The Steps to Recovery
Addiction is a mental health disorder that can affect people from all walks of life and backgrounds. Because of this, there is no one path to recovery and no magic potion to make it an entirely quick and easy process. However difficult the journey proves to be, choosing a life free from drugs and/or alcohol will be one of the best decisions you’ll ever make for yourself.
Although sobriety may seem unachievable, with the right treatment, care, and support, you can begin to take back control of your life. Treatment enables you to begin countering the disruptive behavioral patterns associated with addiction and addressing the mental and physical health consequences of chronic substance use.1 In taking the first steps towards a healthier life and, later, through your continued recovery efforts, you can learn how to abstain from drugs and/or alcohol, control your triggers, create new hobbies and develop a plan to deal with relapse if it occurs in the future.
Below are some stages or general milestones commonly encountered while working through and toward recovery:
Acknowledging the Problem
Often, the first step to recovery is acknowledging that you are struggling with addiction. Though compulsive substance use may be creating problems in your life, interfering with your interpersonal relationships, and/or distracting you from your professional obligations, a recognition that it’s time for help still needs to take place before recovery can really get underway. This initial stage is crucial in the recovery process, and the shift from denial to acceptance and a willingness to make a change, are essential to starting your new life.
Drawing from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), some of the measures through which an individual can determine whether their own substance abuse has become problematic include:
- An inability to stop use altogether, despite attempts to do so.
- An inability to control the amount, length, or frequency of substance use.
- Continued use, even when it causes problems in relationships.
- Needing more of the substance to get the desired effect (i.e., tolerance).
- Experiencing withdrawal symptoms if the substance use is stopped.
- Continuing to use, even when a physical or psychological problem could be made worse by the substance.
Detoxing & Withdrawal
For many types of substances, following a period of chronic use and in anticipation of treatment, the next step involves a detoxification or withdrawal management period. This is sometimes considered the most difficult part of rehab. Because detox from alcohol, sedatives, and opioids can be uncomfortable or dangerous when not managed properly, a supervised medical detox help minimize discomfort and ensure a safe withdrawal.2 In cases of severe physiological dependence or addiction, an inpatient or residential detox protocol may be recommended to ensure medical professionals are present in the event of an emergency. Following detox, you may be encouraged to transition into an inpatient or outpatient rehabilitation program to continue your recovery work.
Once you’ve acknowledged the need for change and successfully go through detox, the next step is exploring your treatment options. Regardless of your level of substance abuse, enlisting the aid of medical and mental health professionals to help you navigate your journey and make the process easier.
They’ll help you decide on the best treatment plan which may involve one of the following settings:
- Inpatient Rehab—In most cases, inpatient rehabilitation settings are home to the most intensive treatment Inpatient and residential rehabilitation varieties encompass both short and long-term programs. Patients in these settings often benefit from the ample interaction with their peers in recovery and round-the-clock access to support staff that such programs provide. Inpatient/residential programs facilitate focused recovery work while minimizing any distractions from environments that may have been contributing to the substance use.
- Outpatient Programs—Those working toward recovery in outpatient programs, live at home or outside of a facility while receiving regularly-scheduled addiction treatment a few days to several days a week. Though these programs only require attendance during sessions, they may vary in terms of intensity and time commitment. Other types of outpatient treatment include intensive outpatient treatment and partial hospitalization.
Participating in Behavioral Therapies
Since addiction development is frequently contributed to or accompanied by certain pathological changes in thoughts and actions, treatment plans also include the use of behavioral therapies to modify maladaptive behaviors and attitudes related to substance abuse. These therapies may be administered through several group and individual counseling sessions over the course of treatment. As a result of certain behavioral therapeutic interventions, patients are better able to handle triggers and situations that may lead to drug or alcohol use and help people remain in treatment longer.1
Some of the therapies you may experience include1:
- Cognitive-behavioral3: Seeks to help patients better understand how to identify, eschew, and cope with situations that can lead to substance use.
- Motivational enhancement4: Helps individuals resolve their ambivalence about treatment and stopping drug or alcohol use.
- Contingency management5: Focuses on reinforcing (through rewards, special privileges, etc.) positive behavioral change such as attending counseling sessions or maintaining sobriety (as measured by negative urine tests, etc.).
- Family Behavior Therapy6: Aims to improve the home environment and overall family functioning by addressing potential household influences on negative substance use patterns and encouraging families to apply beneficial behavioral strategies to everyday life.
- Twelve-step facilitation (TSF)7: An active engagement strategy typically delivered in weekly sessions to prepare individuals to become engaged in 12-step programs as social and complementary support to treatments. The hope is that, when applied to the individual in treatment, TSF will encourage their acceptance of addiction as a disease, a surrender to a higher power of their choice, and their active involvement in 12-step meetings and other recovery activities.
Utilizing Aftercare Programs
Various types of aftercare programs are offered to provide an outlet for continued recovery work and post-rehab sobriety maintenance. Aftercare efforts help people solidify and expand upon the coping strategies learned during rehabilitation. Depending on an individual’s needs upon completion of initial treatment, clinicians can prescribe varying lengths of aftercare. It is important to follow these plans closely since relapse rates are estimated to be between 40 and 60 percent amongst people being treated for substance use disorders. These programs can include individual or group counseling, sober living homes and/or 12-step programs such as Alcoholics Anonymous or Narcotics Anonymous. You may also experience regularly-scheduled outpatient follow-up appointments at a hospital or clinic.
Connecting With Other Sober People
It’s important to remember that recovery isn’t finished once an individual completes treatment. It is a lifelong commitment that will require self-control, self-awareness and self-care. Often times, when searching for support, it’s easiest to turn to friends or family to help navigate your thoughts and feelings. However, for many, those former connections may have helped (directly or indirectly) contribute to addiction in the first place. In those cases, finding sober friends and building up a network of peers who are dealing with similar circumstances can help you maintain your sobriety after your treatment program has ended.8
Maintaining Your Sobriety
Because addiction is a chronic condition, maintaining your sobriety and learning to avoid situations and people that may lead to relapse will become a part of your daily life. Although life may start to seem more manageable, you still need to be aware of the triggers that may lead to relapse and learn how to manage your cravings. One way to do so is to distance yourself from those who may enable your drug or alcohol use or avoid locations where use is prominent. Be sure to also speak with your doctor about your abuse history so that they can suggest other methods of treatment rather than prescription drugs.
. National Institute on Drug Abuse. (2018). Treatment and Recovery. Drugs, Brains, and Behavior: The Science of Addiction.
. Center for Substance Abuse Treatment. (2015). Detoxification and substance abuse treatment. Treatment Improvement Protocol (TIP) Series, No. 45. HHS Publication No. (SMA) 15-4131.
. National Institute on Drug Abuse. (2018). Cognitive-Behavioral Therapy (Alcohol, Marijuana, Cocaine, Methamphetamine, Nicotine). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Ed.).
. National Institute on Drug Abuse. (2018). Motivational Enhancement Therapy (Alcohol, Marijuana, Nicotine). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Ed.).
. Petry N. M. (2011). Contingency management: what it is and why psychiatrists should want to use it. The psychiatrist, 35(5), 161–163. doi:10.1192/pb.bp.110.031831.
. National Institute on Drug Abuse. (2018). Family Behavior Therapy. Principles of Drug Addiction Treatment: A Research-Based Guide (Third Ed.).
. National Institute on Drug Abuse. (2018). 12-Step Facilitation Therapy (Alcohol, Stimulants, Opiates). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Ed.).
. Tracy, K., & Wallace, S. P. (2016). Benefits of peer support groups in the treatment of addiction. Substance abuse and rehabilitation, 7, 143–154. doi:10.2147/SAR.S81535.