By Karen Morgan When I originally entered the addiction field in late 1992, I was completely unaware of Post Acute Withdrawal (PAW) though I had certainly experienced the symptoms. I was six years into recovery at that time, which was a direct result of involvement in and commitment to a 12-Step recovery program. I learned how to get and stay sober, but not how to regulate my emotions or how to effectively manage my stress-related illness. So, when I was introduced to Staying Sober by Terrance Gorski and Merlene Miller, I felt I had struck gold! As the years progressed, many situations arose that produced significant amounts of stress in my life which caused and aggravated PAW or Sobriety Based symptoms. It’s important to point out that everyone experiences stress to some degree as a result of a change in one’s life, good, bad or otherwise. Adding the dynamic of recovery from substance dependence, we tend to have exaggerated experiences and therefore, higher levels of stress. Our brains have been physically altered due to the use and abuse of substances as well as any co-occurring mental health conditions, so we react much more strongly and tend to encounter the following symptoms:
- Inability to think clearly
- Memory problems
- Emotional overreactions or numbness
- Sleep disturbances
- Physical coordination problems
- Stress sensitivity
To conclude that this phenomenon is experienced only in early recovery is a serious misnomer! In fact, these symptoms are present to some degree in sustained, long-term recovery during periods of change resulting in increased stress levels. Physical trauma from an accident or minor or major surgery, also produce these symptoms. Everyday stress that’s not dealt with appropriately or in a healthy way can pile up and lead to the same symptoms. Over time, they can lead one into a downward spiral into unhealthy behaviors and back into active addiction. That’s why it’s so important to be aware of the triggers and the symptoms when they arise, as well as the development of coping strategies. Here’s an overview of each PAW or Sobriety-Based symptom: Inability to Think Clearly Sometimes it’s next to impossible to focus on a simple task or concentrate for more than a few minutes at a time. While you might think something is terribly wrong with your intelligence, rest assured your intelligence is intact, but your brain has been hijacked by the increased stress. Memory Problems When PAW is activated, you might find it difficult to recall certain events in your life or to remember instructions you heard only minutes before. You might also have difficulty recalling simple words, which decreases your ability to carry on a conversation or complete simple tasks. These symptoms can quickly lead you to believe you’re losing your mind. Emotional Overreactions or Numbness More times than not, when we enter the recovery process, we do so with significant unresolved emotional issues. Treatment is where we learn to identify and regulate our emotions to lead a healthy life. During times of increased stress, these feelings tend to rise to the surface even after years of work and progress. We might still overreact with intense emotion or experience apathy when we we think we should be feeling something more. This too shall pass, as we consider this an opportunity to peel another layer of the onion and grow at a deeper level. Sleep Problems While the vast majority of people in early recovery experience sleep disorders, such as disturbing dreams along with difficulty going or staying asleep. These issues often resurface during periods of high stress and reek havoc. This is another example of stress causing and aggravating a situation. Physical Coordination Problems Slow reflexes, unsteady gate, hand-eye coordination, and dizziness are sometimes experienced during times of increased stress. Some people appear under the influence, even though they aren’t. This is where the term dry drunk originated. This actually has more to do with the stress placed on the central nervous system. Stress Sensitivity We’ve already mentioned Addiction as a stress-related illness and how PAW causes and aggravates the symptoms. Now, it’s important to note the difficulty associated with stress management. It can be extremely confusing to become overly aware of one’s reaction, especially when it seems inappropriate to the situation. This creates even more stress and thus intensifies the other sobriety-based symptoms. There is a Solution Awareness of Post Acute Withdrawal and which symptoms you’re likely to experience is key to developing the coping strategies to keeping you on the path. While there is no easy fix, you can become mindful of what triggers your sobriety-based symptoms and develop positive coping strategies. Talk to those who understand your illness and support your recovery. It’s important to verbalize your thoughts and feelings to improve conscious awareness so you can see things more realistically. This is also an opportunity to check your perception with reality. Set achievable goals. Determine what actions can you take to alter your current situation. Remember feelings come from our thoughts and our thoughts come from our actions. Decide what positive action to take to improve your thoughts and thus your feelings. In order to function effectively under these conditions, it’s crucial to educate yourself about PAW symptoms, slow down and focus on one thing at a time, take notes to improve memory and ask questions when in doubt. Proper nutrition, regular exercise, mindfulness/relaxation, spirituality, and balanced living are all important components. It’s imperative to remember that recovery is an ongoing journey that requires work over the course of one’s life. Stress is a part of life that we all experience, it’s critical to take an active role in protecting yourself from anything that threatens your mental health and therefore your recovery. Knowing your triggers, avoiding people or situations that could pose a problem and identifying, as well as attending to your own needs, will set you up for success.