Post Acute Withdrawal Syndrome

James has been clean and sober for six months. He attends 12-step meetings every day, he walks his children to school, he has returned to his career on a part-time basis, and he has assumed most of his pre-addiction responsibilities. Everyone is happy with him. His wife is astonished at how quickly he was able to get off drugs. His mom and dad wish that they could give him the Medal of Valor for accomplishing what their other adult children have not been able to do: James has gotten off drugs. His kids are happy to have their "old" dad back again, and all is well -- except for one thing: James feels miserable.

PAWS is Discouraging but Normal.

Inside, James is dying. He forgets what he's talking about in mid-sentence, he has almost crippling anxiety and depression, he shakes all the time, and even the simplest tasks feel overwhelming to him. He has also become accident prone and clumsy, has difficulty managing stress, is filled with self pity, and sometimes feels numb. Everyone else is convinced that James is okay, but behind his facade of happiness, James feels out of control.

But James is not cracking up. He has post acute withdrawal syndrome.

What is Post Acute Withdrawal Syndrome?

Post Acute Withdrawal Syndrome (or PAWS) is the brain's adjustment to living without chemicals. During periods of addiction to drugs or alcohol, there is artificial stimulation and disruption of normal brain function. The brain gets used to the drug. Altered brain cells and their functioning take 6 to 18 months to return to normal. PAWS can be moderate to severe.

A Bad Day of PAWS is Better Than a Good Day as an Addict.

Post Acute Withdrawal Symptoms

• Forgetfulness
• Self-pity
• Defensiveness
• Difficulty thinking clearly
• Accident prone
• Denial
• Problem with managing stress
• Difficulty handling feelings and emotions
• Problems sleeping
• Compulsive behavior
• Over-reacting or feeling numb

Every recovering addict or alcoholic experiences PAWS symptoms -- some more than others. It's important for people in recovery to know that what they are feeling is normal for someone learning to live without drugs or alcohol. It doesn't feel normal, but it is to be expected.

This Too Shall Pass. . .

These things help the person with PAWS:

• Don't isolate.
• Keep expectations (of self and others) reasonable.
• Eat three regular meals a day.
• Limit work to 40 hours per week.
• Maintain family relationships.
• Journal feelings.
• Take vitamins.
• Regularly attend 12-step groups (NA, AA, CA, etc.).
• Learn relaxation techniques.
• Call other clean and sober friends.

Eventually You Will Feel Better.

Related Links

Post–acute withdrawal syndrome -- (This site gives a concise definition of PAWS): http://en.wikipedia.org/wiki/Post%E2%80%93acute_withdrawal_syndrome


Post-Acute Withdrawal Syndrome (PAWS) — Why we don’t get better immediately? -- (This article is about the changes in neurological function that occur after withdrawing from drugs and alcohol, aka, PAWS): http://digital-dharma.net/addiction/post-acute-withdrawal-syndrome-why-we-dont-get-better-immediately/


Post Acute Withdrawal Syndrome (PAWS) -- (This article is about the three major areas that PAWS impacts an individual: Cognitive processes, the emotions, and memory): http://www.interventionctr.com/paws.htm


Post Acute Withdrawal Syndrome -- (This is about the brain's adjustment, while returning to a life without chemicals): http://www.hopelinks.net/addiction-treatment/post-acute-withdrawal.html


Post Acute Withdrawal Syndrome (PAWS): An Easy to Understand Explanation -- (This site gives the definition, affects, and articles on PAWS): http://www.squidoo.com/postacutewithdrawalsyndrome

How to Help a Chemically-Dependent Loved One

Do you have a loved one who drinks too much or is addicted to drugs? Are you frustrated because your attempts to help have failed?

If this is you, read on because I will show you how to help your chemically-dependent loved one.

At what Stage of Change is your loved one?

The first thing you must consider in helping a loved one with an alcohol or drug problem is how willing he is to admit he has a problem and how willing he is to go into treatment.

Here are the Stages:

• Pre-contemplation: He feels he doesn't have a problem.
• Contemplation: Ambivalence towards change. Not considering treatment right now.
• Preparation: Planning on entering treatment within the next month.
• Action: Actively engaged in treatment.

The video below will tell you more about the Stages of Change:

For a person in the pre-contemplation stage:

It is important for you to validate his lack of readiness to admit that he has a problem. You should reiterate to him that the decision to get help is his, but that he should re-evaluate his current behavior and consequences.

For the person in the contemplation stage:

Clarify that, again, the decision is his, but go over the benefits to his life if he were to stop drinking or get off drugs. Offer treatment options and keep the line of communication open.

The person in the preparation stage:

This person could be actively considering getting help. You can help him to get on a waiting list to a residential treatment program, and let him know that he is capable of doing it. Small steps forward will go a long way at this stage.

The person in the action stage:

The chemically-dependent person is in a recovery program or is attending 12-step meetings and is maintaining his abstinence. You can be his sounding board and reaffirm his ability to succeed.

Info on Addiction and Alcoholism

There are five things that characterize addiction:

1. It is a disease (an involuntary disability).

2. It is often progressive and fatal. (It gets worse with time and you can die from it.)

3. There are adverse consequences. (These can be psychological, physical, occupational, legal, interpersonal, and spiritual.)

4. There is impaired control. (An addict can no longer predict what will occur when he uses.)

5. There is denial. (A delusional system that prevents the user from recognizing reality)


Addiction Always Plays Itself Out in Four Phases:


PHASE ONE:

This is the first use and can only occur once. It moves the person's feelings in a welcome direction, towards the euphoria, and it feels good for most people. They learn how much to take to feel good (the dosage). Because it's pleasant, they move on to Phase Two.


PHASE TWO:

Where the person seeks out the mood swing. He will seek out situations where he can use drugs and experience the mood swing and enjoy it. However, if he is in Phase Two, he will do this within the norms of society. In other words, he will still function in his normal everyday life, and no one will notice any contradictions. Once in awhile he may use drugs to excess, but there is no emotional cost, no remorse over it. He will say things like, "I blew it. It won't happen again." However, for those that have the disease, something occurs that moves them to Phase Three (harmful dependence - where the person exhibits a loss of control.)



PHASE THREE:

At this stage, there is an impairment or a loss of control. The person can no longer predict the outcome of his behavior. It violates his values and causes remorse or emotional pain about what occurred. There are negative feelings that trigger denial (rationalize, minimize, blame), which leads to unresolved emotional pain. A person in denial is literally incapable of realizing that he is addicted. As the disease progresses, Phase Three will occur over and over again. The unresolved emotional pain builds and builds and builds. But the pain is still connected to some wrong done while using drugs. Eventually, the emotional pain becomes chronic. It is there all the time, even when the person is not using drugs. He is angry, resentful, and his self esteem has fallen through the bottom. He says things like, "I'm no damn good" and is sometimes even suicidal.


PHASE FOUR:

Now the chemically-dependent person is covering up the chronic emotional pain, i.e., using drugs or alcohol to feel normal. The negative feelings are present all of the time. The person must use his drug to escape from his pain and try and feel normal. It works, and it can trigger another sequence of more trouble and more loss of control. This is the point where an addict will reach his "bottom," where we can get him into treatment, if we haven't intervened before this time.





Refusal to go into treatment

Many addicts and alcoholics refuse to get help no matter how far they sink in their disease. In this event, the most successful method of help is to have an intervention.

RIP

Staging an intervention

The purpose of an intervention is to present reality to that person in a receivable way. If done correctly, 8 out of 10 people will go into treatment.

There are several parts to an intervention:

Step 1: Gathering the Intervention Team:

• Make a list of meaningful persons other than yourself who surround the chemically dependent person.

These could be:

• Employer or immediate supervisor
• Spouse
• Children
• The chemically dependent person’s parents
• Close friends or neighbors
• Coworkers
• Member of the clergy

Step 2: Form the intervention team:

People who know something about chemical dependency (or if they don’t, you will have to educate them);

• Are willing to risk their relationship with the victim;
• Are emotionally adequate to be interveners.
• You do not want somebody who is chemically dependent themselves.
• They need to know that if they do nothing, the chemically dependent person will die prematurely.

Step 3: Gathering the Data:

• Data is information. There are two types of information that you are going to gather:

Type A:

• Make written lists of specific incidents or conditions related to the victim’s drinking or drug use that legitimatize your concern.
• The lists should have the following: What happened, What I did, How I felt
• The lists should give specifics that, should the person not take the help that is offered at the intervention (treatment), specific things that they will be doing to stop enabling the person's addiction, i.e. calling him in sick to work when he has a hangover, giving him money, etc.).
• (During the intervention, treatment is offered to the addict/alcoholic.)

Type B:

• Find out about treatment options in your area.
• What is it that you are going to do with the person if he/she decides to go into treatment? Example: Drive him to treatment facility and help him during admission.
• If you have adequate insurance, you are going to have a bed in a really top-notch program;
• If there isn’t adequate insurance, you are going to find a program that will take less money or has a sliding scale;
• If none of that is an option, then find a 12-step program – The person will attend 30 meetings in 30 days.

Step 4: Rehearsing the Intervention:

• Designate a chairperson.

• Go over each item on the written lists that team members have prepared.

• Determine the order in which team members will read their lists during the intervention.

• Choose someone to play the role of the chemically dependent person during the rehearsals.

• Determine the responses that team members will make to the chemically dependent person.

• Conduct the rehearsal.

Step 5: Finalizing the Details:

• Leave nothing to chance.
• Where the intervention meeting will be held?
• Who is going to get the person there?
• Who is going to drive him/her to the hospital?

Where there's breath, there's hope.

No matter where your loved one's chemical dependence has taken him, you can help him to get into treatment. Though the ultimate choice is his, your compassion and assistance could make all the difference in the world.

Life Recovery Program

Helpful Links:

Understanding Stages of Change

Substance Abuse Treatment Facility Locator

Site for "I'll Quit Tomorrow"

Intervention's Website

Help for Alcoholism





Interventionists

• Intervention - Meet the Interventionists - A & E TV
  Intervention specialists Jeff VanVonderen, Candy Finningan and Ken Seeley help those suffering from addictions with drug, alcohol and other addiction interventions on A&E TV.

Interventionist Referrals

• Alcoholism Interventionist Treatment Center Drug Alcohol Intervention
  Coast to Coast Interventions is the leader in comprehensive drug and crisis intervention strategies.
• National Intervention Referral
  Referrals all over the U.S. for interventionists
• National Association of Drug and Alcohol Interventionists
  More qualified interventionists -- qualified and certificated

Alcoholics Anonymous

• Alcoholics Anonymous Website
  You will find meetings, literature, and much more about this worldwide, 12-step recovery program.

Cocaine Anonymous

• Welcome to Cocaine Anonymous
  The members of Cocaine Anonymous seek to help others to recover from their addiction. We use the 12 Step Recovery program, and welcome any person who desires to stop using cocaine and any other mind-altering substance.

Narcotics Anonymous

• www.NA.org - the website for the Fellowship of Narcotics Anonymous
  Information on meetings, literature, and more about this worldwide 12-step organization.

Al-Anon / Alateen

• Welcome to Al-Anon and Alateen
  Help for the families of alcoholic/addicted loved ones. This is a worldwide organization and 12-step community.

Crystal Meth Anonymous

• Crystal Meth Anonymous
  The Fellowship of Crystal Meth Anonymous works a Twelve Step program of recovery. We have not felt the need to elaborate in great detail a specific CMA approach to the Twelve Steps: too many other excellent outlines already exist for following these

What is Addiction?

There are five things that characterize addiction:

1. It is a disease (an involuntary disability).

2. It is often progressive and fatal. (It gets worse with time and you can die from it.)

3. There are adverse consequences. (These can be psychological, physical, occupational, legal, interpersonal, and spiritual.)

4. There is impaired control. (An addict can no longer predict what will occur when he uses.)

5. There is denial. (A delusional system that prevents the user from recognizing reality.)

Addiction Always Plays Itself Out in Four Phases:

PHASE ONE is the first use and can only occur once. It moves the person's feelings in a welcome direction, towards the euphoria, and it feels good for most people. They learn how much to take to feel good (the dosage). Because it's pleasant, they move on to Phase Two.

Seeking Out the Mood Swing:

PHASE TWO is where the person seeks out the mood swing. He will seek out situations where he can use drugs and experience the mood swing and enjoy it. However, if he is in Phase Two, he will do this within the norms of society. In other words, he will still function in his normal everyday life, and no one will notice any contradictions. Once in awhile he may use drugs to excess, but there is no emotional cost, no remorse over it. He will say things like, "I blew it. It won't happen again." However, for those that have the disease, something occurs that moves them to Phase Three (harmful dependence). At this next stage the person exhibits a loss of control.

Loss of Control:

PHASE THREE is an impairment or a loss of control. The person can no longer predict the outcome of his behavior. It violates his values and causes remorse or emotional pain about what occurred. There are negative feelings that trigger denial (rationalize, minimize, blame), which leads to unresolved emotional pain. A person in denial is literally incapable of realizing that he is addicted. As the disease progresses, Phase Three will occur over and over again. The unresolved emotional pain builds and builds and builds. But the pain is still connected to some wrong done while using drugs. Eventually, the emotional pain becomes chronic. It is there all the time, even when the person is not using drugs. He is angry, resentful, and his self esteem has fallen through the bottom. He says things like, "I'm no damn good" and is sometimes even suicidal.

Covering Up the Chronic Emotional Pain:

PHASE FOUR is using drugs to feel normal. The negative feelings are present all of the time. The person must use his drug to escape from his pain and try and feel normal. It works, and it can trigger another sequence of more trouble and more loss of control. This is the point where an addict will reach his "bottom," where we can get him into treatment, if we haven't intervened before this time.

Throw the "Willpower" Concept Out the Window:

Addiction is not a willpower issue. It is a chemical dependence and should be treated medically, initially, and later psychologically. Once an addict has been medically weaned off his drug, he must undergo both individual and group therapy to build the necessary ego strength to live life without drugs.

If Your Loved One is Struggling with Addiction:

If you have a loved one who is struggling with addiction to drugs or alcohol, there is a book that I would recommend. It's called "I'll Quit Tomorrow" by Vernon Johnson. It goes into what I have written, but in more detail, and will assist you in getting your loved one into treatment.

The good news about addiction is that it is a treatable disease. With the correct information and family support, an addict can enter recovery and remain abstinent from drugs for the rest of his life.