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PATTERNS OF POST ACUTE WITHDRAWAL

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

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

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

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

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

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

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

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

MANAGING PAW SYMPTOMS

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

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

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

Stabilization

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

Verbalization: Start talking to people who are not going to accuse, criticize, or minimize. You need to talk about what you are experiencing. It will help you look at your situation more realistically. It will help you bring internal symptoms to your conscious awareness. And it will give you support when you need others to rely upon.

Ventilation: Express as much as you can about what you are thinking and feeling even if it seems irrational and unfounded.

Reality Testing: Ask someone if you are making sense. Not just what you are saying but your behavior. Your perception of what is going on may be very different from reality.

Problem Solving and Goal Setting: What are you going to do right now about what is going on? You can choose to take action that can change things.

Backtracking: Think back over what has been happening. Can you identify how the episode started? What could have turned it off sooner? Think of other times that you were experiencing symptoms of PAW. What turned it on? What turned it off? Were there other options that might have worked better or sooner?

Education and Retraining

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

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

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

Self-Protective Behavior

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

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

Nutrition

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

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

DIET FOR A RECOVERING PERSON

-       Three Well-Balanced Meals Daily –

-       Three Nutritious Snacks Daily –

-       No Sugar and Caffeine –

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

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

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

Exercise

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

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

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

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

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

Relaxation

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

Playing is a necessary form of relaxation that is often neglected. It is difficult to define play because it is not so much what you do as how you do it. We all need time for having fun, laughing, being childlike and free. There are other “diversions” you can use as natural 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 produce a sense of well-being. Deep relaxation rebalances the body and reduces the production of stress hormones. What happens when you relax is the opposite of the “fight or flight” reaction. When you relax, your muscles become heavy, your body temperature rises, and your breathing and heart rate slow down. A muscle cannot relax and tense at the same time. It is impossible to maintain tension while physically relaxing. You can learn techniques to allow your body to relax. The distress resulting from thought process impairments, emotional process impairments, memory impairments, and stress sensitivity can be reduced or relieved through proper use of relaxation.

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

(Post Acute Withdrawl Part #3)