The Mayo Clinic just issued the following news release:

Mayo Clinic Researchers Examine the Psychological Impact of Child Abuse

SAN FRANCISCO, May 21 — According to a new Mayo Clinic study, a history
of child abuse significantly impacts the wide range of challenges facing
depressed inpatients.

Included are an increase in suicide attempts, prevalence of substance
use disorder, and a higher incidence rate of personality disorder.

Additionally, these victims also had an earlier onset of mental illness
and an increase in psychiatric hospitalizations for psychiatric issues.

The study was presented at the American Psychiatric Association 2009
Annual Meeting in San Francisco.

The impact of child abuse already is known to increase the risk of
suicide; however, the literature about other characteristics of
depressed victims of child abuse is scarce.

Although the findings of the Mayo study do not confirm causality, the
information stresses the importance of more aggressive approaches from
the public health perspective to prevent child abuse.

“A history of child abuse makes most psychiatric illnesses worse,”
according to Magdalena Romanowicz, M.D., lead author of the study.

“We found that it significantly impacts the wide range of
characteristics of depressed inpatients, including increased risk of
suicide attempt, substance abuse, as well as earlier onset of mental
illness and more psychiatric hospitalizations.

This new information serves as a reminder of the importance of child
abuse prevention from a public health perspective.”

Dr. Romanowicz says plans are under way to further examine the
association between child abuse and metal illness in a larger study of

Other authors of this Mayo Clinic study include: Gen Shinozaki, M.D.;
Victoria Passov, M.D.; Simon Kung, M.D.; Renato Alarcon, M.D.; and David
Mrazek, M.D.

Courtesy of Ken Pope

Post Acute Withdrawal Symptoms (PAWS)

Substance abuse has effects that last even when substance use has been stopped and acute withdrawal is over.

What are Post Acute withdrawal Symptoms?

Withdrawal symptoms that occur after the acute phase of withdrawal is over.

How long do they last?

It depends on how much stress a person experiences in early recovery and how much damage was done to the nervous system by alcohol or drug misuse.  Usually the symptoms last from six months to two years.

Why are they important?

Because PAWS can lead to relapse if not managed properly (e.g., “white knuckle sobriety”).

Types of PAW symptoms

  1. Difficulty in thinking clearly.
  2. Difficulty in managing feelings and emotions.
  3. Memory problems.
  4. Difficulty in recognizing and managing stress.
  5. Difficulty in sleeping restfully.
  6. Difficulty with physical coordination.

Managing PAWS

  1. Stabilization: talk honestly to people who will not accuse, criticize, or minimize about how you are feeling.
  2. Education: learning about all aspects of recovery from chemical dependency helps keep PAWS in perspective.
  3. Self protective behavior: you are responsible for protecting yourself from threats to your sobriety.
  4. Nutrition: three well-balanced meals a day, three nutritious snacks a day, no caffeine and sugar.
  5. Exercise: recommend that it be daily, to reduce tension.
  6. Relaxation: also daily, and includes having fun!
  7. Spirituality: means different things to different people.
  8. Balanced living: cannot afford to overdo some things and neglect others any more.

From Gorski T. and Miller M Staying sober — a guide for relapse prevention 1986



Non-Use – self explanatory. Either prior to onset of use, or a choice to not use substances for one reason or another.

Experimental Use – Usually done out of curiosity. The experience is evaluated and user may or may not continue to use. High level of choice involved at this stage.

Social (Occasional) Use – Use that occurs without incurring problems. High degree of choice involved whether or not to use.

Harmful Use – User may begin to experience occasional heavy intoxication that may cause harm to an aspect of self or another’s. life, or puts self or other at risk (i.e. driving while intoxicated or hungover). Regular use pattern (routine or binges) may start to emerge and/or amount may increase. Level of choice about whether and when to use is decreasing.

Dependence – Characterized by physical symptoms of craving, tolerance and withdrawal. Problems may be evident in many life areas, resulting from excessive use. Substance use is continued despite an increase in problems associated with use. A person’s life may be becoming more centered around acquiring and using drugs; other activities and involvements may become unimportant. There is little or no choice left about whether or not to use, and it is very difficult to stop using the substance. Dependence may be physiological or psychological or a combination of both.

Observable Effects of Drug Use
ALCOHOL Staggering gait, bloodshot eyes, flushing, slurred speech, vomiting,
impaired muscular coordination.

BARBITURATES & BENZODIAZEPINES Similar to alcohol plus: dilated pupils, weak and rapid pulse, drowsiness, shallow breathing, trembling hands, fainting, mood swings.

INHALANTS Chemical odor on body and clothes or in room, nosebleeds rash around nose and mouth, dilated pupils, runny nose, watery eyes, loss of coordination, slurred speech, stupor, vomiting, weight loss.

HEROIN Sleepy appearance, slurred speech, droopy eyelids, constricted pupils,
decreased respiration rate, slow gait.

COCAINE User shows decreased inhibitions, dilated pupils, runny nose, rapid
speech, tremors, sweating, severe weight loss, elevated respiration rate.

AMPHETAMINES Similar to cocaine plus acne that resembles a measles rash.

PCP Muscle rigidity, slurred speech, inability to speak coherently, loss of
coordination, blank stare, rapid and involuntary eye movements, exaggerated gait.

LSD Dilated pupils, confusion, disoriented sense of direction, distance and time.

PSILOCYBIN Dilated pupils, sweating, hyperventilation, rambling speech, hyperactivity, tremors, vomiting, impaired attention span, depression.

MARIJUANA Red or bloodshot eyes, increased appetite, meaningless giggly
conversations, impaired short-term memory, restlessness, dry mouth.

*Lancet* (Volume 371, Number 9629, 14 June 2008)
includes a review article: “Tobacco addiction.”

The article is by Dorothy K Hatsukami, PhD, Lindsay F Stead, MSc b, &
Prakash C Gupta, PhD.

Here’s how the article starts: “Lung cancer was confirmed to be caused
by cigarette smoking over 50 years ago, and since then several other
diseases have been added to the list of diseases caused by smoking and
involuntary exposure to cigarette smoke.1,2 However, the worldwide
production and consumption of cigarettes has continued to increase
unabated during this period. There are about 1.2 billion smokers in the
world, half of whom will die from diseases caused by smoking.3 Smoking
causes 5 million deaths per year, and if present trends continue, 10
million smokers per year are projected to die by 2025. The prevalence
varies greatly, from less than 5% to more than 55% in different
countries. It also varies greatly between men and women, so prevalence
in both sexes needs to be examined separately.”


This morning’s *New York Times* includes an article: “Addiction Doesn’t
Discriminate? Wrong” by Sally Satel, M.D.

The author note states:  “Sally Satel is a psychiatrist and a resident
scholar at the American Enterprise Institute.”

Here are some excerpts:

[begin excerpts]

We’ve heard it before. “Drug abuse is an equal opportunity destroyer.”
“Drug addiction is a bipartisan illness.” “Addiction does not
discriminate; it doesn’t care if you are rich or poor, famous or
unknown, a man or woman, or even a child.”

The phrase “addiction doesn’t care” is not meant to remind us that
addiction casts a long shadow — everyone knows that. Rather, it is
supposed to suggest that any individual, no matter who, is vulnerable to
the ravages of drugs and alcohol.

The same rhetoric has been applied to other problems, including child
abuse, domestic violence, alcoholism — even suicide. Don’t stigmatize
the afflicted, it cautions; you could be next. Be kind, don’t judge.