Disclaimer: I am not a medical doctor, and I do not give medical advice. The natural remedies and supplements that I discuss are based on personal experience and observations speaking with literally thousands of people, and helping many get clean from a multitude of substances, as well as conversations with various holistic health practitioners and herbalists. Always consult with your doctor or medical practitioner before beginning any new supplement or herb, as well as doing your own research. Additional note: If at all possible, please do not quit any substance "cold turkey". It is always preferable to seek medical attention and experience the acute phase of withdrawal under medical supervision whenever possible. This guide is specifically aimed at helping people who experience PAWS in the months and years following the acute withdrawal phase.
So, you did what you never thought you would be able to do. You quit drinking, got off the pills, or stopped snorting and shooting up. The first two weeks were miserable, but here it is a month later and you are finally starting to adjust to this new way of thinking and feeling. For the first time, you are clear headed and feeling hopeful for the future. You think to yourself, "I've really got this!"
But then it happens, one day you wake up and you feel a little...off. It's nothing you can really put a finger on, but you just don't feel good. You shrug it off and go about your day, but the next day you feel even worse. The new job that you love is really stressful. Your significant other is suddenly really annoying, and when you get in bed later that night, your mind is racing and you cannot get to sleep. Suddenly, you really, really want a drink (smoke, pill, hit...whatever) and you spend the rest of the night fantasizing about just one more...drink, pill, hit, line....and by morning you are exhausted, craving your drug of choice and feeling really, really defeated. What if I told you that what you are experiencing isn't your fault? What if I told you that what is happening to you is normal and not a sign that you are a failure or a hopeless cause?
According to one recovery article, Post-Acute Withdrawal Syndrome (PAWS) affects up to 90% of opioid addicts, and up to 75% of alcohol, benzodiazepine, or stimulant addicts. It can affect just about every person who gets clean from drug abuse at some point in their recovery. It is separate from the acute withdrawal phase of addiction and is marked by a decrease in physical symptoms, but an increase in emotional and psychological symptoms.
Symptoms of PAWS include
- Anxiety, panic, and fear
- irritability and mood swings
- depression
- fatigue
- insomnia
- loss of sex drive
- an inability to feel pleasure
- memory loss issues
- sensitivity to stress and stressors
Even though PAWS is not formally recognized by the medical community as a diagnosis, it is cited as the most common reason for relapse from someone newly in recovery.
PAWS can be avoided with some planning which includes a slow taper, easing acute withdrawal symptoms during the withdrawal process and receiving therapy or support, especially a structured support program.
One of the best ways to avoid PAWS is to not quit any substance cold turkey. For some substances like benzodiazepines or alcohol, a slow taper is really the only safe way to discontinue using, and preferably under medical supervision as withdrawal from those substances is quite dangerous.
If you find yourself experiencing PAWS, there are some things you can do to get through the worst of the symptoms. The very first thing is to recognize that you are not alone in this. The feelings you are experiencing do not make you a failure. Your body had to wean off the drugs or alcohol, and now PAWS is basically your brain going through withdrawal. As unpleasant as it can be, it is actually just another step in your recovery.
There are many supplements and herbal remedies that can help you during PAWS. The remedies address the different symptoms you will experience during PAWS. It is important to know that PAWS is cyclical in nature, so it can come and go, lasting a few days at a time. Depending on how severe your addiction was, PAWS can last up to a year or more. Knowledge is power, and knowing that this is what you are experiencing and having some strategies in place to handle the symptoms as they arise, can be the difference between staying sober and moving successfully through recovery, and relapse. Below is a list of my favorite supplements and herbs to help navigate PAWS. It is helpful to note that many of these will also help during acute withdrawal to manage the physical symptoms of withdrawal as they occur.
1. A good quality multi-vitamin.
No matter what your story is or what you were addicted to, addiction ravages the body, and the first thing it does is deplete your body of just about everything. Even if you were not an addict, and are having issues from weaning off your long-term antidepressant, your body will likely need basic nutritional support. This is called drug-induced nutrient depletion. It isn't just addicts that encounter this, in fact, cardiovascular and psychotropic drugs are some of the biggest culprits. Many people on long-term medications are walking around with various vitamin deficiencies and they don't even know it because doctors do not usually screen for vitamin and mineral deficiencies during routine blood work. I read that many drug side-effects are most likely the result of various vitamin deficiencies. That boggled my mind!
I truly believe that when it comes to supplements you get what you pay for. With that being said, if your finances do not allow you to get a top-of-the-line multi-vitamin, get what you can afford because something is better than nothing.
2. Omega 3
I won't get into a lot of the science because it really should be a post all on its own, but our brains run much better when we consume the right amounts of these fatty acids. Unfortunately, our diets often do not provide us with what we need. Omega 3's have antidepressant and anti-inflammatory properties, and many recommend Omega 3's to assist with withdrawal, especially withdrawal from antidepressants and alcohol. I have personal experience with antidepressant withdrawal, and taking Omega 3 was the only thing that helped me as I was severely limited as to what I could take (I was 8 weeks pregnant). Look for an Omega 3 that lists EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) on the label. Again, get the best quality you can afford. For easing withdrawal symptoms you will need to take several doses a day. I also urge you to continue taking omega 3 as part of your daily supplementation routine. It's just plain good for your brain and your body, and your brain will need it as it goes through PAWS. Afterward, when you have put PAWS behind you, it is an important building block for optimal health.
3. Magnesium
Magnesium is one of those nutrients that we don't get enough of. Most people are deficient in magnesium and never know it because blood tests for it are unreliable. Magnesium deficiency can cause a bunch of different issues both physical and mental. I even read a fascinating study that linked fibromyalgia with magnesium deficiency. Magnesium supplementation is also beneficial for easing PAWS symptoms.
There are many different types of magnesium on the market, and they do different things. Cheap magnesium isn't very bio-available and, in my humble opinion, a waste of time to take. From everything I have researched, the best forms of magnesium are the chelated forms of magnesium. I highly recommend magnesium malate, magnesium threonate, magnesium citrate, and magnesium glycinate. I personally take magnesium malate because that form has been linked to easing fibromyalgia symptoms, which I suffer from. There is a great article on the Swanson Vitamin Site about the different forms of magnesium, which types offer the best bio-availability, and what each one does. You can find it HERE.
4. L-Theanine
L-Theanine is a water soluble amino acid found mostly in green and black teas. L-theanine passes through the blood-brain barrier within 30 minutes and is used for the treatment of anxiety and stress relief. It also offers improved concentration and focus. L-theanine is one of those "must have" supplements, especially if you are prone to anxiety or feelings of stress. You will be much more sensitive to stress and anxiety as you move through acute withdrawal and PAWS, and L-theanine can help you better handle that anxiety by helping to create a more relaxed state.
5. Ashwagandha
Ashwagandha is an adaptogen (a natural substance that helps the body manage stress and maintain homeostasis) and one of the most important and powerful herbs in Ayurvedic medicine. Ashwagandha, also called winter cherry or Indian ginseng, has been used since ancient times for its restorative benefits. Over 200 studies have been done on Ashwagandha, so its benefits are well studied. Ashwagandha can help the body handle stress, fatigue, and low energy. It also has many mood benefits and can alleviate depression and anxiety. That sense of panic and dread often associated with anxiety can quickly derail someone new to recovery because they truly feel like their life is in danger. Ashwagandha can also help provide what I have seen called "calm energy", which can be beneficial if you suffer from anxiety, but are also experiencing fatigue.
6. NAC
N-Acetylcysteine (NAC)
comes from the amino acid, L-Cysteine. It has many medical uses, most notably
as a treatment for acetaminophen and carbon monoxide poisoning. It is also used
as a treatment for cystic fibrosis. Recently there has been a lot of interest
in NAC as a treatment for various mental health issues including Bipolar, PTSD,
Obsessive Compulsive Disorder, Substance Abuse Disorder and depression. A
recent study from the Medical University of South Carolina and the Ralph H.
Johnson VA Medical Center found that, along with therapy, the group treated
with NAC showed a significant improvement in symptoms of PTSD and Substance
abuse disorder over the group receiving therapy alone. The numbers were
significant, with a 46% reduction in symptoms, with an 81% decrease in craving
and a 79% decrease in the frequency of cravings compared to the placebo groups.
Because cravings play an important role in PAWS, NAC could provide the support
needed to fight them. NAC is also a powerful antioxidant that could play an
important role in preventing cancer.
7. Agmatine
Agmatine, discovered in 1910, is a metabolite of the amino acid l-arginine and occurs naturally within the body. There has been great interest recently in agmatine for it's use as a treatment for neuropathic pain, diabetes, depression, and addiction. Also, recent clinical trials suggest it has few adverse effects, even at high doses over a long period of time. Because it exhibits neuroprotective properties, agmatine has been touted as a supplement helpful for withdrawal symptoms. Although agmatine can be found naturally from plant and animal sources, not enough can be consumed naturally to produce a benefit. This supplement is interesting enough that it really deserves its own post.
8. Skullcap
Is a popular nervine that has been traditionally used as a calmative. It's calming nature and it's muscle relaxing action helps with anxiety, muscle tightness or spasm, and insomnia. It is used as a sedative during times of stress, and can be a useful tool in dealing with the stress put on the body during the withdrawal process, both during acute withdrawal, and during the PAWS cycle. It is especially known to be helpful during benzodiazepine, antidepressant, and alcohol withdrawal.
***Please note that benzodiazepine and alcohol withdrawal are extremely dangerous and the acute phase of withdrawal must be done under medical supervision. It is NOT recommended to try and get off benzodiazepines or alcohol on your own, especially if you have a history of extended use/abuse.
9. Kava
Kava is a tall shrub in the pepper family that grows in the islands of the South Pacific and has been used safely for millennia by the native people where it grows. Kava is often called "Nature's Xanax", but I personally hate that name and wish people would stop comparing natural plants and herbs to man-made pharmaceuticals in this way, but I digress. Kava is a pretty powerful anxiety reliever, but also reported to not dull your focus. It is often touted to improve sleep quality and ease muscle tension. Because of it's relative fast action, people report it helping with anxiety attacks, and can be a great help during PAWS, when anxiety tends to be one of their biggest complaints of people going through this part of new sobriety.
10. Kratom
Kratom is a tree in the coffee family that grows abundantly in Southeast Asia, and has been used safely by the people of those countries for ages. It can be extremely helpful for active withdrawal, but kratom's popularity as a mood enhancer and anti-anxiety and antidepressant is where it truly shines during PAWS. It is that well-known mood lift that can help ease the worst PAWS symptoms that can waylay someone on their path of sobriety. I have been told by recovering addicts that kratom was the only thing that kept them from either going back to their drug of choice, or giving up on life altogether. That is pretty powerful, and worth having in your tool box.
There are many other useful herbs and supplements that really deserve a mention here, and perhaps at some point they will be added, but for now these are my personal favorites/recommendations that I have gathered from research and speaking with literally thousands of people.
Don't give up or get discouraged if you are experiencing PAWS. By adding some of the supplements and herbs mentioned above, you can greatly alleviate some of the symptoms of PAWS and move your body along on it's journey to sobriety and wellness. You can do this! Remember that your survival rate this far is 100%, so keep going!
