The PAWS Phenomenon

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!

So, You Are New To Kratom?

The statements below have not been evaluated by the Food & Drug Administration (FDA).  Information regarding the use of kratom is provided for educational purposes only, it is not intended as medical advice to diagnose, treat or cure any illness.

So, what is kratom?

If you are a sufferer of chronic pain, anxiety, or addiction to opiates, you may have heard of Kratom through mention on various Facebook groups and message boards, or even in the news. Kratom (Mitragyna Speciosa) is a tree native to Southeast Asia and a member of the coffee family that has been used by generations of people as a natural pain reliever, anxiety reducer and mood lifter. Kratom is also used successfully to help with opiate withdrawal. When we talk about taking kratom, we are specifically talking about the leaves of the plant. These leaves are harvested and dried, and sold as either cut leaf (similar to an herbal tea) or as a ground powder. No matter what form you purchase it in, or how you consume it, kratom is often referred to as "tea" because of how it is traditionally served in its native countries.

Side Note:  Since this is a beginners guide, I am keeping the information here as basic as possible to get you started. There is a lot more information I could be sharing, but we will keep it as simple as humanly possible so as to not overwhelm anyone. This guide was originally a private message I wrote up for an 86 year old new kratom consumer who found much of the online information posted too confusing. She loved my watered down version, and begged me to share it with others. 4 years later, here we are. 

Getting started: 

The first thing you should know about Kratom is that vein color is important. Kratom leaves grow in 3 vein colors: red, white and green. Each vein color provides a different effect.

Red Vein:

Red is one of the most popular veins. Red vein has higher levels of  7-hydroxymitragynine, which is the pain-killing, sedation, and anxiety alleviating alkaloid.  This is also a great vein for people coming off of opiates and dealing with withdrawal issues.

Unlike the other two vein colors, red seems to be the best tolerated by users, while white and green effects vary widely among users. Because red is often a sedating vein, you will often hear users say "red for bed".  This does not mean that red will make you sleepy, however it is best to try red when you do not need to drive or operate heavy machinery before you know how it effects you. 

White Vein:

Also known as "white for flight", white vein is used for energy and as an anti-depressant. It can also help with mental clarity and focus.  White vein is not tolerated by everyone, sometimes causing a “jittery” feeling similar to coffee, especially if used with coffee.  While white vein does offer pain relief, it has the lowest levels of  7-hydroxymitragynine, the pain relieving alkaloid.

Green Vein:

There is a reason green vein is known as the “in between” vein.  People who don’t want the  sedating effects of red veins, or the stimulating effects of white veins, might find that a green vein is the best option for them. Green vein strains are  more moderate in their effects than other the other veins and can be a great compromise. Green vein is a great afternoon vein to get over the 3 o’clock slump without over-stimulating for evening.

Now that you understand what the "color" refers to when speaking about kratom, it's time to lean the next piece of the puzzle.

Strains:  

The simplest way to describe kratom strains is by saying that the kratom strain can be the location where it is farmed, where it is used, or the type of leaf it is. Examples of some popular strains include:

Malaysian (or Malay)

Indonesian (or Indo)

Bali

Thai

Borneo

Vietnam

Horned Leaf

Maeng Da (aka “Pimps grade” or the best of the best)

Kratom is often sold by vein and strain, so you will typically see "Red Bali" or "White Vietnam" listed. It is typically understood that Red Bali would refer to a red vein kratom leaf from Bali. 

Effects of different strains:

One thing new consumers often ask is what each of the different strains does, or what their effects are. There are several guides on the internet detailing this information. Personally, I don't like them! My reason is that my experience with a certain strain will likely be completely different from yours, as kratom tends to effect everyone differently. I have wasted a lot of money buying strains based on what these cute lists have to say about each strain. In most cased, my personal experience has been nothing like what was promised on the list. My best recommendation is to buy a sample pack of several of the more popular strains/veins and see what YOU prefer. 

How is kratom sold?

Kratom is most commonly sold in powder form. You can buy it by the gram or the ounce or even by the pound. Common amounts you will see are:

10 grams:  approx. 4.5 teaspoons (this is a common sample size)

30 grams: approx. 14 teaspoons (this is what you get in a typical sample pack).

120 grams: approx. 4 ounces

250 grams: approx. 8 ounces

Kratom is also sold by the 1/2 pound (8 ounces), pound (16 ounces), 1/2 kilo and kilo.

Ok, all this information is great, but where do I start?

The most important thing to know about kratom is that it is a very individualized experience. There is trial and error involved because what works for me might not work for you. Most users, when asked for advice, can really only give generalized information for that reason. With that being said, there are a few things that should help first time users.

1.  Stick with one vein at a time to start.  Most vendors sell sample packs, and those sample packs usually contain a 2-3 day supply of their most popular strains, one of each vein color. Sample packs are perfect because it gives you the opportunity to try all three veins for a reasonable cost. I have seen sample packs as cheap at $10.   A search of popular vendors will quickly introduce you to the terms “pure leaf” and  ”blends”. Pure leaf is exactly that, the pure leaf. It’s a single vein and strain. That is what you want to start with. Blends are when a vendor takes different veins or strains and combines them into a signature “blend” that they usually give a unique name to, and it will often become something they are known for. Blends are wonderful, but when you are brand new to kratom, you need to know how each vein effects you. Most people find that a white vein is energizing, but a few people find it incredibly sedating. Taking a vein color by itself helps you to know how your body best reacts to each vein;  which vein gives you the best pain relief, which vein makes you jittery , or which vein gives you the best mood lifting.  Once you know this basic information, you can then start mixing vein colors to get the desired results, or buy pre-made blends from your favorite vendor.

2.  With kratom, less is more. Let me repeat that….less is more.  Just because you have been on, for example, Oxycontin for years and have a high pain medication tolerance, does not mean you will need to take high doses of kratom. Often people find that when they take too much Kratom it opens them up to greater side effects. Because each persons dose is different, starting out small and gradually working your way to where you begin to feel "better" will yield the best results. While some consumers need very high doses, there have been plenty of people who have beat long time heroin or opiate addictions, or found complete pain relief, on just a teaspoon dose. Remember, you can always add more kratom if you didn't take enough, but you cannot take away kratom if you take too much.

3.  Join a good support group.  There are many good Facebook groups and forums that can provide information and support to a new Kratom user, and taking advantage of other people’s experiences can be so helpful. On Facebook you will find that some groups are vendor supported, meaning that they were created by a vendor of Kratom and hope to earn your business.  There are some great vendor groups, and they offer very good information.  You will know quickly which groups are vendor supported, and which are not.  There are many wonderful vendors out there who have great product, great prices host fun contests for free Kratom and have fantastic sales. If you have a question about a vendor, feel free to ask on the Facebook groups as anyone will gladly give you a recommendation. 

There are several groups that are not vendor supported. We highly recommend the American Kratom Association (AKA) that exists for the sole purpose of protecting our rights to use Kratom and promoting the safe use of this wonderful plant. The AKA runs off donations and because of its efforts Kratom has remained legal in many areas.  Work to protect Kratom is ongoing and your support is critical.  The AKA also sponsors a support group call The Kratom Consumer Advocacy and Support Group. 

So, I just got my Kratom. Now what?

There are several ways to take Kratom that are popular and often talked about. They include

1.  Capsules.  You can encapsulate Kratom in vegetable capsules. Empty capsules can be purchased online from Amazon, eBay, and through many vendors.

2.  Toss and Wash.  It is called toss and wash because you toss the Kratom in your mouth and wash it down with a liquid of your choice. This is a popular method, but care must be taken to not aspirate powder as you are swallowing.

3.  Mixing.  Mix Kratom with a liquid or soft food. Popular choices are orange juice, iced tea, water, applesauce, ice cream, pudding. Kratom can even be added to a morning smoothie.

4. Parachuting. Parachuting is where you take a small amount of Kratom and put it in a piece of one-ply toilet paper or tissue and swallow it like a pill. Another method is to put kratom in a piece of fruit roll up or rice paper.

5.  Tea. Many users make a tea out of their Kratom. To make a tea,

• add water to a cup or tea pot (1/4 to 3/4 of a cup)
• Add your Kratom dose
• Simmer for 15 – 45 minutes
• Optional: strain powder

If you are kind of lazy like I am, you can also add Kratom to ready-made, commercial teas for taste. Just open the tea bag, add your Kratom dose and steep per the package instructions. It works like a charm but without the mess and fuss.

Dosing

According to the Kratom Bible-A Complete Guide To Kratom, which is a wonderful and extensive source of Kratom information,

Average Dosage by Teaspoon*

• Mild – .5  to .9 tsp
• Moderate – 1 to 2 tsp
• High – 2 to 3.5 tsp

Average Dosage by Grams

• Mild – 1 to 2 grams
• Moderate – 2-4.5 grams
• High – 4.5 – 8 grams

*A good starting dose is 1/2 a teaspoon (tsp). Wait 30-40 minutes and if the desired effects aren’t reached, take 1/2 teaspoon (tsp) more. You can continue this protocol up to 2 teaspoons (tsp). At this point, stop and wait a few hours, then begin again. Some people need larger doses, and that is OK. Youi slowly increase your amount until you begin to get the effects you are looking for. Remember....if you get a good result from 1 teaspoon, stop there! Kratom does not work "better" if you add more than you need. You will either get sick from taking too much, or you will waste kratom by taking more than your body will effectively use.

It should be noted that due to varying potency between strains and plants, this estimate is in no way standardized, instead it's an estimate based on historical and experiential reports. Doses at the “high” end of the spectrum are also much more likely to cause side-effects, depending upon the strain, and is not recommended for a new user of Kratom. Remember, less is more.

A gentle reminder….

Issues with Kratom are unlikely with responsible use. By issues, I mean addiction. I am NOT talking about a physical dependence, which is completely normal when consuming something every day for long periods of time. You can experience physical dependence to anything. People can experience physical dependence to foods, supplements, and medications. It is nothing to be ashamed about, and it does NOT mean you are addicted to something. 

People who consume large quantities of kratom daily (above the specified guidelines stated above) or use extracts and resins (highly concentrated forms of Kratom) can find themselves experiencing withdrawal if stopping Kratom abruptly. Also, if you take more kratom than you need (like dosing more and more frequently or upping your dose constantly), you will experience some withdrawal. I also believe, from speaking to literally thousands of people, that people who consume kratom to help with withdrawal from other substances, seem to have a more difficult time abruptly stopping kratom. Withdrawal symptoms may include diarrhea, muscle aches, irritability, muscle spasm, and runny nose. 
Long term consumers do best to taper their kratom doses gradually over several days or weeks, similar to how someone might taper coffee, cigarettes, or many medications.

Mixing Kratom with other medications may cause interactions. Please do not take Kratom with other medications if at all possible. If taking Kratom with prescription medications, please keep a buffer of 2 hours between medications.

Again, it should be noted that the statements in this blog have not been evaluated by the Food & Drug Administration (FDA).
Information regarding the use of Kratom in Eastern medicine and by its native people is provided for education purposes only, it is not intended as medical advice.