Post Acute Withdrawal (PAWs): Has anyone seen my sanity?

A few months ago, I was having a discussion with a family member of a newly sober spouse. She was having a hard time understanding why he was acting the way that he was. He was as miserable as when he was drinking and he was irritable, cranky, annoyed and depressed. "Nothing has changed..." was her comment to me. Well, some things have changed but she is kinda right, the mood and outlook on life don't change immediately. It's call Post Acute Withdrawal (PAWs) and it will make a person think that their drug of choice HAS to be a better alternative to living like this. I went through PAWs three times, I get it.

On a chemical, neurological level, the brain has been altered by the introduction of a substance. I will stick with alcohol because I know this one best. Most substances including alcohol work on the dopamine in the brain. This is the brain chemical that makes us happy! So, most substances increase the amount of dompaine available in the brain, giving a "high/euphoria" that a person has never felt before. Without the substance a person would never feel like this because the brain is not wired to create dopamine levels this high. The first high is always the best because it is a virgin unaltered brain. With every subsequent use of the drug, the brain is trying to get itself back into homeostasis (somewhere in the middle). I introduce alcohol, I start getting high but my brain has already started to decrease the normal amount of dopamine made trying to get back to center. Hence, I am not as "high" as I was last time. Ever heard the "chasing the high"? It's true. Very very true.

So, what happens when we stop using. Well, although the brain has an amazing ability to repair, it takes time. After the initial phase of acute withdrawal is complete, the PAWs will start to set in. The brain literally feels like it is dying now because the dopamine levels are so low. I was irritable, cranky, annoyed, depressed, listless. I even said to myself in to my first 60 days of sobriety the first time around "Holy crap, if I am going to feel this bad, I should just drink, at least I had something to cope with.....". PAWs lasted for about 12 months for me. I have heard figures as low as 6 months and as long as 18 months for the brain to stabilize itself again. I suppose it does matter how long the use has been going on and what drugs were being used.

The first year of sobriety is a mine field because of PAWs. The brain is trying it's hardest to ramp up the chemicals again, the addict brain just has total free reign and a person like me who enjoys the immediate gratification of getting high has to figure out something else to do. I relapsed a total of 6 times in my first 6 months of trying to be sober. I had learned about PAWs in my first treatment but didn't give it much attention because I was feeling pretty decent and I was also taking antidepressants. In reality, my antidepressants didn't give me the full effect until after a year. I think they functioned as a weak bridge until I got to a year.

At six months of continued sobriety, I started DBT. I was amazed when I started because I was the only one with substance abuse issues. Others in the group suffered from anxiety, depression, bipolar, personality disorders. I connected with the depression and the anxiety folks pretty quickly. I have that as well. However, it only took about 2 sessions before I identified with every illness in that room. I felt like I was crazy at time. I forgot stuff all the time. It took me longer to respond in normal conversations. I felt like I was in a daze. Nothing felt fun or of interest. I was really irritable and snapped at people a lot of the time. DBT was exactly what I needed at that point to start to deal with these behaviors. In my individual DBT sessions, we really worked through these symptoms in the context of PAWs. It's expected, but that is not a license to go out and be a big jerk until my brain has returned to its normal state.

If you ever hear people in early recovery talk about 90 in 90 (90 meetings in 90 days), part of that is really related to the PAWs symptoms going on. People have greater success of staying sober if they are fully engaged in meetings and connecting with a fellowship. When I started reading the research around success post treatment, the 90 in 90 along with engagement with treatment services for 18 months increased the likelihood of sobriety at 1 year, 2 year and 5 year. Our current insurance situation does not really allow this to happen except for the 90 in 90. I believe that MN is one of the most active AA areas in the nation if not the world. We have a HUGE fellowship in MN. In fact, I can't tell you how many people have met at AA meetings who have moved from other states to MN to try to remain sober. I am spoiled, the network is vast and encompassing.

I was very privileged to have stay engaged in counseling, DBT and other services because of my nursing license and monitoring requirements. I wish that everyone would have the opportunity to engage in any services that would help support recovery including sober living, DBT, individual therapy, trauma services, mental health services, intensive long-term treatment. I played the lottery last week and decided that if I had won (which I did not...booooo) I would love to set up scholarship funds at treatment centers to give long-term treatment and support to all kinds of people, especially families. Well, I will keep playing the lottery about every 3 months like I normally do and hope someday that I can set something like this up!

Anyway, PAWs is real and it is probably the hardest time in recovery. I know it was for me. Fortunately, I am well past this point and had the opportunity to get through it with a lot of support.

Hope everyone had a good Memorial Day weekend. Bless all those who have been, are and will be in the armed forces. Thank you for your service.

Peace out