Post-Acute Withdrawal Syndrome (PAWS)

I remember when I was tasked with discussing PAWS with my clients and told that the topic would be covered over the span of two nights.  How am I possibly going to stretch this topic out to 6 hours??  Wrecked with self-doubt, I put my most creative energies to work and walked into the group still struggling with an idea on how to make this topic interesting.  As everyone was checking in I realized that I wasn’t really teaching them about PAWS, they were already experiencing it themselves, I was just opening their eyes to what was happening in their bodies!  With that in mind, I started group asking for everyone to talk about the differences they have felt in themselves while in recovery (excluding initial withdrawal symptoms) and within 15 minutes, they had compiled a list that included every symptom of PAWS.

Engaging the group in this way allows the clients to take ownership of their own learning. They didn’t need to be “taught” about the topic, they knew it and were just vocalizing it to the rest of the group. In addition, having the clients discuss their own symptoms in this way normalized the feelings that were happening in the room. No longer was it just one person who was having trouble with their memory, it was many.

Something I have found interesting was their fascination with the science behind PAWS. Often times when we are discussing a topic, the conversation will go back to the physiological reason behind the topic.  When discussing PAWS, it is important for you as the facilitator to be knowledgeable about the physiology behind it and for that I would suggest reading an oldie but a goodie, Stay Sober by Terence Gorski (excerpt can be found here).

Once you are finished discussing the many symptoms of PAWS, it is essential to have a discussion about managing symptoms. Gorski’s reading provides many talking points that should be included in the group discussion and one of the most important topics that should be covered is managing STRESS!!  

Speak to the group about the various ways we place more stress on our bodies and how we should work on being as LEAST stressed as possible during recovery.  Stress exacerbates the symptoms of PAWS. What are some ways to destress?

  • Cut out or limit the amount of caffeine intake! Human beings were not always caffeine dependent and today it seems we have taken caffeine consumption to a whole new level.  I remember when drinking caffeine to stay awake was when my mom would have her morning coffee.  Now that has turned into the morning coffee, and then 3 or 4 more other morning coffees thanks to the Keurig machines in every office. Don’t even get me started on Monster and Redbull!
  • Exercise!! It’s the word nobody wants to hear, but it is essential in managing stress.  Tired of the treadmill at the gym? Go outside!! Hiking can be done almost anywhere and it’s free so there’s really no excuse for avoiding it.
  • Watch a movie/tv.  Now, I’m not saying spend all of your free time in front of the television, but sometimes it’s essential to just unwind and watch something for pure entertainment, come on guys, “New Girl” is back and I know you are all wondering what’s going on with Nick and Jess…
  • Read a book.  I had to include this after I encouraged everyone to become zombies in front of the tv, but it works! Get lost in another world and become someone else for a change. If you’re stuck on what to read, Harry Potter is always getting into some great adventures and provides an excellent outlet for you to release the kid side of you for a few hundred pages.
  • Laugh with friends.  I’m not sure about you, but when I hang out with my friends I tend to be laughing at least 90% of the time.  Laughter is a natural destresser both physiologically and mentally so give it a try! Worst comes to worst, you will enjoy yourself anyway and have a much needed catch up session.

The Ungame

ungame

While I was looking for fun and exciting games to bring to my group therapy sessions, I kept coming across the Ungame. So, after weeks of hemming and hawing, I decided to give it a chance and bought it through Amazon.  Most of clients are in their 20s/30s so I bought the Ungame for 20 Somethings, hoping it would be less “hokey” and “family fun” and more geared to this age group.

Overall, it was a nice addition to the group because it was a break from our usual conversation based session. Clients were at first excited to play a game, but the problem was that this game doesn’t really feel like a game, rather it feels like you’re just going through a list of questions.

A few suggestions for the game:

  • Use deck 1 if you are utilizing the Ungame for a break from “formal” therapy. The questions are lighter and keep the conversation flowing and the clients connecting with one another without feeling like they need to share some deep, dark secrets.
  • Go through the cards! Some of the cards will be of no benefit to your particular group of clients so take them out.  Nothing kills the momentum of the game faster than pulling a card that takes everyone out of the moment.
  • Great game for clients who do not know each other too well – so try to use it on a newer group, or a group that recently added some new members.  It allows them to open up in an environment without any pressure. It is far easier to share your favorite movie than it is to talk about a relationship you ruined because of your drug use.  However, after connecting with others about something as minor as a favorite movie, the clients are laying the ground work for more deep and serious conversation later on.
  • Make it more of a game! Every other turn, I allowed the clients to either answer their question or give the question to someone else – the only rule was once they passed the question to another person, that other person could not be asked another question that round. Clients love this aspect and it brings more of a “game element” to the activity.

So go out and give the Ungame a try! If you have used the Ungame before or have any ideas on how to better incorporate it into therapy, let me know!