10/13/2016 The100DayHangover|TheFix

The100DayHangover
ByTonyO'Neill04/19/11

Ifalcoholanddrugsstayinyoursystemforjustafewdays,whydosomany
peopleneedmonthstostartfeelingnormalagain?TheFixservesupthelatest
research(andsomehardearnedadvice)onthesavagesideeffectsofsobriety.

Withdrawalsymptomscanplagueyourbrainmonthsafteryoustop
WhenIwasanopiateuser,I using.
thoughtIknewallIneededto
abouthowlongheroinstayedinmysystembecauseasamethadonepatient,youtendtolearn
manytricksthatallowyoutocontinueusingwhilegivingacleanurinesample.Thefactthat
urineusuallybetraysnotracesofherointhreetofivedayslaterenabledmanyapatientatmy
oldclinicinLondontoenjoyabitoffunontheweekendwithoutriskingthelossoftheir
methadoneprescriptions.
ButwhenIdecidedtoquitsmackforgood,IlearnedprettyquicklythatevenafterIhadsurvived
thatfirstnightmarishinitialwithdrawalphase,theheroinstillwasntoutofmysystemnotreally.
Forsixmonthsafterdetoxing,Ifeltlikedeathwarmedover:horriblydepressed,lethargic,
sleeplessandbadtempered.Mybodymayhaveclearedoutalltracesoftheheroin,butittook
mybrainseveralroughweekstorecoverfromthedamageinflictedbymyaddiction.My
neurotransmittersandotherbrainchemicalswerewayoutofwhack.Inmanyways,thislong,
drawnoutpostwithdrawalphasewasevenhardertodealwiththanmyinitialcoldturkeybreak.
Howlongafteryoustopusingdodrugsremaininyoursystem?Mostdoctorsagreethata
healthybodymetabolizesmostsubstancesinamatterofdays:coke,meth,andheroinrarely
remaininthebloodorurinelongerthanfivedays.Whileyourbodycanburnoffalcoholwithin
24hours,theagonizingagitation,shakingandothersymptomsofalcoholwithdrawalcanlastfor
aweekormore.Thesideeffectsofprescriptiondrugs,likebenzodiazepines,canlasteven
longer.Dittoforpotifyou'reaheavysmoker.Butwhilethesubstancesyou'rewithdrawingfrom
mayescapeyourbodyinamatterofdays,itoftentakesalotlongerthanthatforyourmindto
https://www.thefix.com/content/onebigpainbrain 1/5
10/13/2016 The100DayHangover|TheFix

returntonormal.Exactlyhowmuchlongerdependsonwhichsubstanceyouused,alongwith
howmuch,howlong,andhowoften.(CheckoutTimemagazinesAddictionandtheBrainfor
somecoolgraphicsdepictingthescienceofaddiction.)
Withopioidslikeheroinormethadone,therearetwodistinctwithdrawalphases,saysDr.
ArnoldWashton,theauthorofWillpowersNotEnough:RecoveringFromAddictionsofEvery
KindandthedirectorofRecoveryOptions,aprivatepracticegearedtowardhighfunctioning
addicts.Firstthere'stheacutewithdrawalorcoldturkeyphasewhichisfollowedbyalater,
longerlastingphaseknownasprotractedwithdrawal.(Protractedwithdrawalisalsoknownin
somerecoveryliteratureasPAWS,orPostAcuteWithdrawalSyndrome.)Duringprotracted
withdrawalforopioids,accordingtoWashton,manyaddictsarestillhamperedbylowenergy,
sleepproblems,depression,hyperirritability,generalizedapathyand,ofcourse,intense
cravingsfortheirdrugofchoice.Foranyonewhohasbeenusinghighdoseopioids,thatperiod
caneasilygoonforsixmonthsaftertheinitialwithdrawalphase,Washtonsays.These
symptomstaketheirownsweettimetoleave.Mostaddictsdonttellyoutheyfeelsickatthis
stageinsteadtheycomplainthattheyjustdontfeellikethemselves,hesays.
That'stheconventionalwisdom,anyway.Infact,someresearchersbelievethatitcantakeupto
twoyearsforcertainchemicallycompromisedregionsofthebraintoreturntonormal.Thereis
alsogrowingevidencethatonaverage,ittakesabout90daysforthebraintobreakfreeofthe
immediateeffectsofthedrugandresetitself.ResearchersatYaleUniversitycallthis90to100
dayperiodthesleepereffect,atimeduringwhichthebrainsproperanalyticalanddecision
makingfunctionsgraduallyrecover.ThatAlcoholicsAnonymousrecommendsnewbiestoattend
ameetingadayforthefirst90daysoftheirrecoverymightjustbeacuriouscoincidenceora
precientpredictionofmuchlaterscientificstudies.
Butanalternative(andcontroversial)takeonwithdrawalisofferedbyDr.LanceDodes,the
authorofTheHeartofAddictionandBreakingAddictionandanassistantclinicalprofessorof
psychiatryatHarvardMedicalSchool.Dodesdisagreesthatformeropiateaddictsaredoomed
tosuffermonthsofwithdrawal.Hemakesasharpdistinctionbetweenthosewhohavemerely
becomephysicallydependent(likepatientsrecoveringfromlongtermopiatepaincontrol)and
peopleheclassifiesastrueaddictspeoplewhoaredriventousedrugsfordeeprooted
psychologicalreasons.Withhighlyaddictivedrugslikeheroin,unlessyouhavethepsychology
tousethedrugaddictively,onceyoureoffit,youreoffit,hesays.
Tobackuphiscontentions,DodescitesTheRobinsStudy,alandmark1971lookatthe
experiencesofVietnamveteranswhohadreturnedhomeaddictedtothecheap,plentifulheroin
availableonthefrontline.Thenumberswerestaggering:almosthalf(45%)ofallUStroopshad
experimentedwithheroinoropiumwhileoverseas20%claimedtohavebecomeaddictedat
somepointduringcombatand11%testedpositiveforopiatesonthewayhome.Yetdespite
suchhighratesofdruguse,theRobinsstudyshowedthatonly5%ofallsoldierswhocame
homefromthewaraddictedtoheroinhadrelapsedwithinthefirst10monthsoftheirreturnand
only12%withinthefirstthreeyears.Obviouslyitisntjustthedrugsthemselvesthatmakethe
addict,becausephysicallythesesoldierswerejustasaddictedasthestatesidecivilians,
Dodessays.Formanyveterans,oncetheyhadescapedfromthedailyhorrorsofwarandthe
easyavailabilityofherointheynolongerneededtogethigh.Theysimplydidntfeelthe
compulsiontousethedrugoncetheywereoutofVietnam,"hesays.
WhileDodeshasheardstoriesfrompatientssufferingfromprotractedwithdrawals,hesays
thatthemajorityofformeraddictsdonotexperiencesuchlongtermcravingsandotherwoes.
Soyouhavetowonderifitsthedrugorthepersonthatisthecauseofallthesesymptoms,he
https://www.thefix.com/content/onebigpainbrain 2/5
10/13/2016 The100DayHangover|TheFix

says.Idontdenythatpeoplesufferfromwithdrawalexperiences,butIbelievethey'reasmuch
psychologicalasphysical.
Dodes,whohasseensomepatientsswitchfromcompulsivelydrinkingtocompulsively
cleaningtheirhouse,saysthattheheartofaddictionisaprimalfeelingofbeinghelplessor
overwhelmed.Whenyoureoverwhelmedyouhavetodosomething.Thatisaperfectlynormal
reaction.Imagineyouweretrappedinacaveyoudhavetofightbackinsomeway.Itwould
beabnormaljusttositdown,getquietlydepressedanddie,hesays.Addictioniswhenyoudo
somethingbecauseyoufeelhelplessbutitsadisplaced,orsubstitute,action.Whichaction
youchoosetosoothethechaoswithindrinking,say,orgamblingisasecondaryissue.Says
Dodes:Addictionisamechanismofthemindandthesameasanyothernumberof
compulsivebehaviorsthatwedontnormallythinkofasaddictions."

AccordingtoDodes'stakeonaddiction,IsupposeIwouldbeclassifiedasatrueaddict."My
depressionandlethargywereinsomewayrelatedtothefactthatIhadformedanemotional
attachmenttothedrug.Thekickingjunkieundergoesastrangekindofgrievingprocess:you
arelettinggoofyourfavoritesensation,yourgreatestcomfort,andtheultimateemotional
crutch.
Yetitstruethatthereisthatothertypeofuser.ImthinkingofoneparticularguyIusedtoscore
withbackinLAwhofooledaroundwithheroinforyearsbutneverdevelopedanoverwhelming
psychologicalneedforthedrug.Sure,hedfallintosomethingofahabitnowandthen.But
whenhefelthimselfgettingtoooutofcontrol,he'djuststopcoldturkey,withthenonchalant
mannerofamanwhoknewhedbebackonhisfeetinaweekorso.Forhim,heroinwithdrawal
wasmerelyaninconveniencesomethingakintoatriptotheDMVwithadditionalstomach
crampsandviolentdiarrhea.
EventhoughDodesdoesnotagreethatPAWSisaninevitablepartofkickingthehabit,he
acknowledgesthatphysicalsymptomstypicallycomewithwithdrawal.Itscommonforpeople
tofeelachesandpainswhentheyareunderstressthemindandthebodyareconnectedthat
way.Butthecauseispsychological,hesays.
Thelengthofwithdrawalsvariesfromdrugtodrug,accordingtoWashton.Whenitcomesto
stimulantslikecocaineoramphetamines,thehalflifeismuchshorterthanopiates,hesays.
Onceyouquitcocaine,saysWashton,itmighttakeyouanumberofweekstogetbackintoa
normalsleepcycle.Ifyourcokeormethusehadgottentothepointwhereyouwerealready
experiencingcognitiveimpairments,severedepression,orpsychiatricsymptoms,mostofthose
symptomswillprettymuchdisappearwithinsixweeksorso,Washtonsays.Youdontsee
manylingeringsymptomswithstimulantaddicts,especiallywhencomparedtoalcoholics,opiate
addictsorusersofothersedatives.
Still,thecessationofcocaineormethusecommonlytriggersadepressioninmostformer
users.Becausepeoplereliablyshowthesedepressivesymptoms,itnaturallyraisesthe
questionIsdepressionthereasonwhypeopleusecocaineinthefirstplace?Washtonasks.In
hisview,theabruptwithdrawalofselfmedicationmaysimplyallowpreexistingemotional
problemslikedepressiontoresurface.Anothertheorypositsthatchronicdrugabusedepletes
thebrainofcertainneurotransmittersthatgovernyourmood,suchasserotonin,dopamineand
norepinephrine,whichismanifestedasdepression.Asthebrainrecoversitscapacityto
produceadequatelevelsofthesechemicals,thebadmoodwilllift.Treatmentwith
antidepressants,suchasLexapro,Effexor,orWellbutrin,mayalleviatedrugrelateddepression,
https://www.thefix.com/content/onebigpainbrain 3/5
10/13/2016 The100DayHangover|TheFix

butthey'renotasurebet."Thereareplentyofpeoplewhofeeldepressedafterstopping
cocainewhosimplydontrespondtoantidepressants,Washtonsays.
Peopleaddictedtoalcoholalsotendtosufferlongtermeffectsofwithdrawal,butthecrucial
differenceisthatalcoholuseisoftenassociatedwithcognitiveimpairment.Illseeanalcoholic
andwhenheorshestopsdrinking,prettyreliablyafterfourweeksorsotheylltellme,You
know,IdidntrealizethatIwasntreallyonmygamebefore.Everythingseemsclearernow,I
canconcentratebetter,hesays.Thismuddledthinkingsyndromecommonlylastsforthree
months,althoughwithaseveredependencethathasenduredfordecades,itwilltakeeven
longer.
Theroadtorecoverycanbeevenmorearduouswithotherdepressants,suchasthe
benzodiazepines.Thehalflivesofthosedrugsaremuchlongerthanalcohol,Washtonsays.
ThelongestactingareAtivanandValium,whichcantakeuptofivedaystogetoutofa
personssystem.Sowhatevercognitiveimpairmentalcoholwouldcause,benzodiazepines
wouldlikelycausesimilarimpairmentbutforlonger.Certainlyifsomeonewascombining
alcoholwithbenzodiazepineswhichisnotuncommonyougetadoublewhammy.Because
benzosandalcoholaresynergisticwitheachother,theeffectisadditive,saysWashton.If
you'redrinkingfiveMartinisaday,plustaking50mgofValium,yourlevelofdependenceisthe
alcoholplustheValium.CuttheMartinis,andyou'dprobablyneedanother15to25mgofthe
benzotofeedtheaddictionbeast.Thatswhywhenanalcoholicgoesintodetox,wetypically
switchthemovertolongactingbenzodiazepineslikeKlonopinorValiumdrugswillsubstitute
foralcohol.
Whateversubstanceyouredetoxingfrom,theresalwaysanattachment,saysWashton.
Weretalkingaboutpeoplewhoarecuttingoffsomethingthathasstartedtofeelasvitalto
themastheairtheybreathe.Soyouinebitablygothroughthispainfulperiodofwrenching
yourselfawayfromit,andnowyourefeelinglousy.Itsprettycommonformanyrecovering
addictstoask,IsthistherewardIgetforgettingclean?Mostpeopleareledtobelievethat
oncetheystopusing,theirlifewillstarttogetbetter,wheninrealitythisnextperiodcanreally
suck.Butitgetsbetter.
Howcanapersonexperiencingwithdrawalstarttofeelbetter?Tostartwith,trytogetsome
sleep.Lackofsleepreallydrivespeoplecrazy,Washtonsays,buttherearenonaddictive
medicationslikeTrazadone[anonaddictiveantidepressantoftenusedasasleepaid]thatare
prescribedtopeopleinrecoverythatwouldntputthemindangerofrelapsingordevelopinga
substituteaddiction,Washtonsays.Opiateaddicts,inparticular,sufferthegreatestsleep
disruptionduringwithdrawal.Butthemostcrucialaidtobeatingwithdrawalbluesdoesntcome
inapillbottle.Havingsupportandnotdealingwiththisaloneiskey,says.Andyouhaveto
planactivitiestofillupthevoidleftbythedrugsoralcohol.Stayingbusywithexercise,
meditation,sports,andspendingtimewithpeoplewhodonotuseareallhighlyrecommended
activitiesbutthehardestpartcanbejustgettingoffyourassandoutthedoor.
Inmanyways,Iwaslucky.AsIwasgoingthroughmyownsecondarywithdrawalphase,my
daughterwasborn.Asanybodywhohascaredforanewbornchildknows,whilelackofsleepis
definitelyparforthecourse,longperiodsoftimewhereyoudwellonyourconditionarevery
hardtocomeby.AccordingtoWashton,thismayhavebeenablessingindisguise.Theworst
thingaformeraddictcandoistositaroundfeelingmadatyourselforsorryforyourselfand
physicallyuncomfortableatthesametime,hesays.Thatswhatmostoftenleadstorelapse.
InsteadIwasluckyenoughtogetwokenbyloudshreikingeverythreehoursandchange
diaperseighttimesaday.Nowthatsarealhigh.
https://www.thefix.com/content/onebigpainbrain 4/5
10/13/2016 The100DayHangover|TheFix

https://www.thefix.com/content/onebigpainbrain 5/5