The question, “What happens to heroin addicts when they quit cold turkey, and why is it so unbearable?” popped up on my Quora feed the other day. This post is taken, in part, from my response. There are different levels of agony that contribute to addiction. In my opinion there is a spectrum to “addiction” or substance use. This spectrum consists of substance abuse, chemical dependency, and addiction. Each tier of use brings its own misery.
Substance abuse brings on mental cravings. It’s why people will sometimes say they got addicted after just one use. Basically mental cravings are thoughts. In my experience these are the people, those who struggle most with mental cravings, find the most success in AA. The first time I got out of rehab, after 30 days sober, I couldn’t comprehend the idea of never having a drug or drink for the rest of my life. This contributes to the unbearableness of addiction because we can turn any thought into the urge to use. Mental cravings can be overcome, however we need to rewire faulty patterns of thinking subconsciously developed over our entire life.
According to Brittanica chemical dependency is: “the body’s physical and/or psychological addiction to a psychoactive (mind-altering) substance, such as narcotics, alcohol, or nicotine”. In other words, it’s a normal bodily function in response to addictive substances and it’s the culprit for physical cravings. You don’t have to be an addict to become chemically dependent. Normal people go through a range of levels in regard to physical withdrawal after extended periods prescribed opioids. Varying in degrees of intensity, physical withdrawal contributes to what you see from the outside. Nausea, insomnia, cold sweats, and the inability to handle bodily function are a few of the examples this tier contributes to addiction being unbearable. You feel your bodies response, with heroin it’s basically like having violent food poisoning a couple days.
The last tier of “addiction” is psychological addiction which is accompanied by emotional cravings. It’s this group that really makes addiction unbearable. We think through mental cravings, while motional cravings are based on how you feel. They come from developing a conditioned response. The website Summit BHS makes an interesting differentiation between dependency and addiction:
If a substance user can quit, and once the substance has left their system, they no longer crave or obsess about the substance. This person is not suffering from addiction. If the same substance user is noticing that their using is out of control and are still unable to stop, they are now abusing the substance, they may in fact suffer from addiction.Summit BHS
Another way to understand this is to look at the difference between psychological and physical withdrawal. I talk more about these cravings here. Together they make up the unbearableness of addiction.
Here’s what this looked like the first time I tried to quit using. I was going to rehab so naturally I got as inebriated as possible the night before. Almost immediately on arrival to the facility the mental cravings kicked in. Still they’re not the most bothersome ones at first. “I’m not a real addict I can still use after drying out for some time,” and “Just one more time,” were a couple of the thoughts that ran through my mind.
Physical withdrawals are the first round of unbearable cravings that really kick you in the face. After about three or four hours at the facility they really took control. For me, the first wave of physical cravings came in the form of losing control over my bodily functions. I vividly remember sitting on the toilet in my room at rehab not sure if I would vomit or have explosive bowel movements. After another hour or two passed my nerves were a wreck, I would shake uncontrollably, and I was pooled in sweat despite being freezing cold.
Personal Experience: Week Two
The worst of these physical cravings last about a week. I had no appetite and couldn’t keep anything down when I did eat. When I wasn’t shackled to the bathroom I uncontrollably pacing with angst around my small living quarters. There are intense muscle cramps and everything hurt, I hurt in places I didn’t even know could experience pain. Along with the physical pain, anxiety, and everything else that comes along with being “dope sick” is paralyzing depression. All you want to do is sleep but you ache to badly to be able to do just that. Then there’s the craving to use. Your brain is telling you to be rationale, there’s a simple solution to end this physical toll, your brain is yelling to use “give me drugs!”
These early physical cravings are simultaneously accompanied by mental and emotional ones. Which I should mention, psychological withdrawal (mental and emotional cravings) is far worse than the physical. One of the most significant factors behind what makes stopping opioid use so unbearable is the obsession to use.
A Refined Look
You don’t process emotions in active addiction. You’ve spent years suppressing emotions and there’s nothing gradual about when they come back. This makes up, in part, what’s known as post acute withdrawal symptoms (PAWS). In other words, the emotional cravings lasted about a year for me. During my darkest hours I found myself convinced nothing I could do would get me away from them. Even after a year of being off dope, even now from time to time, these continue to creep up. I remember times when I would be driving, some random song would come across the radio, and I’d begin crying uncontrollably. There would be times when I just couldn’t get out of bed long enough to shower and get dressed for the day, because the mental toll depression took was so intense.
Part of the reason why I view addiction as a disease is because it really isn’t about the drugs. I see addiction as a facet of my personality, an obsessive compulsion to seek out, at the detriment to other aspects of my life, pleasurable stimuli. Just because this is a part of who I am doesn’t mean it has to define me, self awareness is a blessing. While the causes aren’t the same for everyone the results tend to be similar. Today I’ve found success in keeping that voice in my head, my inner junkie, in check. Overcoming addiction isn’t about making that voice go away, I’ll always be an addict, it’s about learning to develop the thought and emotional patterns that allow you to put that voice in remission.
The Last Word
To recap: I see addiction as a disease of mental illness. Not everyone who uses drugs, even heroin, is going to become addicted however all drug use can lead to physical withdrawals. For those who do there are three contributing factors to why quitting heroin cold turkey is almost unbearable: mental, physical, and emotional and they correspond with the different tiers on the spectrum of substance use.
What makes heroin withdrawal so unbearable is that prolonged drug use leaves you as a soulless shell of your former self. Addiction is a lie that rewires the patterns for how you think and feel. That doesn’t mean these flawed patterns cannot be overcome, but it takes time and commitment to reset your habits and beliefs. This results in the “unbearableness” in overcoming use cold turkey because drugs hijack your thoughts and feelings. It’s my belief that the primary purpose of rehabilitation should be to rehabilitate a person’s thought and emotional patterns.