The Stages of Recovery–From Active Addiction to the Life You Want
The stages of recovery describe what typically happens for people in recovery from substance abuse and addiction. It is important, however, to recognize that these are theoretical models and that individuals fluctuate between stages. Because such models are laid out in a linear fashion, we sometimes forget that people live dynamic lives and health does not occur in a straight line marching forward. With that said, there are several ways to discuss the stages of recovery people who are addicted to substances go through as they recover.
Addiction Treatment and the Stages of Recovery
A good place to begin when discussing stages of recovery is to explore the process of addiction treatment. Initially, people enter treatment for a variety of reasons. Some, for example, will seek treatment because of physical and mental health problems. Others more involuntarily enter treatment because they have been diverted from jail to treatment, or have been mandated to attend treatment. Within those two large groups of people–voluntary and involuntary–there are other nuances of reasons people seek substance treatment. For example, one may feel pressured to do so by a spouse, partner, or employer. Some enter treatment having been given a mandate. For instance, it is either treatment or divorce, or treatment or unemployment.
The Early Stages of Recovery in Addiction Treatment
Through whatever motivation people go to treatment, they are typically in a good deal of distress and emotional upset. Often, too, they have lived in distress for prolonged periods of time, as have their loved ones. There are many things that happen in the early stage of addiction treatment, and it is hard to make a complete list. However, some of the most valuable things that ideally occur early in treatment help begin to reduce distress and improve basic functioning. Early clinical goals in treatment are typically created to achieve abstinence through withdrawal and detox, manage cravings, learn skills that will stabilize emotions, improve self-control, and eventually learn to prevent relapse.
Some of the basics of this stage of recovery are:
- One finds, contrary to the isolating and alienating experiences in active addiction, that one is not alone. In a therapeutic setting, there is a peer group of people with similar experiences.
- There is a mobilization of hope for change, wellness, and recovery.
- One gathers momentum. Many things happen in the early stages of treatment that help mobilize momentum, such as education – gathering information about both addiction as an illness and recovery as a process, and an increasing sense of improving physical health, greater clarity of mind.
- Emotional processing occurs that reduces distress.
- One joins in problem-solving with a group of people who share a common goal, and the treatment professionals who are helping the group work toward those goals.
The Middle Stage of Addiction Treatment
The next stage of treatment, which may be called the middle stage, occurs when one has successfully completed detox, and are experiencing more physical well-being. In this stage, too, people learn to express emotions more appropriately, as well as to use their peer supports and professional support to explore their inner life, behavior, and relationships.
In the middle stage of addiction treatment, people begin to identify the impact of substance use upon their lives, and the consequences of previous use. They also begin to compare those with the vision of the lives they want to live. Additionally, people become more familiar with the concepts of recovery, begin to focus on progress and to identify themselves as recovering.
People also identify the impact of substance use on their lives, the consequences of previous use, and compare those with the vision of a life they want to live. They become more familiar with the concepts of recovery, begin to focus on progress and to identify themselves as a recovering individual.
The Late Stage of Addiction Treatment
Toward the end of rehab, or the late stage of addiction treatment, one prepares for re-entering life in the community without substance use. Relapse prevention planning is the focused upon maintaining the gains made in treatment after transitioning back home. Relapse prevention planning is a comprehensive plan for how to cope with daily stressors, manage symptoms and triggers, establish and use a recovery-informed support system, and continue one’s momentum in recovery.
Stages of Recovery as Stages of Change
Stages of recovery, of course, happen in and outside recovery treatment settings. Recovery is in great part an internal process, but naturally, there are outer manifestations in behavior. Some of the most obvious issues arise in dealing with other people about one’s substance use. We can easily see the defenses that keep one entrenched in addiction in the interactions we have with people who confront our problems. The Transtheoretical Model of Change is an excellent way to think about the stages of recovery in these ways.
In this theory, the stages are:
Precontemplation in the Stages of Recovery
Precontemplation simply means that one has not gotten to the stages of recovery in which a substance problem is accepted and addressed. This is, of all the stages of recovery, the one in which the most consistent denial occurs. Denial is the characteristic symptom of all addictions and is a very different phenomenon than you may think. It is more a perceptual problem, meaning one simply does not see what others may see regarding their substance use and problems with it.
In the precontemplative stage, a person may adamantly deny having any problems with their substance use, and this can lead to many interpersonal conflicts, especially when loved ones are concerned and alarmed. Life can be very difficult at this stage. Behavior is apt to be out of control and negative consequences of substance use are beginning to accumulate. These consequences can be in relationships certainly, but also in other daily functioning such as work productivity, legal issues, finances and so on.
However, each phase along the continuum of moving from active addiction to recovery is important. The precontemplation stage and its denial become the foundation upon which later sustainable recovery can be built. We see evidence of this, for example, in 12 step meetings during which recovering people discuss in retrospect their journeys from active addiction. Reminding themselves and others in their stories of what it was like at bottom is a significant part of the healing process within the groups.
Resolving the stage of change often takes a great deal of pain and struggle. Beginning to perceive the realities of one’s situation can be overwhelming. It can mobilize our defenses and make us resist, argue, and attempt to gain some kind of control. The irony is, of course, that we are out of control.
What is most helpful to move us along toward addressing our problems is acceptance and non-judgmental attitudes of other people who understand the process. People in this stage are helped a great deal by others who can keep open lines of communication, state their observations directly and factually, but remain compassionate. This is always the burden for loved ones who seek to help, but who are also overwhelmed with fear for the addicted person in their lives.
The Stage of Contemplation
Hitting bottom is a familiar concept in the world of addiction recovery. In the precontemplation stage, people are very often at their bottom, meaning things have fallen apart. Others can be at this stage as things are falling apart and have not quite gotten as worse as they will be. Continuing along the stages of change, one enters the stage of contemplation from this point. In the second stage, we get a better picture of the problem in our lives. This means internally our denial is breaking apart and our perception is more reality-based. Also, our ability to self-reflect is increasing. We’re better able to hold a vision of the life we want, compared to the life we have.
Of all the stages of recovery, this one may be the most tumultuous and painful. We can mobilize our defenses over and over each time we better see the problems we have. We typically fluctuate between holding a vision of ourselves as being in trouble and slipping back into denial.
The Preparation Stage of Recovery
In the preparation stage, we essentially become ready to take some action. Our denial has slipped away enough for us to realize something has to be done–some change needs to happen if we are to have the lives we want. The notion of substance use as problematic is held more steadily, and often this is a stage in which we gather information, gather our internal fortitude and determination, and gather our supports and resources. We get ready to take the leap of faith that we can be helped. It can require a good deal of painful experiences, especially as we begin to talk to others more, revealing what is happening to us. We often must confront issues of shame and guilt about our situations.
Also, most of us must deal with resisting help. We struggle to admit we need help and struggle to receive it. In some form or fashion, all of us in this situation must resolve in ourselves that we can do it. In the action stage of change, we make specific behavioral changes. For the first time in the process, we are moving forward in our outer lives. We develop a plan and we follow a plan. For many, this is the point at which they decide to seek treatment and enter rehab. For others already in some form of treatment, they may step up to another level more directly addressing addiction. Still, others turn to 12 Step programs like AA or NA (Alcoholics Anonymous or Narcotics Anonymous). A great many do both addiction treatment and a 12 Step program.
Maintenance and Termination
The stages of recovery in this model occur in many treatment settings for many types of problems. In some cases, one finishes treatment and moves on to what is known as a maintenance phase for a time. In this phase, the gains one has made are practiced in ‘real life’ for an extended period until stability is achieved. After a period of stability, in certain cases, treatment is terminated.
In addiction per se, the maintenance and termination phases can be different. For example, one may leave rehab and maintain sobriety in the community through other supports such as 12 Step groups and/or outpatient therapy. Rehab has terminated or ended, but recovery efforts continue elsewhere.
If you or a loved one need help to overcome an addiction, call us for a free consultation. We can help clarify treatment needs, find out what your insurance will cover, and make recommendations appropriate for your situation, or that of a loved one. The process of change can start today.