What Is PAWS?

PAWS, otherwise known as Post Acute Withdrawal Syndrome, is a real issue that few people realize is effecting them in recovery. 

Transcript

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Time again for Doc Jacques, Your Addiction Lifeguard Podcast. I am Dr. Jacques Debruckert, a psychologist, licensed professional counselor, and addiction specialist. If you are suffering from addiction, misery, trauma, whatever it is, I'm here to help. If you're in search of help to try to get your life back together, join me here at Doc Jacques, Your Addiction Lifeguard, The Addiction Recovery Podcast. to be real clear about what this podcast is intended for it is intended for entertainment and informational purposes but not considered help if you actually need real help and you're in need of help please seek that out if you're in dire need of help you can go to your nearest emergency room or you can check into a rehab center or call a counselor like me and talk about your problems and work through them but don't rely on a podcast to be that form of help it's not it's just a podcast it's for entertainment and information only so let's keep it in that light all right have a good time learn something and then get the real help that you need from a professional so Welcome, welcome, welcome to another edition of Doc Jacques, Your Addiction Lifeguard. I wanted to talk about and try to teach you about something that occurs in recovery that many people don't realize happens and the um at some point in their recovery and it's usually my experience is like in three six months and maybe as long as a year in you start to experience things that are really confusing to you um if you're in recovery and it doesn't matter if it's drugs or alcohol you know there are physiological or neurological issues that happen depending on the drug of choice and that affects you of course in your recovery as well not just your usage but there's a thing that occurs when people get into recovery that is literally it's very confusing because it's so subtle in in many ways and seemingly just um a people see it as their own failings or they're concerned because somehow they've done so much neurological damage to themselves in their recovery or in their usage that they are concerned that this is a long-lasting thing these these problems that they have and we refer to it as post acute withdrawal syndrome and the post acute withdrawal pause is a known thing and it happens it doesn't happen to everybody and it happened but when it does happen it happens in varying levels in varying ways people experience it in different ways it's not always exactly the same but there are types of symptoms that are included in this. Inability to think clearly, memory problems, emotional overreactions, or a feeling of just emotional numbness to things, your distant sleep disturbances, physical coordination problems, stress sensitivity. These are the things that can manifest in the stages of recovery, the earlier stages of recovery. It's not... to say that something couldn't have happened with your usage. You could have some long-lasting neurological damage caused depending on your drug of choice. And sometimes they don't go away. There's Wernicke's syndrome. There are things that vitamin B deficiency, for example, can cause all kinds of Alzheimer's-type problems. symptomology. And if you're an older person and you're getting into recovery for the first time and you're in your 60s or 70s, well, you might have the onset of Alzheimer's. And that can be mistaken at first, perhaps, as part of the post-acute withdrawal syndrome. However, the issues that can come up are disturbing to people. And if you're in recovery and you've had any experience with this or you are experiencing it, you know exactly what I'm talking about. It's depressing and upsetting. You're not as sharp as you used to be. You can't function as well. If you're an athletic person like myself and you've always been in good command of your body and maybe you start stumbling around your hand-eye coordination's off, your psychomotor control seems to not be functioning properly, it can be a real problem for people, and they get very upset about it. The emotional dysregulation is something that also can be part of that, and I'm not going to suggest that you shouldn't do a visit to a psychiatrist or a neurologist because you're just going to brush it off as part of the pause that goes on the post-acute thing. But if it is pause, and that's short for post-acute withdrawal syndrome, if it is pause, well, you need to know that. If it's not, you most certainly need to know that as well. So things like emotional dysregulation, that overreaction or that numbness, like you just don't feel anything, it can be something that you end up going to a psychiatrist about and saying, Hey, you know what? I'm depressed. I don't seem to, you know, you can't describe it accurately. So you just say you're depressed. Really what you're doing is you're just experiencing a numbness that goes with, um, with the pause or the overreaction. You seem very, um, agitated. You got that, that, uh, that Joe Biden, just excitable, you know, angry outburst thing that happens. He's got it because he's got, you know, age-related issues, but it can come across as that way. So people in recovery, they can be very dysregulated. Can you medicate that? Perhaps you can take a medication to help with the mood stabilization, but it would go away on its own over time as pause does. So memory problems, sensitivity to stress, physical coordination problems, all these things. What do you do about those things? So the recovery from damage caused by addiction needs to be addressed, and that needs to be addressed by cutting off that drug of choice. That's the first thing. The other thing is that you really need to get into some really heavily supervised, guided, therapeutic process i i believe that if you're working on recovery you need to be working with a therapist competent therapist who is trained in addiction and understands it and hopefully they are well versed in in trauma but you've got to abstain from your drug of choice that's the very first step and so having those issues of of those you know five or six things i named you don't have to have them all you can have one or two but i'll tell you something that's really interesting I have people that will come into my office and I work with them for three or four months. And then they start talking about how they just seem flat and they don't engage. Or they're easily agitated, quick to agitate. And perhaps they're stumbling around some. They don't... They're tripping over things easily or whatever. They'll tell me a few of those things and I say, do you know anything about pause? And they look at me like, what are you talking about? Like I need to stop doing what I'm doing? No, no, no, not P-A-U-S-E, P-A-W-S, pause, post-acute withdrawal syndrome. They have no idea what I'm talking about. So I start going through the list of things and you can see the aha moment as they're hearing it for the very first time. I'm like, really? Do you mean that's a thing? That's a real thing? So what's the cure? Time. Really? Time? Yes, time. And not using your drug of choice. That's a normal part of recovery. They are so relieved when they hear that kind of thing. When it's relieving to them that they're not actually damaged beyond repair because of their addiction. So Let's talk about each one of these things individually so we can understand them. So thinking clearly. It's not an intelligence thing, but thinking clearly. It's clouded thinking. I like to think of it as the experience that I can relate it to the most close. The thing I can relate to it most closely would be, for example, if you are not feeling well, you have a flu, right? And somebody comes in and they start talking about very detailed information about something. And you're just like, you've had a fever, you got a mild fever, you've had a flu for a few days. You're not receiving the information very well. And so you can't really process what they're saying. And if it requires calculations and understanding of things, and you're just not there, like you just can't quite get your processing part of it. And that's the thinking. It's one of the most common symptoms of pause. And it's an abstraction. It's thinking in the abstract, the non-concrete idea or concept in the abstract. They can't... kind of formulate things into solid information. So they just, it's like you, and if you think about it, when you have a flu and you've had a fever, not, not like 104, but you know, just like 101, 102, all you really want to do is just like lay there in bed and just stare at the television. And it's funny cause you're not really, you don't have to think a lot when you're watching TV. So they'll just stare at the television and they'll be watching some show, um, Perhaps it's something that they've seen before or it's familiar or it's just like a stupid sitcom. They don't really have to think. And if you think about it, when that happens, you're not really thinking, are you? You're just kind of laying there. Somebody can come in and say, hey, what are you watching? It's like, I'm watching Seinfeld. What's Seinfeld? What's that about? I don't know. I really wasn't paying attention. So you're just looking for your eyes to be sitting on something without having to process it. That's pretty common. That's kind of what pause is like when you're going through it in withdrawal. And the other side of that is the more rigid thinking, the repetitive thinking, just ruminating on things. And you just can't stop ruminating on it. And it could be something simple or it could be the relationship with your wife or your husband or it could be the fact that you wish you hadn't eaten what you ate for lunch. You wanted something else and you just can't stop thinking about it. And it's unnatural for you to do that in a normal situation. Like you're not that person. You're not the ruminator. So it's trying to put those order to thoughts. Memory problems. Memory problems would be more in the short term. Not the long term. It's not like during pause you're going to forget your child's name. It's not like some advanced Alzheimer's kind of situation. You've got plaque in your brain and it's causing neural dysfunction. It is more of the... I just, I can't, you know, I know, I know you, it's like, I remember one time my boss came in and talked to me and I was not feeling well. It wasn't pause, but I wasn't feeling well. Again, I had, had the, the flu and he came in and he was talking to me about something and I was just not tracking with him. And, and then he left and then he came back like an hour later and asked me if I had followed up on what he had talked to me about. And I honestly couldn't remember what he had talked to me about. It's a very strange feeling. And that's what happens in pause. You're not retaining this information. You forget it. And so you'll forget to get the milk that your wife told you to get on the way home because you're just so distracted and you don't really have an answer for why you're forgetting this stuff. And it's very frustrating. So the memory problems in recovery... can be a time when it's hard to engage in learning new things, new skills. So if you were to bracket your recovery in such a way that you could be successful in that recovery, maybe that's not the time to be learning new skills, advanced skills, things that you need to be able to retain the details of. So if you're in recovery, give yourself a break. And if you feel like that memory thing is happening, like you're not really there, maybe you could postpone those that you were going to take for three months. Take it the next semester. Learning some new skill at work, learning some new hobby you want to take something on because many of us in recovery, we kind of shut down. So we want to try to take on new things. Maybe you need to take a pause on that because you're not retaining what it is. So if you're trying to learn something to occupy your time, not necessarily the best time. The emotional overreaction and numbness issue. Overreaction. When I am working with a client and they are just very, very agitated at what we're talking about, what I'm trying to get them to talk about, or perhaps even my suggestions or things that I say to them, and they get very reactive, I expect it. I just note that it seems like there's some pause going on here. It's displaced. It's out of place. It's strange. It's odd that they're doing it. That's okay. Hopefully it doesn't rise to the occasion where they drop the F-bomb at me and storm out of my office, which has happened in the past. Perhaps they come back after a while because I've overreacted. And it's like, you don't need to apologize. This is part of the deal of recovery. And they're relieved and confused at the same time. But it's that overreaction. So they go from zero to 100 instantly and then back down to zero again. And they feel like they have literally just completely lost control. of their abilities to function when you haven't. It's just part of pause. Sleep problems. Sleep problems, very common. Different drugs have different effects on the sleep issue, disrupted sleep pattern. In, for the example of alcohol, it's not that uncommon for people to either massively oversleep or have a really hard time getting to sleep. Vivid dreams, hear that a lot of people in recovery. Vivid dreams when they weren't having dreams at all. It's not that they weren't having dreams, they were not remembering them, but having vivid dreams. For marijuana, your sleep disturbance, man, that could go on for a year as a withdrawal symptom, that post-acute withdrawal symptom issue. It takes a long time to get over the feelings that you have around sleep and you become almost paranoid about going to sleep after a while because you either have a hard time getting to sleep or you wake up at two or three in the morning and you're up for a couple hours and then you're trying to go back to sleep and then you fear going to sleep because you're failing in it so badly and you're tired and exhausted during the day. But that sleep, that episodic sleep thing, really, really bad. Coordination problems. Dizziness, trouble with balance, problems with coordination, hand-eye coordination, slow reflexes, the clumsiness, and being accident-prone. It depends on where you are in your life and what you're doing. If your job requires a lot of physicality, if you're a construction worker, a truck driver... forklift operator something where you are really required to use a lot of hand-eye coordination and psychomotor control and it's critical and you're using a piece of heavy equipment or you're around other people where you could cause injury again probably not the time for you to be engaging in in those activities if you can avoid it but if if you notice that you're having trouble even driving a car sometimes you're just not reacting well i ride motorcycles i have very large big powerful you know 1600 cc motorcycles um when i'm not coordinated that's dangerous right if you ride a motorcycle and you don't have good hand-eye coordination good reflexes uh towards things you can you can kill yourself And so there are times when you want to not be doing things and paying attention to it and realizing that, oh, this is pause. This is the thing that could be causing some real damage to either material things, the physical things around you, or people. Not worth it. But if you have pause and you understand, oh, this is part of pause. It's psychomotor control. I'm usually very coordinated. Maybe, you know, again, extending some grace to yourself to understand that perhaps maybe this is not the time to be doing those things. Stress sensitivity. Stress sensitivity. Difficulty managing stress. Let's see. How could that be playing out? Well, you're a mom and you've been drinking for the last six years. You've got now young children. And you're working on recovery and you've got a three-year-old or a three and a five-year-old or a three, a five and a 10-year-old. Wow, you're going to be challenged beyond belief with stress. And as a parent myself, I know what that stress is like. I had no idea when I didn't have children how bad it is, but it's pretty bad. Let's say that you have a high stress job. You're a fireman. You're a policeman. You are a broker, stockbroker, somebody who buys and sells stocks on a desk. And you've got multiple phones ringing all the time, and you're screaming and yelling, trying to buy and sell things. Or you've got, you know, it's 3 in the morning, and you're laying in the station house, and, you know, the alarm goes off, and you've got to jump on the truck. Very, very stressful. Very stressful. That's extreme stress, and so you're gonna get a quick reaction to that. Let's say that you had not extreme stress. Your life wasn't quite so stressful. You blow those stress situations up a lot, making a molehill into a mountain, and you have a real hard time dealing with that. So it's the overreaction to situations um that's one but the other one is reacting at all the situations that perhaps didn't bother you previously maybe you were very good with your children you were very calm and patient and attentive to them and you they they weren't you know unless it was extreme you were fine with the crying and the disobedience and the not following things and breaking things and you know them running away or just the constant go go go you were fine with it now you're four months into recovery, three months into recovery, and you're snapping at your children and you're just not able to tolerate the noise. It's that audio sensitivity and the noise and it really sets you off. So the relationship between elevated stress and the severity of pause is there. And if you think about it, if you knew that you had issues with pause and So that's stressful. And you've got something going on in your life that is stressful. So the stress about being stressed and then the incoming stress is going to be really, really, really difficult to deal with. One of my clients, he ended up taking a three-month sabbatical. from work. He reduced his pay down to almost nothing because he was really struggling with what he thought was severe depression after his recovery from alcohol. And so I think he came in to see me. He was probably two months into his recovery at that point and was chugging along pretty well. He'd gone to residential treatment for 45 days. He got out And then he was about two months after that, and he came into my office, and he just was... I said, well, what can I help you with? And he said, well, I'm just really... I feel disconnected and depressed. And I said, disconnected? What does that mean? What do you mean? And he said, well, I just kind of, like, I don't really... engage with what's going on around me now he he was an employee of a government agency so his he was a security guy so he had to be aware it's heightened awareness um was was part of his job and he just couldn't seem to do it and so he's like i don't know what's i don't know what's wrong with me i said have you seen a psychiatrist and he said yes and i said did he recommend medication he said well he gave me um well butrin because he thought if it was depression, this would be a good thing to treat the depression. But he also suggested I call you and start trying to work through whatever the issue was. And my next question was, well, did you tell him that you were in recovery? He said, yes. And I said, well, did he say anything else about the recovery process or where you were or what may be happening to you? He said, no, which I was not surprised by. But then I said, well, maybe pause. I was trying to trick him into seeing if the psychiatrist had used that term. He said, what's that? So I explained it to him, and I went through the symptoms, and I went through how they manifest, and he was presenting in my office with having seemingly depression, but actually given his years of alcohol usage and then his you know, two months into recovery, it was pretty clear that what was going on was post-acute withdrawal symptom. And I told him, I went through the list of things, and he was so relieved because he thought his sleep and his agitation and his loss of coordination and his numbness, which he kept describing as depression, He thought all that was just something that was, there was something wrong with him. Like he, he, you know, he's doing the guy thing. I should be able to get over this. I'm like, no, this is, this is part of your post-acute withdrawal symptom. He was so relieved. He didn't have to take on the responsibility of something that really wasn't a problem that he was either generating or was insurmountable for him to overcome. So I said, well, let's just stay with the recommendation of the wellbutrin for now and and let's start talking about your your stuff you know um i had a subsequent conversation with that psychiatrist who um i used the term pause and he knew what it was and i said well did did you consider that clinically that there may be something else did you ask him questions about the uh symptomology of of pause symptoms you know what what there could be and he said no and i said well did did you really understand that he was in recovery? Did you get that? And he said, you know, I, I didn't really consider that as being, I didn't connect them. I said, well, okay. So how long do you think you might want to keep them on Wellbuter? And he said, well, you know what, let's just, let's just stay with that for, you know, six months or something and see if it helps him through a pause. And I said, okay, well, that sounds, it sounds agreeable to me. And so we did. It's something that is so subtle, and that's the problem. It's subtle, but it's agitating. Each of those things combined, mix and match, or even one of those symptoms of pause can be just so subtle but agitating. And you feel like you've lost control. The other big issue, I think, for people in recovery is they feel like, well, I got into recovery, so I should be able to, I should be feeling better. I stopped the drug of choice. I've worked really long and hard on my recovery. I'm not drinking. I started, you know, I started working or I started, you know, engaging in my relationship more. I should be over this. And the only thing I could think was, well, you know what? you are getting over it. It just takes a little bit longer than you thought. And maybe there's some more things involved than you thought. So if you're thinking about recovery or you're in recovery and after, you know, if you're thinking about it and you start getting into recovery or if you're in recovery and you start experiencing those six things, you know, the depression, psychomotor control, the clumsiness, the agitation, The numbness, I think I said sleep issues already. The sleep issues and the emotional overreaction stuff and the memory problems. And you don't normally have those things. You didn't have those things in the past. Hey, perhaps what you've got is pause. And if you really would like to get more information about pause, pause, I would suggest that you do some research on it. There's plenty of things on the internet about it. They talk about it in Recovery. The publication is put out by Hazleton. There's a lot of information about PAWS out there. Look into it. Recovery is a very complicated thing. It's complex. It's involved. There's a lot to it. It's not as simple as just not drinking or not doing cocaine anymore. That's not what Recovery is about. Recovery is a lot of work to work on a lot of things and it takes... quite a long time to do it, a year and a half to two years, and then you'll get there. But be kind to yourself and be considerate and understand that maybe what you're doing is experiencing something that's a very common recovery symptom. Pause. Well, that's it for this episode of Doc Shock, Your Addiction Lifeguard. I hope you have enjoyed this episode and you have learned something. having an addiction is a killer, literally. If you are looking to get into recovery, please go to a rehab, go see a therapist, go see your psychiatrist, walk into the emergency room. But whatever you do, there is no point in you saving your addiction by ending your life. It's just not worth it. So get the help you need. If you need help from me, you can reach out to me through my website, wellspringmindbody.com. And as an addiction specialist, I will do my best to help you. So until the next episode of Doc Shock, your addiction lifeguard, I hope you have a good, clean, sober day. See ya.