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Essay Name       : 1026.txt 
Uploader         : Rich Laban
Email Address    : 
Language         : english
Subject          : Health
Title            : Post Acute Withdrawal
Grade            : 80%
School System    : graduate school
Country          : USA
Author Comments  : 
Teacher Comments : 
Date             : 11/14/96
Site found at    : web search
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                          POST-ACUTE WITHDRAWAL (P.A.W.)

Post Acute Withdrawal or P.A.W. is a sobriety-based symptom that makes 

abstinence difficult and often contributes to relapse.  The presence of brain 

dysfunction and change in alcoholics has been documented in 75-95% of recovering 

alcoholics tested from a neurological standpoint.  These symptoms begin to appear

in 7-14 days after abstinence and can continue for a period of six months (or 

longer).  Recovery and the accompanying changes in family, social and work spheres, 

generates a great deal of stress for which some people never learn to manage 

without reusing.  The severity of P.A.W. depends on two things:

          1. Severity of brain dysfunction
          2. Amount of psycho-social stress experienced in recovery

Stress of any kind can aggravate the brain dysfunction, which would heighten the 

magnitude of the symptoms.  P.A.W.  will peak in intensity over a 3-6 month period 

but the damage is usually reversible after a period of time if proper treatment is 

received.  Recovery from the nervous system damage usually requires anywhere from 

6-to-24 months with involvement in a health program.

    There are 6 major symptoms of P.A.W.  First, the person will have an Inability 

to think clearly as evidenced by poor concentration and  rigid and repetitive 

thinking. They will also have  Memory problems as seen with being unable to retain 

something heard or forgetting things within 20 minutes.  Persons with P.A.W. tend 

to be emotionally over-reactive or experience emotional numbness in situations. 

They will also experience varying degrees of  sleep disturbances with either too 

much or too little sleep or sleeping at different times of day and having 

nightmares or powerful 'drug dreams'.  They will encounter physical coordination 

problems as seen with clumsiness and being accident prone.  They may report this 

as balance difficulty.  The term "dry drunk" is derived from these symptoms.  

Stress Sensitivity is a factor that makes it hard to distinguish between low and 

high stress and often prompts the person to be over-reactive to stress.  It is 

fairly easy to recognize the interplay each of these symptoms would have in 

triggering one another.  For example, a person who is not sleeping well would 

experience an increase in frustration tolerance which could be further aggravated 

by trouble remembering certain tasks with a job.

    It is necessary to understand and learn about P.A.W. and to recognize 

that a person experiencing these effects is not incompetent and not going 

crazy.  P.A.W. symptoms are not the same for everyone nor does every person in 

early recovery experiences any significant P.A.W. symptoms.  Traditional drug and 

alcohol treatment has not addressed these symptoms because they were unrecognized 

until recent times.  With the proper education with regard  to necessary measures 

and healthy activities,  further degenerative changes can be averted to a more 

stable phase of P.A.W.  The stable period of P.A.W. would then progress to  a more 

regenerative state of brain healing.   Even in the absence of any P.A.W. symptoms, 

there remains the risk for them to recur during the critical  period of 3-6 months. 

Proper management of P.A.W. symptoms is a MUST.   Accurate  recognition of stress 

producing factors is key along with learning how to both reduce or manage stress. 

Once the sources of stress are identified,  specific skills-training along with  

decision making and problem solving education can help reduce stress.  Proper diet, 
exercise, regularity with daily habits and a positive attitude can all contribute 

to a manageable control of P.A.W.   Several suggestions  to help interrupt P.A.W. 

symptoms might include the following.  Having the ability to Verbalize  and talk 

about the P.A.W.-based symptoms is critical.  Extending this to deeper expression 

or  Ventilation  of feelings and thoughts can provide balance and feedback before 

impulsively acting on the experiences.   Reality Testing, in this context, refers 

to the process of asking others to validate your perceptions and behaviors and 

'checking things out'.   Effective  Problem Solving and Goal Setting skills can 

also thwart P.A.W. symptoms and allow one to make healthier choices in life and 

gain control over decisions and in effecting change; Backtracking is a process by 

which the person will think back over what has happened (with a P.A.W. experience) 

and identify how the episode started and what could have minimized the P.A.W.  

experience.  By recollecting  other episodes of P.A.W. and recalling what worked 

and did not work in terms of alleviating the symptoms brings forth a conscious 

effort to process these events which can lead to both greater control as well as 

reduction of P.A.W. symptoms. 

     Retaining is a competency that involves practicing certain skills in a safe 

environment that can lead to an increase in self confidence.  This might include 

learning how to approach a problem step-by-step and to handle one element of a 

problems at a time in order to avoid becoming overwhelmed.  It could include 

writing things down  in order to assist remembering and in facilitating questions 

when clarification is needed.  Learning about the symptoms of P.A.W., knowing what 

to expect, and not overreacting to the symptoms, increase one's ability to function 
appropriately and effectively. 

     Nutrition is especially important to the recovery process and in combatting 

P.A.W.  Poor health contributes to stress and malnutrition contributes to poor 

health, physically and emotionally.   Changes with physiological systems, caused 

by the addiction,  may prohibit  one's body from utilizing consumed nutrients.  

Abstinence alone will help some, but is usually not enough.  A  recommended diet 

for an early recovering individual would be three well-balanced meals daily,  three 
nutritious snacks daily and the avoidance of sugar and caffeine. Both concentrated 

sweets and over-the-counter stimulants (caffeine being one) give the body a "quick 

pick up"  but one experiences a "let-down" about an hour later.  Nervousness, 

irritability and sleeplessness, along with restlessness and concentration 

difficulties can accompany this which would inflame the P.A.W process.  

     Exercise is also important in reducing P.A.W. symptoms.  Exercise can 

stimulate the production of endorphins and other brain neurotransmitters.  These 

chemicals are natural chemical transmitters in our brains that regulate all of our 

thoughts, feelings and behaviors and also help to reduce pain, anxiety and tension. 

Different types of exercises are helpful for different reasons.  Stretching and 

aerobic exercises are probably most helpful for recovery needs in that stretching 

exercises help to keep the body limber and to relieve muscle tensions while 

aerobics are rhythmical and vigorous exercises for large muscles. Aerobics are 

intended to raise the heart rate to 75% of its maximum rate and maintain that rate 

for at least 20-30 minutes. Aerobic exercises are recommended and may include 

jogging, swimming, jumping rope and cycling.  It is important for the client to 

choose a form of exercise that is personally enjoyable.

     Relaxation is another prescription for the treatment of P.A.W. is often 

claimed to be used for reducing stress and as well a producing serenity. Relaxation 
is also a highly individualized activity and examples might include reading, body 

massage, laughter, musical pursuits, crafts and hobbies and other creative 

endeavors. Deep relaxation provides  balances to autonomic systems and initiates 

parasympathetic activity which reduces stress hormones (i.e., adrenalin).  By 

following some of the guidelines presented above, the debilitating effects of Post-

Acute Withdrawal can be reduced or avoided.  

 
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