This is a guest post by Todd Branston.
Having a difficult time staying sober and being able to help yourself?? Maybe it’s not you — maybe it’s brain chemistry.
You know the drill: you have spent countless hours in meetings, on the phone with your sponsor asking endless questions about your desire to use. You have worked the steps and you’ve even consulted specialists. In a moment of desperation, you found help by attending treatment.
You’re able to rack up six to twelve months, but eventually, you find yourself in the throes of your addiction. None of this seems to work. You find yourself questioning your commitment and ability to stay sober. Maybe your sponsor was right when he said you lack willingness.
Not so fast….
What you are likely experiencing is Post Acute Withdrawal Syndrome or PAWS.
PAWS consist of a set of impairments that occur immediately and at times simultaneously after the withdrawal from alcohol or other substances. These impairments affect three distinct areas of functioning and last six to eighteen months from the last use of alcohol or drugs as your brain tries to regain homeostasis.
Some of these impairments include cognitive problems like racing thoughts, rigidity, numbing of emotions, difficulty with abstract thinking and poor attention span, all of which are prevalent during this time. Emotional difficulties include shame and guilt, as well as difficulties with resentments. Depression is common during this time and may lead to relapse as the addict is generally not prepared to deal with the wealth of emotions they experience. The dearth of emotions can lead people close to the addict to believe they might have relapsed.
While some counselors and organizations support 100% abstinence as the only way to resolve addictive behaviors, this approach tends to come across as a ‘one size fits all’ solution to dealing with these impairments. While recovering from addictive behaviors it is remiss to not include an alternative approach without the mention of anti-craving medication as a treatment for PAWS.
Anti-craving medications may be appropriate for some individuals. The use of medication does not represent a weakness in one’s ability to recover from addictive behaviors. If anything, it should represent the idea that there is ‘another way’.
There are various medications that have been found to have efficacy in dealing with alcohol/drug cravings:
Prazosin is often prescribed to deal with PTSD and night terrors. It has been found to be successful among Opiate addicts and individuals using Cocaine and Methamphetamine.
Acamprosate is used to treat Alcohol cravings. In addition to its apparent ability to help patients refrain from drinking, evidence suggests that Acamprosate is neuroprotective. It has been shown that it can protect neurons from damage and death caused by the effects of alcohol withdrawal.
Naltrexone has been prescribed for Opiate cravings but is largely recommended as a treatment for alcohol abuse. It is also available in a monthly injectable form under the trade name of Vivitrol.
Baclofen and Topiramate have found therapeutic utility for Cocaine and Alcohol cravings.
While Methadone and Antabuse have found success in treating addictive disorders, they are not seen as anti-craving medications. Antabuse is a deterrent to drinking as it prevents the breakdown of alcohol. Some 5–10 minutes after alcohol intake, a person will experience the effects of a severe hangover for a period of 30 minutes up to several hours.
Methadone is a synthetic Opioid and has been used as part of an Opiate substitution regimen. The drug has found success in supporting long-term Heroin addicts to wean off the drug. In addition, Methadone has been used as a pain management protocol due to its long duration of action.
There is a fair amount of controversy around Methadone for Opiate substitution as the detractors point to the length of time a patient uses the drug, suggesting that addicts are essentially substituting one drug for the next. Conversely, The Addiction Recovery Institute points out the following benefits of Methadone Maintenance Treatment:
- Reduced or stopped use of injection drugs
- Reduced risk of overdose and of acquiring or transmitting diseases such as HIV, hepatitis B or C, bacterial infections, endocarditis, soft tissue infections, thrombophlebitis, tuberculosis, and STDs
- Reduced mortality – the median death rate of opiate-dependent individuals in MMT is 30 percent of the rate of those not in MMT
- Possible reduction in sexual risk behaviors, although evidence on this point is conflicting
- Reduced criminal activity
- Improved family, employment and pregnancy outcomes
It is important to reinforce the notion that an approach of 100% abstinence as a singular modality is not for everyone. Medications can provide additional support but they should not be seen as a complete solution. The goal of the medication should be to offset cravings and free up “emotional space” for the newly recovering person to add support in the form mutual aid groups, group or individual therapy, connection with a community of faith, exercise or involvement in an alcohol and drug treatment program.
Todd Branston has been working in the field of addictions for over 27 years, within the inpatient and outpatient settings, as well as working in the Department of Corrections, the Director of Counseling for a large chemical dependency hospital, to where he’s currently employed doing in-home chemical dependency engagement with (mostly) seniors.
He is part of an experts forum on chemical dependency and has a contract gig running the chemical dependency program for a long-term transitional program to support people to overcome homelessness. His sense is that sobriety is a skill and that recovery looks different for everybody. Feel free to check out his podcasts at askanaddictioncounselor.com.
This is a marvelous post on so many fronts — sharing the information about PAWS, the fact that there is no “one size fits all” when it comes to addiction treatment, and the descriptions of various drugs that can help with addiction cravings. Thank you Cathy and Todd!
Thanks so much for the nifty response. I’m glad the post resonated with you. My sense is that recovery looks different for everybody.
My success came through a 12-step program. I did have to hit my bottom and be willing. After that I was fortunate to have a great sponsor who knew the program (most don’t) and a spritual advisor. Their way of dealing with resentments worked for me. The resentments would come back sometime so I just worked the process again. It was a matter of letting go for me. I do know others who quit without a 12-step program and that is wonderful. It is what worked for me, however
I think that’s true. I am reminded of something I heard long ago: there is no one road to home, many paths lead there.
So many wholistic health people are against medication of any kind. I agree with you. I think a person needs to do what’s right for them, what works for them. Take off the judgment and get the help you need..
It is always strange to me that I would encounter rigidity amongst various practitioners, or that some people would consider medication as akin to relapse. It’s important to have a sense of comfort in your sobriety. I don’t know many people who wanted to be miserable when they got sober.
I am very happy to see PAWS getting so much more air time in the past couple of months than it has for years! What therapists and clients often fail to realize is the profound impact substance abuse has on the cellular, biological and neurological levels. The neurological side of ANY issue being addressed in treatment in general is much more in the forefront now than at any other time in the history of counseling. What I appreciate about this more than anything, is that it allows for the ability to take that much more control and responsibility of ones self in an effort toward sobriety/health/well being. PAWS is one very crucial part of that understanding. And I agree with Mr. Branston that the bias against medication is unfortunate. If I had my way, I would wave a magic wand over all the treatment providers, and anyone else with the negative medication bias, and remove that bias, as I believe more folks would be enjoying recovery otherwise. Thank you Todd Branston for your post!
Thanks for the response. I’m glad these meds exist. I think people need to be given a choice.
I have a cousin who may be experiencing this right now. It is very discouraging for his family. I will send this on to my aunt. People who decide to go through recovery are very brave!!
I’m glad this was helpful for you. I think the medications are important. My sense is that there are no rewards for suffering in sobriety.
Todd…
Thanks for such an informative post. I agree with you that there is ‘no one treatment that fits all’…like everything in life. It’s no different than dealing with cancer, or being overweight, etc.
I have read studies on how certain individuals are pre-wired with an addictive personality which makes it much more difficult for than to be weaned from an addiction. I would think that the type of recovery program they choose should be specifically in dealing with their pre-disposition. Fran
Fran,
I have always been a fan of treatment matching. It seems to me that we need to question the method and not the person. Thanks for your post.
I like the point that it cannot be a “one size fits all”. But of course! The idea is to find the solution that best fits a person’s profile, personality, habits, past and behavior. It will be great if the treatment can be drug-free but if medication is required to help break the addiction, leave the judgement out and use it!
Evelyn,
My sense is that recovery looks different for everybody. Thanks for your post.
Todd
Thanks Cathy and Todd. I did not know about PAW. I do know that when my father quite drinking, he started drink soda. I believe it had something to do with the sugar in it. Thanks again for more great info. So many people can can be help when they have the right information.
Blessings,
Debbie
Debbie,
My sense is that part of the addiction to alcohol is the addiction to sugar as alcohol is metabolized in part like sugar. I have known quite a few clients who drink soda after they quit drinking alcohol to deal with cravings.
Thanks for the post..
Todd