Managing PAW Symptoms

By Terence T. Gorski

women in bed with pill bottle on nightstand

Post-Acute Withdrawal (PAW) are symptoms of brain dysfunction cause by addiction that makes it difficult to think clearly, manage your feelings and emotions, remember things, sleep restfully, and manage stress. If you don’t recognize and manage PAW symptoms they can spiral out of control and lead to progressive problems that cause relapse. Knowing that the PAW symptoms you are experiencing are a normal part of recovery tends to relieve anxiety, guilt, and confusion caused by not knowing. Once you know what is happening, you can learn how to manage the symptoms.

Recognizing and managing PAW is an important part of preventing relapse. If you are experiencing PAW 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.

1. Verbalization: Start talking to people about what you are experiencing. It will help you look at your situation more realistically and help you to consciously identify areas of stress
in your life and the PAW symptoms caused by the stress.

2. Ventilation: Express as much as you can about what you are thinking and feeling even if it seems irrational and unfounded. Using a feeling list and a list of addictive and irrational thoughts can also be helpful.

3. Reality Testing: Ask those who are in recovery and who know you well if you are making sense. Ask for feedback about both what you are saying and what you are doing. Getting another point of view on you problems can be very helpful.

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

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

High stress triggers and intensifies the symptoms of PAW. Learning to manage stress is the first step in learning how to prevent and manage PAW symptoms. Stress management involves:

• Learning immediate relaxation methods, including mindfulness meditation.
• Identifying the sources of stress in your life. This is done by doing a daily plan each morning and a review of your day each evening before going to bed.
• Learning and using decision-making and problem solving skills. The better you are at identifying and effectively solving problems, the lower your stress and the less severe the PAW.
• Developing a balanced lifestyle that includes a healthy diet, daily exercise and a daily schedule that includes addiction recovery activities.
• Learning how to recognize and challenge addictive and negative thinking and getting into the habit of using sober and positive thinking.

A Quick Guide for Managing Post Acute Withdrawal (PAW)

You can manage Post-Acute Withdrawal (PAW). Here is a quick-guide of the steps you need to take.

1. Accurate Information: Explain PAW and have the person do a self-evaluation of PAW and review the results. This will give them words and ideas to explain what they are experiencing. It will also help people to stop feeling crazy, judging themselves for having the symptoms, and being anxious and afraid because they don’t know what is happening.

2. Stress Management, Relaxation and Meditation: PAW is stress sensitive. This means the symptoms get more severe when experiencing high stress and less severe under low stress levels.

3. Proper Diet: Have an alcohol and drug free diet. Eat a high protein, complex carbohydrate meal plan. The diet plan closest to this is a hypoglycemic diet. Ask a nutritionist or look it up the internet. Avoid foods high in sugar and limit your caffeine intake. Supplement with multiple vitamins, Vitamin B-12, and broad spectrum amino acids.

4. Aerobic Exercise: At least twenty minutes per day, three days per week (at least) in a heart-measured aerobic zone. (Subtract your age from 220. 80% of that number is you minimal training zone. 80% is the max). Too high or too low doesn’t seem to help much.

5. A Recovery Program: Have a regular schedule of recovery activities that put you in places and around people who support your recovery, a place where you can talk honestly about yourself without judgment. It is also important to have a sponsor/mentor and therapist who is a trained addiction professional.

These practices stabilize you brain chemistry and reduce the frequency and severity of PAW episodes. Don’t leave PAW management to chance. Get a plan. Work the plan. If it doesn’t
work, get additional help.

Please don’t spread the mistaken belief that there is nothing that can be done to lower the severity of PAW symptoms. This is just not true! The brain grows in response to experiences especially when stress is managed well during the experience. Having a structured recovery program, scheduling time each day for relaxation, meditation and connecting with how to build a sober and responsible life provide the experiences needed for the brain to heal in sobriety.

PAW symptoms and the habits of thinking and living which cause them, can threaten your recovery. Reducing the stress by learning meditation and how to identify and solve immediate problems in recovery must be one of your top priorities.

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, learning to change those situations by avoiding them, changing your reactions, or learning to interrupt them before they get out of control can make a big difference. This is what a structured recovery program is designed to do.

Terence T. Gorski is the Founder and President of The CENAPS Corporation. He is an internationally recognized expert on substance abuse, mental health, violence, and crime. He is best known for his contributions to relapse prevention, managing chemically dependent offenders and developing community-based teams for managing the problems of alcohol, drugs, violence, and crime. He is a prolific author and has published numerous books and articles. Terence is the Director of The National Certification School for
Relapse Prevention Specialists.
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