Post Acute Withdrawal Essay, Research Paper
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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