STAGES OF RECOVERY

Addiction and recovery are two things that are unique to every individual.  No two addictions are exactly the same and therefore no two recoveries will be either.  There are simply too many variables that impact both the addiction and the recovery process, that make it impossible to accurately predict what recovery path is right for an individual. There are however certain stages that every individual must go through when getting clean and sober.  As well, there are fairly predictable needs that must be met in order to maintain motivation and secure long term abstinence if this is the path chosen.  Immediate on-demand treatment and an uninterrupted continuum of appropriate care are necessary to promote progression through the stages.

 

The five stages of recovery are identified as follows;

1.      Recovery Contemplation (pre-abstinence)

2.      Detox and Early Abstinence (0 – 3 mo.)

3.      Treatment and Early Recovery (3 - 12 mo.)

4.      Active Recovery and Maintenance (1 - 5 yr.)

5.      Advanced Recovery (5 years and beyond)

 

For an individual struggling with addiction to heal, they must take the time to follow through the stages.  Rushing the process will yield inadequate results and increase the potential for relapse.  The body and mind need time to heal from the adverse effects of active addiction.  Each of the stages account for this healing time which is dependent on variables such as length of time in active addiction, severity of traumas, drug of choice and poly drug use.  Of primary concern, is entering into a residential treatment program too soon after becoming abstinent.  The body and mind has not yet had time to heal and as such the individual will receive limited benefit from such treatment.  Residential treatment digs deep into an individual’s mind to uncover the root causes of addiction.  If an individual does not yet have the mental or emotional capacity to handle this information, they are likely to push back or suppress the information even further.  The result can be devastating, as digging up these old wounds without an actual resolution, can quickly manifest into more destructive behaviors.  It is very important to the overall success of treatment that the individual is healthy enough, both physically and mentally, to take on the challenge of their darkest demons.

The Residents in Recovery pre and post treatment sober living programs provide a continuum of care for individuals in their first year of recovery.  As a result of this continuum of care, rushing individuals to treatment is not necessary.  Taking the time to prepare for treatment in a safe and supportive recovery environment will yield much better results and more positive outcomes.

Recovery Contemplation (Pre-Abstinence)

Recovery Contemplation is the first stage of the recovery process.  The individual begins to experience negative consequences from their addictive behavior. In an effort to minimize these consequences, the individual tries to regain control by reducing use or changing their behavior.  Perhaps they will try to regulate times of use, or perhaps even try to shut it down at a specific time.  Some people may even go so far as to have their DOC or alcohol present in their home, or tempt themselves with their behavior, in order to prove to themselves that they can control it.  Eventually, they are forced to acknowledge that there is a problem and they may begin to consider reaching out for help.  This stage of the recovery process can go on for some time with the individual wavering between the pre-contemplation, contemplation and preparation in the Stages of Change, Model of Recovery. 

True recovery, does not in fact take place until the individual makes a commitment to change, and to acknowledge the fact that they cannot do it on their own.  Whether or not there is a significant motivating factor directing this change of mindset, when an individual is at the point of acceptance of the problem, immediate access to support is necessary.  This on-demand and immediate access is required as this window of opportunity most often closes very quickly.  It is imperative that people are afforded every opportunity to get clean and sober when they are ready, as there may not be another chance.  Drugs and alcohol kill people every day and one can quickly lose all hope by not having this support available when they are of the mindset that they are ready for help.

The following are services that should be available in every community, either local or accessible with prearranged supervised transportation.  Depending on the size and demographics of the community, the degree that each of the services are made available will change.  Cities such as Vancouver or Edmonton will require multiple combinations of services whereas a city the size of Lloydminster may only require a wet shelter, outreach and a harm reduction program.

1.      Outreach support for those struggling and their families

2.      Harm reduction program

3.      Supervised injection / inhalation sites

4.      Wet shelter / Warming Room

5.      Peer support meetings

6.      Individual and group counseling for victims of trauma and abuse

Detox and Early Abstinence (0 to 3 months)

The second stage in the recovery process is the detox and early abstinence stage.  It is at this point that the individual has decided to get clean and sober and stops using their drug of choice.  This stage can be excruciating for some people and may require medical supervision for the first week to ten days.  For some, especially opiate users, drug assisted therapy options such as methadone should be explored at this point.  During this stage, in particular the first month, individuals will go through some significant physical, mental and emotional changes.  For some, it may have been years since they did not have any drugs or alcohol in their system.  This will be a new and frustrating experience and requires a lot of support and attention.  Mental processes may be foggy, and learning anything other than basic self-analysis will likely prove to be rather ineffective and perhaps, even counter-productive.  It is not until residential treatment that individuals will be required to look deep within themselves to the source of their addiction. 

The primary goal during the detox and early abstinence stage is to maintain support for abstinence (from illicit forms for drug assisted therapy cases) while the body heals.  Physical nourishment along with cognitive awareness are the two main focuses.  With a healthy body and mind, the treatment stage will be that much more effective and not sidetracked with withdrawal symptoms and cognitive distractions. 

Given the state of treatment in Canada at this point in time, immediate acceptance into a residential treatment program is not likely.   It is recommended that the body and mind be given two to three months to heal prior to entering an intensive program anyways.  As such, it is necessary to provide the recovering individual with a healthy and supportive environment until a treatment bed becomes available.  Returning to the environment that the individual used or drank in before is counterproductive, and typically results in a return to use and sometimes even worse, death.  The following services need to be available in every community and these services MUST be available free of charge, on-demand and immediately accessible.

1.      Medically supervised detox or drug assisted therapy

2.      Pre-treatment sober living

3.      Individual and group counseling

4.      Psychiatric assessment for co-occurring disorders

5.      Peer support meetings

Treatment and Early Recovery (3 months to 1 year)

This is the meat and potatoes of any recovery program.  Residential Treatment, group therapy, one-on-one counseling, therapies (i.e. EMDR, REBT, CBT) and 12-step or other related meetings are the key features of this stage.  As previously mentioned, it is important that this stage does not get rushed as the body and mind need time to heal.  The individual must be able to rationalize, consider consequences and have stabilized emotions.  In order to ensure appropriate residential programming, a psychological assessment should have been completed a month or so into the previous stage, to identify any co-occurring disorders.  Mood stabilizing drugs and applicable programming will further promote treatment success.

This stage typically starts with residential treatment. Intensive self-examination combined with 24-hour supervision and support helps the individual identify and expose the underlying issues that caused their addiction to manifest.  A detailed preliminary assessment/evaluation in the previous stage will help determine the appropriate and most effective residential treatment program.  It is fairly typical for an individual to simply be placed in the closest treatment program or one associated with the detox facility.  There is very little thought put into the appropriate or most effective program for the individual.  As every person is unique, certain programs would be much more effective and placements should be determined based on the individual's temperament, history, addiction as well as their mental and emotional state.  Getting the person into the most appropriate residential treatment program will greatly increase the effectiveness of the program.  A proper fit of program and client will support the exposure of issues and facilitate the dealing with such issues.  The residential treatment program is used to identify, expose and develop a recovery plan with the underlying issues in mind. 

Treatment of the underlying issues will require extensive therapy beyond the residential treatment program.  It is important to seriously consider a sober living program after treatment.  Sober living will facilitate healthy integration back into the community and alleviate any issues still present in the individual’s home environment.  Sober living will also facilitate directed care to ensure that adequate attention is being paid to underlying issues.  Therapy and counseling are not easy and as such not motivating.  They are however necessary to mitigate future complications and potential relapse.

Regardless of therapy, the individual must get themselves into a healthy environment to ensure that they receive the treatment or therapy that they require. This stage will typically last anywhere from 6 months to a year but could last up to 18 months in certain circumstances.  The following services need to be available free of charge, however some of them do not necessarily have to be within the community.  If services are not available within the community, transportation must be available as this can be one of the greatest barriers to services.

1.      Residential Treatment (Not required within community)

2.      Post-treatment sober living (Within community)

3.      Individual and group counseling

4.      Psychiatric care

5.      Peer support meetings

Active Recovery and Maintenance (1 to 5 years)

The active recovery and maintenance stage begins once the individual has come to terms with their issues, and has accepted that the work and awareness will continue throughout the remainder of their lives.  The individual will have completed extensive work on themselves and will have started a complete transformation of their lives (mind, body and spirit).  People at this stage of their recovery have learned new tools to cope and to guard against a relapse.  Individuals reaching this stage of recovery are also aware of the importance of managing their thoughts, emotions and behaviors and know the connection between each of them.  They are also keenly aware of how their old beliefs and thoughts can creep back into their lives.  Without keeping them in check, these old beliefs and thoughts could ultimately lead to a lapse or relapse.  They continue with counseling when necessary, and seek support through self-help groups and/or meetings and other resources.  Careful attention is paid to maintaining a balanced lifestyle with healthy and stable relationships.  This stage lasts approximately five years and is still considered to be early recovery in a number of programs. 

Community services and programming are not as critical at this stage of the recovery process.  Individuals are better equipped to seek out supports when required.  Individuals have the ability to function on their own and do not require direct attention and a structured continuum of care.  That being said, there are some services that are necessary to maintain a strong recovery as well as provide the individual the opportunity to give back through service and pass on what they have learned through their own process of recovery.  The following services should be available.

1.      Individual and group counseling

2.      Psychiatric care

3.      Peer support meetings

Advanced Recovery (5 years and beyond)

Advanced recovery is depicted by at least 5 years of clean time.  At this stage of recovery their program has evolved into a living and almost subconscious program.  The tools that the individual has learned becomes second nature and is used on a daily basis without even realizing it.  Typically, when the individual has reached this stage of recovery, the recovering individual has become a positive and productive member of society.  Life free of their drug of choice or alcohol is second nature at this point, and urges or cravings become few and far between.  The person is able to quickly identify when there is a problem with their program, as old habits creep into their lives or they start having frequent urges again.  By this point, they are very comfortable in their new identity and purposefully live a wholehearted and authentic life.  Many people will continue with their support programs such as 12 step groups, and tend to be active in service.  Giving back and volunteering to help others is a good indicator of an effective and active advanced recovery program.  This stage continues until death and provides the recovering individual the opportunity to die knowing they lived their life to their full potential in spite of their addiction.

Just as in the previous stage, services and programs are not as demanding and are required more for the service aspect than stabilization and understanding.  The following services should be available.

1.      Individual and group counseling

2.      Psychiatric care

3.      Peer support meetings

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