13 Oct The 100-Day Hangover
Tony O’Neill thought he understood everything he needed to know about how long drugs stayed in his system: continuing on with methadone treatment while cheekily taking heroin over the weekend, he knew how to fool a urine test—three to five days and the drugs were gone. That was until he quit altogether, and six months later he still felt like he was suffering the effects of withdrawal. He felt “not quite himself,” depressed, irritable and apathetic. So, what was happening? He addresses this issue in an article published in The Fix, drawing on different viewpoints and pieces of research in order to get to the bottom of the process of withdrawal. Although most of us feel like we understand it, the notion of a 100-day hangover initially seems laughable. The problem is that this is a concise way of explaining what beating addiction really feels like.
Drug Withdrawal: The Physical and Mental Challenges
As O’Neill’s street wisdom about the half-life of his substance of choice attests, drugs don’t ordinarily stay in your system for particularly long. Five days is typically enough time for the body to process the last traces of substances like cocaine, methamphetamine and heroin, and although some substances may differ, the “acute,” physical phase of withdrawal ordinarily lasts about this long. But in all the time you abuse substances, you’re messing with your brain chemistry too, and overcoming these changes takes much longer. The acute physical effects will be gone, but the psychological effects, as your brain regains its normal functioning, will still be running strong.
According to Dr. Arnold Washton, author of Willpower’s Not Enough: Recovering From Addictions of Every Kind, there are two distinct withdrawal phases for opioids. First is the cold turkey, acute-withdrawal phase, where the substance physically clears the individual’s system and he or she would pass a drug test afterward. Then there’s “protracted withdrawal,” otherwise known as post-acute withdrawal syndrome (or PAWS for short). For high-dose opioid users like O’Neill, this can mean six months of lethargy, irritability, sleep problems, depression, apathy and cravings. It can last a long time, and most people going through it don’t feel particularly sick, just “not themselves.” The mental effects of withdrawal go on for much longer, and are always tempting the individual to use again.
The 100-Day Hangover
According to the current body of research, it takes 90 to 100 days for the brain to fully reset itself following a period of addiction, but some regions can be impacted for much longer. The 100-day “hangover” period is referred to by Yale University researchers as the “sleeper effect,” and they argue that it’s over these few months that the brain’s decision-making and analytical functions get back to normal. Interestingly, Alcoholics Anonymous recommends daily meetings for those in the first 90 days of recovery—likely the result of an experience-driven realization that this is the most challenging time for addicts.
However, not everybody agrees with the 100-day hangover theory. Dr. Lance Dodes of Harvard Medical School makes a distinction between mere physical dependence and what he refers to as “true addicts,” who have a deep-seated psychological dependence on a substance. He argues that those who aren’t using the substance as a crutch to cope with an underlying psychological issue—low self-esteem or recurring depression, for instance—will not experience the 100-day hangover of PAWS, and will likely be able to stop using quite easily. He points to evidence from the Vietnam War to back up his view.
The study he references is from 1971, after the cheap and plentiful heroin available in Vietnam meant that 43 percent of U.S. troops had tried the drug, and 20 percent became addicted at some stage in the war. However, the study showed that of all the soldiers who came back physically addicted to heroin, only 5 percent relapsed within 10 months of their return, and only 12 percent had relapsed within three years. Without the horror of war or the plentiful supply, addictions just disappeared. To Dodes, this is strong evidence that addiction and withdrawal don’t affect all users in the same way.
Getting Through Withdrawal
The different theories on addiction and withdrawal are certainly interesting, but what does it all mean for somebody struggling with addiction and trying to make it through the process? First, and most important, remember that the physical, clearing-your-system stage is not the end of the process; in fact, it’s more like the beginning. Additionally, different drugs have different timelines during withdrawal: stimulants like cocaine or methamphetamine ordinarily have a shorter-lasting impact than heroin or alcohol, and these in turn don’t usually produce symptoms for as long as substances like benzodiazepines. There are still issues with stimulant withdrawal (for example, depression is a very common symptom just after you stop using), and each does depend on the length and extent of use, but this gives a general picture of whether you’ll be in for the long haul.
Additionally, it’s important to remember that things don’t immediately get better when you get clean. Chances are you have some psychological issues you’ve been dealing with by using drugs, and learning to cope with these in a healthy way can be challenging. While you’re working through these issues—ideally with professional support—you need to make a conscious effort to maintain a good sleeping pattern (this may be more difficult for ex-opioid addicts, but is consequently all the more important for them too) and find ways to stay busy. Playing sports, meditating, exercising and hanging around with non-using friends are all good ideas.
You can get through withdrawal, but it may last longer than you think, and it won’t be easy. For O’Neill, it was the birth of his daughter that helped him through the toughest days—he didn’t spend much time being bored or feeling sorry for himself because he was too busy changing diapers and soothing her back to sleep. You don’t need something quite so pressing and challenging to occupy your time, but finding a non-drug distraction can help get you through the tough times.
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