Expert: Peter L. - 5/4/2010

Question
Hi Peter,
I'm a male, almost 60 yo.
I was on oxycontin and percocet for 10 years (lupus/arthritis/gout).
Dosage peaked at 300mg/day morphine. Fentanyl patches for a while.
I tapered myself off it; doctors were not encouraging at all. I quit smoking cold turkey over 25 years ago with no help so I knew I could do it. The effects of the drugs became worse than the pain. I learned that if you run from pain you usually just trade it for a different kind of pain...there's really no escape.
Anyway, I have been free of these drugs since New Year's Eve 2007; almost 2 and a half years. I'm active, exercise a lot, 6-7 x weekly, hiking etc. Got a great wife, training a young Belgian Shepherd pretty successfully (very time consuming).
Now (finally!) my question: I used to be a very upbeat person, I enjoyed every day. I enjoyed waking up to a new day, had a good sense of humor, etc. Since getting off these drugs, I have not had ONE happy day, or hour, or minute. The best I ever feel is a sort of flat neutral aspect. I used to love to read, but I no longer can. I've seen many doctors to no avail. Anyway, I know you're not a doctor, etc (disclaimer), but I was wondering about any thoughts you might have regarding any non-drug, alternative strategies. I no longer drive much (motorcycle sitting there in the garage, truck waiting in the driveway (narcolepsy since quitting). I do work (graphics) though I'm really not very creative anymore ( I was an extremely creative  person before)...I can do rote work though. In short, I'm getting by. No satisfaction, brightness, creativity. I make an effort to not be a drag to others and mostly succeed, most of the time.
Most drugs seem to have a paradoxical effect; nothing has helped at all. I do have a great doctor, btw. I feel like some neurotransmitters may be the problem, but haven't made much progress. Wellbutrin helps me to plan a job, but that's about it. Adderall helps me stay on task a little but frankly I take  "drug holidays" of a week every so often (abstain)and can't really tell much difference. My wife asked my GP (who also has practiced treating addiction for 10-15 years) if some people just never really recover from these drugs; she said, yes, some don't. Any advice appreciated. I have no craving physical, or mental for drugs of any kind. You could put any kind of opiate next to me for a week and I guarantee it would be untouched. Zero interest...but zero interest in just about everything else too. I get the most from exercise...am currently trying to learn some basic gymnastics moves with some success.
Thanks for any thoughts, "out of the box" or otherwise.
With appreciation,
Max

Answer
Max,

Thanks for your very interesting question, and about a subject for which I have had a great deal of interest lately.  

In my work as an addiction counselor I have seen, and am seeing more on a daily basis, a much greater incidence of opioid dependency. This class of drugs has rushed to the forefront of the addiction landscape and has thrown us all "for a loop."  Interestingly, and this may shed some light on on your circumstances, we tend to rely almost exclusively on opioid replacement therapies for these substance abusers.  Those opioid replacements are Suboxone and Methadone.  Of course for alcohol treatment we have had some medications, like Antabuse and more recently Campral and Revia, but there is not an "automatic" turning to these medications like we see with the opioid population.

OK, so what does all this mean...  Opioids are very highly addictive substances, we know, and present challenges for those who want to be free of them.  The are prescribed universally for chronic pain management without consideration of what may be the implications.  Part of the problem is, in my view, the profound impact these drugs have on brain (and body) biochemistry not only in the short term in building up the "ruthless" dependence they incur, but in the long term as well.

I have reason to believe, from observation of many recovering opioid clients, that the impact of these substances is long term and chronic.  I have a sense we have deferred to the opioid replacement therapies because we don't know what else to do.  We can't seem to effectively talk people into opioid recovery much of the time.  It's almost that a portal has been opened in the mind via opioids, and the all-encompassing effects they have on feeling states corrupts normal mood sensibility.  Now, I don't have much research to support this (but have not really looked into it that much) but feel something along these lines is happening.

Put simply, I feel there are long term difficulties for recovering opioid users to regain normal mood, and along with that, normal levels of motivation and reward.  Your use was long-term, so the return to normal mood functioning may be a lengthy process, but there might be some things you can do to speed it up, some of which you are already doing.  

Exercise is one of these, to generate positive mood alteration and "feel good" neuro-chemistry. You are already doing that, so that's good. Diet is also extremely important.  Consider this similar to what is being recommended for those with depressive disorders: Omega 3 fatty acids, berries of all sorts (particularly blueberries), and reductions in sugars and processed carbohydrates.  You might want to move toward organic foods for the maximum nutrient content. A lot more information about this is available on the net or in bookstores.

I would try acupuncture, meditation, guided imagery, etc. some of the holistic techniques out there.  

I would recommend cognitive rehabilitation, along the lines of what is being recommended for those of us aging to keep our brains sharp.  I have a theory that cognitive exercising has benefits for mood.  One web site, one that I use and recommend, is www.lumosity.com.  You sign up with a small monthly fee and do as many exercises as you would like.

Overall, consider this a pursuit of wellness overall.  I think with a concerted effort, you will see the benefits eventually.

Best,
Peter