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Post-Acute Withdrawal Is Often Not Recognized in Early Recovery

  • Ali2610 Asks ...

    My daughter was in rehab for 28 days for drugs and alcohol. While she was in rehab, she wanted contact with both her family and her in-laws. Now that she is out, she only wants contact with her rehab buddies - none with her in-laws, husband (who is off on military orders), or parents. Has decided that she may want a divorce and for me to stay out of her life. As my only child this is breaking my heart. Both myself and her husband have cut her off financially as she won't communicate with us. I'm in an online support group and I've encouraged her husband to go to meetings on base. She threatened to have her father in law arrested if he stopped by the house again (the house belongs to him and its up for sale). I don't understand what is going through her mind and it is so opposite and extreme to her previous self. I know I didn't cause the addiction, can't cure it, can't change it. But I am open to suggestions...

    Bless you all..

  • Delisted Expert Says ...

    The prominent feature that you have described in your recovering daughter is her high need to control people, places, and things. This would be considered fear-based behavior. In recovery, people learn that they cannot control anything beyond their own skin or behavior. Although I am not fully informed with your daughter's substance abuse history, she sounds like she is having a very difficult transition from addiction to recovery. Her current behavior suggests a potential for relapse.

    There are all kinds of little steps and hints prior to actually relapsing. Some information on early relapse prevention and common relapse symptoms can be found at: http://www.addictionsandrecovery.org/relapse-prevention.htm. Please note that it is important to recognize that "relapse is a process, not an event." The same can be said about personal recovery.

    From your description, it sounds like your daughter is suffering from post-acute withdrawal as she is exhibiting behaviors not previously exhibited. The website http://www.addictionsandrecovery.org/post-acute-withdrawal.htm identifies common traits seen in people undergoing post-acute withdrawal. Most recovering people go through post-acute withdrawal, can have extreme reactions, and show impaired coping/decision making abilities while the brain is normalizing its chemistry. Does this describe your daughter?

    Normally, you would be happy that a family member is choosing people in recovery rather than old using friends. However, in many treatment centers, recovering addicts are discouraged from associating with anyone that they meet while in treatment during their initial 6 months of sobriety. This is because of the high risk of relapse among former patients or residents. Your daughter and her new rehab friends do have not had enough "clean time" to really know how to support each other in recovery like a sponsor or old-timers in recovery. Perhaps her former treatment staff could help resolve these difficulties with your daughter, her in-laws, her husband, and her own family.

    Most people have the recommendation of staying in some kind of treatment or program for at least 6 months after their last drug usage or entrance into a rehab program. Is your daughter in outpatient treatment or aftercare? Does she go to 12 Step meetings? Does she have a relapse prevention treatment plan? Does she have any kind of relationship with her recent treatment center, staff or doctors? If so, these resources could be very helpful in helping her address any difficulty with post-acute withdrawal.

    I understand that watching your daughter behave in a discounting, atypical, and uncooperative manner is painful and stressful for you. However, you have been wise to put your own recovery system in place so you do not enable you daughter or get manipulated by her or her disease.

    My suggestion is to “let God and let go.” All attempts to reach out to your daughter have met with harsh disappointment so maybe another plan is needed. Here are some ideas:

    1. Allow your daughter time and space to see that you are “for” her and not against her.
    2. Go to Al-Anon or Naranon for your own support and recovery.
    3. Continue to use your online community for support and encouragement.
    4. Recognize that your daughter could be alienating herself which is not good because it could make recovery more difficult.
    5. Keep channels open with her daughter and those who still have contact with her. Be patient and allow her to initiate contact with you.
    6. Avoid all criticism and choose to make positive, supportive and empathetic remarks to her or about her.
    7. Acknowledge your daughter when she does things well instead of when she does things wrong. Is she still sober, for example?
    8. Recognize that the ball is in her court and she ultimately decides what happens to her. Don’t accept blame and avoid defensiveness.
    9. Share this will your daughter’s husband and family so they will take a more supportive and less confrontational position which would only create more alienation and stress.
    10. If you talk with your daughter, it might be helpful to talk to her as a person you recognize has had to made some difficult choices and could be having a difficult time with sudden, intense internal and external changes. Be open to the fact that she may be more frightened or sad than angry.

    Recovery is a “one day at a time” process. If you need more than I have suggested, I would ask you to consider consulting with a mental health professional who is experienced with addiction and families. I do recognize that this is not an easy situation for anyone, and there are not always easy answers. I hope this has provided you with some support or assistance.

    If I can be of any further assistance, please let me know.


    John W. O’Neal, Ed.S, MSW, MA, LPC, NCC

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