Post Acute Withdrawl (PAW)
Exerpted From "Staying Sober" By: Terence T. Gorski
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with additions by: Lee Jamison
Most people think acerca When 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, post acute withdrawal Especially, 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. And syndrome means a group of symptoms.
Syndrome: A group of symptoms
..........................Post: After
..........................Post Acute Withdrawal: Symptoms That Occur after acute withdrawal.
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.........................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 Appear These symptoms 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 we 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 we 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 regulating "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 have Often PAW symptoms for no apparent reason for up to 10 years after doing lot stopped using Their drug of choice. Appear Often PAW symptoms 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
How do you know if You have PAW? The most identifiable characteristic is the simplest usually we Inability to solve 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 problems usually we just 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 interferes with productive and challenging living. Let's take a look at some of the PAW symptoms That Contribute to the Inability to solve problems usually we just.
TYPES OF PAW SYMPTOMS
1. Inability to think Cleary
Two. Memory problems
Three. Emotional overreactions or numbness
April. Sleep disturbances
May. Physical coordination problems
June. stress sensitivity
Inability to Think Clearly
There are several thought disorders experienced by a person recovering 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 concentrate for more than a few minutes. Impairment of abstract reasoning is another common symptom of post acute withdrawal. An abstraction is a nonconcrete notion or concept, something That you can not 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 . May The same thoughts 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. May You 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 May you walk away, and That memory clouded Becomes May or disappear completely.
During stressful periods Sometimes it May Also be Difficult to remember significant events from the past. These memories are not gone, the person May Be Able to Easily remember them at other times. The person realizes That He or she knows but just can not 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 do not remember all of my story. That I do remember 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 not 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 outstretch to overreact. When things happen que requieren two units of emotional reaction, They react with ten. It is like holding the "times" key down on a calculator. May You 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 should feel you know something, you do not. May You 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 interferes with your abitur 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 we Lasted for several months. During the time I was not drinking, I 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. Faq frequently I would jump out of bed, screaming in terror. When I was Able to awaken him and calm him, I could not remember what I dreamed, but I remembered being afraid. After a year of sobriety, I 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. May you 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 drunk alcoholics Appeared 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 Often people are unable to Distinguish Between Situations and low-stress high-stress situations. They May not Recognize low levels of stress, and then overreact When They Become aware of the stress They are experiencing. May They feel stressful in Situations That ordinarily would not bother them, and in Addition, When They react They overreact. May They do Things That are Inappropriate for the situation completely. So much so That They May later on Wonder Why They Reacted Strongly so.
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 it, your brain May suddenly shut down. May You 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, May you feel you are going crazy. You are not. These symptoms are a regular 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 Increased stress and 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 abitur 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, Eventually the disease will 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 acerca PAW and methods of controlling 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 Their Affected Their Lives without being aware of what was happening to them.
Ray is a young, single, recovering alcoholic. 've stopped drinking When I was 22 and was very excited about the possibilities That lay ahead of him in his sobriety. After his initial treatment I Began restructuring his life around recovery. I was eager to make up for the time I had wasted During his years of drinking. I've got a full-time job, enrolled in college, and Committed himself to doing some volunteer work.
After a while I Began to notice That I 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. I was having trouble taking care of his financial responsabilidades, and when to People that cared acerca him tried to help him figure things out, I felt panicky and overwhelmed. Thoughts rushed through his head, and I 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 could not 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 I would drink, Ray "ran." Instead of Evaluating things in his life what I needed to change and what I needed to hold onto, I 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 I could "get himself together." These actions created additional problems with Which He found it increasingly Difficult to cope. Until I went to a counselor and learned some ways to manage his symptoms, Ray thought I was having a nervous breakdown, when in fact what I was experiencing was PAW.
PATTERNS OF POST ACUTE WITHDRAWAL
Post-acute withdrawal symptoms are not the same in everyone. They vary in how severe They are, They Occur How often, and how long They last. Some people experience symptoms Un certain, some People Have other symptoms, some people have none at all.
Over a period of time PAW May get better, get worse May it May it 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 it intermittent.
Regenerative PAW Improves Gradually 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 outstretch to Become relapse prone. Sobriety Becomes feel so painful That They Must They 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 the symptoms REMAIN Essentially unchanged. Most recovering people find this very frustrating Because They Believe That They Should be feeling better the longer They are sober. With sober Sufficient 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, Rapidly Their symptoms 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 symptoms These Because They Were unrecognized until recently. 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. Gradually it 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 They Occur How often, 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 resources. It is Necessary to build a resistance against them - an insurance policy That lowers your risk.
PAW MANAGING 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 had no idea what 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 we 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 can not remove yourself from all stressful Situations you need to preparing 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 PAW Control. You can learn to identification identify sources of stress and Develop skills in decision making and problem solving to help reduce stress. Proper diet, exercise, regulate 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 acerca 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 to rely upon others.
Ventilation: Express as much as you can acerca 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 acerca 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 identity 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 relief the anxiety, guilt, and confusion That outstretch to create the stress That Intensify PAW symptoms. As a recovering person, you need information in order to Realize During what recovery symptoms are standard.
Also You need to learn management skills so That You will know what to do to interrupt and controlling the stress and the symptoms When They occur. Through retraining you can Improve Your Ability to remember, to concentrate, and to think clearly. Involves Retraining practicing Un 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 identification identify your own stress triggers, Those Situations That Might bring acerca 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 abitur 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 avoid foods específicamente That produces 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 an hour later acerca 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 Increased stress 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 They found her diet 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 regularly ate meals and several nutritious snacks THROUGHOUT the day her craving for ice cream Could easily disappeared and she Eliminate it from her life.
Also Caffeine causes nervousness and restlessness. It May Also interferes with concentration and your abitur to sleep. Loss of sleep or irregular sleep causes irritability, depression, and anxiety.
Exercise
Exercise Helps rebuild the body and keep it functioning properly Also while Reducing stress. Exercise produces chemicals in your brain That make you feel good. These chemicals are nature's own tranquilizers to relief pain, anxiety, and stress.
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 highlight muscle stress. 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 to 30 minutes.
We recommend use of aerobic exercise regularly. Jogging, swimming, jumping rope, and bicycling are common aerobic exercises, or you Might want to join an aerobics class. Dancing Also can 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. They exercise After 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 recovering That 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 do not 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 form of relaxation Necessary That is Often neglected. It Is Difficult to define porque play 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 nature as stress reducers. 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 produces a sense of well-being. Deep relaxation rebalances the body and you reduce the production of stress hormones. What Happens When You relaxation 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 can not relax and tense at the same time. It is impossible to Maintain Physically stress while 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.
ONe of the posts from the paws thread thats under construction..
also here is a really good link
> Why We Don’t Get Better Immediately: Post-acute Withdrawal Syndrome (PAWS)
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, but I cant...thankfully. But, I get on this website and read about others experiences and questions and statements and everything having to do with my former ice-queen. Why do I do this to myself, it just makes me reminisce about the 'fun' times. WHY DO I DO THIS?!?!?! 
) But there were definatlly more harsh gut wrenching heart ripping moments. The fighting, near divorce, cruel words, lack of emotion, hatred fear utter sadness, panic attacks severe depression and suidicdal thoughts. Towards the end there were so many more horrible moments than good moments. Everytime one happened I gave the whole "we have to stop! NO MORE! Its ruining us!!!" only to get more a few days of sleep later. Eventually it stopped when we moved away from our neighbors who were supplying us. [[[WARNING:Dont live nextdoor to dealer!!!]]]
