Recovering addict suffers symptoms

Dear Dr Roach: I’m in recovery from addiction to opioids, benzodiazepines and cocaine, which I used for up to three years. I have been clean and sober for almost a year now, yet I continue to suffer from headaches, muscle aches, insomnia, excessive fatigue and worsening anxiety and depression. I’ve visited my family doctor several times and was told that I shouldn’t be suffering any symptoms of physical withdrawal anymore. The doctor prescribed Seroquel. I have had routine bloodwork done to rule out any other issues. I believe I have post-acute withdrawal syndrome, yet there seems to be very little knowledge or treatment for it. — N.E.

Congratulations on successfully being in recovery. I think that Post-acute withdrawal syndrome (PAWS) is a real phenomenon for a subset of people who have stopped abusing substances. In most reported cases, symptoms can go on for up to a year (occasionally more). The risk of PAWS seems to be increased in people who took larger doses; used for a long period of time; took the substance multiple times daily; or quit suddenly (“cold turkey”). Treatment for PAWS may include medications; however, because the syndrome is poorly defined, there hasn’t been much research on what drug treatment might be effective. Quetiapine (Seroquel) is a powerful antipsychotic drug that should not be used lightly. Commonsense approaches, such as regular moderate exercise, healthy nutrition and good sleep habits, can’t hurt, but they are not likely to solve any serious mental health problem by themselves. The best advice is probably a mental health professional well-versed in substance abuse. Sometimes, just some reassurance that the symptoms are due to prolonged withdrawal and that they eventually will go away can provide relief.