Opioid addiction has become the most common addiction in the U.S.  Abuse of pain medication like vicodin (hydrocodone plus tylenol), percocet (oxycodone plus tyelnol) and MS Contin (morphine) is already an epidemic and as a psychiatrist I see patients every week coming to me for help.  Although almost everyone who has been hooked on opioids knows, the acute withdrawal symptoms are one of the most painful experiences physically and mentally that a human being can experiences.  There is a lot of data out there in regards to this acute withdrawal process so I will not go into it hear but needless to say it is typically 1 week of severe discomfort, no sleep, and emotional pain.

What opioid addicts usually are not aware of, is the prolonged effects of opioid addiction which can last for 6 months to over a year depending on the length and severity of the addiction.  The two most bothersome symptoms include long-lasting depression and fatigue/no energy.  Typically the energy level and fatigue is extremely low for the first 3 months and then as the months go on, an improvement is noted.  However I see patients often who have taken a year or more to regain the level of energy they had on the drugs or before their addicition.

In terms of a lingering depressed mood, this also lasts for up to a year or more in many case.  It is not to say people do not experience some degree of happiness and pleasure during this stretch of time but rather patients describe it as a chronic level of mental anguish that is relentless on a day to day basis, making it hard to motivated themselves to socialize, work and move on with their life.

The biggest mistake addicts make is stopping treatment once the acute phase detox is over. That is only one step and albeit a very crucial step, it is only the beginning to a long-lasting recovery.  Utilizing medication, lifestyle changes, diet changes and ongoing therapy, recovering patients can combat much of the mental anguish and have an improvement in overall quality of life during recovery.

Why does this take so long? Many changes to your bodies neurochemistry, including many hormones are effected with both acute and chronic opioid use.  One important change is a suppressed cortisol level throughout opioid use.  Cortisol is your bodies “stress” hormone among other things but it is involved in regulating many important functions of mood, energy and overall wellbeing. It can often take months to years for cortisol levels to return to normal after stopping opioids.  One option people do is take replacement hormones during opioid treatment which provides a level of cortisol throughout the period of using the drugs.  However this is the worst thing someone can do when they stop. Taking supplemental hormones only further suppress our bodies natural production of cortisol which in turn prevents your body from recovering back to normal.  So it is crucial to get off hormone replacement once you are off the opioids and let your body learn to regulate itself back to normal. This is only one aspect of hundreds of chemical changes that goes on throughout the course of an addiction and fully recovery but it illustrates the complexity of the physiological changes and their effect on emotions.

See a psychiatrist and follow-up with treatment after the acute phase detox. Maintaining sobriety is equally important because going through withdrawal again and again becomes virtually unsustainable for people and prolonged recovery becomes less likely each time they relapse. You can give yourself the best chance of having a lasting recovery by immediatly working closely with a psychiatrist who provides therapy, appropriate medication and guidence in terms of healthy lifestyle changes.  The entire year following being off opioids is a real test but pays big dividends