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Expert Q&A

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How long does it take for a once-addicted brain to heal?

Asked by Ann, Central Pennsylvania

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Because of the complexity of this viewer question, three of CNNHealth's expert doctors are offering advice. Last week, Diet and Fitness expert Dr. Melina Jampolis had ideas for gaining weight in a healthy way. Yesterday, Dr. Jennifer Shu offered information about concerns for a baby born to an addicted woman. Today, Mental Health expert Dr. Charles Raison weighs in.

My daughter is a heroin addict -- the "new face" of the heroin addict. My question concerns her weight. She is 5-foot-3 and is probably somewhere in the 85-to-90-pound range (I hope). She has always eaten a large amount of food, even to maintain her before-addict weight of 108 to 110 pounds. I realize most of the population does not have this problem, but how can we add weight gain to her? Is GNC OK? The one supplement I found has over 2,000 calories, and I told her to halve that amount and eat regularly. She still is not gaining weight. Are there any weight-gain "diets" out there for this small minority of people who have trouble gaining weight? I would like to have her eating something healthy to gain and maintain the weight. Is there a daily drink she could have? I'm afraid her little body will just give out one day.

We have a history of heart disease in our family. I can't always control the "addict" in her, but I do try to make sure she has food, etc. She's supposed to be taking Suboxone, which works great for her when we/she can afford it. It's such an awful addiction. Any help would be appreciated.

She is an identical twin, and her twin sister is also an addict on Suboxone, and pregnant. She's due September 6 and has great prenatal care and a good job. I worry about the effects of the Suboxone on the baby, but it has to be better than the alternative. She is doing wonderful, though, on Suboxone, and I hope that she can just continue to take it after the baby gets here. Thanks in advance.

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Mental Health Expert Dr. Charles Raison Psychiatrist,
Emory University Medical School

Expert answer

Dear Ann,

My medical colleagues at CNNHealth.com have already discussed issues related to use of opioid medications during your one daughter's pregnancy, as well as tips for helping your other opioid-addicted daughter gain weight. I won't add to their excellent answers other than to comment on the fact that being extremely underweight often makes it difficult for the brain to make the neurotransmitters required for a person to think and feel normally. So there is, unfortunately, a psychiatric -- as well as a medical -- mandate for trying to get your non-pregnant daughter's weight up into the normal range if you can. When people are on chronic opiates, gaining weight can be next to impossible because of the tendency of these substances to profoundly suppress appetite.

But let me address a set of questions you sent to us after sending the original question posted above. Specifically you asked:

"How long do you have to be on Suboxone (or methadone) before the heroin cravings go away? Is there a timeline for this addiction/disease? From what I have seen, it looks like the brain gets damaged and has to heal. Is that true for this addiction? And if so, how long does it take for your brain to heal itself?"

The answer to the first question is probably something like "forever," by which I mean that drugs such as Suboxone work by giving the brain the opioid stimulation it craves, but does so in a gentler and safer manner than does heroin. When Suboxone works, it does so by meeting the opioid craving, not by making the brain not want the opioid. This is partly why many people on agents such as Suboxone or methadone still abuse heroin on the side, either chronically or intermittently. The problem is serious enough that a recent study actually looked at whether results would be better if addicts were just given reasonable doses of heroin. The study suggested the answer to this might be yes.

If your daughters would just stop the Suboxone, they would undergo a very uncomfortable withdrawal syndrome, but not as uncomfortable as the syndrome that would ensue from stopping heroin "cold turkey." Were they to stop Suboxone, the receptors in their brains for opioids would slowly return to normal. This usually takes many weeks to months. This is truly a time in which the brain "heals."

Whether it ever recovers completely from heroin addiction is another question. We don't know as much about heroin as other drugs, but studies from these other drugs of abuse (mostly cocaine and amphetamine) suggest that drugs of abuse can rob the brain of its ability to feel pleasure for long periods after use of the drug has stopped. Drugs also appear capable of shrinking brain areas that are essential for wise decision-making and being able to withstand momentary urges -- which might help explain why so many people relapse.

The best data I know of regarding the timeline of heroin addiction are a classic case of the "glass being half empty or half full," depending on whether you want to be pessimistic or optimistic. The "half-empty" part is that perhaps up to 50 percent of people with serious heroin addictions will struggle with these addictions for the rest of their lives. The "half-full" part is that a sizeable percentage of people with heroin addiction will eventually get past it and leave drugs alone. Based on the information you have provided, your daughters are blessed with a number of factors that (other things being equal) tend to predict good outcomes in the context of heroin addiction.

What is very clear from studies is that people who are unable to give up heroin addiction face lives of great mental and physical suffering that often end in premature death. People who get all the way free of opioid use (and can stay off other drugs and alcohol) have a far, far better outcome. People who spend years of their lives taking a medication such as Suboxone or Demerol generally have outcomes between these two extremes -- lives that are passable but not what you would wish for your two daughters.

Like my medical colleagues, I wish you all success in your attempts to help your daughters, and I applaud the honesty and courage of your questions.

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