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

January 16, 2014

By Terence T. Gorski, Author
January 16, 2014

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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

 


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) and Neurocognitive Recovery In Alcoholism

December 4, 2013

Imageby Terence T. Gorski, Author

I first introduced the concept of Post Acute Withdrawal (PAW) in training programs that I presented starting in 1976 and the concept was originally published in the first edition of book Learning To Living Again – A Guide for Recovery From Alcoholism and in Passages Through Recovery. 

The concept of PAW was based upon a combination of clinical experience with relapse-prone alcoholics and a small but growing literature published by the National Institute of Alcohol Abuse and Alcoholism (NIAAA) which was suggesting long-term neuropsychological impairment in recovering alcoholics. These impairments made it difficult for alcoholics to respond to traditional addiction counseling, even when advances in the cognitive therapy field were specifically adapted to alcoholism treatment.

The use of harsh confrontation, which was common in the treatment of alcoholics and drug addicts in the 1970’s, actually increased client denial and defensiveness, decreased the ability of recovering people to hear understand and integrate new information. The client got stuck in recovery was unable to progress in recovery, and became increasing frustrated. Symptoms if increased stress were obvious, but clients were unable to respond to the relaxation and stress management training which was just starting come of age. I coined the word stuck point to describe this inability to progress in recovery in spite of attempts to do so.

Once the client got stuck their stress increased and a predictable pattern of early warning signs became apparent. In a future article I will present the independent research which resulted in the AWARE Questionnaire, which confirmed and refined the ability to recognize the early warning signs of relapse.

The stuck point led to increased stress. The high stress, in turn, increased frustration and a morbid fear of inevitable failure. Since alcohol and drug use had been so destructive in the past, the fear of relapse activated a survival threat seemed to decrease the ability to think clearly and learn new information and skills. The relapsing people usually failed to understand what was happening and judged themselves as dumb, stupid, and unable to recover. Therapist often failed to recognize the neuropsychological basis of the symptoms, mislabeled it as denial and resistance and proceed to confront the client. The confrontation just made things worse. Other therapists decided the neurocognitive impairment was caused by unresolved family of origin problems and used deep relaxation and guided imagery to resolve trauma from previous physical or sexual abuse. This of course, was the hallmark of the codependency era.

The use of confrontation, regressive hypnosis, and catharsis techniques all increased the stress of clients, lowered their self-esteem by making them feel crazy, and decreased their self-confidence. This lack of self-confidence or absence of the positive belief in their ability to successfully recover was later dubbed low efficacy by cognitive therapists such as Alan Marlatt, Dennis Donovan, and Dennis Miller.

Convincing evidence began to develop that low efficacy was directly related with an increase in early relapse warning signs and the eventual failure to maintain recovery. The final trigger event was a high risk situation which activated craving in an environment that reinforced alcohol use while removing support for ongoing recovery.

Alan Marlatt observed the same thing. He originally described the phenomenon of apparently irrelevant decisions, which, in essence, described the same phenomena that I described as early relapse warning signs.

Both concepts were pointing at the same thing – symptoms caused progressive neuropsychology or neurocognitive dysfunction related to the stress of feeling stuck in a dysfunctional state and slowly becoming so dysfunctional and having no effective way to manage the growing inability to function. This produced a survival threat. We now know that high levels of stress activates the amygdala in the brain. The amygdala would shift behavioral control from slow-moving conscious decision-making to automatic use of emergency survival skills.

I labeled this progressive stress-induced dysfunction as the relapse syndrome.

The relapse syndrome was a progression of early warning signs of relapse  that ended in a high risk situation which activated craving, drug-seeking behavior, exposure to high risk situations, and the return to using alcohol and or other drugs.

The bottom line is this. In 2008 a compelling body of evidence exists that there is progressive brain dysfunction in alcoholic clients. This brain dysfunction is measurable and supported in the scientific literature. What follows is the research verification for the Post Acute Withdrawal Syndrome (PAW) Syndrome. This evidence is summarized in the following Alcohol Alert.

National Institute on Alcohol Abuse and Alcoholism
Alcohol Alert, No. 53 – July 2001

ON THE INTERNET: http://pubs.niaaa.nih.gov/publications/aa53.htm

 Brain damage is a common and potentially severe consequence of long-term, heavy alcohol consumption. Even mild-to-moderate drinking can adversely affect cognitive functioning (i.e., mental activities that involve acquiring, storing, retrieving, and using information) (1). Persistent cognitive impairment can contribute to poor job performance in adult alcoholics, and can interfere with learning and academic achievement in adolescents with an established pattern of chronic heavy drinking (2). A small but significant proportion of the heaviest drinkers may develop devastating, irreversible brain-damage syndromes, such as Wernicke-Korsakoff syndrome, a disorder in which the patient is incapable of remembering new information for more than a few seconds (3).

It stands to reason that cognitive impairment also may impede recovery from alcoholism, although evidence has not conclusively shown this to be the case.  For example, Morgenstern and Bates (4) studied whether deficits in a patient’s learning and planning abilities-core aspects of many treatment strategies-affected recovery from alcoholism. They found that impairment was not a significant predictor of poor treatment response. On the other hand, evidence does support the possibility that brain damage, whether resulting from or predating alcohol use, may contribute to the development and progression of alcoholism (5).

Designing practical strategies to cope with the complex combination of alcoholism and cognitive impairment requires an understanding of the nature of cognitive functions and their interactions with structural and functional brain abnormalities. This issue of Alcohol Alert describes the nature and consequences of common alcohol-associated cognitive defects, explores the extent to which some cognitive abilities recover with abstinence, and summarizes recent research on the effects of cognitive deficits on alcoholism treatment outcome.

Cognition and Alcohol

Most alcoholics exhibit mild-to-moderate deficiencies in intellectual functioning (6), along with diminished brain size and regional changes in brain-cell activity. The most prevalent alcohol-associated brain impairments affect visuospatial abilities and higher cognitive functioning (7). Visuospatial abilities include perceiving and remembering the relative locations of objects in 2- and 3-dimensional space. Examples include driving a car or assembling a piece of furniture based on instructions contained in a line drawing. Higher cognitive functioning includes the abstract-thinking capabilities needed to organize a plan, set it in motion, and change it as needed (2).

Most alcoholics entering treatment perform as well as nonalcoholics on tests of overall intelligence. However, alcoholics perform poorly on neuropsychological tests that measure specific cognitive abilities (8). For example, an alcoholic who has remained abstinent after treatment may have no apparent difficulty filing office documents correctly, a task that engages multiple brain regions. However, that same person might be unable to devise a completely different filing system, a task closely associated with higher cognitive functioning.

How Much Is Too Much?

The link between duration and lifetime quantity of drinking and the development of cognitive problems is unclear. Some investigators have proposed that cognitive performance worsens in direct proportion to the severity and duration of alcoholism (6,9). Studies suggest that social drinkers who consume more than 21 drinks per week also fit into this category (6). Other investigators have suggested that cognitive deficits may be detectable only in those alcoholics who have been drinking regularly for 10 years or more (8,10). Long-term, light-to-moderate social drinkers have been found to fall into this category as well, showing cognitive deficits equivalent to those found in detoxified alcoholics (8). Although further research is needed to determine how a person’s pattern of drinking is related to cognitive impairment, some deficits are possible even in people who are not heavy drinkers.

Tracking Structural and Functional Brain Abnormalities

Structural and functional brain abnormalities generally are measured by noninvasive imaging techniques that provide a picture of the living brain with minimal risk to the individual. Structural imaging techniques, such as computed tomography and magnetic resonance imaging, are used to generate computerized pictures of living tissue. Functional imaging techniques, such as positron emission tomography and magnetic resonance spectroscopy, permit scientists to study cell activity by tracking blood flow and energy metabolism. For more information about imaging, see Alcohol Alert No. 47, “Imaging and Alcoholism: A Window on the Brain.”

Structural imaging consistently reveals that compared with nonalcoholics, most alcoholics’ brains are smaller and less dense (11,12). Loss of brain volume is most noticeable in two areas: the outer layer (i.e., the cortex) of the frontal lobe, which is considered a major center of higher mental functions (7,12,13); and the cerebellum, which is responsible largely for gait and balance as well as certain aspects of learning (14). Support for these results is provided by functional imaging studies, which reveal altered brain activity throughout the cortex and cerebellum of heavy drinkers (15). In addition, functional imaging often is sufficiently sensitive to detect these irregularities before they can be observed by structural imaging techniques, and even before major cognitive problems themselves become manifest. This suggests that functional imaging may be particularly useful for detecting the early stages of cognitive decline (15).

Understanding the Basis of Cognitive Impairment

Accurate measurement of cognitive abilities is challenging, and relating those abilities to a specific brain irregularity simply may not be possible with the current technology (16). Discrepancies among research findings have led scientists to develop improved cognitive-measuring techniques. Using a battery of tests, Beatty and colleagues (9) have suggested that widespread (i.e., diffuse) cognitive impairment could arise from damage to multiple brain areas, each of which regulates distinct but related abilities. Likewise, damaging the network of brain cells that synchronizes the overall activity of those multiple areas may produce the same cognitive impairments previously attributed to localized damage (9).

Is Impairment Reversible?

Certain alcohol-related cognitive impairment is reversible with abstinence (17). Newly detoxified adult alcoholics often exhibit mild yet significant deficits in some cognitive abilities, especially problem-solving, short-term memory, and visuospatial abilities (18). By remaining abstinent, however, the recovering alcoholic will continue to recover brain function over a period of several months to 1 year (19)-with improvements in working memory, visuospatial functioning, and attention-accompanied by significant increases in brain volume, compared with treated alcoholics who have subsequently relapsed to drinking (18).

Rewiring Brain Networks

Reversibility of alcohol-related cognitive function also may be the result of a reorganization of key brain-cell networks. Some researchers have proposed that such reorganization may contribute to the success of alcoholism treatment. Using advanced imaging techniques, Pfefferbaum and colleagues (20) examined the brain activity of cognitively impaired alcoholic participants during a series of tests designed to assess cognitive function. They found that although the alcoholic subjects had abnormal patterns of brain activation, compared with control subjects, they were able to complete the tasks equally well, suggesting that the brain systems in alcoholics can be functionally reorganized so that tasks formerly performed by alcohol-damaged brain systems are shunted to alternative brain systems.  This finding-that cognitively impaired alcoholic patients use different brain pathways than unimpaired patients to achieve equivalent outcome-also was suggested in a study of patients in 12-step treatment programs (4). Functional brain reorganization may be particularly advantageous for adolescent alcohol abusers in treatment, because their developing brains are still in the process of establishing nerve-cell networks (21).

Cognitive Function and Alcoholism Treatment

The exact role that cognitive function has in alcoholism treatment success is unclear. Structural and functional imaging, as well as more specific cognitive tests, may provide scientists with the tools needed to reveal subtle relationships between alcohol-related cognitive impairment and recovery. Meanwhile, certain conclusions can be drawn from existing research that help to explain how cognitive function may influence alcoholism treatment:

Cognitive deficits have been hypothesized to affect the efficacy of alcoholism treatment, although a clear association has not been established. One view finds that cognitively impaired patients may not be able to comprehend the information imparted during therapy and, thus, may not make full use of the strategies presented, thereby hampering recovery. Another view is that cognitive functioning may not directly influence treatment outcome, but may impact other factors that, in turn, contribute to treatment success (22). Focusing on those factors-such as improved nutrition, opportunities for exercise, careful evaluation of comorbid mental or medical disorders, and/or treatment strategies aimed at enticing the patient out of long-standing social isolation-ultimately may be more beneficial than focusing exclusively on recovery from alcoholism.

Other types of non-alcohol-related brain damage also can produce symptoms resembling those associated with chronic alcoholism. Clinicians must be aware that no matter the cause of the impairment, it may have an impact on the patient’s ability to benefit fully from alcohol-treatment strategies. Cognitive impairment is usually most severe during the first weeks of abstinence, perhaps making it difficult for some alcoholics to benefit from educational and skill-development sessions, which are important components of many treatment programs (22,23). For example, one study found that alcoholics tested soon after entering treatment were unable to recall treatment-related information presented in a film they had just been shown (4). As time goes by and cognitive function improves, however, patients may make better use of information presented to them in individual and group therapy, educational programs, and 12-step programs.

Cognitive Impairment and Recovery From alcoholism
 – A Commentary by NIAAA Director Enoch Gordis, M.D.

The new noninvasive imaging techniques that allow us to “see” how the brain operates have been a boon to the study of cognition. Through this medium, we now know that the brain is capable of “rewiring” itself. In doing so, the brain can regain some of the cognitive abilities previously diminished as a result of damage from alcohol or other diseases. The brain’s remarkable ability to recover is important for at least two reasons. First, alcohol use over a period of time, even at low levels of drinking, can produce varying degrees of cognitive damage, a problem that is of particular concern because alcohol use is so widespread. Thus, the brain’s self-repairing ability may help defer or reduce alcohol-induced cognitive problems among a large portion of the population. Second, the brain’s ability to rewire itself may have implications in terms of adolescent drinking. Recent evidence suggests that the adolescent brain, which is still forming important cellular connections, is more vulnerable than the adult brain to alcohol-induced damage. This is particularly troubling, given the problems associated with chronic binge drinking, which is all too common among young people. The brain’s ability to rewire important neurological systems might help mitigate a lifetime of cognitive difficulties resulting from chronic drinking during adolescence, but we do not yet know if this is true. Future research will help clarify this and other important questions about alcohol’s effect on cognition.

References

(1) Evert, D.L., and Oscar-Berman, M. Alcohol-related cognitive impairments: An overview of how alcoholism may affect the workings of the brain. Alcohol Health Res World 19(2):89-96, 1995. (2) Giancola, P.R., and Moss, H.B. Executive cognitive functioning in alcohol use disorders. In: Galanter, M., ed. Recent Developments in Alcoholism: Volume 14. The Consequences of Alcoholism.New York: Plenum Press, 1998. pp. 227-251. (3) Oscar-Berman, M. Severe brain dysfunction: Alcoholic Korsakoff’s syndrome. Alcohol Health Res World 14(2):120-129, 1990. (4) Morgenstern, J., and Bates, M.E. Effects of executive function impairment on change processes and substance use outcomes in 12-step treatment. J Stud Alcohol 60(6)846-855, 1999. (5) Bowden, S.C.; Crews, F.T.; Bates, M.E.; et al. Neurotoxicity and neurocognitive impairments with alcohol and drug-use disorders: Potential roles in addiction and recovery. Alcohol Clin Exp Res 25(2):317-321, 2001. (6) Parsons, O.A. Neurocognitive deficits in alcoholics and social drinkers: A continuum? Alcohol Clin Exp Res 22(4):954-961, 1998. (7) Oscar-Berman, M.; Shagrin, B.; Evert, D.L.; and Epstein, C. Impairments of brain and behavior: The neurological effects of alcohol. Alcohol Health Res World 21(1):65-75, 1997. (8) Parsons, O.A., and Nixon, S.J. Cognitive functioning in sober social drinkers: A review of the research since 1986. J Stud Alcohol 59(2):180-190, 1998. (9) Beatty, W.W.; Tivis, R.; Stott, H.D; Nixon, S.J.; and Parsons, O.A. Neuropsychological deficits in sober alcoholics: Influences of chronicity and recent alcohol consumption. Alcohol Clin Exp Res 24(2):149-154, 2000. (10) Eckardt, M.J.; File, S.E.; Gessa, G.L.; et al. Effects of moderate alcohol consumption on the central nervous system. Alcohol Clin Exp Res 22(5):998-1040, 1998. (11) Pfefferbaum, A.; Rosenbloom, M.; Crusan, K.; and Jernigan, T.L. Brain CT changes in alcoholics: Effects of age and alcohol consumption. Alcohol Clin Exp Res 12(1):81-87, 1988. (12) Pfefferbaum, A.; Lim, K.O.; Zipursky, R.B.; et al. Brain gray and white matter volume loss accelerates with aging in chronic alcoholics: A quantitative MRI study. Alcohol Clin Exp Res 16(6):1078-1089, 1992. (13) Lyvers, M. “Loss of control” in alcoholism and drug addiction: A neuroscientific interpretation. Exp Clin Psychopharmacol8(2):225-249, 2000. (14) Sullivan, E.V.; Rosenbloom, M.J.; Deshmukh, A.; et al. Alcohol and the cerebellum: Effects on balance, motor coordination, and cognition. Alcohol Health Res World 19(2):138-141, 1995. (15) Eberling, J.L., and Jagust, W.J. Imaging studies of aging, neurodegenerative disease, and alcoholism. Alcohol Health Res World 19(4):279-286, 1995. (16) Parsons, O.A. Determinants of cognitive deficits in alcoholics: The search continues. Clin Neuropsychologist 8(1):39-58, 1994. (17) Volkow, N.; Wang, G.J.; and Doria, J.J. Monitoring the brain’s response to alcohol with positron emission tomography. Alcohol Health Res World 19(4):296-299, 1995. (18) Sullivan, E.V.; Rosenbloom, M.J.; Lim, K.O.; and Pfefferbaum, A. Longitudinal changes in cognition, gait, and balance in abstinent and relapsed alcoholic men: Relationships to changes in brain structure. Neuropsychology 14(2):178-188, 2000a. (19) Sullivan, E.V.; Rosenbloom, M.J.; and Pfefferbaum, A. Pattern of motor and cognitive deficits in detoxified alcoholic men. Alcohol Clin Exp Res 24(5):611-621, 2000 b. (20) Pfefferbaum, A.; Desmond, J.E.; Galloway, C.; et al. Reorganization of frontal systems used by alcoholics for spatial working memory: An fMRI study. NeuroImage 13:1-14, 2001. (21) Spear, L. Modeling adolescent development and alcohol use in animals. Alcohol Res Health 24(2):115-123, 2000. (22) Allen, D.N.; Goldstein, G.; and Seaton, B.E. Cognitive rehabilitation of chronic alcohol abusers. Neuropsych Review 7(1):21-39, 1997. (23) McCrady, B.S., and Smith, D.E. Implications of cognitive impairment for the treatment of alcoholism. Alcohol Clin Exp Res 10(2):145-149, 1986.


Addiction Symptoms, PAW, and The Circle Of Denial

December 2, 2013

By Terence T. Gorski

imagesAlcohol and drug addiction has progressive symptoms that are readily observable. There are the SUBSTANCE-BASED SYMPTOMS, which occur while the addict is actively using with a high blood level of the drug. Then there are the ABSTINENCE/WITHDRAWAL-BASED SYMPTOMS, which come into play when an alcoholic/addict tried to stop using. This includes an acute withdrawal syndrome, known and recognized for decades. It also includes the symptoms of Post Acute Withdrawal (PAW).

PAW, an Abstinence-based group of symptoms, shows up in the following ways:

(1) Problems in thinking clearly and solving usually simple problems;

(2) Problems managing feelings and emotions which results in alternating episodes of emotional over-reaction or emotional numbness;

(3) Problems with storing short-term memory into long-term memory which makes people forgetful;

(4) Sleep disorders marked by the inability to sleep restfully until exhaustion imposes a sleeping marathon of 20 hours or longer;

(5) Problems with psychomotor coordination making people stumble, drop things, or knock things over (the origin of the term “dry drunk);

(6) Problems with managing stress marked by the tendency of the previous five symptoms getting dramatically worse when tired, fatigued, or under pressure.

The incredible thing is that all of these symptoms, both SUBSTANCE-BASED SYMPTOMS and ABSTINENCE/WITHDRAWAL-BASED SYMPTOMS, are very noticeable. They are not at all funny although there is a tendency to laugh about them. It is what is called dark humor, gallows humor, or a cold joke. But then again, humor is more about pain than anything else. We rarely laugh at people who are doing healthy functional things. We laugh at the things that hurt so bad we need some comic relief to get away even for a little while.

So how are these readily observable symptoms so easily accepted in the real world, enabled by people close to the addict, and denied by the alcoholics themselves, and usually no diagnosed by trained physicians, psychiatrists, and mental health professionals?  It is liked a circular closed loop of denial:

“I deny! à My friends & family deny! à The world denies à Start again.

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Post-Acute Withdrawal (PAW): The Symptoms

October 27, 2013

By Terence T. Gorski

Post Acute Withdrawal (PAW) is a cluster of symptoms that occur in recovering addicts and alcoholics. PAW symptoms usually begin to occur between seven and fourteen days after the acute period of withdrawal, and usually peak between three and six months after the start of abstinence.

Post-Acute Withdrawal (PAW) Syndrome is also referred to as:

– The protracted withdrawal syndrome,

– Chronic brain toxicity,

– Long-term neuropsychological impairment

– Long-term neuro-cognitive impairment

Acute withdrawal (AW) is composed of physical symptoms that occur as a result of stopping the use of a drug after the addict has develop tolerance and dependence.

– Tolerance means that the body adapts to the constant use of large quantities of the primary drug of choice. As a result it takes more and more of the drug to experience the desired effect from taking the drug.

– Dependence means that the body learns to function normally with a high dose of the drug. When they stop taking the drug they experience symptoms of acute withdrawal.

– Symptoms of Acute Withdrawal (AW) includes shakes, vomiting, chills, muscle soreness and cramps, headaches, diarrhea or constipation, extreme skin sensitivity, sensitivity to light, and more. PAW begins to emerge as AW symptoms begin to subside.

PAW is a bio-psycho-social syndrome that 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.

PAW symptoms can be divided into the following six groups or clusters:

1.  Difficulty Thinking Clearly:  PAW causes recovering people to have difficulty recognizing and solving usually simple problems, making decisions, concentrating, understanding abstract concepts, and stopping rigid and repetitive ways of thinking.

2.  Difficulty Managing Feelings: PAW creates the tendency to vacillate between emotional overreactions or emotional numbness;

3.  Difficulty Remembering Things: PAW causes people to have difficulty remembering what they learn and understand. The memories tend to fade after several hours something. It’s as if the memories are not shifted from short-term memory to long-term memory.

4.  Difficulty Sleeping Restfully: PAW causes sleep disturbances. Many recovering people have difficulty falling asleep and sleeping restfully. Their sleep is fitful; they awaken many times during the night, and do not feel rested after sleep.

5.  Problems With Physical Coordination: Recovering people often have difficulty with hand-eye coordination and controlling fine muscle movements. They also have problems with balance and can easily feel dizzy and disoriented.

6.  Stress Sensitivity: Recovering people tend to be stress sensitive. This means that a low level of stress can cause an exaggerated reaction on their brain and nervous system. Living in high stress, which is necessary in facing the challenges of early recovery, cause the problems with managing thoughts, feelings, memory, and sleep to become even more severe.

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