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Addiction to Drugs/Long term recovery

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QUESTION: Hello,
I've asked a question of you before (some time ago) and your answer was helpful, so I'd appreciate any insight you can offer.

I'm 62 and was on opiates for about 10 years due to pain from lupus and arthritis. I've been drug free for almost 6 years. I tapered myself off fairly high doses---300mg morphine or the equivalent in oxycontin or fentynal (I can't remember now). It was pretty hard but I did it and pretty successfully in one sense---I've had no relapses nor even have the slightest temptation to start again.

But in another sense, I haven't been so successful: I always feel "flat". I never have a sense of enjoyment in anything I do. I may as well be watching someone else do it. I try to do as many healthy and/or productive things as I can---and many are quite helpful, such as regular exercise, acupuncture, good diet, woodworking, keeping up with current events, etc. I keep busy, I have great marriage of 30+ years, but I never feel enjoyment even momentarily----its not an attitude problem, it really feels as if the ability to enjoy things has been surgically removed, gone. I make an effort to be pleasant to others (innocent bystanders after all), but I don't feel it. Ever.
I've tried some mental exercises (I think you may have suggested them---and found that Tetris seems to stimulate something (really helped my memory anyway) so I play it often. I have regular checkups, blood tests, all that. But its been 6 years---I thought it would take about six months to "normalize". I'm healthier, but something's missing that I used to have. I used to wake up each day as if it was an adventure, was interested in almost everthing---now its the opposite. My doctor doesn't feel its depression and neither do I. It feels as if I damaged something with the drugs and I'm still waiting for it to heal. Something to do with dopamine possibly.
Thanks in advance for any insight you may offer!
Anthony

ANSWER: Hi Anthony,

The long-term effects of opioids (opiates) have been an area of interest for me, as well as many others in the field.  I've been of the belief that opioids radically affect the neuro-biochemistry of mood.  This is a very difficult area to study, because one would have to have monitored a subject prior to their developing an addiction, in order to get a credible research result.

I've seen some research that supports my sense that the mood centers are damaged.  I see opioid addicts over many months in my practice, and can see the post acute withdrawal and how it affects mood status.  Most people do seem to struggle for some time.  But I find many of them normalize eventually.  Your use of these drugs was pretty heavy, so I'd expect a slower recovery.

Your problem is compounded by age, as well, I would say.  I think the drop in hormonal levels associated with age produces a greater likelihood of a mood anomaly, completely independent of substance abuse.  At least that is what I've read.

I hesitate to say the damages to the brain biochemistry due to opioids are permanent in some regard, but I can't deny this is the case, either.  But for you to believe this is permanent will be utterly counterproductive.  You have to believe the effects can be eventually reversed -- a positive mind engenders a positive reality.  

It is also possible you have endogenous depression.  Check out this link: http://en.wikipedia.org/wiki/Endogenous_depression

And check out the first study mentioned in the references.

I wish I could give you some conclusive feedback on this problem, but I just don't know enough about it and what could be done for it.  You may wish to try some different medications.

Keep up the holistic efforts, but understand they may take quite a bit longer to produce benefits.

Thanks for your question,
Peter










---------- FOLLOW-UP ----------

QUESTION: Thank you. That link seems to have been removed, I've not been able to find the study. BTW, I'm going to try L-methylfolate, if its promising I'll perhaps get an Rx for Deplin. If you're interested I can let you know if it helps at all.
Thanks again

Answer
Hi Anthony,

Yes, I'd be very interested in any feedback you have about the benefits of L-methylfolate. I have a lot of faith in supplement-based approaches.  I think that's where the answer lies to concerns such as yours, ultimately.

We continue as an industry to be inordinately focused on opioid replacement medications, which, to me, just reinforce the anhedonic and dysphoric symptoms.  We have to revive the pleasure pathways at the molecular level, not just substitute.

All the best in your efforts.  I did notice that L-methylfolate was effective with depressive disorder.

Peter

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Peter L.

Expertise

I am available to answer any questions about substance use, abuse, and dependence. I can also offer perspective on treatment options and how to motivate someone to get help. I have over 27 years of experience as a substance abuse treatment professional, working with adolescents and adults in a variety of treatment settings. I feel I can answer just about any question in this topic area but can also access reference sources, or direct you to these for additional information gathering or education on your own.

Experience

I am a professional addictions counselor working in a very highly respected treatment center, as well as having a private practice in two states.

Education/Credentials
Masters Degree in Behavioral Science Licensed Alcohol and Drug Abuse Counselor in three states. Also an Internationally Certified Alcohol and Drug Abuse Counselor

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