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

Addiction: You Don't Have to Talk About It

Unless you die of an overdose, you don't have to talk about your addiction or your recovery from addiction. Well, if you're dead, you won't be the one doing the talking anyway, but everyone else will!

What motivated this rant was an actress on a talk show I watched last night. With every topic of discussion, she tossed her drug recovery into the ring. It was annoying to hear this on a comedy talk show because addiction is not funny.

When celebs "broadcast" in a discussion about their taking drugs and their recovery from drugs, it sets up a precident for everyone who has ever had a problem with drugs or alcohol. This is not to shortchange the work of many celebrities and regular folks in overcoming their addiction problems. There is nothing harder to pull off than to recover from addiction. Anyone who succeeds is a giant in my eyes.

If a recovering addict wants to talk about his addiction, that is his prerogative, and I wish him the best. I'm not saying that he is wrong to talk about his recovery -- even online. But, sometimes in their enthusiasm to help others, recovering addicts share dark secrets about their drug pasts that are just as well left unsaid.

An addict in recovery should be known as a really nice guy, or a great actor, or a generous philanthropist -- not as an addict. People are so much more than their addictions -- they are moms and dads and co-workers and valued friends. Why tarnish their image? Not everyone shares my positive views on addicts who have overcome the disease of addiction. In fact, many people (like potential employers) are downright mean spirited about it.

Just something to think about. Addiction is ugly and deadly -- and there is nothing (and I mean nothing) funny about it. 

Solving the Problem of Addiction

(A once-beautiful meth addict)

The American Medical Association's definition of disease is a condition that is chronic, progressive and fatal, if not arrested. The AMA classifies addiction as a disease because it meets these three criteria.

It's a shame, though, that addiction is being treated primarily by the legal system and is considered a legal and societal problem -- not a medical problem.

Society's idea of helping addicts is to lock them up. But what people don't realiize is that addicts get out of jail and are back out on the streets again. Only now the addicts are felons and parolees. They can't find jobs because no one wants to hire felons.

A large percent of the nonviolent offenders in the prison system are there because of addiction. Addicts have to steal to get their drugs. Drugs are like air for addicts, and just like we can't live without air, addicts can't live without their drugs.

No one wakes up at the age of 19 and says, "I think that I will become a drug addict. Heroine will be my drug of choice." This young person is exposed to peer pressure, bad parenting, and all kinds of abuse in and out of the home. No wonder she's an addict.

In a country where the government can bail out the banks and the car companies, why -- then -- can't they get a handle on addiction? It takes detox, treatment and follow-up, and these take money.

Most addicts haven't got the money to invest in comprehensive health insurance, and if you saw what an addict must endure in government-sponsored addiction care, you would be appalled. We treat dogs better.

Addiction is not an impossible problem. It just takes funding.

I wonder if The Donald would read this? Nah. . .

Society is Imploding

Some 45.9 million, or around 1 in 5 American adults (age 18 and over) experienced a mental illness in the past year, according to the US government's latest National Survey on Drug Use and Health, released this month.

The survey, published by the Substance Abuse and Mental Health Services Administration (SAMHSA), finds that the rate of mental illness among 18 to 25-year-olds was more than twice as high as among people aged 50 and over (29.9% versus 14.3% respectively).

The survey report defines mental illness as having a diagnosable mental, behavioral or emotional disorder based on criteria given in DSM-IV (the Diagnostic and Statistical Manual of Mental Disorders edition IV, published by the American Psychiatric Association, APA, in 1994). The definition excludes developmental and substance use disorders.

According to the World Health Organization (WHO), in developed countries mental illness accounts for more disability than any other group of illnesses, including heart disease and cancer.

The economic impact of mental illness in the US is high: estimates suggest it came to about $300 billion in 2002.

The US National Survey on Drug Use and Health (NSDUH) includes about 67,500 people (age 12 and over) throughout the country every year.

The latest survey (2010 NSDUH) also found:

• Adult women were more likely to have experienced mental illness in the past year than adult men (23 versus 16.8%).
• Substance dependence and abuse was higher among people with mental illness (20% versus 6.1% compared to those without mental illlness).
• 11.4 million adults (5% of the adult population) suffered from a serious mental illness in the past year (one that leads to a serious functional impairment that substantially interferes or limits one or more major life activities).
• These had an even higher rate of substance dependence or abuse (25.2%).

SAMHSA Administrator Pamela S. Hyde said in a press statement that:

"These data underscore the importance of substance abuse treatment as well."

However, "Mental illnesses can be managed successfully, and people do recover," said Hyde, adding that the government "is working to promote the use of mental health services through health reform. People, families and communities will benefit from increased access to mental health services."

She also said mental illness is not an "isolated public health problem". It often co-exists with other diseases such as cardiovascular conditions, diabetes, obesity and cancer. It is also linked to risk behavior such as physical inactivity, smoking, excessive drinking, and insufficient sleep. And if you treat the mental illness you often succeed in reducing the effects of the other disorders, said Hyde.

The report shows that 39.2%, or about 4 in 10, people experiencing any mental illness received mental health services during 2010. For those with serious mental illness, the rate of receiving services was considerably higher at 60.8%.

The report also mentions that an estimated 8.7 million adults had seriously contemplated suicide in the past year, including 2.5 million who made plans to kill themselves and 1.1 million who tried.

The report also highlights some important mental health issues among 12 to 17-year-olds. For 2010 it finds that 1.9 million youngsters (8% of 12 to 17-year-olds) had experienced a major depressive episode in the past year. A major depressive episode is one that lasts for at least 2 weeks and is characterized by loss of interest or pleasure in daily activities, and which meets at least four of the seven symptom criteria laid out in DSM-IV.

And, reflecting the same pattern in the figures on adults, the report shows that young people in this age group who experienced a major depressive episode in the past year had more than twice the rate of illicit drug use in the past year (37.2%) compared to peers who had not had a major depressive episode during the same period (17.8%).

Dr Ileana Arias, Principal Deputy Director of the US Centers for Disease Control and Prevention (CDC) said the report "provides further evidence that we need to continue efforts to monitor levels of mental illness in the United States in order to effectively prevent this important public health problem and its negative impact on total health".

Crisis Hotline

If you are in crisis or know someone who is and who may be at immediate risk of suicide, then SAMHSA urges that you call the National Suicide Prevention Lifeline 1-800-273-TALK (8255), or go to their website at http://www.suicidepreventionlifeline.org/.

The hotline is funded by SAMHSA and provides immediate, round-the-clock, every day of the year, free and confidential counseling to anyone in need throughout the United States.

If you are outside the US then try this website Befrienders International.

In the UK, contact The Samaritans.

Written by Catharine Paddock PhD

Changing Our View of Addiction

According to the U.S. Department of Justice, in 2009, 50.7 percent of the inmates in United States federal prisons were there for drug offenses. This percentage represents an increase of 28.2 percent from 2000 to 2009. Just in case  you’re not convinced that these figures are problematic, let me give you some more.

Drug Incarcerations on the Rise:

With drug incarcerations rising so consistently, the decrease in releases from prison and re-incarceration for technical parole violations, there is a gargantuan  problem of overcrowding in state and federal prisons. In 40 out of 50 states, the prisons are at 90 percent or more over capacity. Twenty-three of those states are operating at over 100 percent capacity. How cou any addict become rehabilitated in an environment like that? It could, therefore, be surmised that nonviolent drug offenders enter prison with a drug problem and are paroled from prison with a drug problem. Only now, violence may have become part of the equation because of repeated exposure to violence while in prison.  

The Disease Concept:

The American Medical Association and the American Psychological Association use the disease-model approach to addiction. This is because addiction is chronic, progressive and fatal, if not put into remission. This is like cancer, but if you entered prison with cancer, you would receive chemotherapy, radiation and other aggressive cancer treatment. Even one the Manson Family murderers, Susan Atkins, received cancer treatment while in prison.

Drug Program Failure:

In California, the SAP (Substance Abuse Program) was an abysmal failure. While not going into the reasons for this failure, it must be said that though it didn’t work, there are other models of treatment that should be implemented until a successful one is found. Otherwise, we are going to waste more taxpayer money incarcerating drug offenders, releasing them and then re-incarcerating them for similar drug or drug-related offenses. To even a totally uninformed citizen, this revolving-door approach to drug addiction must seem entirely counter-productive.

Look at this quote from the Justice Policy Institute:

"Substance-involved people have come to compose a large portion of the prison population. Substance use may play a role in the commission of certain crimes: approximately 16 percent of people in state prison and 18 percent of people in federal prison reported committing their crimes to obtain money for drugs. 21. Treatment delivered in the community is one of the most cost-effective ways to prevent such crimes and costs approximately $20,000 less than incarceration per person per year.22 A study by the Washington State Institute for Public Policy found that every dollar spent on drug treatment in the community yields over $18 in cost savings related to crime.23 In comparison, prisons only yield $.37 in public safety benefit per dollar spent. Releasing people to supervision and making treatment accessible is an effective way of reducing problematic drug use, reducing crime associated with drug use and reducing the number of people in prison." 

It is time to stop sending addicts to prison. Lowering recidivism will cut down on prison costs, elevate the status of addicts to people suffering from a disease, and it will cut down on crime.

Re-educate Society:

Why can’t society be re-educated in the disease-concept of addiction when it must be obvious to most people that the “Lock-‘em-up-and-throw-away-the-key” approach isn’t working and is a colossal waste of money that could be directed into solutions that do work.

Addiction is not a criminal problem or a failure of will. Rather, it is about biology and resultant behavior – a disease that society is treating like a crime.

Sources:

1.  Justice Policy Institute, "How to safely reduce prison populations and support people returning to their communities,"(Washington, DC: June 2010), p. 8. /www.justicepolicy.org/images/upload/10-6_FAC_ForImmediateRelease...

2.  American Psychological Association, “What does it mean that addiction is a brain disease ,” Alan I. Leshner, Ph.D.; June 2001 http://www.apa.org/monitor/jun01/sp.aspx

3.  Get the Facts: Prisons & Drug Offenders; 2011 http://www.drugwarfacts.org/cms/node/63

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.