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Your Top 8 Burning Questions About Sobriety Answered by an Expert

Recently, we had the pleasure of asking a highly-trained psychiatrist, Dr. Steven Wayne Powell, MD, MPH, CPE, FAPA, some of the most frequently-asked-questions from the Soberish community about sobriety and addiction.

What’s up with PAWS? Why do some people do better with sobriety than others? What about co-occurring mental health issues?

Here’s what Dr. Powell had to say and his suggestions for how we can get the right support for our sobriety.

psychiatry session for alcoholism
sobriety questions answered by a psychiatrist

Q. Is PAWS (post-acute withdrawal syndrome) a medically real thing? Why do some people struggle with it while others don’t?

Yes, PAWS can affect many patients.  It is not well known or discussed often.  Acute withdrawal will
take approximately 1-2 weeks with symptoms that mimic the flu.  [These] symptoms include nausea, vomiting, diarrhea, and muscle aches. 

PAWS can persist from many months up to one to two years.  PAWS include varying symptoms such as anxiety, depression, mood instability, low energy, difficulty concentrating, and thought disruptions.  The symptoms can be episodic as well. 
It is believed that it occurs from the re-emergence of suppressed emotions, recovery of brain function that was impaired, nutritional deficiencies, and other mental illness that was either undiagnosed and/or “treated” with the illicit substances. 

If not treated, these symptoms can lead to a relapse. It takes the development of coping skills and strategies to avoid relapse.

Q. How long does it take the brain to recover from alcohol abuse?

It can take considerable amounts of time to completely recover from long term alcohol abuse. 

Certain areas of the brain can shrink and that can lead to cognitive issues.  These can slowly improve once the body is free of alcohol for some time.  Doctors call the process “alcohol-related cognitive impairment.” 

Two particularly affected areas of the brain are the frontal lobe of the brain, which controls higher-level thinking, and the cerebellum, which controls coordination.  Studies have shown measurable improvement in brain volume in as little as five weeks.

Related Post: Does Alcohol Actually Kill Brain Cells?

mental health questions about sobriety

Q. What advice do you have for people suffering from mental health issues, like depression and anxiety, alongside alcohol abuse disorder? 

People can certainly have both mental health issues and substance use disorders.  Mental health issues can lead to substance abuse, and substance abuse over time can lead to mental health issues

Both issues share many common causes, and people need to address both issues. 

Q. Does trauma predispose someone to addiction or substance abuse?

Yes.  The struggle to cope with past trauma can be overwhelming.

When people are stressed, their ability to resist temptation can become difficult.  Victims of trauma often feel alone and isolated and are vulnerable.  It is noted that of people who use IV drugs, over two-thirds report a history of trauma.

Alcohol and illicit substances provide temporary pleasure and comfort. 

The comfort results in repeated behavior to achieve this comfort which can spiral out of control quickly.  When the joy that should come from human connections and experiences, is obtained with substances, people are often hurt more. 

trauma and addiction

Q. Is there a medical explanation for why some people are able to get sober while others continue to relapse?

What advice do you have for people stuck in a relapse cycle?

Failing to stay sober is the result of many different issues. 

Professional help is needed for most to overcome the addiction. Choosing your friends, acquaintances, and experiences carefully is needed.

Clearly, some people can stay sober “easier” than others, and that is likely related to brain chemistry, childhood and adult experiences, and many other processes that are not yet fully understood.

You don’t have to figure this out on your own.

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Q. What is your professional opinion on medical marijuana for people in recovery who suffer from anxiety disorders?

Marijuana can be effective for many, although it not legal in many places.  

It can lead to negative consequences and side effects as well, [which] can affect a person’s employment status. 

That being said, there are many individuals who have benefited from medical marijuana for anxiety.  

There are many different types of strains, classifications, and delivery systems, and using the wrong type can lead to increased anxiety. 

When marijuana is obtained from illicit sources, there is no way to know which strain is being used, and many strains can lead to increased anxiety.  In addition, many people often struggle with medical use and misuse. 

CBD is another option that is legal nearly everywhere and can improve anxiety symptoms as well. 

Q. What is your professional opinion on the efficacy of intensive outpatient treatment programs for alcoholism?

Alcohol addiction requires mental and physical care which very often needs to include therapy and in- or outpatient programs. 

Both individual and group therapy are highly recommended for people with alcohol addiction.

Intensive outpatient therapy allows patients to come for treatment and services, but still stay in their home, be with their family, and use other supports already in place as well.  An IOP can last for varying [lengths of] times, and often span 1-3 months. 

The main goal of treatment is to help people actively practice using skills in a supportive, and educational environment. The skills taught in IOP are all based on preventing relapse and teach skills to cope with symptoms of withdrawal or cravings for alcohol

Many states offer local, regional, and state-wide resource websites for individuals to find programs. 

Q. What advice can you give to people who are trying to find a mental health professional to work with?

Mental health professionals diagnose and treat mental health conditions. The majority will have at least a master’s degree or more-advanced education, training, and credentials.

There are many options including counselors, licensed social workers, therapists, nurse practitioners. and psychiatrists.  

People should find a provider who is skilled to treat their specific condition.

If medications are needed, a medical provider will be needed as well. It is important to make sure insurance is accepted as well if you have insurance coverage. There are also telehealth companies that allow you to schedule a telepsychiatry consultation online without insurance.

Finding a provider can be achieved by word of mouth, asking your regular providers, or looking for state or national resources. 

The internet is full of medical advice. It’s often hard to sift through what’s medically sound and what’s merely the trend du jour. That’s why it’s so important to rely on trained, medical professionals for advice concerning our health and wellness. We thank Dr. Powell for taking his time to answer these questions for us. You can read more about Dr. Powell’s expertise below.

About Dr. Steven Wayne Powell, MD, MPH, CPE, FAPA

Dr. Powell is currently the Chief Medical Officer for Pursue Care, and the Chief Executive Officer for New England Medicine and Counseling Associates which provides addiction treatment across New England.  Prior to this role, Dr. Powell was the Chief Medical Officer for New London Hospital, a Dartmouth affiliate, for greater than six years. 

He graduated Suma Cum Laude from Clayton College and State University in Georgia with a Bachelor of Science in Integrative Studies.  He earned his M.D. from Mercer University School of Medicine in Georgia and his M.P.H. in Health Policy and Clinical Practice from The Dartmouth Institute at Dartmouth College in New Hampshire.  He completed internships in Psychiatry and Internal Medicine, a combined residency in Internal Medicine and Psychiatry, a residency in Leadership Preventive Medicine, and was Chief Resident in the departments of Internal Medicine and Psychiatry all at Dartmouth Hitchcock Medical Center. 

He is Board Certified in Addiction Medicine and Psychiatry, and he is a Fellow of the American Psychiatric Association.   Dr. Powell is also Board Eligible in Internal Medicine and Preventive Medicine.  He is also a Certified Physician Executive through the American College of Physician Executives.  Dr. Powell currently works clinically as an Internist and a Psychiatrist, with a focus on Addiction Medicine.  He currently holds academic appointments at Dartmouth Medical School as an Instructor in Psychiatry and as an Instructor with The Dartmouth Institute. 

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