Addiction is hell. That’s a given. Hell, however, can have many forms. Although I feel a kinship with all addicts, my heart sometimes goes out with a special intensity toward those who shared my main drug of choice: opiates. Opiates and opioids, if you want to get technical. I have no illusions that our suffering is any worse than others, mind you, and there are some drugs I am really grateful never to have tried. But it’s the flavor of suffering I know most intimately.
So when I meet a newcomer withdrawing from these types of drugs, I always have the urge to let them know I have been where they are. That I know what it feels like. When I do, they tend to have two questions for me: How long have you been clean? And does it get better?
When someone’s in early recovery, the “it” can refer to many things. Inability to sleep. Anxiety, depression, despair. Fatigue, confusion, extreme mood swings, memory trouble, digestive problems, aches and pains…let alone trying to deal with the chaos of external life and the wreckage that probably exists there. But when I hear the “it” from someone who has a few days or weeks off of opiates, they are usually referring to the anhedonia.
Anhedonia is the medical term for the lack of ability to feel pleasure. It’s often a symptom of depression, so anyone can experience it in recovery. Recovery from opiates, though, brings it with a special certainty and intensity. There are biological reasons for this: these drugs affected our brain’s mechanisms for producing pleasure-giving and pain-relieving chemicals like endorphins, pushing them to produce more and more. Our brains became used to this artificial stimulation and have “forgotten” how to do it the natural way.
I tried to explain it to a non-addicted friend once, and found myself floundering for words. I said it was like having a big gray hole in my brain. It’s hard to describe because it’s just nothing, just dead, and the thought of being alive again seems like a theoretical musing at best. With it comes the trademark flat expression.
Anhedonia sucks for many reasons, but it poses a special danger in recovery. Complete lack of pleasure or satisfaction in life might convince us that it’s not worthwhile to keep trying; that this deadness we feel indicates that life without our substance is inherently boring and without pleasure. Complete lack of passion or excitement about anything makes us forget why we are doing all this. We become unable to care about the reasons, and if the thought of using comes into our head there isn’t much happening to stand in its way.
Anhedonia is one of many brain chemistry issues that can sabotage our recovery, and I always try to share my own experience of it with people. I want them to know that it’s a real, physical thing they are experiencing, and that it will improve with time. It did for me, and it has for other addicts I know. Some addicts need treatment for depression in early recovery, and then their treatment needs diminish with time. Some dually diagnosed addicts will need ongoing treatment, although their specific needs might change as they get healthier. But the sheer intensity of early-recovery anhedonia should not be taken as a sign of how the future will go.
There are recurring waves of debate about the use of “maintenance” opiates and opioids such as methadone and the newer Suboxone to prevent relapse. Anhedonia is one of the symptoms these are designed to treat. In treatment, I knew addicts who were given Suboxone and slowly weaned off of it during their inpatient time, making their detox phase a bit less painful and drastic. But I also know addicts who were still on it when they left, and I have heard some professionals speak of “lifetime maintenance.”
The controversies about this aren’t going away soon, and I don’t have an answer to them. I know that I’m grateful to have entered recovery without them because my brain chemistry got a chance to heal, and because I would hate to be paying for expensive medicine indefinitely, and because I think I’d have a lot of trouble with feeling compulsive about it. But that’s me. My experience. My particular level, and flavor, of mental and physical suffering. Someone else’s might be a lot worse, in ways that I can’t possibly understand. It is, to put it mildly, not a good idea for me to judge.
So, if you face choices related to this issue, please don’t think I am trying to tell you what to do. Experience, strength and hope is all I have to offer, and only my own. All I really wanted to do when I sat down to write this was give an encouraging nod to that addict struggling through a gray fog of anhedonia and say: I’ve been where you are, and there is a world beyond it. There’s a sun that shines, and food that tastes good, and a world of things that could begin to feel relevant again.