Monday, May 24, 2010

PAWS in Sobriety

PAWS is not some cute AA acronym that stands for something like Please Act Wisely Sober; PAWS is actually a diagnostic term for a set of symptoms called Post Acute Withdrawal Syndrome that can occur for a long time after you put down the alcohol or other addictive drugs. Research has suggested that up to 95% of recovering alcoholics and addicts when tested show the presence of brain dysfunction. Essentially, that is PAWS – symptoms from a dysfunction in the nervous system after quitting booze and drugs. Not to be confused with Wet Brain Syndrome, PAWS is a temporary condition. Do not panic, this too shall pass! However, you can take positive action to help get through it faster and with more ease!

Symptoms of PAWS

When you first detox off alcohol and/or drugs, acute withdrawal is experienced. After a week or two of continuous abstinence from alcohol and drugs, Post Acute Withdrawal Syndrome may be experienced and can last for 3 months to 2 years into sobriety. For most people, PAWS is regenerative - meaning over time and with proper care the symptoms will diminish and damage can be repaired.

Symptoms of PAWS can include difficulty solving simple problems, reacting either overemotionally or having emotional numbness, sleep disturbances, memory problems, inability to think clearly at times, difficulty managing stress, and sometimes problems with physical coordination may present as well. The cognitive symptoms can lead to diminished self-esteem as well. Note, not all of these symptoms may occur and each does not happen constantly but rather periodically. The severity and length of occurrence of PAWS varies individually; it does not look the same for everyone.

What Causes PAWS

Damage to nervous system from the alcohol and/or drugs causes the physiological nature of PAWS, in combination with the other component of PAWS which is the emotional stress of having to deal with life without the old coping mechanism of drugs or alcohol. How much brain dysfunction your addiction has caused + how much psychosocial stress you experience in sobriety = the severity of PAWS. With proper care, it can be reversed.

Taking Action Against PAWS

“… and courage to change the things I can”. This is one of those things you can take positive action to help get through it more rapidly and in a healthier manner. PAWS causes symptoms that are not particularly conducive to your sobriety. In fact, recent research supports the belief that PAWS can contribute to incidents of relapse. As part of a relapse prevention strategy, it is important to address the physical aspects of your alcoholism which includes taking proactive steps to treat PAWS. Your first couple years sober are difficult enough without the added challenges of PAWS symptoms like sleep disturbances and trouble thinking clearly.
Education is always a good start (Education leads to proper Action which leads to Results!). Getting a better understanding about PAWS can ease some of the anxiety and confusion, and help prevent self-esteem problems that can result in the absence of such awareness.

Next, find healthy ways to manage your stress. Stress can be caused by PAWS and also stress exacerbates the symptoms of PAWS so stress management is key! Working the 12 steps with a sponsor is not only the best method for relapse prevention in general, but also a great component to stress management. Meditation is highly recommended! Find what works for you, it can be as simple as setting time for deep breathing daily. Specific nutritional recommendations can really give you the edge on managing stress as well, see this article for details.

Last but not least, get educated about ways to improve your physical health most specifically in terms of your nervous system. If you do just one thing physically to support your nervous system, supplement with a high quality B vitamin Complex. Bill Wilson, A.A. founder, was a big proponent of supplementing with B vitamins to support recovery! To learn about options for a more detailed and custom approach for your nutritional needs in recovery, see this article.

You are not powerless against PAWS. Post Acute Withdrawal Syndrome can be treated by applying the recommended actions listed above, and you can enjoy a long healthier life sober!

Wet Brain in Sobriety

Wernicke-Korsakoff Syndrome, alcoholic encephalopathy (brain damage), Korsakoff psychosis, Wernicke’s disease… all these names refer to what is most commonly called by people in recovery as “Wet Brain”. What’s the real story with Wet Brain Syndrome?

You have probably heard the scary stories about the dangers of LSD - people who dropped acid one too many times or had a bad trip just once who would then suffer random hallucinations and psychotic episodes the rest of their life despite never doing acid again. Perhaps the closest thing to that phenomenon of acid flashbacks for alcoholics would be Wet Brain Syndrome since it involves neurological damage and symptoms that can last long after putting the plug in the jug. When “partying” back in the active days, despite maybe a few jokes about killing brain cells, rarely do heavy drinkers think the alcohol could slowly cause such very serious neurological impairment as is the case with Wernicke-Korsakoff Syndrome. And much like the disease of alcoholism itself, wet brain can sneak up on the heavy drinker, as it develops gradually.

Symptoms of Wet Brain

In reality a much better comparison of Wet Brain would be to Alzheimer’s. Dementia, short term memory loss, and confabulation (false memories) characterize wet brain syndrome. Also, Wet Brain aka Wernicke-Korsakoff Syndrome, typically includes problems related to eye movements, balance and gait, and loss of coordination. Some of these symptoms resemble drunkenness; like with the acid flashbacks, despite absence of the drug, the neurological effects can prevail long after the initial damage was inflicted. Other signs include fatigue, irritability, and sleep disturbances. Late stage Wernicke-Korsakoff syndrome can even result in coma and death.

If you are in early in sobriety, sometimes concerns of Wet Brain are confused with actually suffering from PAWS. PAWS stands for Post Acute Withdrawl Syndrome which can include symptoms such as inability to think clearly, memory problems, sleep disturbances, emotional overreactions or numbness, sensitivity to stress, and problems with coordination. PAWS is temporary, whereas Wet Brain is typically more permanent. Experts suggest PAWS starts a week or two after abstaining from alcohol and can last for 3 months to 2 years into sobriety!

What Causes Wet Brain

Wet brain is caused by gradual brain damage from thiamin (vitamin B1) deficiency. For alcoholics, this syndrome technically known as Wernicke-Korsakoff, develops gradually as a result of a deficiency of thiamin which leads to brain function decline and even neuron death. Chronic excessive alcohol consumption leads to a multitude of vitamin deficiencies, including that of vitamin B1 a.k.a. thiamin. Thiamin plays a crucial role in glucose metabolism, and anything that inhibits the crucial creation of glucose (which the brain relies on to function) can thus cause the brain to rapidly decline in function.

Active alcoholics typically have a poor diet which contributes to vitamin and mineral deficiencies, however even with healthy eating habits the heavy drinking will interfere with absorption of thiamin.

Can Non-Alcoholics Get Wernicke-Korsakoff Syndrome

While wet brain is mainly associated with alcoholism, sometimes non-drinkers can develop Wernicke’s disease as well. There are other ways to become thiamin deficient and therefore susceptible to Wernicke-Korsakoff syndrome, as with the following conditions: severe malnourishment, Chron’s disease, stomach surgery (gastric bypass or stapling), eating disorders involving starvation or vomiting, and even side-effects of chemotherapy.

Can Wet Brain Be Treated

The successful treatment of wet brain depends mainly on the stage of its progression. Early onset of wet brain can be treated and often reversed entirely if caught in time. Anyone exhibiting signs of Wernicke-Korsakoff Syndrome should be given thiamin immediately. Doctors typically administer thiamin intravenously at first. For those looking to supplement on their own, the closest thing to IV is taking a supplement in an isotonic form (for 90-95% absorption, versus 100% with IV, and as little as 20-30% with tablet supplements). In this case, it is recommended to take a B complex supplement rather than choose an individual B vitamin as the various Bs work synergistically together.

Late stage wet brain may be referred to as “Korsakoff psychosis” due to the serious permanent nature of its symptoms. Unfortunately, in its later stages the disease is not reversible.

Patients with Wernicke-Korsakoff Syndrome are sometimes treated with medications used for Alzheimer’s disease when thiamine treatments are ineffective. A more natural alternative to those drugs is Cognitin, a natural cognitive support formula. Cognitin contains the antioxidants acetyl L-Carnitine and alpha lipoic acid (both very beneficial to brain function), and contains vinpocetine (derived from periwinkle extract) which has been used for decades around the world to treat Alzheimer’s and dementia, and is becoming more widely used for general cognitive support.

Do All Recovering Alcoholics Have Some Brain Damage

On a more subtle level, it is probable that all recovering alcoholics have suffered various degrees of cognitive impairment over the course of active drinking years. With this in mind, even the younger and seemingly healthier recovering alcoholics who have no fear of wet brain can benefit from supplementing with a quality vitamin B complex in sobriety (see related article). In fact, researchers have found that supplementing with thiamin (part of B Complex) can also help prevent the development of Wernicke-Korsakoff Syndrome a.k.a. Wet Brain in heavy drinkers.

Friday, May 7, 2010

Good Grief

GOOD GRIEF?
Dealing with grief and loss in recovery, while excruciating, can be the most significant experience to aid in personal growth and secure a strong relapse prevention foundation. “Pain is the touchstone to all spiritual progress.” Once you get through something that feels so painful that it should kill you, but you survive it -and you survive it without a drink or drug- you then know you can get through anything without a drink or drug. After all, isn’t that basically what sobriety is all about… learning to cope with feelings without picking up a drink or drug? Grief kicks up all the toughest feelings we encounter in life: Shock, anger, despair, sadness, depression, loneliness, guilt, remorse, fear and anxiety. If we can endure the roller coaster of bereavement, a certain level of acceptance awaits us. “And acceptance is the answer to all my problems today”.

In early sobriety, we actually gain our first experience at enduring grief without a drink or drug. Having read Caroline Knapp’s memoir “Drinking: A Love Story”, it was easy to grasp the reality that we actually had a relationship with alcohol/drugs. Perhaps it was your best friend who betrayed you in the end, or your lover that abused you but you kept going back for more. Quitting that relationship cold turkey does produce grief effects. It’s the loss of your liquid courage, your instant oblivion, your coping mechanism to just about any undesired feeling or situation. Not to mention the loss of your perceived identity in relation to the drink- i.e. as the outgoing partier, or whatever the case may have been. The anxiety of “who will I be without my good ol’ pal, Captain Morgan (or Jack Daniels perhaps)?”

Stages of Grief in Recovery

First of course there’s the denial. With addiction, that’s a major symptom of the active disease anyway. With the loss of a loved one, especially if it’s sudden and unexpected, during the initial shock and denial it may actually not feel real – you think, how could something so awful be real? It feels like a nightmare and you just keep expecting to wake up from it.

In the stage known as Bargaining, closely linked to denial, we may try foxhole prayer... “Please God, if you just get me out of this situation, I’ll never [drink] again”. We sometimes flip this concept and it becomes what we’d call Reservations. Reservations are those dangerous exceptions you hold on to in which you justify “if this happens… then I can drink”. Like, I can stay sober but if so-and-so dies, all bets are off. That is how an alcoholic reserves her/his right to drink… under certain circumstances. This obviously is discouraged, and why newcomers are encouraged to drill it into their brains: “don’t drink even no matter what” or sometimes heard “don’t drink, even if you’re a$$ falls off”.

Anger is another stage of grief. The A.A. big book warns “if we were to live we had to be free of anger” … but anger is normal stage of grief; it’s what we do with it that matters. As always, step work with a sponsor helps. It is important when the anger comes to get it out, for example screaming when you can (i.e. alone in car so your neighbors don’t think you’re a lunatic), working out is great for this stage- focus on your anger as you lift weights or whatever exercise you engage in.

Typically just beneath the anger we find sadness. Depression is another symptom of grief. When going through grief, sudden bursts of crying are normal and common. Experience dictates that they become fewer and farther between when you actually let it out when these come on. You may fear “if I start, I’m afraid I won’t be able to stop” but this is not true. How often in meetings (or in general!) do we see people ashamed to cry in public? Letting it out not only will help you, but by example in showing your true feelings of grief you may help countless others too.

Is it the -ism Talking or the Grief?

In recovery, dealing with the depression phase of grief in particular can be confusing. There can be a fine line between grief talking and your disease (stinkin’ thinkin’) talking. How do you know when you are experiencing normal depression/sadness as a stage of grief, versus your addict mindset taking over which is serious cause for concern? Keeping your sobriety first- focusing on your program and keeping it simple. If you are working your program then you know you are not shifting into dangerous “dry drunk” territory and thus whatever emotions are coming up are likely to be the grief and they WILL pass and ease up with time. When in doubt, talk it out with another alcoholic and/or share on group level.

Note- it is common and normal to have thoughts of wishing you could join your lost loved on the other side. This can be scary to experience some suicidal-related thoughts. Again, share them. …Ideally with a professional. Be aware that unless these thoughts get to the point of having a specific plan you wish to carry out, you do not have to fear being institutionalized for sharing these feelings with a professional. It is a common phase of the grief. This too shall pass, really.

Remember that the stages are not always linear… Don’t panic if you feel like “wait, I got through this stage, why am I [angry, sad, whatever] again?” The stages don’t always progress in order and only once… much like the roller coaster of emotion experienced during your first year sober. Just remember that it will even out eventually, so hang on and use your support during the ride.

Tools to Support your Healthy Journey Through Grief

Spiritually…
Thankfully for all the intense emotions that accompany grief, the 12 steps can be applied for support, relief, relapse prevention, and ultimately character growth. Throughout the stages of grief during sobriety utilize your support system as much as possible- friends, family, sponsor, therapist, whatever the case may be. It is easy to isolate during grief and feel very alone, which is particularly dangerous for recovering alcoholics and addicts. Whatever type of prayer and meditation you practice, use it! And again, share share share.

Emotionally…
Intense and sudden grief in particular can lead to symptoms of Post Traumatic Stress Syndrome. Seeking outside help is something of which Bill Wilson was a big fan. An effective scientific and holistic modality called EMDR is often utilized in the psychotherapy field to resolve PTSD and can be very helpful during your grief process. EMDR can help to safely accelerate healing and help process the various emotions during grief to help you on your journey to a place of emotional acceptance. To learn about this particular modality, visit the EMDR Insitute and you can search for licensed certified practitioners near you.

Physically…
Last but not least, grief takes a serious toll on us physically. Being so drained emotionally we can tend to neglect our physical health which during times of grief also suffers a great deal from the stress. Read this important related article on nutritional support during stress. A little support physically can really go a long way in supporting you mentally and emotionally during your stages of grief.

Tuesday, May 4, 2010

Nutritional Support During Stress

Need for Nutritional Support During Stress

Our adrenal glands physically endure the biggest brunt of all our emotional stress and thus benefit from nutritional support especially during times of stress. If you are not familiar with these crucial glands, adrenals are involved with the well-known Fight or Flight reaction. The adrenal glands secrete hormones that influence all the major physiological processes in your body. Stress can fatigue them. When your adrenals become weak or burnt out, this can cause you to feel fatigued, and be less equipped physically and mentally to handle the prolonged emotional stress. Also, you will be prone to other health issues as weak adrenals lead to lowered immune health. You can probably think of at least one person you know under constant stress who is also chronically sick. Adrenal fatigue can also make you more prone to allergies, inflammation, weight gain, and other health challenges.

What else taxes the adrenals aside from emotional stress? Physical stressors to the body such as sugar and caffeine… the very things many of us are prone to reach for when we are already feeling emotionally stressed! One of the many functions of the adrenal glands is related to regulating your blood sugar! Especially during times of stress it is best for us to avoid sugar.

For Serious Adrenal Fatigue

If you are seriously concerned about the health of your adrenal glands, you can request to have them tested via labwork. Good doctors that specialize in integrative medicine (docs who are up on the current tests and various modalities available in addition to conventional medicine) can easily hook you up with a saliva test and/or bloodwork to test your adrenal function looking at all the hormone levels your adrenals are supposed to secrete! It is best to use a test that requires samples at various times of the day (usually a take home kit then mailed to lab or returned to doc) because hormone levels are meant to fluctuate and have different parameters that should be evaluated at different times of the day.

Great Supplement for General Support

Bliss anti-stress formula is a highly recommended herbal supplement for daily nutritional support of your adrenals, or even just to use on particularly stressful days/weeks as needed. The natural ingredients are a unique blend of adaptogenic herbs- meaning they help your body (adrenal glands) adapt to stress better. If you adrenals are working too hard, they may need to chill out. If they are weak, they may need a boost. That’s why adaptogenic herbs are great in this manner. You can read up on the ingredients, benefits, research FAQ, etc on Bliss by clicking HERE then scroll down. If you have questions regarding taking Bliss when on medications i.e. for anxiety or depression, you can print out the info from that link to bring it to your physician.

What else can you supplement with to support your body in coping with emotional stress? Try a quality highly absorbable B Complex. B vitamins are also essential for helping your body cope with the effects of stress. If you are a recovering alcoholic or addict, you should seriously consider supplementing with B Complex anyway (Read more here). Giving your physical health extra nutritional support during stress can aid you in the difficult emotional challenge of stress, particularly in times of grief but also in daily life.