Vincent Van Gogh, “At Eternity’s Gate”

I have lost pride in myself, including personal hygiene. Will that change?

Why do I feel alone; like I don’t know who I am any more; worthless?

You are suffering from depression.  Alcohol and other drugs affect us by stimulating the brain’s reward system.  Generally speaking, this causes higher levels of dopamine, serotonin, and some other chemicals that cause us to feel pleasure, contentment, and have extra energy, or that calm and relax us, depending on the drug(s).

Over time, our brains change in an attempt to bring us back as close to normal as possible.  This results in tolerance, meaning that we need more and more of the drug to get the same effects.  The more drugs we use, the more our brains compensate.  Eventually we reach a point where we are unable to get high, and unable to feel good no matter what we do.

When we stop using, we usually experience acute withdrawal that can, in the case of alcohol, benzodiazepines and a few other drugs, be potentially fatal.   Fatal or not, it can convince us that we’re dying.  However, even the most severe acute withdrawal lasts only about three weeks, and we begin to feel much better.  If we have had the services of a good medical detox facility, we may not find the acute phase of our withdrawal to be all that uncomfortable.

But that isn’t the entire story.  While our bodies are rebuilding damaged systems and getting our brains back to normal, we may experience a prolonged period of reduced and intermittent — but often still severe — symptoms called Post Acute Withdrawal Syndrome, or PAWS.  Depending on what drugs we used and our individual body chemistry, those can include jitters, anxiety, depression, mood swings, and a variety of less serious symptoms, and can last for quite some time.   PAWS can occur even when there is no acute withdrawal, and it can occur with any drug or combination, including marijuana.

Especially if we have used stimulants such as cocaine, methamphetamine and similar drugs, we may find that we become seriously depressed.  If we happen to be one of the many people who tend towards depression and (perhaps unknowingly) used drugs to fend off those feelings, we may end up in more severe or prolonged depressed episodes.  These can be  life threatening because of the dangers of not caring properly for ourselves, increased likelihood of relapse and using again, and, in extreme cases, suicidal thoughts and acts.

It is normal to feel down at times.  Everyone does, and people who are experiencing PAWS may feel down more often.  Usually those periods are brief, and in a day or so things look up.  When they don’t, we need to talk to a physician or addiction counselor about it.  Depression is nothing to fool with.  Anyone who has lost a family member to depression (this writer has), or who has experienced the feelings of worthlessness and hopelessness that it can bring (I’ve been there, too), will tell you that — if they survive.

Some of the best treatment for depression in recovery is self-care, with particular attention to the things we can do to reduce PAWS.  See this article for more information about PAWS.  We need also to have some fun if possible, go to meetings, mix with other people, and try to have as normal a life as we can, even though we may not feel like doing those things.  Sitting around and being miserable is dangerous emotionally and physically, and we must avoid it at all costs.  Our support groups and people are critical for us at this point in our recovery.

If we are feeling severely depressed, we must talk to someone about it!  At the very least, we need to talk about it in meetings and with our supports.  We must force ourselves to get out and see people, do things, get exercise, feed ourselves properly, and try to get enough rest.  If that doesn’t help, then we may need to speak to our physicians about treatment with antidepressants.  When it comes to depression, we must not let the idea of taking a drug put us off.  Antidepressants (with the exception of benzodiazepines) are not addictive, and we may not have to take them for long.  Until our brains get back to normal, though, they may be essential.

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