Painkillers, coffee, and the concept of withdrawal reversal

I am not a doctor, but I listened to one yesterday. Harvard professor Clifford Woolf sat down with a16z for a podcast (linked below) to discuss the biology of pain. Naturally, the conversation covered opioids and what some are calling an epidemic of addiction and abuse. Woolf explains how some addicts describe never feeling a high as great as the first time and how the highs become less and less powerful over time. After frequent enough use over a long enough duration, these people continue to use not so much because they crave the highs, but rather, to be saved from the lows. Maybe that is why they call it a fix. The scientific term is called withdrawal reversal.

I often point to this concept of withdrawal reversal when explaining to people why I do not drink coffee daily. I typically love both the feeling and the taste — even the temperature, the act of drinking it, and the ritual itself. Still, I do not drink coffee daily because I do not believe it is a good habit, and because I do not want to be dependent on anything to maintain my normal state. With regular consumption of coffee, as with many other things, comes a growing tolerance and a lowering of the peak high feeling, but the fall of post-peak withdrawal does not become any less severe. As I understand it, the same sized fall simply starts from a lower peak until at some point the bottom of the fall is as low below your original baseline (your normal state before your coffee habit) as your original and highest peak ever was above it. At that point, your new peak is the same as your old baseline and you are no longer drinking coffee to feel better than your natural normal but simply to not feel worse.

I am not necessarily advising you to stop drinking coffee daily. I think different things impact different people in different ways, and like I said, I am not a doctor. More than anything, I think the concept of withdrawal reversal and its role in the phenomenon of addiction is important to understand as it relates to everything from opioids and coffee to juul and adderall and maybe even my addiction to my phone which I imagine pales in comparison to that of many. With coffee, I have on average a cup or two a week, and I try to have it on days when I can do things that I want to do more than on days when I have things that I have to do. It feels more like a want than a need that way. My father, a doctor, often advocates for the simple sounding but challenging to abide by principle of everything in moderation. In large part because of the concept of withdrawal reversal, I believe we would be wise to strive for moderation in many areas of consumption. Now, I think I will go treat myself to a coffee today.

a16z Podcast: The Biology of Pain