Managing Post Acute Withdrawal (PAW): Five Things You Can Do

January 16, 2014

By Terence T. Gorski, Author
January 16, 2014

images

Five Things You Can Do!

This is an Excerpt From The Book: Straight Talk About Addiction
By Terence T. Gorski
Get It From GORSKI BOOKS — Get It From AMAZON

Post Acute Withdrawal (PAW) can be a serious problem for nearly 90% of people in recovery from chemical addictions. There is hope. There are some simple recommendation that can help you manage PAW symptoms. In severe cases and when coexisting disorders, especially depression, are present, there are medications that can help. Don’t be too quick to start medications. The consistent use of five simple and straight forward steps can make a big difference in reducing the frequency and severity of PAW symptoms episodes. Here are the recommended steps in managing PAW:

1. Accurate Information: Explain PAW and have the person do a self-evaluation of PAW and review the results. This will give them words and ideas to explain what they are experiencing. It will also help people to stop feeling crazy, judging themselves for having the symptoms, and being anxious and afraid because they don’t know what is happening. Everything that needs to be covered in a comprehensive recovery education program on Post Acute Withdrawal is presented in the Comprehensive Guide to PAW.

2. Stress Management, Relaxation and Meditation: PAW is stress sensitive. This means the symptoms get more severe when experience high stress and less sever under low stress levels. Mindfulness Meditation has been shown to be especially effective. (See the Blog: Mindfulness Made Simple)

3. Proper Diet: Have an alcohol and drug free diet. Eat a high protein, complex carbohydrate meal plan. The closest diet plan is a hypoglycemic diet. Ask a nutritionist or look it up the internet. Avoid foods high in sugar and limit your caffeine intake. Supplement with multiple vitamins,Vitamin B-12, and broad spectrum amino acids. (Eating Right To Live Sober is a book on solid no-nonsense nutrition principles that have stood the test of time.)

4. Aerobic Exercise: Doing heart-measured aerobic exercise at least twenty minutes  per day, a minimum three-days per week in a heart-measured aerobic zone improves psychological well-being and overall health. To determine you aerobic training zone, subtract your age from 220. 80% of that number is you minimal training zone. 80% is the max). Too high or too low don’t seem to help much.

5. A Recovery Program: Have a regular schedule of recovery activities that put you in places and around people who support your recovery and where you can honestly talk about yourself without judgment. It is also important to having a sponsor/mentor and therapist trained as an addiction professional.

These practices seem to help stabilize brain chemistry, lower stress, and improve levels of self-esteem.

Don’t leave PAW management to chance.
Get a plan.
Work the plan.
If it doesn’t work, get additional help.

Please don’t spread the mistaken belief there is nothing that can be done to reduce the frequency and severity of PAW symptom episode. IT’S JUST IS NOT TRUE. The brain is plastic. It grows in response to experiences especially when stress in managed well during the experience.

THE MIND IS A POWERFUL THING — USE IT WISELY 

This is an Excerpt From The Book: Straight Talk About Addiction

By Terence T. Gorski
Get It From GORSKI BOOKS — Get It From AMAZON

 


The AWARE Questionnaire: For Monitoring Relapse Warning Signs

January 8, 2014

AWARE_RWS_LogoBy Terence T. Gorski, Author
January 6, 2014

The risk of relapse is an important factor in determining the type and level of care for addiction treatment. A useful tool called The AWARE Questionnaire has been developed been developed and is in its third revision based upon ongoing use (Miller et al 1996). This questionnaire provides an evidenced based approach for measuring the risk of relapse.

The AWARE Questionnaire (Advance WArning of RElapse) was designed as a measure of the warning signs of relapse, as described by Gorski (Gorski & Miller, 1982).

Gorski’s thirty-seven warning signs of relapse was originally developed as a result of clinical interviews with 117 patient conducted by Gorski.  The patients were chronic stage gamma alcoholics who had completed at least one 28-day residential rehabilitation program for alcoholism and subsequently entered treatment again for alcoholism.

The AWARE Questionnaire (Advance WArning of RElapse) was designed as a measure of the warning signs of relapse, as described by Gorski (Gorski & Miller, 1982). In a prospective study of relapse following outpatient treatment for alcohol abuse or dependence (Miller et al., 1996) the researchers found the AWARE score to be a good predictor of the occurrence of relapse (r = .42, p < .001). With subsequent analyses, the researchers refined the scale from its 37-item original version to the current 28-item scale (version 3.0) (Miller & Harris, 2000).

The items are arranged in the order of occurrence of warning signs, as hypothesized by Gorski. In our prospective study, however, we found no evidence that the warning signs actually occur in this order in real-time (Miller & Harris, 2000). Rather, the total score was the best predictor of impending relapse.

This is a self-report questionnaire that can be filled out by the client. Be sure that the client understands the 1-7 rating scale. When the client has finished, make sure that all items have been answered and none omitted.

Scoring is completed by adding up  the total the numbers circled for all items, but reversing the scoring for the following five items: 8, 14, 20, 24, 26. For these five items only. In other words, if the client circles this number: 1 2 3 4 5 6 7 Add this number to the total score: 7 6 5 4 3 2 1

INTERPRETATION: The higher the score, the more warning signs of relapse are being reported by the client. The range of scores is from 28 (lowest possible score) to 196 (highest possible score). The following table shows the probability of heavy drinking (not just a slip) during the next two months, based on our prospective study of relapse in the first year after treatment (Miller & Harris, 2000).

Probability of Heavy Drinking During the Next Two Months

AWARE
Score

If already drinking
in the prior 2 months

If abstinent during
the prior 2 months

28-55

37%

11%

56-69

62%

21%

70-83

72%

24%

84-97

82%

25%

98-111

86%

28%

112-125

77%

37%

126-168

90%

43%

169-196

>95%

53%

This instrument was developed through research funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA, contract ADM 281-91-0006). It is in the public domain, and may be used without specific permission provided that proper acknowledgment is given to its source. The appropriate citation is Miller & Harris (2000).

References

Gorski, T. F., & Miller, M. (1982). Counseling for relapse prevention. Independence, MO: Herald House – Independence Press.

Miller, W. R., & Harris, R. J. (2000). A simple scale of Gorski’s warning signs for relapse. Journal of Studies on Alcohol, 61, 759-765.

Miller, W. R., Westerberg, V. S., Harris, R. J., & Tonigan, J. S. (1996). What predicts relapse? Prospective testing of antecedent models. Addiction, 91 (Supplement), S155-S171.

AWARE Questionnaire 3.0

Please read the following statements and for each one circle a number, from 1 to 7, to indicate how much this has been true for you recently. Please circle one and only one number for every statement.

Never

Rarely

Some-
times

Fairly
often

Often

Almost
always

Always

1. I feel nervous or unsure of my ability to stay sober.

1

2

3

4

5

6

7

2. I have many problems in my life.

1

2

3

4

5

6

7

3. I tend to overreact or act impulsively.

1

2

3

4

5

6

7

4. I keep to myself and feel lonely.

1

2

3

4

5

6

7

5. I get too focused on one area of my life.

1

2

3

4

5

6

7

6. I feel blue, down, listless, or depressed.

1

2

3

4

5

6

7

7. I engage in wishful thinking.

1

2

3

4

5

6

7

8. The plans that I make succeed.

1

2

3

4

5

6

7

9. I have trouble concentrating and prefer to dream about
how things could be.

1

2

3

4

5

6

7

10. Things don’t work out well for me.

1

2

3

4

5

6

7

11. I feel confused.

1

2

3

4

5

6

7

12. I get irritated or annoyed with my friends.

1

2

3

4

5

6

7

13. I feel angry or frustrated.

1

2

3

4

5

6

7

14. I have good eating habits.

1

2

3

4

5

6

7

Never

Rarely

Some-
times

Fairly
often

Often

Almost
always

Always

15. I feel trapped and stuck, like there is no way out.

1

2

3

4

5

6

7

16. I have trouble sleeping.

1

2

3

4

5

6

7

17. I have long periods of serious depression.

1

2

3

4

5

6

7

18. I don’t really care what happens.

1

2

3

4

5

6

7

19. I feel like things are so bad that I might as well drink.

1

2

3

4

5

6

7

20. I am able to think clearly.

1

2

3

4

5

6

7

21. I feel sorry for myself.

1

2

3

4

5

6

7

22. I think about drinking.

1

2

3

4

5

6

7

23. I lie to other people.

1

2

3

4

5

6

7

24. I feel hopeful and confident.

1

2

3

4

5

6

7

25. I feel angry at the world in general.

1

2

3

4

5

6

7

26. I am doing things to stay sober.

1

2

3

4

5

6

7

27. I am afraid that I am losing my mind.

1

2

3

4

5

6

7

28. I am drinking out of control.

1

2

3

4

5

6

7

SCORING FOR THE AWARE 3.0

For these items, record the number circled

1. ___ 2. ___  3. ___ 4. ___ 5. ___ 6. ____7. ___ 9. ___ 10.__ 11.____ 12.___ 13.___ 15.___ 16.___ 17.___
18.___ 19.___ 21.___ 22.___ 23.___ 25.___ 27.__ 28.___

Subtotal #1: _________

For these 5 items,
reverse the scale
1 = 7; 2=6; 3=5; 4=4; 5=3; 6=2; 7=1;

8. ___ 14. ____ 20. ____ 24. ____ 26 .____

Subtotal #2: _________

Subtotal #1: ______ + Subtotal #2: ______ = AWARE Score:  ______


The Fog of Recovery

December 28, 2013
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The Deep Fog In Recovery

By Terence T. Gorski, Author
December 28, 2013

When a deep fog covers the land, it is good to walk carefully. When it invades the mind, we cannot trust even ourselves. In those times we need to reach out for help and accept the guidance from trusted friends and professionals.

The fog burns off under the bright sun of a sober and responsible life. We need to stay out in the light as we recover and avoid the shadows and dark places.

It also helps to eat healthy meals (low sugar, low-fat, complex carbs), supplement with B-complex vitamins and amino acid, meditate, and develop more effective life management skills.

When in a fog you need the help of others who know the way out. They can guide you to the bridge and the city beyond. No one can walk the path for you. You have to make the journey on your own two feet, taking one step at a time. You need to be willing to develop a lifeline of sober and responsible people who have traveled this path before and be willing to follow their lead.

The fog is caused by Post Acute Withdrawal (PAW), which results the long-term of after effects of brain dysfunction caused by active addiction. Post mean after, in this case, after acute withdrawal. A syndrome is a collection of symptoms. So post acute withdrawal is a collection of predictable symptoms that occur in addicted people after acute withdrawal subsides.

PAW can last three months or longer. The symptoms include difficulty in:
– Thinking clearly,
– Managing feelings and emotions,
– Remembering things,
– Sleeping restfully, and
– Problems with balance and physical coordination.

The symptoms are stress sensitive. This mean problems get more severe when under high stress.

A complete guide to Managing Post Acute Withdrawal (PAW), which is the major source of fog in the addict’s mind, is available in Terry Gorski’s Blog.
http://wp.me/p11fHz-eo

It is also explained in the Books
Staying Sober – A Guide for Relapse Prevention  and
Straight Talk About Addiction

LIVE SOBER – BE RESPONSIBLE – LIVE FREE

GORSKI BOOKSGORSKI TRAINING/CONSULTATION


Post Acute Withdrawal: Survey Confirms PAW

December 23, 2013

PAWS affects 91% of addicts

The first-ever survey on Post Acute Withdrawal Syndrome polled more than 1200 drug addicts and alcoholics and resulted in some fascinating and troubling statistics.  For instance, nearly 91% of addicts will suffer from the condition, but just more than 1 in ten will actually get help or treatment for it.  In reality, most addicts have probably never heard of the condition and organizers of the 2013 Post Acute Withdrawal Survey hope to change that.

The following press release was published in PRWeb on 09/10/2013 describing the survey and its results in detail:

Survey Showing 91% of Addicts Face Post Acute Withdrawal Published by Recovery First, Inc.

In the first survey on Post Acute Withdrawal Syndrome, results indicate that 9 out of 10 addicts suffer from the condition responsible for most cases of drug or alcohol relapse, but only 13% of addicts receive PAWS-focused treatment.

Ft. Lauderdale, FL (PRWEB) September 10, 2013

Despite widespread recognition as the leading cause of relapse among recovering addicts and alcoholics, few addiction treatment centers address Post Acute Withdrawal Syndrome. But in a large survey conducted by the nation’s leading expert on PAWS, the results indicate that this lack of focus could be largely responsible for the revolving door nature of most drug rehab centers.

James F. Davis, CAS, is a Board Certified Interventionist and an authority on Post Acute Withdrawal. He’s also the founder of a large drug treatment center in South Florida. When he learned that his treatment center was one of just a handful in the country that treats Post Acute Withdrawal Syndrome, he set out to do something about it.

Davis founded the website PostAcuteWithdrawal.org and spent 6 months polling recovering drug addicts and alcoholics in the first-ever survey to collect information about PAWS.

Now Davis says the survey indicates that the drug addiction treatment industry needs to undergo a transformation.

“What we found is that very few treatment centers address Post Acute Withdrawal, and those that do approach the condition rather cursorily. As a consequence many addicts leave rehab sober but quickly relapse when their PAWS symptoms go untreated.”

Davis went on to explain that PAWS is the most critical and persistent problem facing people in recovery.

According to the Wikipedia entry for the condition, Post Acute Withdrawal Syndrome;

“The syndrome may be in part due to persisting physiological adaptations in the central nervous system manifested in the form of continuing but slowly reversible tolerance, disturbances in neurotransmitters and resultant hyper excitability of neuronal pathways.”

But Davis claims that there’s a lot more to this relapse-causing condition than neuronal disturbances alone:

“PAWS is caused by changes in neurons as a result of prolonged substance abuse, but this is just one piece of the puzzle. Other forces are at work, including the backfiring of evolutionary survival mechanisms and a powerful conditioned response similar to that experienced in the case of Pavlov’s drooling dogs.”

Davis is in the process of publishing a book which explains his theories on PAWS in expansive detail. The book is based in part on the survey results, which shows that of the 91% of recovering addicts afflicted with the condition, more than 25% will experience symptoms lasting longer than 2 years.

Other key findings in the Post Acute Withdrawal Survey include:

  • *71% of survey respondents believe that PAWS has led to one or more drug/alcohol relapses
  • *AA & NA Meetings are the favored method of treatment for symptoms related to PAWS
  • *Most respondents do not treat symptoms with medication
  • *Most physicians are not familiar with PAWS
  • *”Stress” and “Emotional Symptoms” were chosen by nearly half of all respondents as the primary symptom types leading to relapse
  • *61% of those polled had attended an inpatient drug treatment program, with 34% of those failing or quitting the treatment early
  • *28% of respondents have relapsed 3-6 times, with another 20% relapsing more than 10 times

At Davis’ clinic in South Florida, Post Acute Withdrawal is a primary focus of treatment. Recovery First, Inc. was founded by Davis more than a decade ago, and in that time he’s helped thousands of addicts and alcoholics achieve sobriety. By addressing the condition on a national level, Davis hopes to bring awareness to both the medical community and the general public.

“Many people still view addiction as a matter or poor morals, weak will power or some other character defect. But the fact of the matter is that this is a progressive neurological disease that if left untreated invariably leads to death. Many of these deaths occur during a relapse episode caused by PAWS. This means that understanding this inactive state of addiction is critical in order to save lives, and that’s where the survey comes in. By distributing these troubling results, we hope to transform the way we treat addicts.  The traditional focus has been to get addicts clean and get them out the door and into some support [networks], but this method does not address the fact that people in recovery will experience severe withdrawal-like symptoms for months after rehab. Without a plan to identify and manage PAWS symptoms, relapse is highly likely for people in the early stages of recovery.”

According to an astonishing number of forums, chats, blog posts, articles and recovery communities, the symptoms of PAWS include cognitive impairment, balance and coordination problems, wild emotional disturbances, sexual dysfunction, communication and socialization impairment and a wide range of physical ailments like headaches and sleep disturbances.

However, the primary symptom that most people in recovery report is a profound, often uncontrollable urge to use drugs or drink again despite devastating consequences.

Preventing relapse is the singular focus at Recovery First, Inc. – the leading sponsor and driving force behind the 2013 PAWS Survey. Interestingly, when James F. Davis, CEO speaks about addiction, recovery and relapse, he isn’t just speaking from a professional standpoint. 32 years ago he was severely addicted to cocaine and had been nursing a lifelong problem with alcoholism that almost killed him. Now he says his mission is to ensure that other addicts don’t travel a similar path.

Eric Oakes, LCSW and chief clinician at Recovery First, agrees that treatment of Post Acute Withdrawal is the most effective method of helping addicts avoid a relapse that could lead to imprisonment, illness or death;

“It’s not over when an addict or alcoholic leaves rehab, and this is where most treatment centers fail. According to the PAWS survey, the majority of people in recovery experience the most debilitating symptoms with the most likely propensity to relapse within 6 months or less of completing a rehab program. If we don’t prepare them for this, we have failed them as treatment providers.”

The Post Acute Withdrawal survey is a 20-question survey that polled 1,246 addicts and alcoholics over the course of more than 6 months. The entire survey including raw data, formal results and graphic representations can be found on the following URL: http://www.postacutewithdrawal.org/post-acute-withdrawal-survey/. Davis, Recovery First, Inc. and PostAcuteWithdrawal.org have given public permission for all survey results and data to be republished or used for any purpose with proper attribution.

Plans to broaden the survey with questions related to specific drugs of abuse and how those symptoms might compare with other substances are in development. An updated version of the PAWS survey will be available in early October 2013.

This press release has been republished from PRWeb: http://www.prweb.com/releases/2013/9/prweb11099624.htm


Post Acute Withdrawal (PAW): A Comprehensive Guide

December 23, 2013

p-a-wBy: Terence T. Gorski, Author

Excerpted From Staying Sober – A Guide for Relapse Prevention and
Straight Talk About Addiction   

When most people think about alcoholism or drug addiction they think only of the alcohol/drug-based symptoms and forget about the sobriety-based symptoms. Yet it is the sobriety-based symptoms, especially post acute withdrawal, that make sobriety so difficult. The presence of brain dysfunction has been documented in 75-95% of the recovering alcoholics/addicts tested. Recent research indicates that the symptoms of post-acute withdrawal associated with alcohol/drug-related damage to the brain may contribute to many cases of relapse.

Post-acute withdrawal means symptoms that occur after acute withdrawal. 

  • Post means after. 
  • Acute means immediate or severe; short-term
  • Post Acute Withdrawal: Symptoms that occur after acute withdrawal.

Post-acute withdrawal is a group of symptoms of addictive disease that occur as a result of abstinence from addictive chemicals. In the alcoholic/addict these symptoms appear seven to fourteen days into abstinence, after stabilization from the acute withdrawal.

Post-acute withdrawal is a bio-psycho-social syndrome. It results from the combination of damage to the nervous system caused by alcohol or drugs and the psychosocial stress of coping with life without drugs or alcohol.

Recovery causes a great deal of stress. Many chemically dependent people never learn to manage stress without alcohol and drug use. The stress aggravates the brain dysfunction and makes the symptoms worse. The severity of PAW depends upon two things: the severity of the brain dysfunction caused by the addiction and the amount of psychosocial stress experienced in recovery.

The symptoms of PAW typically grow to peak intensity over three to six months after abstinence begins. The damage is usually reversible, meaning the major symptoms go away in time if proper treatment is received. So there is no need to fear. With proper treatment and effective sober living, it is possible to learn to live normally in spite of the impairments. But the adjustment does not occur rapidly. Recovery from the nervous system damage usually required from six to 24 months with the assistance of a healthy recovery program. Recent research is showing that for some recovering people the symptoms of PAW often occur at regular “moon cycle” intervals and without apparent outside stressors. Often those 30, 60, 90, 120, 180, and 1 & 2-year sobriety dates seem to be “triggering” times for PAW symptoms to increase. People recovering from long term opiate and stimulant use often have PAW symptoms for no apparent reason for up to 10 years after they have stopped using their drug of choice. Often PAW symptoms appear to come and go without apparent reason and without any specific pattern. Individuals who intend to have consistent long-term recovery must learn to recognize these symptoms and learn how to manage them.

 SYMPTOMS OF POST ACUTE WITHDRAWAL

Excerpted From
Staying Sober – A Guide for Relapse Prevention and
Straight Talk About Addiction

How do you know if you have PAW? The most identifiable characteristic is the inability to solve usually simple problems. There are six major types of PAW symptoms that contribute to this They are the inability to think clearly, memory problems, emotional overreactions and numbness, sleep disturbances, physical coordination problems, and general problems in managing stress. The inability to solve usually simple problems because of any or all of these symptoms leads to diminished self-esteem. A person often feels incompetent, embarrassed, and “not okay” about themselves. Diminished self-esteem and the fear of failure interfere with productive and challenging living. Let’s take a look at some of the PAW symptoms that contribute to the inability to solve usually simple problems.

TYPES OF PAW SYMPTOMS

images1.   Inability to think clearly
2.   Memory problems
3.   Emotional overreactions or numbness
4.   Sleep disturbances
5.   Physical coordination problems
6.   Stress sensitivity

Inability to Think Clearly

There are several thought disorders experienced by a recovering person when PAW is activated. Intelligence is not affected. It is as if the brain is malfunctioning sometimes. Sometimes it works all right. Sometimes is does not.

One of the most common symptoms is the inability to concentratefor more than a few minutes. Impairment of abstract reasoning is another common symptom of post acute withdrawal. An abstraction is an idea or concept that is not concrete, something that you cannot hold in your hand, take a picture of, or put in a box. Concentration is more of a problem when abstract concepts are involved.

Another common symptom is rigid and repetitive thinking. The same thoughts may go around and around in your head and you are unable to break through this circular thinking in order to put thoughts together in an orderly way.

Memory Problems

Short-term memory problems are very common in the recovering person. You may hear something and understand it, but within 20 minutes you forget it. Someone will give an instruction and you know exactly what to do. But you may walk away, and that memory becomes clouded or may disappear completely.

Sometimes during stressful periods it may also be difficult to remember significant events from the past. These memories are not gone; the person may be able to remember them easily at other times. The person realizes that he or she knows but just cannot recall it while experiencing the stress.

For an alcoholic named Jan this created a problem in AA. “I have trouble presenting my story at AA,” she said. “I have trouble remembering events that happened before my drinking days, let alone things that happened while I was drinking. So to put my life in story form is hard for me. I don’t remember all of my story. I do remember that some things occurred, but I get confused about when they happened. Many times I can remember things when I am alone with no pressure that I can’t remember under the stress I feel when I talk at meetings.”

Because of memory problems in recovery, it may be difficult to learn new skills and information. You learn skills by acquiring knowledge and building upon what you have already learned. Memory problems make it difficult to build upon what you have already learned.

Emotional Overreaction or Numbness

Persons with emotional problems in sobriety tend to overreact. When things happen that require two units of emotional reaction, they react with ten. It is like holding the “times” key down on a calculator. You may find yourself becoming angry over what may later seem a trivial matter. You may feel more anxious or excited than you have reason to be. When this overreaction puts more stress on the nervous systems than it can handle, there is an emotional shutdown. If this happens to you, you become emotionally numb, unable to feel anything. And even when you know you should feel something, you do not. You may swing from one mood to another without knowing why.

Sleep Problems

Most recovering people experience sleep problems. Some of them are temporary; some are lifelong. The most common in early recovery is unusual or disturbing dreams. These dreams may interfere with your ability to get the sleep you need. But they become less frequent and less severe as the length of abstinence increases.

Mike was a periodic drinker. Periods of sobriety usually lasted for several months. During the time he was not drinking, he had dreams that severely disrupted his sleep. His wife said, “I never realized the nightmares Mike was having had anything to do with drinking or not drinking. He would frequently jump out of bed, screaming in terror. When I was able to awaken him and calm him, he couldn’t remember what he dreamed, but he remembered being afraid. After a year of sobriety, he seldom had the dreams. Only then did I realize that they were related to his drinking.

Even if you do not experience unusual dreams, you may have difficulty falling asleep or staying asleep. You may experience changes in your sleep patterns; sleeping for long periods at a time or sleeping at different times of the day. Some of these patterns may never return to “normal,” but most people are able to adjust to them without severe difficulty.

Physical Coordination Problems

A very serious PAW problem – though perhaps not as common as the others – is difficulty with physical coordination. Common symptoms are dizziness, trouble with balance, problems with coordination between hand and eye, and slow reflexes. These result in clumsiness and accident proneness. This is how the term “dry drunk” came into being. When alcoholics appeared drunk because of stumbling and clumsiness, but had not been drinking, they were said to be “dry drunk.” They had the appearance of being intoxicated without drinking.

Stress Sensitivity

Difficulty in managing stress is the most confusing and aggravating part of post acute withdrawal. Recovering people are often unable to distinguish between low-stress situations and high-stress situations. They may not recognize low levels of stress, and then overreact when they become aware of the stress they are experiencing. They may feel stressful in situations that ordinarily would not bother them, and in addition, when they react they overreact. They may do things that are completely inappropriate for the situation. So much so that later on they may wonder why they reacted so strongly.

To complicate things further, all of the other symptoms of post acute withdrawal become worse during times of high stress. There is a direct relationship between elevated stress and the severity of PAW. Each intensifies the other. The intensity of PAW creates stress, and stress aggravates PAW and makes it more severe. At times of low stress, the symptoms get better and may even go away. When you are well rested and relaxed, eating properly, and getting along well with people, you will probably appear to be fine. Your thoughts will be clear, your emotions appropriate, and your memory all right. At times of high stress, however, your brain may suddenly shut down. You may begin experiencing thinking problems, inappropriate emotions, and memory problems.

If your thoughts become confused and chaotic or you are unable to concentrate, if you have trouble remembering or solving problems, you may feel you are going crazy. You are not. These symptoms are a normal part of your recovery and are reversible with abstinence and a recovery program. If you do not understand this you may develop shame and guilt which leads to diminished self-esteem and isolation which creates stress and increased PAW. It is a painful cycle that is unnecessary if you understand what is happening. As your body and your mind begin to heal and as you learn ways to reduce the risk of post acute withdrawal symptoms, productive and meaningful living is possible in spite of the very real possibility of recurring symptoms.

Recovery from the damage caused by the addiction requires abstinence. The damage itself interferes with the ability to abstain. This is the paradox of recovery. Use of alcohol or other drugs can temporarily reverse the symptoms of the damage. If alcoholics drink, or drug addicts use, they will think clearly for a little while, be able to have normal feelings and emotions for a little while, feel healthy for a little while. Unfortunately, the disease will eventually trigger a loss of control that will again destroy these functions.

For this reason it is necessary to do everything possible to reduce the symptoms of PAW. It is necessary to understand PAW and to recognize that you are not incompetent and you are not going crazy. Because post acute withdrawal symptoms are stress sensitive, you need to learn about PAW and methods of control when stress levels are low in order to be able to prevent the symptoms or to manage them when they occur.

Here are some stories about some people who experienced post acute withdrawal and how it affected their lives without their being aware of what was happening to them.

Ray is a young, single, recovering alcoholic. He stopped drinking when he was 22 and was very excited about the possibilities that lay ahead of him in his sobriety. After his initial treatment he began restructuring his life around recovery. He was eager to make up for the time he had wasted during his years of drinking. He got a full-time job, enrolled in college, and committed himself to doing some volunteer work.

After a while he began to notice that he was having trouble with his schoolwork. He found himself confused about things that had at one time been easy for him to follow and figure out. He was having trouble taking care of his financial responsibilities, and when people who cared about him tried to help him figure things out, he felt panicky and overwhelmed. Thoughts rushed through his head, and he was unable to put them in order. He says, “When someone in the financial aid office at the college started talking to me about grant money, loan money, interest, and forms that needed to be filled out, I was so confused and overwhelmed that I couldn’t hear what she was saying. Everything was going around in my head at once and I had to get away. I got up and left without filling out the financial aid form.”

In desperation, and out of fear that he would drink, Ray “ran.” Instead of evaluating what things in his life he needed to change and what he needed to hold onto, he gave up everything. He quit his job, dropped out of school, and stopped doing volunteer work. He gave up his apartment and moved in with a relative until he could “get himself together.” These actions created additional problems with which he found it increasingly difficult to cope. Until he went to a counselor and learned some ways to manage his symptoms, Ray thought he was having a nervous breakdown, when in fact what he was experiencing was PAW.

PATTERNS OF POST ACUTE WITHDRAWAL

Excerpted From
Staying Sober – A Guide for Relapse Prevention and
Straight Talk About Addiction

Post-acute withdrawal symptoms are not the same in everyone. They vary in how severe they are, how often they occur, and how long they last. Some people experience certain symptoms; some people have other symptoms; some people have none at all.

Over a period of time PAW may get better, it may get worse it may stay the same, or it may come and go. If it gets better with time we call it regenerative. If it gets worse we call it degenerative. If it stays the same we call it stable. And if it comes and goes we call itintermittent.

Regenerative PAW gradually improves over time. The longer a person is sober the less severe the symptoms become. It is easier for people with regenerative PAW to recover because the brain rapidly returns to normal.

Degenerative PAW is the opposite. The symptoms get worse the longer a person is sober. This may happen even when a person is going to AA/NA and/or following some type of recovery program. People with degenerative PAW tend to become relapse prone. Sobriety becomes so painful that they feel they must self-medicate the pain with alcohol or drugs, collapse physically or emotionally, or commit suicide to end the pain.

A person with stable PAW experiences the same level of symptoms for a long period of time into recovery. There may be days when the symptoms are a little better or a little worse, but essentially the symptoms remain unchanged. Most recovering people find this very frustrating because they believe that they should be feeling better the longer they are sober. With sufficient sober time many people learn to manage these symptoms.

With intermittent PAW the symptoms come and go. Initially people with intermittent symptoms will appear to experience a regenerative pattern. In other words, their symptoms rapidly get better. But them they begin to experience periodic PAW episodes that can be quite severe. For some people the episodes get shorter, less severe, and farther apart until they stop altogether. In others they occur periodically throughout life.

These patterns describe people who have not had treatment for PAW and who do not know how to manage or prevent the symptoms. Traditional treatment does not address these symptoms because until recently they were unrecognized. If you know what to do and you are willing to do it, degenerative PAW can be changed into stable, stable into regenerative, and regenerative into intermittent PAW.

The most common pattern of PAW is regenerative and over time it becomes intermittent. It gradually gets better until the symptoms disappear and then it comes and goes. The first step is to bring PAW symptoms into remission. This means bringing them under control so that you are not experiencing them at the present time. Then the goal is to reduce how often they occur, how long the episode lasts, and how bad the symptoms are. You must remember that even when you are not experiencing them there is always the tendency for them to recur. It is necessary to build a resistance against them – an insurance policy that lowers your risk.

MANAGING PAW SYMPTOMS

The less you do to strengthen yourself against an episode of post-acute withdrawal, the weaker your resistance becomes. It is like a tetanus shot. The longer it has been since you have had one, the more risk there is that you will become seriously ill if you cut yourself on a piece of rusty metal. Conditions that put you in high risk of experiencing post acute withdrawal symptoms are usually lack of care of yourself and lack of attention to your recovery program. If you are going to recover without relapse you need to be aware of stressful situations in your life that can increase your risk of experiencing PAW.

Since you cannot remove yourself from all stressful situations you need to prepare yourself to handle them when they occur. It is not the situation that makes you go to pieces; it is your reaction to the situation.

Because stress triggers and intensifies the symptoms of post acute withdrawal, learning to manage stress can control PAW. You can learn to identify sources of stress and develop skills in decision-making and problem solving to help reduce stress. Proper diet, exercise, regular habits, and positive attitudes all play important parts in controlling PAW. Relaxation can be used as a tool to retrain the brain to function properly and to reduce stress.

Stabilization

If you are experiencing post acute withdrawal symptoms, it is important to bring them under control as soon as possible. Here are some suggestions that may help you be aware of what is going on and help you to interrupt the symptoms before they get out of control.

  • Verbalization: Start talking to people who are not going to accuse, criticize, or minimize. You need to talk about what you are experiencing. It will help you look at your situation more realistically. It will help you bring internal symptoms to your conscious awareness. And it will give you support when you need others to rely upon.
  • Ventilation: Express as much as you can about what you are thinking and feeling even if it seems irrational and unfounded.
  • Reality Testing: Ask someone if you are making sense. Not just what you are saying but your behavior. Your perception of what is going on may be very different from reality.
  • Problem Solving and Goal Setting: What are you going to do right now about what is going on? You can choose to take action that can change things.
  • Backtracking: Think back over what has been happening. Can you identify how the episode started? What could have turned it off sooner? Think of other times that you were experiencing symptoms of PAW. What turned it on? What turned it off? Were there other options that might have worked better or sooner?

Education and Retraining

Learning about addictive disease, recovery, and post acute withdrawal symptoms helps to relieve the anxiety, guilt, and confusion that tend to create the stress that intensify PAW symptoms. As a recovering person, you need information in order to realize what symptoms are normal during recovery.

You also need to learn management skills so that you will know what to do to interrupt and control the stress and the symptoms when they occur. Through retraining you can improve your ability to remember, to concentrate, and to think clearly. Retraining involves practicing certain skills in a safe environment as you build confidence. It includes learning to take things step by step and to handle one thing at a time so you do not feel overwhelmed. It includes writing down what you want to remember and asking questions when you think that need to have something clarified.

Learning about the symptoms of post acute withdrawal, knowing what to expect, and not overreacting to the symptoms increase the ability to function appropriately and effectively.

Self-Protective Behavior

When all is said and done, you are responsible for protecting yourself from anything that threatens your sobriety or anything that triggers post acute withdrawal symptoms. Reducing the stress resulting from and contributing to the symptoms of post acute withdrawal must be of prime consideration for you. You must learn behavior that will protect you from the stress that might put your sobriety in jeopardy. This self-protective behavior is behavior that will enable you to be firm in accepting your own needs and not allowing other people or situations to push you into reactions that are not in the best interest of your sobriety.

In order to protect yourself from unnecessary stress, you must first identify your own stress triggers, those situations that might bring about an overreaction from you. Then learn to change those situations, avoid them, change your reactions, or learn to interrupt them before they get out of control.

Nutrition

The way you eat has a lot to do with the level of stress you experience and your ability to manage the symptoms of post-acute withdrawal. Poor health itself contributes to stress, and malnutrition contributes to poor health. You may be malnourished because of poor eating habits or because your body, damaged by alcohol or drugs, was unable to use the nutrients that you consumed.

Abstinence from alcohol and drugs will bring about some improvement but abstinence alone is not sufficient to rebuild damaged body tissue and maintain good health. New eating habits must be established and practiced regularly and permanently. Your daily diet should contain a balance of vegetables, fruit, carbohydrates, proteins, fats, and dairy products. Ask a nutritionist to help you figure out how many calories you need each day and what quantities of each type of food.

DIET FOR A RECOVERING PERSON

– Three Well-Balanced Meals Daily
– 
Three Nutritious Snacks Daily –
– No Sugar and Caffeine –

Hunger produces stress. Try to plan your eating schedule so that you do not skip meals and so that you can have periodic nutritious snacks. Do not eat candy, donuts, soft drinks, potato chips, or other high calorie, low nutrient foods. You should specifically avoid foods that produce stress such as concentrated sweets and caffeine. Both of these produce the same kind of chemical reaction in your body as being frightened or overly excited. Concentrated sweets such as candy, jelly, syrup, and sugar-sweetened soft drinks will give you a quick “pick-up,” but you will experience a let-down about an hour later accompanied by nervousness and irritability. Remember that your reason for eating a snack is to combat fatigue and nervousness. Have a nutritious snack before you feel hungry to prevent a craving for sweets.

Jayne, a recovering alcoholic, was in the habit of eating a large quantity of ice cream every night. She often talked about the craving for it she felt, and believed that by eating it she was reducing a craving for alcohol. The next morning she always felt sluggish and irritable. Throughout the day her stress increased until it was relieved by the ice cream. When her counselor suggested that she remove the ice cream from her diet she felt she could not get along without it. When she and her counselor examined her diet they found that she ate no breakfast and was not getting adequate nutrition throughout the day. She agreed to try eating a balanced diet and to eliminate the ice cream on a trial basis. She discovered that when she ate a balanced diet and ate regular meals and several nutritious snacks throughout the day her craving for ice cream disappeared and she could easily eliminate it from her life.

Caffeine also causes nervousness and restlessness. It may also interfere with concentration and your ability to sleep. Loss of sleep or irregular sleep causes irritability, depression, and anxiety.

Exercise

Exercise helps rebuild the body and keep it functioning properly while also reducing stress. Exercise produces chemicals in your brain that make you feel good. These chemicals are nature’s own tranquilizers to relieve pain, anxiety, and tension.

Different types of exercise are helpful for different reasons. Stretching and aerobic exercise will probably be most helpful for your recovery. Stretching exercises help to keep your body limber and to relieve muscle tension. Aerobics are rhythmical and vigorous exercises for the large muscles. Aerobics are intended to raise your heart rate to 75% of its maximum rate and maintain that rate for at least 20-30 minutes.

We recommend regular use of aerobic exercise. Jogging, swimming, jumping rope, and bicycling are common aerobic exercises, or you might want to join an aerobics class. Dancing can also be aerobic, but remember that it must be done vigorously.

Many recovering people will testify to the value of exercise in reducing the intensity of PAW symptoms. After they exercise they feel much better, find it easier to concentrate and remember, and are able to be more productive.

Choose a form of exercise that is fun for you so that you will stick with it. Most doctors and health books will tell you to exercise three or four times a week, but we recommend that recovering people make time for it every day because of its value in reducing stress. Any day that you do not exercise is a day that you are cheating yourself of a way to feel more relaxed, be more productive, and have more energy. Whatever exercise you choose, remember, do not over-do it! If it hurts don’t do it. The old adage “no pain, no gain” is not true for recovering people. Consistency and regularity are the key words for the recovering person.

Relaxation

There are things you can do to readily reduce or escape the stress you feel when you are unable to change a situation or to better cope with the stress of everyday living. Laughing, playing, listening to music, story telling, fantasizing, reading, and massage are some methods of natural stress reduction.

Playing is a necessary form of relaxation that is often neglected. It is difficult to define play because it is not so much what you do as how you do it. We all need time for having fun, laughing, being childlike and free. There are other “diversions” you can use as natural ways of reducing stress. Try a body massage, a bubble bath, a walk by yourself or with a friend.

Deep relaxation is a way of relaxing the body and mind to reduce stress and produce a sense of well-being. Deep relaxation can rebalance the body and reduces the production of stress hormones. What happens when you relax is the opposite of the “fight or flight” reaction. When you relax, your muscles become heavy, your body temperature rises, and your breathing and heart rate slow down. A muscle cannot relax and tense at the same time. It is impossible to maintain tension while physically relaxing. You can learn techniques to allow your body to relax. The distress resulting from thought process impairments, emotional process impairments, memory impairments, and stress sensitivity can be reduced or relieved through proper use of relaxation.

There are a variety of relaxation exercises that you can use. You can get a book that will offer you a selection of exercises or you can purchase tape-recorded exercises. You can close your eyes in a comfortable position and repeat a pleasant word over and over to yourself. Or you can imagine yourself in a soothing environment such as by a quiet lake or in a green meadow. Pick a method that is relaxing to you and use it often. You will find it a helpful aid for reducing stress and creating peace of mind and serenity.

Spirituality

Spirituality can be defined as “an active relationship with a power greater than yourself that gives your life meaning and purpose.” When you work a spiritual program, you consciously, actively attempt to become a part of something bigger, greater, and more powerful than yourself.

Belief in a Higher Power takes you out of the center of your universe and offers peace of mind and serenity by an awareness that there is a power that is not restricted by your weaknesses and limitations. Through spiritual development you can develop new confidence in your own abilities and develop a new sense of hope. It is through a spiritual program that you can reach with hope and a positive attitude toward the future.

In working on your spirituality it is important for you to use the principles of the AA/NA program. AA/NA provides guidelines for “increasing your conscious contact with your higher power.” You do not have to have any one image of your higher power to increase your conscious contact. You do have to be open to the possibility of a Higher Power and be willing to experiment with communicating with that Power. It is important to structure your life in such a way as to spend time alone each day to interact with your Higher Power. It is important to examine your values and look within yourself to determine whether your life is in harmony with those values.

Spiritual discipline is a consciously chosen course of action. Discipline is uncomfortable for many recovering addicts. They have lived lives of immediate gratification, and discipline is the reverse of that. The purpose of spiritual discipline is freedom from the slavery of self-indulgence. Spiritual discipline includes prayer and meditation, spiritual fellowship, and regular inventory of your spiritual growth.

Balanced Living

Balanced living means that there is bio-psycho-social-spiritual harmony in your life. It means that you are healthy physically and psychologically and that you have healthy relationships. It means that you are spiritually whole. It means that you are no longer focused on one aspect of your life. It means you are living responsibly, giving yourself time for your job, your family, your friends as well as time for your own growth and recovery. It means allowing a Higher Power to work in your life. It means wholesome living.

It means having a balance between work and play, between fulfilling your responsibilities to other people and your need for self-fulfillment. It means functioning as nearly as possible at your optimum stress level, maintaining enough stress to keep you functioning in a healthy way and not overloading yourself with stress so that it becomes counterproductive. With balanced living, immediate gratification as a lifestyle is given up in order to attain fulfilling and meaningful living.

Balanced living requires proper health care so that the body is functioning well. Nutrition, rest, and exercise all receive the proper focus in your life to provide energy, manage stress, allow freedom from illness and pain, combat fatigue, and rebuild a damaged body.

Freedom from physical distress allows psychological growth. When you feel good it is easier to think about your attitudes and values and to work on eliminating denial, guilt, and anger. Balanced living requires doing things to develop self-confidence and self-esteem and learning to feel good about yourself.

Balanced living needs a strong social network that nurtures you and encourages a healthy, recovery-oriented lifestyle. A healthy network provides a sense of belonging. It includes relationships in which you feel you are a valuable part. It includes immediate family members, friends, relatives, co-workers, counselors, employers, self-help group members, and sponsors.

Even after a couple of years of sobriety, Walter had times when he found it more difficult than usual to remember things, when he was more irritable and anxious, when he overreacted around his family and friends, when he felt confused and overwhelmed. His wife began to notice that he experienced these symptoms more on Saturday. What was different about Saturday? He usually slept later and had a couple of cups of coffee as soon as he got up, he began going over to visit his AA sponsor as early as possible. Together they drank coffee, ate donuts, smoked their pipes, and talked. Walter stayed until early afternoon, and by the time he got home and had lunch it was usually 1:30 or 2:00 in the afternoon. If one of his kids left a bike in the driveway or his wife was on the phone too long, he found himself overreacting and leaving the house. The rest of the day was totally unproductive because of what became known in his family as his “Saturday Syndrome.”

Walter decided to try some alternate activities to see if there was a change in his reactions. He started drinking orange juice as soon as he woke up instead of coffee. That helped, so he decided to try eating breakfast. That helped even more. He and his sponsor started drinking decaffeinated coffee and he skipped the donuts. He came home early enough to have lunch and to exercise for a while. He then felt like doing something with his family in the afternoon. They were all amazed at the disappearance of the “Saturday Syndrome.” 

A Quick Guide for Managing Post Acute Withdrawal (PAW) 

You can manage Post Acute Withdrawal (PAW) can be. Here is a quick-guide for the steps you need to take.

1. Accurate Information: Explain PAW and have the person do a self-evaluation of PAW and review the results. This will give them words and ideas to explain what they are experiencing. It will also help people to stop feeling crazy, judging themselves for having the symptoms, and being anxious and afraid because they don’t know what is happening.

2. Stress management: relaxation and meditation. PAW is stress sensitive. This means the symptoms get more severe when experience high stress and less sever under low stress levels.

3. Proper Diet: Have an alcohol and drug free diet. Eat a high protein, complex carbohydrate meal plan. The closest diet plan is is a hypoglycemic diet. Ask a nutritionist or look it up the internet. Avoid foods high in sugar and limit your caffeine intake. Supplement with multiple vitamins,Vitamin B-12, and broad spectrum amino acids.

4. Aerobic Exercise: At least twenty minutes per day at least there-days per week in a heart-measured aerobic zone. (Subtract your age from 220. 80% of that number is you minimal training zone. 80% is the max). Too high or too low don’t seem to help much.

5. A Recovery Program: Have a regular schedule of recovery activities that put you in places and around people who support your recovery and where you can honestly talk about yourself without judgment. It is also important to having a sponsor/mentor and therapist trained as an addiction professional.

These practices stabilize brain chemistry. Don’t leave PAW management to chance. Get a plan. Work the plan. If it doesn’t work, get additional help.

Please don’t spread the mistaken belief there is nothing that can be done to lower the severity PAW symptoms. THIS JUST IS NOT TRUE. The brain is plastic. It grows in response to experiences especially when stress in managed well during the experience.

THE MIND IS A POWERFUL THING USE IT WISELY

Excerpted From
Staying Sober – A Guide for Relapse Prevention and
Straight Talk About Addiction

Learning To Live Again – A Guide For Recovery From Addiction by Terence T. Gorski 

Gorski Books – Gorski Training/Consultation/Home Studies

LIVE SOBER – BE RESPONSIBLE – LIVE FREE

 


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