Recovering addict still feels terrible

Dear Dr Roach: I’m in recovery from addiction to opioids, benzodiazepines and cocaine. 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. Oftentimes I feel worse now than I did when I was actively using drugs. It makes staying sober very hard, and I wonder why I bother most of the time since I feel terrible and my quality of life is poor. 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 appear to be physically healthy, yet I feel awful. From speaking to other addicts in recovery, I believe I have post-acute withdrawal syndrome, yet there seems to be very little knowledge or treatment for it. Do you have any additional insight you can offer me?

N.E.

Answer: Post-acute withdrawal syndrome is a controversial topic, with some doctors feeling it is just withdrawal, and some payers feeling that it’s a made-up syndrome designed by practitioners to keep people in treatment longer. Although there may be a small element of truth in both of these criticisms, I think that PAWS is a real phenomenon for a subset of people who have stopped abusing substances.

PAWS is more than just cravings. In PAWS, the symptoms are more like acute withdrawal symptoms, including dizziness, headaches, nausea and vomiting.

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.

I sense that you may feel your concerns are not taken seriously. The best advice is probably a mental health professional well-versed in substance abuse.

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