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Severe acute withdrawal symptoms such as delirium tremens and seizures rarely occur after 1-week post cessation of alcohol. The acute withdrawal phase can be defined as lasting between one and three weeks. In the period of 3–6 weeks following cessation increased anxiety, depression, as well as sleep disturbance, is common;[65] fatigue and tension can persist for up to 5 weeks as part of the post-acute withdrawal syndrome; about a quarter of alcoholics experience anxiety and depression for up to 2 years. These post-acute withdrawal symptoms have also been demonstrated in animal models of alcohol dependence and withdrawal.[66] A kindling effect also occurs in alcoholics whereby each subsequent withdrawal syndrome is more severe than the previous withdrawal episode; this is due to neuroadaptations which occur as a result of periods of abstinence followed by re-exposure to alcohol. Individuals who have had multiple withdrawal episodes are more likely to develop seizures and experience more severe anxiety during withdrawal from alcohol than alcohol-dependent individuals without a history of past alcohol withdrawal episodes. The kindling effect leads to persistent functional changes in brain neural circuits as well as to gene expression.[67] Kindling also results in the intensification of psychological symptoms of alcohol withdrawal.[65] There are decision tools and questionnaires which help guide physicians in evaluating alcohol withdrawal. For example, the CIWA-Ar objectifies alcohol withdrawal symptoms in order to guide therapy decisions which allows for an efficient interview while at the same time retaining clinical usefulness, validity, and reliability, ensuring proper care for withdrawal patients, who can be in danger of death.[68]
Feeling a "kinship of common suffering" and, though drunk, Wilson attended his first Group gathering. Within days, Wilson admitted himself to the Charles B. Towns Hospital after drinking four beers on the way—the last alcohol he ever drank. Under the care of William Duncan Silkworth (an early benefactor of AA), Wilson's detox included the deliriant belladonna.[16] At the hospital a despairing Wilson experienced a bright flash of light, which he felt to be God revealing himself.[17] Following his hospital discharge Wilson joined the Oxford Group and recruited other alcoholics to the Group. Wilson's early efforts to help others become sober were ineffective, prompting Silkworth to suggest that Wilson place less stress on religion and more on "the science" of treating alcoholism. Wilson's first success came during a business trip to Akron, Ohio, where he was introduced to Robert Smith, a surgeon and Oxford Group member who was unable to stay sober. After thirty days of working with Wilson, Smith drank his last drink on 10 June 1935, the date marked by AA for its anniversaries.[18]
In the case of expectant mothers who drink, future healthcare costs double, now including both the mother and child. For example, a child born with fetal alcohol syndrome could require special schooling. Not only is this a personal and unnecessary family tragedy but also it stands to impact the social system financially in the form of healthcare and education for years.
The first female member, Florence Rankin, joined AA in March 1937,[6][7] and the first non-Protestant member, a Roman Catholic, joined in 1939.[8] The first Black AA group was established in 1945 in Washington DC by Jim S., an African-American physician from Virginia.[9][10] AA membership has since spread internationally "across diverse cultures holding different beliefs and values", including geopolitical areas resistant to grassroots movements.[11] Close to 2 million people worldwide are members of AA as of 2016.[12]
As defined by the American Society of Addiction Medicine (ASAM), addiction is a disease that disrupts brain chemistry and circuitry, which in turn impacts willpower, reward, memory, and motivation. The first step calls for individuals to accept that they are unable to control their drinking and/or drug use and that their willpower and motivation have been compromised. When someone struggles with addiction, they are no longer able to manage how much and how often drugs and/or alcohol are abused. Recognition of this loss of control and admission of being powerless over addiction is the first step toward recovery.
AA is a faith-based program where, in order to succeed in their recovery and progress through the 12 steps, members are instructed to admit their lack of control over both alcohol and their own lives and turn themselves over to a higher power. While the foundations of AA are based in Christianity, the 12-Step program is meant to be nonspecific regarding religion and focus more on a spiritual awakening.
One review warned of detrimental iatrogenic effects of twelve-step philosophy and labeled the organizations as cults,[41] while another review asserts that these programs bore little semblance to religious cults and that the techniques used appeared beneficial to some.[42] Another study found that a twelve-step program's focus on self-admission of having a problem increases deviant stigma and strips members of their previous cultural identity, replacing it with the deviant identity.[43] Another study asserts that the prior cultural identity may not be replaced entirely, but rather members found adapted a bicultural identity.[44]
While admitting that the oft-cited success rate of 5 percent “isn’t great,” Dr. Drew Pinsky, a celebrity doctor and addiction medicine specialist argued that “the fact it, [Alcoholics Anonymous] does work when people do it,” saying the real success rate is as high as 12 percent. The American Society of Addiction Medicine speculated that approximately 10 percent of the people who become part of a 12-Step program enjoy long-term success in their recovery. In 2014, AA self-reported that 27 percent of the 6,000 members who participated in an internal study were sober for less than a year; 24 percent retained their sobriety for up to five years, and 13 percent lasted for as long as a decade. Fourteen percent of the study’s participants stayed sober between 10 and 20 years, and 22 percent reported remaining sober for more than two decades.
Twelve-Step Recovery addresses the psychology of the person with addiction as well as the individual’s spirituality--his/her values, his/her connectedness to others, and his/her willingness to engage with others and humbly ask for help. The process of change in Twelve-Step Recovery starts with an acceptance that when friends or loved ones point out that things are amiss in one’s life, they are likely correct, and things have likely become unmanageable. And while taking personal responsibility and accepting accountability for one’s actions are considered key steps, Twelve-Step Recovery outlines that excessive self-reliance and the firm stance that “I can get myself out of this,” and “I know what to do about this,” will be roadblocks to recovery from addiction. “Getting out of oneself” and recognizing that one doesn’t have all the answers, and humbly asking for help from another human being—from a health professional or from a lay person—are behaviors and behavioral styles that are promoted by Alcoholics Anonymous and related “Twelve-Step” programs of peer support.

The first book written to cover the 12 step program was titled "Alcoholics Anonymous", affectionately known as the Big Book by program members. Following the subsequent extensive growth of twelve step programs for other addictive and dysfunctional behaviors, many additional books were written and recordings and videos were produced. These cover the steps in greater detail and how people have specifically applied the steps in their lives. An extensive chronology and background about the history of A.A. has been put together at Dick B.'s website.

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

The program offers a comprehensive array of clinical services for individuals seeking recovery from alcohol and other drug addiction. Our team is unique in that it brings together experts from the field of medicine, psychiatry and addiction, which gives us the ability to care for patients with both addiction and co-existing medical and/or psychiatric illnesses.
The illness of the spiritual dimension, or "spiritual malady," is considered in all twelve-step groups to be self-centeredness.[17][18] The process of working the steps is intended to replace self-centeredness with a growing moral consciousness and a willingness for self-sacrifice and unselfish constructive action.[18] In twelve-step groups, this is known as a spiritual awakening not a religious experience.[21] This should not be confused with abreaction, which produces dramatic, but ephemeral, changes.[22] In twelve-step fellowships, "spiritual awakening" is believed to develop, most frequently, slowly over a period of time.[23]
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