Question for Addiction Doctors/Specialists

Started by Ceke2002
This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

Ceke2002

Purveyor of Strange
15+ Year Member
Advertisement - Members don't see this ad
Quick note of clarification, this is purely out of academic interest, absolutely not looking for medical advice of any sort.

This is just something I've been curious about for a while now, and I'd like to understand the physiological or psychological,or if there's a combination of the two, type mechanisms that may be at work in this particular situation.

As some of you know from my posts on here, I am a recovered heroin addict. When I first became physically dependent on the drug, it took at least 3-4 week of continual daily use, before I even began to feel the first signs of withdrawal. From that point on, every time I went through withdrawal (when I was trying to get off the stuff) & then ended up relapsing, it seemed as if the physical dependency took a shorter and shorter time to return. Like in the beginning it was 3-4 weeks of daily use, then it took just a couple of weeks after going through withdrawal, then next time around it was like a week and a half of using every day, before I was already back to physical dependence. It eventually got to the stage where I could go through withdrawal, relapse, and within less than 5 days of using I could already feel the physical symptoms of dependence coming on again.

Is it common for it to progress that way? Why does the rate of onset of physical dependence seem to decrease with every attempt at withdrawal. I mean to me it seems more logical that you go cold turkey, you get the drug out of your system completely, if you relapse then regardless of how many withdrawal attempts you've made, your body should still be set back to zero tolerance, and it should still take the usual 3-4 weeks to get physically hooked again. Except in my experience that's not how it happened, and like I said I'm really curious to learn about/understand the actual mechanisms behind it - physiological or otherwise.
 
This is not uncommon. There's no actual solid scientific understanding of the phenomena of withdrawal. One possibility is plasticity at the receptor level, where continued use causes upregulation of opioid receptors, which in turn causes a faster withdrawal because a large number of them quickly become unoccupied once you stop using. However, there also may be more complex neural circuitry level reasons for this phenomena, likely cannot be explained in simple language but require sophisticated mathematical modeling. I.e. this is more akin to asking, why is the climate getting warmer or why does hydrogen and oxygen combine to make water.

Suffice it is to say, understanding this is not particularly useful to your own personal treatment, for which this board cannot offer any advice and we will refer you to your own provider. Nevertheless, it's a very interesting research question and if you are interested in this from that perspective I would encourage you to talk to your local university or start by taking a course in basic neuroscience or addiction.

Is it common for it to progress that way? Why does the rate of onset of physical dependence seem to decrease with every attempt at withdrawal. I mean to me it seems more logical that you go cold turkey, you get the drug out of your system completely, if you relapse then regardless of how many withdrawal attempts you've made, your body should still be set back to zero tolerance, and it should still take the usual 3-4 weeks to get physically hooked again. Except in my experience that's not how it happened, and like I said I'm really curious to learn about/understand the actual mechanisms behind it - physiological or otherwise.
 
This is a fairly well known aspect of physical dependence, and can also be demonstrated in animal models. Basically, one never does "set back to zero tolerance".

Never ever, like if you quit for 50 years then relapsed, or is it time independent?
 
Is this related to the kindling phenomenon in benzodiazepine withdrawal? I don't really know anything about heroin, but maybe someone else here could comment on whether the phenomena are related.

http://en.wikipedia.org/wiki/Kindling_(substance_withdrawal)

Also, as an edit: I've anecdotally heard about benzo patients "resetting" after withdrawal with flumazenil (obviously you would never do that during withdrawal), and it supposedly re-sensitizes receptors. Not sure if there's an equivalent antagonist for opiates.

I want to very readily admit I know just enough to ask these questions.

Info on flumazenil in protracted withdrawal:
http://en.wikipedia.org/wiki/Benzodiazepine_withdrawal_syndrome#Effect_of_flumazenil
 
Last edited: