Someone recently responded to one of my blog posts, asking for some guidance in getting off marijuana after smoking it regularly for 20 years. The reader is struggling with depression—common to early recovery from both alcohol and marijuana, is taking a prescribed antidepressant, and wanted other suggestions, particularly those that might help with the depression. I answered the query with the following:
Marijuana takes a long time to recover from. A man in recovery from marijuana addiction spoke at an addiction conference I attended some years ago. He said: "It took three years before the marijuana bubble burst." While it may not take quite that long in every case, it can and usually does take longer than expected. In part this is due to the complex nature of the drug itself, in part how long it takes one's brain to be able to rewire itself, correcting whatever unfortunate changes the pot managed to make. Every person is unique in multiple ways, and differences show up in personality, traits, and susceptibility to addiction, meaning how fast you become addicted, and how fast your brain rewires itself post-addiction. In my own practice I've seen it take three years to recover from marijuana, but not always. Negotiating the rather wild waters of recovery depends upon what damage regular pot used made in your life—your social and economic life, your relationships, your spiritual life if that is important to you.
The next part of recovery—getting over the problems drug use caused in your life-—is not physiological per se, it is more dependent upon cognitive and behavioral habits, psychological factors, and therefore more under your direct control in terms of setting things right again, picking up the broken pieces etc. I have seen people make progress more easily when they are able to get involved in a 12-step recovery program like AA (Alcoholics Anonymous) or NA (Narcotics Anonymous) or if there are meetings close to where they live, MA (Marijuana Anonymous). What going to AA etc. meetings does is provide someone in recovery with a social group that doesn't use drugs—and in this "better living through chemistry" world we live in, that can be helpful. In the ordinary day in the lives of ordinary people, they may walk into an ordinary store with drugs on prominent display—different strengths, different flavors, different colors, but right out there, our legal drug alcohol. That’s a better living through chemistry culture. So finding people to socialize with, hang out with, people who don’t use drugs, is sometimes difficult. People using drugs ordinarily hang out with others who are using drugs, and recovery can mean the end of a whole social circle for the recovering addict. So if it is possible you would be wise to find a local AA or NA or MA meeting and go every day, or as often as there are meetings. If that is not possible, try to find another social group that is not based on drinking or drug use. If your drug use isolated you socially, you definitely need to head out to find social groups with whom to interact. This is so difficult to do while you are depressed, but you can do it slowly but surely. In early recovery paranoid ideas, obsessions, fears, worries are hum-drum, common. But these screwy, frightening thoughts so routine for people in early recovery are to be ignored as much as possible, they’re unreal, they’re wrong, and meaningless.
Another source of support in early recover. Consider hiring a “professional” to go through it with you. This includes psychotherapists, counselors, social workers, or community peer counselors. Here I’m suggesting you find one person to talk to who knows something about addiction and who also knows something about depression. In a 12 step program it is advised that people in early recovery get a "sponsor" who serves as that person—in fact, people often recover more quickly when they have both an AA sponsor AND some kind of individual therapist who can support their continuing abstinence as well as their involvement in AA. An AA sponsor may be afraid of symptoms of depression, so if that’s a big part of the picture for you, then definitely find a therapist. A cognitive-behavioral therapist (CBT) may be helpful, although you might also make good use of a general "talk therapist" who knows cognitive behavioral techniques. CBT and talk therapy that uses techniques from CBT have been empirically studied as treatment for depression, and they have been found effective. These things really make a difference, both to the course of a depression, and to recovery from drug addiction.
Using an anti-depressant is also an excellent idea—it will help your brain begin to make proteins ("Brain Derived Neurotrophic Factor" or BDNF) that will lead to it producing new neurons in a process known as "neurogenesis.” So getting treated with an antidepressant prescribed by an MD is a wise move. Ask your doctor to start you on a low dose, and increase your dose very slowly. This will help you avoid what are commonly referred to as “side effects.” Stick with the psychopharmacological treatment, and stick with the prescribing physician—whether he/she is an internist or psychiatrist. Make use of every possible kind of support. Give yourself permission to go all out on this one, you’ll never regret it.
Begin a program of meditation right now, today. Currently this is being called "mindfulness" but really, it is good old-fashioned meditation, an activity that’s been used to help people with “mind problems” for almost 5000 years. It is not hard to learn, try it today. Simply sit down somewhere and for three or four minutes, partly shut your eyes (or shut them completely if that is easier) and try to pay attention to your breath, breathing in and breathing out. You don't have to breathe particularly deeply, just breathe your normal way. You can count each breath with each exhalation. Or you can say silently, to yourself "I's breathing in, I'm breathing out." If three minutes is too long, do it for two minutes. Eventually you will be able to do it for longer. Don't worry about all the thoughts that come into your mind and drag your attention away from your breath—when you notice them, simply go back to paying attention to your breathing. Being dragged away by thoughts is entirely normal, it's how our minds work. Bringing our attention back to our breath is the magic, that’s the activity that rewires the brain. Doing this for very short periods of time in the beginning is much better than trying to meditate for a longer time that might get uncomfortable. You want to love your time meditating. I have written some simple instructions in how to meditate that I plan to post on my blog in Psychology Today. Daily meditation will rewire your brain. It will help regulate your emotions. That hyper-sensitivity to negative comments, to feeling rejected, will change. You'll become more resiliant
Start taking walks every day, the longer the better. Any physical activity or exercise you even half enjoy will help you. And exercise has been demonstrated to help rewire your brain more efficiently. Like anti-depressants, it kicks your brain into gear so that it begins making more BDNF.
Educate yourself about addiction disease. There are many books out there about it, many of which are written by recovering addicts just like you. Read their stories, learn about this disease that is as they say in AA "cunning, baffling and powerful." It is but it can go into complete remission and stay there by the simple method of not using any mind-altering, “recreational” drugs.
A side comment: You mentioned having drug dreams—where marijuana made an appearance. This is normal for people who are withdrawing from drugs. They are “warning dreams,” that is in your dream you are telling yourself that you are in danger of using marijuana again. You’re reminding yourself to be cautious, be alert and vigilant and avoid using marijuana. You also mentioned light drinking on occasion. From clinical experience I feel obliged to say that using “other” drugs, or drugs that were not the recovering person’s’ “drug of choice” is risky. Drugs often work to drop inhibitions, drugs interfere with decision-making. Using alcohol at all is likely to end up a problem. Being around people who recreate by drinking is a problem, because your recreational drug has been marijuana. As said above, find people who know how to relax and recreate while drug-free. You can do this.
Cut yourself some slack. Whatever "bad" or "stupid" things you did in your addiction are NOT your fault, they are the fault of the disease of addiction. Addiction highjacks the brain. It highjacks the part of the brain responsible for making decisions. It highjacks the pleasure center in the brain. These problems will be corrected with time off mind-altering drugs (and by this I do not mean antidepressants). What you do now, in your recovery, is your responsibility. But what happened in the past, put that aside. You will make amends if you need to, later. For now try to dump all the feelings of guilt, all your worries about other people. Try to take these steps I've suggested, even if you are weighed down by depression. The ups and downs of pot withdrawal are difficult, but they will diminish slowly but surely, and you will recover completely.