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Post Acute Withdrawal Syndrome (PAWS)

Many of us are aware that when someone stops using certain drugs or alcohol, that person can experience withdrawal. This phase of discomfort, called acute withdrawal, often manifests in muscle aches, nausea, headaches, gastro-intestinal distress, increased heart rates, and irritability. Sometimes acute withdrawal can even lead to life threatening situations without proper medical care, such as in the case of withdrawal from alcohol and benzodiazepines. Acute withdrawal’s effects vary from mild to severe depending on factors such a substance, frequency, duration, and quantity used. They can last a few days to a few weeks. For many, withdrawal can continue past this acute phase, though often it is not identified as withdrawal. This phase of withdrawal is called Post Acute Withdrawal Syndrome or PAWS for short.

PAWS is a period of adjustment where the brain is essentially “recalibrating” after an active addiction stage since chronic substance use can change molecular, cellular, and neurocircuitry in the brain. This period of adjustment can last weeks to months, and for some, maybe even years depending on the intensity and length of time of the active addiction. Protracted withdrawal symptoms are often misidentified or not understood because PAWS is not always discussed amongst recovery communities and even medical providers. This can lead to greater distress in the person’s life and ultimately leads to  a series of events that can trigger resumption of substance use, or relapse.

Symptoms related to PAWS vary by the substance and other factors but can include irritability, hostility, depression, anxiety, low energy, fatigue, sleep issues, memory problems, trouble focusing, cravings, impaired executive control, anhedonia (inability to feel pleasure), lack of sex drive, and sometimes even chronic pain. These symptoms can sometimes worsen or be triggered by increased stress. People often identify many of these symptoms as occurring in waves that lessen in intensity and duration over time.

To recover from PAWS time helps, but cannot be the only factor in healing. Often people learn to manage the symptoms related to PAWS. Some suggestions include mental health/psychiatric care, good self-care practices, building support networks through family and friends and/or mutual support groups, identifying triggering events, taking care of physical health, good sleep hygiene, educating yourself about symptoms and coping skills, and practicing patience. Recovery cannot be hurried. Not every day will be a good one and treat yourself with some compassion.

If you or a loved one need assistance with mental health or substance use, visit our resources page for more information here. If you are experiencing an emergency situation, please dial 911 or your local emergency services. Much love.

-Chris Dorian, Founder of Know Your Why Recovery

 

Information in this blog post came from the following pages

https://www.mirecc.va.gov/visn16/docs/post-acute-withdrawal-syndrome-veteran-guide.pdf

https://www.hazeldenbettyford.org/articles/post-acute-withdrawal-syndrome

https://americanaddictioncenters.org/withdrawal-timelines-treatments/post-acute-withdrawal-syndrome

https://www.medicalnewstoday.com/articles/post-acute-withdrawal-syndrome#summary

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What You Do Matters

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Creator/Copyright: Ivan Mikhaylov Credit: Getty Images/iStockphoto

No matter how small your action is. No matter how seemingly insignificant of an impact you think you have, what you do matters. This can be a difficult concept to not only remember but sometimes to even recognize. We tend to set our sights on the larger goal, the end product, the overall process. In doing so, we set ourselves up to miss the small victories in the progress we make. We can fail to recognize that what we are doing can and will make a difference. We can lose our motivation and passion.

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Dudeism & Recovery

Not too long ago I had the idea to bring different perspectives on recovery that may not be well known into this blog. However, I was stuck. I didn’t know where to start. Aside from current view points of addiction and mental illness that are well known to the treatment field, I didn’t know what I could present. Then I realized the answer had been in front of my face for the past couple years. In a philosophy, religion actually for some, that I have tried to incorporate more and more into my lifestyle. As a Dudeist Priest, or Cleric of the Church of the Latter-Day Dude (if you’re not into the whole brevity thing), I realized Dudeism could help provide this alternative perspective.

Yes. You read that right. Dudeism. Some of you may be saying “What in God’s holy name are you blathering about?” While others may be saying “A wiser fella once said, sometimes you eat the bear, and sometimes, well, the bear eats you.” According to dudeism.com, Dudeism is “the slowest growing religion in the world…an ancient philosophy that preaches non-preachiness, practices as little as possible.” Dudeism is a philosophy that recent has been organized into a religion (that’s just, like your opinion, man). It uses the movie The Big Lewbowski as a parable.  Its roots lie in Taoism but it incorporates a number of other philosophies.  I could spend a whole blog entry explaining Dudeism but instead why don’t you explore and learn for yourself here.

For those familiar with the movie, you would know there is a fair share of drinking, drug use, and other problematic behaviors. Despite this, others have been able to embrace Dudeist concepts and incorporate them into their lives without use of substances.

We are here to see some viewpoints of Dudeism and recovery. Though I could write on this myself, I thought it would be better coming from others.  For this, I asked some members of Dudeism to share their experience and perspectives. Below are two of those contributions with more to possibly come soon. Click “continue reading” to see their entries.

-Chris Dorian, Founder of Know Your Why Recovery

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Know Your Term

New Episode-Know Your Term-Stages of Change

A long awaited new episode of Know Your Term is finally out. Here we briefly cover the Stages of Change (Transtheoretical Model) of Pre-Contemplation, Contemplation, Preparation, Action, and Maintenance. View below for more!

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Dungeons & Dragons is My Therapy

Before we go further, I have to do the responsible thing and say this—when I describe Dungeons & Dragons (D&D) as therapy, I do not mean it in a sense to replace formal therapy with a trained and licensed professional such as a psychologist, counselor, or social worker. There are some professionals that integrate table top role playing games (TTRPGs) into their treatment and I will cover that a little below. When I call D&D my therapy, I’m referring to it as a therapeutic activity, a coping skill, and a personal vehicle for introspection and growth. Should you or a loved one need professional help you may be able to find some useful links on our resources page.

In April 2020, right after the start of COVID-19 pandemic spread in my area, five friends from college decided to take a leap of faith and do something many of us had talked about for a long time but either never did or hadn’t done for a long time—enter the world of Dungeons & Dragons. Little did I know, this new social activity in my life would thrust me into worlds I never expected and provided invaluable support when needed most.

Some background info–Whether it be recent controversy and conflict over D&D’s gaming license, satanic panic of the 80’s, the recent media coming out (Vox Machina, Honor Among Thieves), or some other means which may or may not implicate you as a collaborator in nerdery, you’ve probably heard of Dungeons & Dragons.  D&D is a table top role-playing game where players form an adventuring party to explore fantasy worlds together (or separate, though splitting the party is a surefire way to bring trouble) and participate in quests to earn experience, riches, and grow their character. All of this is coordinated by the Dungeon Master (DM) or Game Master (GM) who is not only referee but story teller. The game may involve use of official created stories and adventures or player created content (referred to as homebrew), but any game requires creativity and adjustments on the fly as all possible scenarios can never be accounted for, just like in real life. Games can vary from “one shots” which are usually a few hours of play, to multi-session campaigns which can take years to develop and complete.  While fates are often determined by rolls of the dice, a player’s role play and decision making can have greater implications in outcomes. We must never doubt the power of “The rule of cool.”

Back to us. Since the group of five of us are spread throughout multiple states and we started this in the middle of the pandemic, we utilized online systems such as Roll20, Zoom, and Discord to aid us in playing the game. This is opposed to the traditional in person pencil and paper experience. For those who wish to play but do not have in person options these are amazing ways to learn and there are a number of communities online which will help you get started and explore the rules. To be honest, I was always intimidated when I read the rules. They seemed overly complicated and difficult without showing you how to start. Once we began playing, I learned that while it is a bit easier if playing with those who know what they are doing, it really is a game anyone can pick up and play. Within my first few months I even ran a leg of our campaign as the DM and set up a separate campaign for a long-time friend and his two teenage children.

Wednesday nights was, and still is our time. For the first two years of playing, we missed maybe 1-2 weeks of playing. In the world of D&D this is apparently a rarity. This past year we probably have missed more due to various life circumstances but we still are regular and often if one player will be out we take advantage of the opportunity to play a one shot which may or may not be related to the campaign. Some weeks when not everyone was available we still met and basically had a social hour, checking in with each other, often hardly game related. I look back at this anomaly of our regularity and it was one of the things that prompted me to write this blog entry.

As I mentioned we started this right at the beginning of COVID-19 exploding in our areas. Lockdowns and quarantines started. People were sent to work from home or lost jobs all together. I work in a hospital, so throughout the pandemic I reported to work. My fellow adventurers worked in various fields but all were able to work from home to some extent whether by choice or by employer decree. The one thing we all had in common with each other, and essentially the rest of the world in our area was a feeling of isolation. Though I had more in person interaction due to my work, something about being dressed like I’m exploring Chernobyl doesn’t scream human interaction. For the rest of us and a portion of my job, all other interaction other than maybe with close family, was done via online meetings with co-workers. Again, not ideal socially for humans. While our weekly meeting was no different in the sense it was online, it felt different. It felt genuine. It felt real. It felt like true human interaction. For the few hours each week it was a respite from the chaos of the world. Call it escapism or fantasy, I don’t care. It was leisure but so much more than that. It brought the five of us peace and maybe even some level of control (random dice rolls aside) when outside of our sessions was unpredictable chaos and constant stress. We all needed a little more human connection and surprisingly we found it amongst elves, dwarves, orcs, and undead.

Our weekly space became so much more than the game. I described us as college friends but the reality of it is we really were more like acquaintances in general. Over the next few years we not only grew friendships and developed a safe space within the game time to discuss our joys and strife of real life, but a small network of support which had almost constant contact outside of the game via various messaging services.  When the work place bogged down on someone, we lifted them up. When someone’s kid was sick we offered support. When I started and completed a divorce, they were there if I needed. When someone got a promotion, sold and bought a house, earned a black belt post 40 years old, we were the probably the first to share in the joy. As the world opened a little we even set up an all day D&D-a-thon to kick off a new campaign, in person, despite the physical distance we all lived from each other. If this doesn’t represent friendship and brotherhood, then I’m not sure what does.

I mentioned introspection above. While D&D is a role playing game, there are a number of players who get through it and enjoy it without getting too deep into role play. For them that is fine. Maybe they are nervous. Maybe they are uncomfortable. Maybe they don’t feel they have the social skills or “acting” skills to truly role play how they want. Then there are players like us. We are no Critical Role, but most of the time we took great effort and attention to detail in our character creation and how we portrayed their personalities. We would act as our character would act (without being complete jerks or edge lords). We found the more you put in, the more you got out of it. It made the game an immersive experience. For some of us, especially me, it allowed us a venue to explore areas of our psyche we might not have otherwise explored. You’re normally a shy person, so maybe you create an attention seeking, publicly performing bard. After all, you have the safe space and it’s a great practice setting to work on your social skills. Have some agnostic tendencies but want to learn more about divinity and experience with it in a non-religious and safe way? Make a cleric or paladin, choose a god they work with, do some research. Never handled grief well? Trust me, you will go through it when your character or a close party member dies (in game). Need to explore dark sides of yourself? Maybe your character pushes boundaries of what “good” means. You always wanted to be the hero but felt inadequate…no worries, you now are the hero! Maybe this is why groups such as Geek Therapeutics and Game to Grow have developed products and trainings to integrate TTRPGs and other gaming media into legit therapy sessions. Professional organizations such as Saving Throw Therapeutics are implementing them already.

We each have about 2 characters that have been long lasting, but due to one shots we have been able to create multiple characters each. I’ve made a barbarian, a druid, multiple clerics, a ranger, a fighter, a sorcerer, and a bard. Each has their own set of qualities and skills that make them unique. I learned over time, most of them reflected parts of my personality and often there were themes that ran throughout. To be fair, not all characters had this closeness to my heart. I made Elsa, a sorcerer for a one shot, that was literally Elsa from Disney’s Frozen. But looking at some other characters there are themes that reverberate and qualities that stand out. Karnagg was a half orc barbarian, Qurion Galanodel (Q) an elven Druid, and Odifin Tuttuolla a human ranger. While they each have unique personalities and backstory experiences they commonly share some sort of reverence for nature which is a quality I have grown to embrace personally (I’ll return to this later). My various clerics including human Nehebu-Kau Khet-Sah, human Sese Mes-en Duat, half-ling Luq’ee Cointosser, and human Bridey Teine all felt responsibility to heal and care for others to some extent. This is a quality also shared by Karnagg and Q. Is this a reflection of my real life role as a counselor, healer, and often caretaker for others? Donnelly Ignatius Eversham is my Edgar Allen Poe inspired bard who tapped into not only my poetry skills but my less than desirable qualities of self-loathing, depressive mood, and sometimes intrusive passive suicidal thoughts. Karnagg, and the two Eqyptian inspired clerics also shared some of these qualities. I can’t forget Ulfgar Fireforge, the red headed dwarf who just wanted to scrap. He doesn’t seem to fit into any neat box that might describe me, my personality, or desire but maybe I enjoyed him as a dad-joke making, high energy, brute that likes to have fun. Each of these characters allow me to reflect in myself, explore safely, or demonstrate qualities I either need to embrace or heal—or both. I’ll be damned if I ever thought a game could do that for a me.

In doing research to make my D&D characters feel more genuine and sincere, as well as exploring themes like the nature reverence many of my characters have, I was thrust on a learning and spiritual path I would’ve never guess my traditionally science-based, agnostic self would be on.

I am a lifetime learner, spiritual collector, and avid reader. I absorb and read all types of spiritual philosophies and take the viewpoint of “take what you need, leave the rest.” Generally, I never embraced organized religion. I am not a fan of dogmas. I am not a fan of zealots. You do you, but leave the rest of us out of it. I don’t take it all too seriously, which is why maybe being an ordained Dudeist priest suits me well. To start, when searching for information about Q, who is an in game Druid, I briefly came across some information about modern Druidry. I actually took pieces of a celebration/ritual and incorporated it into the game so Q could protect a plot of land from the undead. Jury is still out whether or not it was effective. Then, one of our party members gave me a box of books he was tossing when we met in person. In the box was a number of books about trauma, counseling, and other topics. But, buried underneath were books on mythology and Shamanism which were left over from college courses. After reading more about modern Druidry and finishing the book on Shamanism, it sent me down a rabbit hole focused on modern Paganism. Druidry, Shamanism, and Wicca are considered the big three philosophies (for some a religious practice) in modern Paganism. What all three share are a reverence and respect for nature, and often a desire to help keep our Earth viable for its inhabitants. I connected with this immediately, though I wasn’t too keen on some of the belief systems and practices in general at first. However, this lead me to do what I always do and try to learn all that I can about these practices. I learned many modern Druids embrace Druidry as a practice of nature reverence and can associate themselves with a Druid philosophy while being members of other religions and spiritual practices.  Whether or not their other practices respect that is another question, but there are plenty out there. Some groups or individuals may also be gatekeepers in the sense that they may not agree with the way these individuals view Druidry. To each their own. I’m going to butcher this and maybe be completely wrong in the quote, but I believe it was Damh the Bard of the Order of Bards, Ovates, and Druids who said something like “if someone tells you their way is THE way, stay away.”  I’ve also come across this sentiment multiple times in my studies of various philosophies.

In trying to learn historical and modern viewpoints, I found myself identifying with modern pagan beliefs more and more. When I discussed these things with people around me people began to share and open up about their own belief systems when it comes to spirituality and religion. What I found was a ton of people that either had overtly and open pagan beliefs, people with pagan beliefs that hid them, and others who were also refining their belief systems through various religious and spiritual practices, rejecting dogma in search of a personalized experience while connecting to something greater in humanity. Although on the surface their views looked different and frequently varied, they were all saying some of the same things. It was essentially like a character in a game. You change the skin (aesthetic look) but the function remains the same.  Symbolism never had so much meaning and power for me. In keeping my mind more open to these belief systems than it had been in the previous 20 years, I have been able to meet some amazing, loving, and healthy people and be exposed into communities where I’ve seen almost exclusively acceptance and compassion. As anything in life, there are bad actors, but I found them to be few and far in between.

Finally, it gave me a new hobby. Not just playing weekly, but I collected the books, the modules, figures, etc. For Q the druid I created (or rather attempted to create) a dream catcher using vines I found on my property. For the campaign leg I DM’d, I wrote an entire narrative not included in the deadly module we were using. For the other game I ran, I hand drew and colored massive maps on oversized graph paper since we were playing in person with that group. At a time when all the self-care and coping skills in the world were not exactly working to stave off pandemic burnout, D&D was working. So, I embraced it and absorbed it whichever way I could. I should note despite this new obsession it stayed a healthy coping skill as I did not allow it to interfere with real life responsibilities, remove me from reality, or impact my wallet too bad.

So brief summary, finding and embracing D&D has allowed me the following:

-positive, healthy coping skill in a great time of need

-a healthy hobby

-a small, supportive, close-knit network of friends

-exploration and introspection of my personality, psyche, and character traits

-pushing my boundaries in healthy ways

-fostering social interaction and growth

-fostering creativity

-keeping my mind open and increasing my knowledge about practices and communities I knew little about

-helping me grow spiritually and refine my own belief systems

Everyone may not have this experience. This was mine. Afterall, it is just a game and if you play it and all you get out of it is a few hours of fun, it has served its purpose. But for some it can be so much more and I am thankful to have finally leapt into this universe.

-Chris Dorian, founder of Know Your Why Recovery and currently Level 10 Elf Circle of Dreams Druid Quarion Galanodel, or as friends know him, Q.

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Guest Blog- The Healthy Road to Recovery

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This entry once again comes from our guest contributor Kimberly Hayes of PublicHealthAlertInfo.

The Healthy Road to Recovery

Recovery from mental illness or substance abuse isn’t something that happens overnight. In fact, it’s not something that you ever get to complete since it’s an ongoing process, a way of life. But that’s a good thing. It means you’re living your life with purpose.

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Don’t forget to visit our YouTube!

In case you have not visited yet, don’t forget to stop by our YouTube Channel. There you will find numerous videos covering manu different topics and in different formats including Brief Educational Videos, Inspirational Shorts, Recovery Tips, Anger, Relaxation and Meditation, and more!

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Guest Blog-Find Positivity During A Midlife Crisis By Becoming An Entrepreneur

Know Your Why is focused on mental health and substance recovery, as well as, all types of wellness. Many of our readers have expressed struggle with needing change or positivity in life. This guest blog from Kimberly Hayes of PublicHealthAlertInfo describes how for some they can address that need for change by becoming an entrepreneur.

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Guest Blog-5 Habits to Help You Through Trauma Recovery

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If you’re healing from trauma, you might be struggling to stick with healthy routines for your mental and physical health. Choosing a few beneficial habits or lifestyle changes and gradually adapting them to your schedule can be a smart strategy. You can find lots of informative recovery resources from Know Your Why Recovery to help you along your journey. Furthermore, these suggestions can guide you as you recover from trauma and prioritize your healing.

Consider a Career Change 

Your career might be impeding your healing process. Think about your current job, and ask yourself some essential questions. Do you truly feel fulfilled at work? Do you get the opportunity to work on challenging yet satisfying projects? Does your job tend to leave you feeling stressed and overwhelmed? Depending on your answers, it might be time to consider a career change.

Switching careers to something you’re more passionate about can benefit your mental health. If you have some knowledge of medical coding, you can apply for a number of medical coding online courses to learn essential skills, like assigning proper codes, identifying medical procedures, and processing service claims. Once you’ve completed the coursework, you’ll take an assessment to prove your skills. 

Keep Your Household Healthy 

Working through trauma is difficult for anyone, but it can be particularly hard for people with dependents who rely on them each and every day. It’s tougher to focus on your own healing when you’re also responsible for other people.

To make caring for your household easier during this rough time, you can turn to in-depth product reviews when shopping for your family to ensure that you’re spending your money wisely. Make sure to look for reviews from unbiased sources for the most honest recommendations. 

Work With an Online Therapist 

Perhaps you’ve seen a therapist before, but it was hard to keep up with your sessions when you had so much going on in your life. Working with a therapist who offers online sessions can be easier to fit into your schedule. To get the most out of virtual therapy, Psych Central recommends looking for a platform that suits your budget and specific needs, finding a private, quiet space in your home for sessions, and asking plenty of questions during sessions. 

Exercise for Your Mind and Body 

It can be hard to get into fitness when you’re healing from trauma. You might have lost interest in your favorite sports or active hobbies, or you might feel like you’re not strong enough for exercise. But exercise can be an essential part of your healing process, as it supports both your mental and physical health. Very Well Mind states that in addition to improving your cardiovascular health and mobility, exercise can also help people with PTSD alleviate their symptoms, cope with depression, and even sleep better at night. 

Practice Mindfulness

Practicing mindfulness can be tricky for people who are healing from trauma – while living in the present moment can help you avoid rumination, you might worry that facing your emotions head-on in meditation could be re-traumatizing. You may want to work on mindfulness techniques in therapy, where you can process your emotions with the support of a professional. Journaling, meditation, and yoga can all be fantastic mindfulness practices to incorporate into your daily routines.

Healing from trauma does not happen overnight. It’s important to be patient with yourself throughout this process. Whether you’re interested in seeking professional development for a career change, outfitting your home with healthy products, or picking up an exercise routine, these tips can help you make all of these lifestyle changes and more.

Are you ready to commit to trauma recovery? Find the motivation you need through Know Your Why Recovery! Visit our website today for valuable recovery resources.

Dylan Foster, guest blogger 

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Awareness Events General Information Resources

National Months – September 2022

September has been designated Recovery Month and National Suicide Prevention Awareness Month. For more information on each, please continue reading.

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