SECTION XL: SUBSTANCE INTOXICATION/WITHDRAWAL Therapists Overview

COPING WITH POST-ACUTE WITHDRAWAL (PAW)

GOALS OF THE EXERCISE

1. 2. 3. 4. 5. 6. Recovery from substance intoxication/withdrawal, and participation in a chemical dependency assessment. Learning about a common syndrome in recovery from chemical dependency which might otherwise lead to demoralization, anxiety, and relapse. Becoming empowered to cope with post-acute withdrawal (PAW) and learn about resources and supports available for assistance. Stabilizing the clients condition medically, behaviorally, emotionally, and cognitively and returning to functioning within normal parameters. Keeping health care providers informed of withdrawal symptoms. Compliance with instructions of health care providers in coping with PAW.

ADDITIONAL PROBLEMS FOR WHICH THIS EXERCISE MAY BE USEFUL

Depression Relapse Proneness Substance-Induced Disorders

SUGGESTIONS FOR PROCESSING THIS EXERCISE WITH CLIENT

The Coping with Post-Acute Withdrawal activity is intended primarily for clients in early recovery after long-term or heavy abuse of alcohol or barbiturates, but some of the features of PAW may be seen in users of other categories of substances as well including opioids and stimulants. The exercise normalizes the experience of otherwise alarming persistent symptoms and relieves clients fears that those symptoms are permanent, increasing motivation to remain abstinent. Follow-up for this activity may include discussion of symptoms with the therapist, group, a physician, and a program sponsor; keeping a log of gradual improvement; and planning of coping strategies.

EXERCISE XL.A

COPING WITH POST-ACUTE WITHDRAWAL

Heavy drinking or drug abuse upsets the chemical balance in a persons body. Although it may only take days or weeks for alcohol or other drugs to leave the system, this chemical balance can take months to get back to normal. This is called post-acute withdrawal, or PAW. While this happens, a recovering person may continue to experience physical, mental, and emotional problems. It is important to know that though these PAW symptoms may hang on for months, they will keep gradually getting better if you stay clean and sober! This exercise will help you understand PAW and teach you how to get through these problems without relapsing. 1. Some symptoms of post-acute withdrawal (PAW) are as follows: Difficulty thinking clearly Problems with memory, especially short-term memory Increased feelings of anxiety, depression, and/or irritability Rapid mood swings that seem to happen for little or no reason Emotional over-reactivity or numbness Sleep disturbances Problems with physical coordination

Have you repeatedly experienced any of these problems since you stopped using alcohol or other drugs? If so, please check the ones youve experienced. 2. What methods have you tried to cope with these symptoms?

3.

What methods have worked best for you?

EXERCISE XL.A

4.

Your assignment now is to talk with other people in recovery and ask how they have coped with PAW without returning to using/drinking. Who will you ask, and how will you ask them for this information?

5.

Based on what you have found works for you and on the experiences of other people, please list five things you can do to cope with PAW if you experience the symptoms listed earlier. a. b. c. d. e.

Be sure to bring this handout back to your next therapy session, and be prepared to talk about your thoughts and feelings about the exercise.