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Post-Acute Withdrawal Syndrome (PAWS) in Opiate Rehab

When you get started in a program for opiate rehab, you can expect to undergo plenty of changes—both emotional and physical. Considering the huge change that you are making in your life, it should come as no surprise, but the onset of symptoms can be very unsettling if you’re unprepared. The whole range of symptoms related to addiction recovery is known as PAWS—Post-Acute Withdrawal Syndrome.

Most people in opiate addiction treatment experience symptoms for weeks or months, and in some cases for years. The Substance Abuse and Mental Health Services Administration (SAMHSA) tells us that people in opiate rehab will suffer symptoms from acute withdrawal, immediately after they stop using opiates, for a period of 4-10 days. If you were abusing methadone, your acute withdrawal period will last up to 21 days.

In acute withdrawal, you go through the symptoms that you’ve undoubtedly already experienced in trying to detox on your own or if you weren’t able to obtain a supply of heroin or pain pills. Those symptoms include nausea, muscle aches, chills, intestinal cramping or diarrhea, runny nose and eyes, shaking, and more. Most people cannot get beyond the symptoms and they use their drug of choice again before their body can complete detox. Fortunately, treatment in an approved methadone treatment or Suboxone program can ease those symptoms and make it possible to develop and sustain a recovery plan.

Your years of substance abuse wrought substantial changes to your body at the molecular level. Even your brain circuitry has become rewired. Even with successful treatment in a methadone program, your body will take time to stabilize from the long-term abuse.

Rebuilding Enjoyment Through Post-Acute Withdrawal Syndrome

Drugs obviously provided some level of enjoyment for you at one time or you wouldn’t have kept doing them. By the time most people go into rehab, however, they have reached a level of tolerance so that the drugs no longer provide enjoyment. It’s just a miserable struggle to find them every day and not overdose. There’s constant worry over the cost and getting the next high. So there’s no longer any fun in using drugs.

But there’s not much fun about going into opiate rehab, either. Now you have to become accustomed not only to a life without drugs but also to your body’s restabilization from the changes it underwent when you were taking drugs throughout the day.

One of the major changes has been a reduction in the natural production of the bio-chemicals that flood the brain following pleasurable experiences. Those biochemicals act as neurotransmitters that tell the brain you have had a pleasurable experience—that you’ve taken opiate drugs. Because the opiates were stimulating the release of those chemicals, your brain no longer needed to produce them on its own. Now that you’re in opiate rehab treatment, you are no longer taking the mass quantities of drugs as before, but your brain must learn all over again how to produce those neurotransmitters on its own.

The result of this chemical mishmash is that your brain forgets how to recognize that you’ve experienced fun without chemicals. If you’ve listened to some great music or enjoyed a wonderful meal without feeling a great deal of pleasure over it, you’ve developed a condition called anhedonia. It’s one of the most common of the post-acute withdrawal symptom in opiate rehab. But as you go through opiate rehab, your brain will slowly, gradually, re-learn the ability to produce those neurotransmitters on its own.

Other Post-Acute Withdrawal Syndrome Issues That Bother You

Your opiate rehab treatment team will assess your mental or emotional health to see if you are suffering from any co-occurring disorders. About half of the people who use drugs at any given time have a co-occurring disorder. Until you’ve been living a recovery lifestyle for a few weeks—and the illicit drugs are out of your system—it’s difficult to determine if mental or emotional highs and lows are related to substance abuse or to emotional health.

You can also expect substantial interruptions in your sleep pattern. Opioids are natural systemic depressants, and now that you are in recovery using managed medication therapy your body will develop new sleeping patterns. Some people experience dreams of using drugs as they go through the stages of recovery. Others simply report very vivid dreams.

Anxiety is reported by many people who are in opiate rehab treatment. You are anxious about not doing drugs. You are anxious you will do drugs. You are anxious about the relationships with the people you care about. Anxiety is normal, because your body and your lifestyle are undergoing major changes.

So-called brain fog is yet another among the common Post-Acute Withdrawal symptom. You may also have difficulty concentrating and making decisions. Doctors previously used one term to describe both the short-term memory problems that come with drug withdrawal and also the pathophysiologic symptoms of delirium. However, clouding of consciousness—or simply brain fog—now refers to the less serious but still worrisome mental confusion that comes when you are no longer getting high throughout the day. There actually is no conclusive test to confirm brain fog; it just depends upon your subjective observations and the doctor’s objective findings.

Impaired executive control means you may make unwise decisions at this time of your life. When you are not doing drugs, your impulsivity in other areas may increase. For some people, this means a greater risk of picking up another addiction—going to the racetrack and betting it all, or sleeping around promiscuously. For others, it affects their ability to put together the decisions necessary for their new lifestyle.

Now Some Reassurances

Not everybody will experience the same post-acute withdrawal symptom. Not everybody will experience them for the same length of time. So if you feel bothered by the symptoms described here, don’t panic, but do discuss them with your counselor and with the doctor who manages your opiate rehab treatment.

The counselor and the doctor will educate you about the symptoms that you may experience early on and help you anticipate other symptoms. Being forewarned is being forearmed, after all.

Your counselor will also help you to celebrate the natural highs in your life—and of course we are not referring to drug highs but to accomplishments, to the high marks of each day, the moments that bring you joy and encourage you to keep moving forward.

If you’re having problems with anxiety or sleeping, for example, the counselor can teach you some simple stress reduction techniques. Reading books on sobriety or practicing guided imagery techniques each and every day will do much to lighten your outlook on life.

Increasing your activity level will help your body rid itself of stress hormones. Activity will be part of your new healthy regimen, along with improved hygiene and better nutrition. Don’t be afraid of taking a look into yourself and sharing your thoughts and fears with your counselor. Diagnosing any co-occurring disorders that affect you, after all, is the first step in treating them.

You also must be patient. You did not get into trouble with opiate drugs overnight, and you won’t recover from them that quickly, either. It’s best to keep accessing the therapies that help you maintain recovery, including methadone treatment or a good Suboxone program, so that you can work on improvements in all areas of your life. If you haven’t yet reached out for help, it’s time to pick up the phone and make that call.

Post-Acute Withdrawal Syndrome

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