WEBVTT

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Around month four, give or take, something
is going to happen that nobody warned

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you about.

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You're going to wake up on a Wednesday,
sober, doing all the right things — meeti

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ngs, sponsor, sleep, the routine — and
your mood is going to be in the b

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asement.

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Not a craving, exactly.

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Not a trigger you can name.

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Just a flat, gray, what is wrong with me
feeling that won't lif

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t.

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You're going to think: I'm doing
everything I'm supposed to do.

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Why do I feel worse than I did in week
two?

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You are not failing.

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You are not doing it wrong.

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Your brain is doing exactly what brains do
when they are healing from substance

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use disorder.

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And almost nobody tells you about it in
advance, which is why so many people

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quit on month four.

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This session is about what's happening
inside your skull.

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The repair process.

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The cravings.

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The waves.

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The reason month four is harder than month
one.

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By the end, you're going to have language
for things you couldn't name before, and
th

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at language is going to make the next nine
months survivable.

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But before any of that — let's name where
you are.

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Right now.

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What month you're in.

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What the heaviness feels like, in your
body, today.

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The fog gets smaller once it has words.

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Here's the frame for this session.

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We are going to treat your brain like an
organ that has been through something,
because it

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has.

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When you were using — alcohol, opioids,
stimulants, benzos, doesn't matter —

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the substance was teaching your brain a
particular set of habits.

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Reward pathways.

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Stress responses.

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Sleep architecture.

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Emotion regulation.

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Every one of those systems was, over time,
rewired around

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the substance.

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When the substance goes away, the brain
has to rewire back.

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That is not a metaphor.

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That is a physiological process, and it
has a timeline.

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The acute part — the first one to two
weeks of withdrawal — most of you have
already been

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through.

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That's the part that feels like the flu,
or worse.

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That's the part that gets the medical
attention.

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What almost nobody tells you about is the
second part.

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The part that comes after the acute
withdrawal is over.

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The part that lasts six to eighteen
months, give or take.

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In recovery and clinical practice, it has
a name.

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It is called Post-Acute Withdrawal
Syndrome, or PAWS.

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It is not a formal diagnosis in any
handbook — it is a clinical description
used in recove

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ry to name a real, observed pattern.

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And it is, for most people in early
recovery, the actual hard part.

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You should know its name.

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You should know its shape.

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You should know that what you are
experiencing is predictable, common, and —
this is the i

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mportant part — temporary.

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Three things.

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The brain itself.

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The cravings.

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And what to do with both.

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Number one.

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PAWS — what's happening, and how long it
lasts.

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Post-Acute Withdrawal Syndrome is what
your brain does for the six to eighteen
months afte

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r the acute withdrawal is over.

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It is your nervous system rebuilding the
systems that the substance was running.

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The symptoms are real and they cluster.

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Mood swings that come out of nowhere.

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Anxiety with no specific object.

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Irritability you can't justify.

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Sleep that breaks even when you're tired.

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Cravings that arrive in waves.

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Brain fog.

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And a general flatness, where things that
used to be fun aren't fun yet — the p

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leasure system is offline, temporarily,
while the receptors recalibrate.

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PAWS does not happen in a straight line.

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It comes in waves.

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You'll have a good week, then a hard week,
then a few good weeks, then a brutal day.

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It tracks with sleep, stress, and social
isolation — but the moment-to-moment
experience c

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an feel random.

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The most im

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portant thing to know about PAWS is the
timeline.

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The peak, for most people, is months two
through six.

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It improves slowly through month nine.

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By month twelve to eighteen, the worst of
it is behind you.

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So when you are sitting on the bed in
month four, feeling worse than you did in
month one,

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you are not relapsing.

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You are not failing.

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You are in the middle of the repair, and
the middle of the repair is louder than
the begin

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ning.

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The brain is healing.

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The healing has a sound.

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Number two.

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Cravings — the wave, not the wall.

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Now

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to

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cr

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avi

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ngs

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specifica

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ll

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y.

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Most people, before they understand
cravings, picture them as a wall.

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Something that comes up, gets bigger and
bigger, and either you break through it
sobe

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r or it breaks through you.

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That's not what a craving is.

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A craving is a wave.

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Every craving has the same architecture.

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It rises, it crests, it falls.

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From start to finish, even an intense one
rarely lasts more than fifteen to thirty

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minutes.

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Your nervous system cannot sustain that
level of activation.

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The wave will come down on its own.

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Every time.

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Even if you do nothing.

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Once you know that, you have one job:
don't act for thirty minutes.

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Just hold.

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The wave goes down.

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The practice is called urge surfing.

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When a craving comes, you don't fight it.

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You don't argue with it.

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You watch it.

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You notice where it is in your body, how
it changes minute by minute,

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and you let it rise and crest and fall.

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Treat the craving as weather, not an
enemy.

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Fighting a craving feeds it.

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Watching a craving lets it move through
you and leave.

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The wave is theory until you've watched
one.

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So before the next craving shows up —
let's pre-commit.

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Where you'll be when it comes.

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How long you'll hold.

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Write it down now.

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You'll come back and fill in what changed
after you've surfed one.

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The tool that pairs with this is HALT.

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Four letters.

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Hungry, Angry, Lonely, Tired.

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When a craving comes — before anything
else — run the HALT check.

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Am I hungry?

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Am I angry?

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Am I lonely?

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Am I tired?

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Most cravings, especially in early
recovery, are not really cravings.

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They are the brain reaching for the
substance because one of those four needs
is not being

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met.

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Eat.

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Cool down.

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Call someone.

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Sleep.

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The craving usually softens within
minutes.

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Number three.

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What helps, neurologically.

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Let me give you a short list of the things
that, in the research and in the clinic,
most r

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eliably accelerate the brain's repair.

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Sleep.

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Seven to nine hours, regular times.

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Sleep is when the prefrontal cortex — the
part of you that makes good decisions —
rebuilds

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.

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Short sleep — chronically under seven
hours — is consistently associated with
stronger cra

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vings and higher relapse risk.

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This is data, not preference.

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Aerobic exercise.

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Twenty to forty minutes, four or five days
a week.

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Walking counts.

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Running counts.

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Swimming counts.

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Aerobic exercise raises BDNF —
brain-derived neurotrophic factor — which
is, very literall

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y, fertilizer for new neurons.

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Your brain is trying to grow new
connections.

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Exercise helps it.

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Real food.

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Protein, fat, vegetables, water.

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Not just calories.

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Not just caffeine.

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The brain rebuilds out of what you put in
your mouth.

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Connection.

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Daily.

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Human voice.

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Eye contact when possible.

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Social isolation drives the craving system
harder than almost anything else.

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Sunlight, especially in the morning.

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Ten minutes, ideally before nine a.

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m.

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It resets the circadian rhythm, which is,
in early recovery, often a wreck.

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None of this is exotic.

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All of it is unglamorous.

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And every one of those interventions has
measurable effects on the brain in early
recovery

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.

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They are not lifestyle suggestions.

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They are medicine.

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Before we go on — look at this week.

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Four lines.

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What's actually on the calendar for sleep,
exercise, sunlight, and meals.

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Not w

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hat you wish you'd do.

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What's there.

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If a line is blank, that's where the work
is.

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The sixth piece — medication, where it's
appropriate — has its own session next.

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For now, hold that none of it is cheating,
and all of it is, when indicated, exactly
what

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the brain is asking for.

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Number four.

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What's underneath — and when to route it
out.

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I have to slow down for this one.

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PAWS is one thing.

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The brain rebuilding the systems the
substance was running.

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That's the part the routine can address.

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For some of you, somewhere in months two
through nine, a different kind of question
will s

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urface.

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It is not PAWS.

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It shows up as a baseline of dread that
does not match your life.

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As an intrusive memory that keeps coming b

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ack

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.

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As an anniversary date that flattens you
for reasons you cannot articulate.

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As your body holding a memory your mind no
longer holds.

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That is what the using was getting between
you and.

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It

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is

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what the substance was an answer to,
before the substance became its own
problem.

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I want to be plain with you.

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CVR coaches are not trauma therapists.

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This is not the place where that work
happens.

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We can sit with you.

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We can notice the question with you.

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We cannot, and should not, do the work
itself with you.

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That work happens with somebody whose
practice this is, in a regulated ner

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vous system, with the substance steady and
out of the way.

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If anything I just named lit up for you —
if the dread is steady, if the

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memory keeps coming back, if the body is
holding something the mind is not

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— the next call is not to me.

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It is to a clinician.

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There are a handful of modalities to ask
about, by name, so you walk into a consu

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lt with vocabulary.

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EMDR — eye movement desensitization and
reprocessing

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— is a structured, well-researched
approach to specific traumatic memories

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.

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Trauma intensives are week-long programs,
often run as IOPs,

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that compress months of work into a
sustained container.

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Somatic experiencing and somatic therapy
more broadly work with the imp

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rint that lives in the body.

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Internal Family Systems, sometimes called
parts work, treats the psy

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che as an internal family and helps the
protective and wounded parts u

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pdate.

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I am naming them so you have the words.

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Look for somebody trauma-trained who is
also familiar with addiction.

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The two have to be in the same room.

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A CVR coach can help you find the right
person — but the work itself h

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appens with the specialist.

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If any of that lit up for you, write down
one consult to make this week.

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Margin of the worksheet, the back of an
envelope — wherever.

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The work doesn't begin until the
appointment is on the calendar.

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A story.

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A woman I'll call Priya came out of a
forty-five-day program for alcohol use
disorder.

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The first month home, she felt great —
sharp, optimistic,

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sleeping, eating, going to meetings.

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Around week six, the floor dropped out.

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Flat, gray weight on her chest that
wouldn't move.

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Sleep got bad.

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Small things made her cry.

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She wasn't craving alcohol, exactly.

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She was deeply uncomfortable in her own
skin.

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She came in convinced she had a relapse
coming.

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She said, "I made it through the easy
part.

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Now it's getting hard.

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I don't think I can do this for a year.

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" I asked her two questions.

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Have you been sleeping?

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No, not really, last few weeks.

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Have you been exercising?

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She had stopped about three weeks ago
because she was too tired.

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Then I drew her a graph on a piece of
paper.

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X-axis: time, in months.

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Y-axis: discomfort.

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A line that went up sharply through month
two, peaked around month four, came down
slowly

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through month nine, and flattened out
around month twelve.

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I said, "This is PAWS.

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You are exactly where the graph predicts
you'll be.

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You are not relapsing.

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You are not failing.

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You are in month six, on the high part of
the curve.

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It is the worst part.

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It will get better.

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" Something in her face changed.

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She said, "Nobody told me there was a
graph.

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" We did three things.

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Got her sleeping again — phone out of the
bedroom, ten p.

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m.

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lights off, a routine.

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Got her walking forty minutes a day.

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Got her into a yoga class twice a week.

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Within three weeks, she had her floor
back.

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By month nine, the heaviness had lifted on
its own.

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Looking back, she told me the most useful
thing in her entire first year was the
graph.

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Once she knew what the curve looked like,
the heaviness stopped being evidence that
recove

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ry wasn't working.

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It became evidence that recovery was
working, and her brain was doing the
repair.

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The brain heals on its own timeline.

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Your job, in months two through nine
especially, is to not interpret the
healing as failur

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e.

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One more practice for the week — run HALT,
daily.

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For the next seven days, three times a day
— late morning, late afternoon, before bed
— pa

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use for thirty seconds and run the check.

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Am I hungry?

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Am I angry?

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Am I lonely?

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Am I tired?

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If the answer to any of them is yes,
address it.

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Eat something.

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Cool down.

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Call someone.

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Sleep earlier.

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You will, over the course of one week,
notice that the same questions keep
getting yes ans

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wers.

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That is your specific pattern.

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Most of us have o

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ne

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or two HALT letters that are our
particular weakness.

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Lonely is mine.

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For other people it's tired.

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For some it's hungry — they forget to eat
and turn into different

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hum

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an

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s b

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y

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fou

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r p

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.

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m.

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Once you know your letter, you can
intervene before the craving builds.

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That intervention, repeated over months,
is one of the best craving-prevention

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tools that exists.

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Come back to the worksheet at the end of
the week and name your letter.

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The page will hold the question for you.

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I want to close with this.

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You are going to have a hard month
somewhere in the first year.

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Probably more than one.

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The hard month will not feel like
withdrawal.

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It will not feel like cravings, exactly.

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It will feel like a low, gray, restless
dissatisfaction with your own lif

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e that you cannot explain.

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You will look around and think, I am doing
everything right.

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Why is this so heavy?

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The answer, almost always, is that your
brain is in the middle of the longest
healing proc

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ess it will ever do, and the middle of
healing is louder than the end of healing.

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This is not weakness.

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This is repair.

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The graph is real.

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Month four is, statistically, harder than
month one.

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Month nine is, for most people, the place
where it starts to lift.

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By month twelve to eighteen, the worst of
the heaviness is behind you.

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You do not have to power through it.

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You have to feed the repair.

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Sleep.

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Move.

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Eat.

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Connect.

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Sunlight.

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Run HALT.

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Surf the wave.

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What you are doing right now, on the heavy
days, is not nothing.

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You are sitting in the middle of an organ
rebuilding itself, and the rebuilding
takes the

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time it takes.

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You are not behind.

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You are exactly where the curve predicts
you'll b

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e.

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I'll see you in the next session.

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Be patient with the brain.

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It is doin

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g its job.

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You just have to stay long enough for it

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to

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fin

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is

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h.