{Part 1} The Biggest Breakup of My Life: It’s All in My Head

The Long Hard Road Out of Hell

27 years of self-discovery, emancipation, friendship, survival, and human connection; all shaped, challenged, and facilitated by a kaleidoscope of drugs. 

It has been 18 years since recreational became routine and 11 since I realised I am addicted. Now, I stand at the edge of a precipice. My body cannot continue. I have no choice; I have to proceed with the breakup of my life. I have to end it, my relationship with the only thing that has never abandoned me, the one thing that got me through the worst, the most reliable force I’ve ever known. 

I am terrified. 

Detox day is coming.

One factor that complicates the situation is the fact that only my inner circle knows about my substance use, and they only know because I told them.

Consider me the anti-tweaker. Everything you think you know about people who use methamphetamine does not apply to me. 

I do not stay awake for days on end. I have a routine, with exceptions like any other adult: I go to sleep between 8 pm and 12 pm, and I’m up in the mornings between 6 am and 7 am. 

I eat three meals a day, with snacks in between. 

I have good teeth.

I don’t own a poodle.

I don’t have red eyes or pale pasty skin.

I’m not underweight.

I don’t engage in dodgy or secretive behaviour.

No Jerky, erratic movements; twitching; facial tics; animated or exaggerated mannerisms;

No verbal diarrhoea

I do not have a criminal record,

I do not engage in criminal behaviour or risky behaviour.

I do not borrow money from people or sell my or anyone else’s possessions, 

I’m just another soccer mom. 

Photo by Emily Bernal on Unsplash

Just over a year ago, I had a mild heart attack. Since I didn’t have anyone who could take care of my son and I didn’t have medical aid, the doctor had no choice but to let me go home with the instruction to rest and stop using methamphetamine immediately. I stopped using meth; but he didn’t say anything about Methylphenidate, Phendimetrazine or CATHINE (nor pseudoephedrine). Don’t judge me. I thought it quite clever, innovative if you will. But alas, substituting wasn’t as effective as I had hoped, and I relapsed within a month.

Don’t get me wrong, I wanted to stop after the heart attack. I have a beautiful 7-year-old who needs me, who I want to live for. 

The truth is that the substitute chemicals weren’t cutting it. My doctor prescribed Prozac and Atomoxetine; These were NOT helpful at all. If anything, the meds made me feel even worse. I recall gaining consciousness after 5 days of continuous sleep, suicidal and murderous. I thank the gods for my unbelievable best friend. If I didn’t have such an amazing, compassionate and trauma-informed woman in my corner, my mother would have had to bury the last two generations of our bloodline on the same day.

With regards to the replacement stimulants: I was stupid to think that a diet pill or ADHD stimulant would have an effect comparable to 16 years’ worth of chronic meth use. I am always open to conversations and brainstorming with anyone who has novel ideas or advice, but the available literature doesn’t offer any shortcuts or hacks. And no, I am not a viable candidate for Iboga (heart, remember?)

Fate did orchestrate a serendipitous meeting recently when my path crossed with an inspirational woman. Speaking with her was surreal. It felt like I was conversing with a future version of myself. It was uncanny how similar our life stories are. She is on a different continent, working with a neurology laboratory and will be my mentor on this journey. 

So what exactly are we dealing with? 

Many standard treatment facilities recommend 3 or 6-week detox programs, and almost all of the common resources online provide timelines similar or identical to the one below:

Withdrawal timeline according to https://www.therecoveryvillage.com

Due to my history of chronic use (16+ years), and based on previous cessation attempts, after 1-2 months, I will likely still be in the crash phase, and I can anticipate Post Acute Withdrawal Syndrome (PAWS). This is attributed to long-term neurobiological alterations in brain circuits involved in dopamine function, stress response, and neuroplasticity.

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My Neurobiology

I have not experienced euphoria or a 'high' in years. Instead, I am what some refer to as a ‘functional addict’. I use meth to feel ’normal’ so that I can get out of bed in the morning and do normal-person things. This transition is due to profound neuroadaptations in the brain’s dopamine system, stress response, and cognitive functions after prolonged use.

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The neurobiological action of methamphetamine

Methamphetamine floods the brain with dopamine (DA), a neurotransmitter responsible for pleasure, motivation, and reward. It does this by:

• Increasing dopamine release from presynaptic neurons.

• Blocking the dopamine transporter (DAT), preventing dopamine reuptake.

• Inhibiting monoamine oxidase (MAO), which normally breaks down dopamine.

This results in a massive dopamine spike, leading to intense euphoria, energy, and confidence.

But, over time and with chronic use, the brain adapts in ways that reduce the drug’s effects:

1. Dopamine depletion – Overactivation of dopamine neurons eventually leads to dopamine system exhaustion. The brain produces less dopamine naturally, so even with meth, dopamine levels never reach the highs they once did.

2. Dopamine receptor downregulation – The brain reduces dopamine receptor density (D1, D2 receptors) to protect itself from overstimulation. This means even when dopamine is present, it has fewer receptors to bind to, resulting in weaker effects.

3. Increased dopamine transporter (DAT) activity – To compensate for constant stimulation, the brain upregulates DAT, clearing dopamine from the synapse more quickly (D’Arcy et al., 2016).

In short, this means that my brain can't produce or process dopamine efficiently anymore. My natural dopamine production is so low that without meth, I become profoundly dysphoric and unable to function normally.

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The Stress System (HPA Axis) & Methamphetamine

The Hypothalamic-Pituitary-Adrenal (HPA) axis controls the body's stress response by regulating cortisol, adrenaline, and norepinephrine (hormones that control energy, focus, and alertness.)

Methamphetamine triggers an extreme fight-or-flight response by:

• Massively increasing norepinephrine & epinephrine (adrenaline) levels

• Activating the amygdala (fear & stress centre) causes chronic overactivation of the HPA axis.

In my case, the HPA axis has become severely dysregulated:

• Cortisol levels are erratic and are now extremely low.

• My adrenal glands are depleted, unable to keep up with constant stimulation (chronic fatigue, depression, weakness).

• Norepinephrine and dopamine receptors have downregulated, leading to extreme fatigue, needing excessive sleep (16+ hours) but still feeling exhausted and unable to function, severe depression, and extreme brain fog when I don’t use.

• Without meth, I experience suicidal thoughts & extreme emotional numbness.

• Hypothyroidism: My thyroid gland underproduces thyroid hormones, resulting in a slowed metabolism, weight gain, and cold intolerance.

• Chronic pain & muscle weakness

• Dizziness, low blood pressure & vertigo

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Hypofunction of the Prefrontal Cortex & Increased Relapse Risk

• Withdrawal leads to long-term impairments in prefrontal cortex function, which affect impulse control, decision-making, and emotional regulation (Li et al., 2019).

• Therefore, relapse risk remains high even 18+ months post-abstinence.

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So, why don’t you just stop? Do it for your kid!

If anyone says this to my face, know this: I WILL kick you in the baby! If only it were that simple.

Once a person reaches the point of ‘functional use’, quitting has some unique challenges:

• PAWS can easily last for 24 months! That is 2 years!

• Chronic anhedonia makes life unbearable.

• Natural dopamine function is severely impaired.

• Dopamine is fundamental in daily functioning:

  • Dopamine plays a key role in initiating action in pursuing goals and overcoming inertia. Low dopamine levels cause apathy, procrastination, or an inability to "get going". When dopamine levels are optimal, you are more likely to feel motivated to get out of bed, start your day, and engage with the world.

  • Dopamine is essential for motor control, as it helps facilitate communication between neurons in the basal ganglia, the part of the brain responsible for initiating and fine-tuning movements.

  • Dopamine reinforces behavioural patterns, making it a key player in habit formation. Repetitive actions that provide some reward (even small ones) can strengthen neural pathways associated with those behaviours.

  • Dopamine evaluates cost vs. reward, helping you decide whether an action is worth taking. It influences risk-taking, planning, and assessing future outcomes.

  • Dopamine strengthens the brain’s ability to pay attention and learn from experience. It enhances memory consolidation by reinforcing rewarding behaviours.

  • Dopamine helps regulate mood, working in balance with serotonin. While serotonin is linked to contentment, dopamine fuels the drive to seek and pursue.

  • Dopamine helps regulate alertness and wakefulness, counteracting melatonin production.

  • Dopamine is heavily involved in social behaviour, reinforcing interactions that feel rewarding.

So, what about meds, right? There are currently no FDA-approved medications for stimulant withdrawal, nor are there any in development. Potential treatments (e.g., gabapentinoids, antidepressants, NMDA modulators) have shown limited efficacy (Bahji et al., 2022).

The road ahead is daunting, and the science is a source of clarity and reminder of the challenges that lay ahead. My body and brain have been rewired, and quitting isn’t as simple as flipping a switch—it’s a slow, gruelling recalibration of my entire being. But knowledge is power, and understanding what I am up against is the first step towards (re)claiming my life.

If you’re still here, thank you for sticking it out. In part 2, I conclude with the recovery blueprint and estimated timeline

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