hair as you plummet down a steep incline on a roller coaster, fear causes endorphin release. Why do you think extreme sports are so popular? No one wants to get hurt; it's just fun (in a twisted kind of way) to cheat death. "The thrill of a high-speed ride induces a positive mood state that can leave you giddy," says Dr. Hirsch. And Freddy Krueger can do it for you too. Who knew he was such a heartthrob?

• Watch a Funny Movie or TV Show. More specifically, research has proven that simply the expectation of watching one's favorite funny movie releases Beta-endorphin and human growth hormone.** Go ahead and buy the Seinfeld Box DVD.
  

2. MAXIMIZING NERVE CONDUCTION. or How to Increase Electrical Conductivity WITHIN Neurons.

The portion of your body that is re-learning its own equilibrium WITHOUT OPIATES is essentially an aquatic salt-water ecosystem that runs almost entirely off electrolytes (+ and - particles called "ions" dissolved in solution) and VERY THIN membranes. These membranes are "semi-permeable" which means that with some assistance from various proteins, these membranes allow your body to separate and partition off positively-charged & negatively-charged ions. This creates VOLTAGE--the difference in charges across a membrane or "potential energy."

You can imagine the separated + and - ions as being like a battery. As long as the membranes are intact and your body is able to separate positives from negatives, then your batteries are "charged." But, if you punch a hole in one of the membranes or stop actively separating out positives from negatives, you end up with a lifeless or DEAD battery. ions from

Anytime you 'fire' off a neuron, an "ON" signal is propagated from somewhere deep inside the brain, along a LOOOONG axon, that ends by terminating into either another neuron (inside the brain) or somewhere else outside the brain (like a muscle or a salivary gland, for example).

If you were to tell yourself, "I am now Lifting my right fore-finger," then a neuron in your brain's motor cortex will first "fire" using a neurotransmitter. But the signal actually travels all the way down on a single neuron from the brain to your right arm. All the way down a discrete "wire" found in a bundle of other wires (your spinal cord) until the single nerve cell finally ends on muscles in your forearm where ANOTHER neurotransmitter is released, cause you to LIFT YOUR RIGHT FOREFINGER.

Why the description? well, the FIRST step involved in this example involves a neurotransmitter. In this case, the neurotransmitter is called acetyl-choline... but there are plenty of other neurotransmitters whose functions are to transmit various ideas, emotions, reactions, reflexes, memories, etc.

The SPECIFIC neurotransmitter you're missing is ENDORPHIN. Earlier in this post, I listed suggestions to help you SHOWER your brain with endorphin--and these will make you feel much better. If you can assimilate some or all of these activities into your daily routine, then you'll not only be back to normal very soon, BUT (swear to GOD) you'll actually FEEL MUCH BETTER THAN YOU DID ON OPIATES!!!

The reason I went thru the whole explanation of the + and - ions, the function of cell membranes to partition off these charged particles, and how that nerves & thus your entire brain FUNCTIONS by using a continuous flow of ions in and out of various partitions is because I want you to really REALLY UNDERSTAND something about how our bodies work.

You see, all this fine detail about nerve transmission can ONLY take place under ONE condition. And this is one of the most convincing arguments for evolution that I've ever heard… The ONLY PERFECT ENVIRONMENT for the proper flow of electricity and nerve conduction is found---IN THE OCEAN!

Fortunately, our body's have a "waxy coat" of skin that traps the ocean INSIDE US!

So, whenever you hear someone say "SALT IS BAD FOR YOU", you can tell them they would be DEAD if it weren't for the salt they eat!

Without getting too involved in this, just know that your body has exquisite mechanisms for hanging onto precious minerals and filtering out 'excess' ions. This is mostly done by the kidneys. HOWEVER, your body has NO WAY of either DILUTING or CREATING electrolytes. (i.e. sodium, potassium, calcium, magnesium, & trace minerals)


So, HOW CAN YOU ASSIST YOUR BODY IN ACHIEVING THIS OPTIMUM AQUEOUS ENVIRONMENT???

Simple. Drink plenty of water. Plain water. Not colas, not coffee, not beer. Your body will utilize pure water to form the MOST PERFECT, EXACT ion levels in the various partitioned areas. Unlike what many people believe, drinking extra water does NOT go straight into your piss!! Rather, the water goes from your GI tract, into your bloodstream where it is then dispersed EVENLY throughout every single cell in your body!

That's right…when you drink a glass of pure water, that water becomes almost instantly available to EACH AND EVERY CELL IN YOUR BODY, in order beginning with those cells which NEED WATER THE MOST! So, those cells which urgently need this pure water will get 'first dibs', and so on until the water has been evenly dispersed.

What do the cells DO WITH this pure water??

• Rejuvenate Cell Processes/Restore Cellular Health. First off, the new water allows overly-concentrated, sluggish, toxic (dehydrated) cells to return to their original healthy size, shape, & texture. You may recall from biology that a single water (H2O) molecule is generated in cellular energy generation (called respiration). Glucose and Oxygen are transformed into energy, releasing CO2, and H2O. Well, if your teachers were like mine, they neglected to teach how important pre-EXISTING H2O was for this energy to be produced in the first place! Without a surplus of pure H2O, NONE of this energy can be produced!!
• Eliminate Toxins. This pure water is necessary for your muscles (and other cells) to mobilize their toxic byproducts for excretion in to the urine. Plus, the additional water will optimize sub-cellular activities that have become erratic or sub-optimal from dehydration, built-up waste materials, and are living in an overall unbalanced, unhealthy state. These molecular-level processes will be cleansed by way of excessive hydration, dilution of toxins, and toxic elimination when these toxins are absorbed along with excess water into the bloodstream and almost immediately filtered into the urine. This 'flooding' leads to a "clean slate" on a sub-cellular level, which then allows the cell's energy production to normalize, which translates into higher energy, more energy efficiency on the tissue & organ level which affects the energy and health that we "FEEL" as organisms!!
• Enhance Normal Nerve Conduction Velocity. Remember all that talk about positive and negative ions being separated by membranes to form a 'biological battery'?? Well, one of the most vitally important pieces of the nerve-conduction puzzle is adequate hydration! Adequate hydration allows nerves to conduct their signals FASTER and also allows each nerve to 'reset itself' FASTER as well! So, in essence, adding pure water into your body will make your brain and muscles faster and more efficient--as though your neurotransmitter levels were actually HIGHER--when in reality, you haven't done anything to change your neurotransmitter levels!

When your urine has any yellow coloration or smells, this signifies waste products and toxins that your body must ELIMINATE in order to create this perfect aqueous environment for your nerve cells, muscles, and every tissue.

HOW MUCH WATER SHOULD YOU DRINK? honestly, everyone is different. People going through drug withdrawal require more water than someone whose tissues are already in equilibrium. Your need for 'extra' water during times of stress or drug detoxification will be obvious by the color and smell of your urine.

RULE OF THUMB REGARDING PURE WATER CONSUMPTION: Your urine should be clear and have no smell. This signifies optimal hydration.

Vitamins and Minerals. For fastest re-equalization, you should take ONE daily vitamin with minerals. These days, most every daily vitamin includes minerals as well as folate (aka folic acid). Don't waste your money on expensive vitamins or supplements. All you need are the basic RDA. The *REAL* secret to maximizing the absorption of vitamins is to simply take them WITH FOOD. Taking excess or "mega-dose" vitamins is just a waste of vitamins. 250mg to 500mg of Vitamin C per day is also encouraged, especially in the first few months of withdrawal.

The basic message is to take care of the things that you probably never even THOUGHT ABOUT while on the junk. Things like making sure to take vitamins, eat balanced meals to provide sustenance, exercising and drinking PLENTY OF WATER!

There are other threads which discuss supplements which can be taken to boost other neurotransmitters like norepinephrine, dopamine, and serotonin. Feel free to ask me if you have any questions...this is just WAY TOO HUGE of a topic to answer in a single post! good luck future smack quitters, and to all the Ex-Junkies--PEACE!

-DICK

* Endorphins 101: Your Guide to Natural Euphoria, Slotnick, MD David & Walke, Melissa. YourTotalHealth.ivillage.com

**Just Expectation Of A Mirthful Laughter Experience Boosts Endorphins. American Physiological Society session at Experimental Biology 2006, Lee S. Berk of Loma Linda University, 07 Apr 2006

Reputation Comments on this post:

	great useful information
	Nice post dick, hope for all of us
	thanks for sharing
	Good PAWS info i am gonna need.
	Very helpful and informative
	Incredible post! Would love to know this much detail about benzodiazepine withdrawal.
	thanks again for posting this
	His attention to detail requires being honest.
	This is amazing, great job
	This is such greAt info. TY.
	thank you so much. i thought PAWS was going to last forever. very helpful post
	great post! a section about ADs would be nice as well.. and just "more". maybe also supplements (fatty acids, ...
	Excellent pot. Tons of usefull info for the recovering addict!
	very helpful information for SWIM, currently experienceing PAWS
	thanks so much, swim really needs this right now
	Very important for so many to see this...thanks!
	what a wonderful topic and a good source of support for people who fear the worst.