Addiction is a disease of the mind and of the body. Addicts and alcoholics need to be in a safe and structured environment where they can learn to function without the use of drugs and alcohol. The mental obsession and the phenomenon of craving can be overwhelming, even for the strongest of will. The best case scenario, is that the addict be in a safe place where they can learn about the problem of addiction, the solution to addiction, and the program of action to overcome addiction.
A group of people, sometimes led by a therapist, who provide each other moral support, information, and advice on problems relating to some shared characteristic or experience.
Treatment and recovery are interconnected, but not the same. As the NIDA Principles of Drug Addiction indicate, treatment is an important component to the recovery process. According to the Center for Substance Abuse Treatment (CSAT), “Treatment” is defined as in–or outpatient services that focus on initiating and maintaining an individual’ recovery from alcohol or drug abuse and on preventing relapse. Treatment can include detoxification, group or individual counseling, rehabilitation and the use of methadone or other prescription medications. It also can involve drug or alcohol education and self–help groups, such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA). Quite often, treatment is considered the “Light at the end of the tunnel” for those afflicted with substance abuse addiction. Unlike addiction itself, treatment is a positive process, involving a variety of support systems that systematically help lead individuals to successful, fulfilling lives without drugs and/or alcohol.
Individuals who have participated and completed treatment programs are considered to be “In recovery”. Thus, recovery is recognized as? “An ongoing process of improvement–biologically, psychologically, socially and spiritually–while attempting to maintain abstinence from alcohol and other drugs”. (Strawn, Julie, WIN, “Substance Abuse Welfare Reform Policy”, Issue Notes, Vol. 1, No. 1, 1/7/97. p.3) Furthermore, individuals can be forced into treatment, but cannot be forced into recovery. Recovery from alcohol and other drug abuse is a voluntary process, and a strategy to reach recovery should include treatment. Therefore, treatment is not a long–term solution to alcohol and other drug addiction, but a commitment to recovery is. In addition, some people become “Clean and sober” solely through continuous participation in 12–step programs, instead of through treatment. They, too, consider themselves “In recovery”.
Individuals who have participated and completed treatment programs are considered to be “In recovery”. Thus, recovery is recognized as? “An ongoing process of improvement–biologically, psychologically, socially and spiritually–while attempting to maintain abstinence from alcohol and other drugs”. (Strawn, Julie, WIN, “Substance Abuse Welfare Reform Policy”, Issue Notes, Vol. 1, No. 1, 1/7/97. p.3) Furthermore, individuals can be forced into treatment, but cannot be forced into recovery. Recovery from alcohol and other drug abuse is a voluntary process, and a strategy to reach recovery should include treatment. Therefore, treatment is not a long–term solution to alcohol and other drug addiction, but a commitment to recovery is. In addition, some people become “Clean and sober” solely through continuous participation in 12–step programs, instead of through treatment. They, too, consider themselves “In recovery”.
There are six stages that addicts must undergo for long–term recovery:
Transition? The period of time needed for the addict to realize that safe use of alcohol or other drugs for them is not possible.
Stabilization? The period of time in which the addict experiences physical withdrawal and other medical problems and learns how to separate from the people, places and things that promote drug abuse.
Early recovery? When an individual faces the need to establish a chemical–free lifestyle and builds relationships that support long–term recovery.
Middle recovery? The time for developing a balanced lifestyle where repairing past damage is critical.
Late recovery? The period of time in which the individual identifies and changes mistaken beliefs about oneself, others, and the world that causes or promotes irrational thinking.
Maintenance? The lifelong process of continued growth, development and management of routine life problems.
Transition? The period of time needed for the addict to realize that safe use of alcohol or other drugs for them is not possible.
Stabilization? The period of time in which the addict experiences physical withdrawal and other medical problems and learns how to separate from the people, places and things that promote drug abuse.
Early recovery? When an individual faces the need to establish a chemical–free lifestyle and builds relationships that support long–term recovery.
Middle recovery? The time for developing a balanced lifestyle where repairing past damage is critical.
Late recovery? The period of time in which the individual identifies and changes mistaken beliefs about oneself, others, and the world that causes or promotes irrational thinking.
Maintenance? The lifelong process of continued growth, development and management of routine life problems.
Addicts should realize that their life can never be the way it was before their addiction. This does not mean that a recovering addict cannot live a healthy and fulfilling life. Rather, addicts should be aware that recovery is a process that always will need to be maintained.
No. Sobriety or abstinence is simply refraining from the ingestion of alcohol or other drugs. Recovery is the process by which the ingestion of alcohol or other drugs is recognized as problematic and avoided.
Individuals recovering from substance abuse addiction have a chronic, yet manageable disease. As such, these individuals should be treated like people with other life–threatening illnesses or disabilities. By its very definition, an individual “In recovery” is on a life–altering path fraught with social stigma, isolation as well as the possibility of relapse and failure. The availability of treatment can make all the difference, and, given the chance, people in recovery can make important contributions in the workplace. This is because they:
Recognize their chronic and possibly recurring disability,Often are more educated through treatment than they would be without it because they often are self–motivated to learn, Create, cultivate and maintain extensive professional and peer support networks as part of their commitment to recovery, Are self–aware and committed to change. They understand that through their recovery, they have created their own “Second chance” or a “New lease on life|” Often are highly motivated to make up for past mistakes and lost time, and want to pursue meaningful employment.
Recognize their chronic and possibly recurring disability,Often are more educated through treatment than they would be without it because they often are self–motivated to learn, Create, cultivate and maintain extensive professional and peer support networks as part of their commitment to recovery, Are self–aware and committed to change. They understand that through their recovery, they have created their own “Second chance” or a “New lease on life|” Often are highly motivated to make up for past mistakes and lost time, and want to pursue meaningful employment.
There are many addictive drugs, and treatments for specific drugs can differ. Treatment also varies depending on the characteristics of the patient. Problems associated with an individual’s drug addiction can vary significantly. People who are addicted to drugs come from all walks of life. Many suffer from mental health, occupational, health, or social problems that make their addictive disorders much more difficult to treat. Even if there are few associated problems, the severity of addiction itself ranges widely among people.
A variety of scientifically based approaches to drug addiction treatment exists. Drug addiction treatment can include behavioral therapy (such as counseling, cognitive therapy, or psychotherapy), medications, or their combination. Behavioral therapies offer people strategies for coping with their drug cravings, teach them ways to avoid drugs and prevent relapse, and help them deal with relapse if it occurs. When a person’s drug–related behavior places him or her at higher risk for AIDS or other infectious diseases, behavioral therapies can help to reduce the risk of disease transmission. Case management and referral to other medical, psychological, and social services are crucial components of treatment for many patients.
The best programs provide a combination of therapies and other services to meet the needs of the individual patient, which are shaped by such issues as age, race, culture, sexual orientation, gender, pregnancy, parenting, housing, and employment, as well as physical and sexual abuse. Treatment medications, such as naltrexone, are available for individuals addicted to opiates. Nicotine preparations (patches, gum, nasal spray) and bupropion are available for individuals addicted to nicotine.
Medications, such as antidepressants, mood stabilizers, or neuroleptics, may be critical for treatment success when patients have co–occurring mental disorders, such as depression, anxiety disorder, bipolar disorder, or psychosis. Treatment can occur in a variety of settings, in many different forms, and for different lengths of time. Because drug addiction is typically a chronic disorder characterized by occasional relapses, a short–term, one–time treatment often is not sufficient. For many, treatment is a long–term process that involves multiple interventions and attempts at abstinence.
A variety of scientifically based approaches to drug addiction treatment exists. Drug addiction treatment can include behavioral therapy (such as counseling, cognitive therapy, or psychotherapy), medications, or their combination. Behavioral therapies offer people strategies for coping with their drug cravings, teach them ways to avoid drugs and prevent relapse, and help them deal with relapse if it occurs. When a person’s drug–related behavior places him or her at higher risk for AIDS or other infectious diseases, behavioral therapies can help to reduce the risk of disease transmission. Case management and referral to other medical, psychological, and social services are crucial components of treatment for many patients.
The best programs provide a combination of therapies and other services to meet the needs of the individual patient, which are shaped by such issues as age, race, culture, sexual orientation, gender, pregnancy, parenting, housing, and employment, as well as physical and sexual abuse. Treatment medications, such as naltrexone, are available for individuals addicted to opiates. Nicotine preparations (patches, gum, nasal spray) and bupropion are available for individuals addicted to nicotine.
Medications, such as antidepressants, mood stabilizers, or neuroleptics, may be critical for treatment success when patients have co–occurring mental disorders, such as depression, anxiety disorder, bipolar disorder, or psychosis. Treatment can occur in a variety of settings, in many different forms, and for different lengths of time. Because drug addiction is typically a chronic disorder characterized by occasional relapses, a short–term, one–time treatment often is not sufficient. For many, treatment is a long–term process that involves multiple interventions and attempts at abstinence.
Many drug addicts, such as heroin or cocaine addicts and particularly injection drug users, are at increased risk for HIV/AIDS as well as other infectious diseases like hepatitis, tuberculosis, and sexually transmitted infections. For these individuals and the community at large, drug addiction treatment is disease prevention.
Drug injectors who do not enter treatment are up to six times more likely to become infected with HIV than injectors who enter and remain in treatment. Drug users who enter and continue in treatment reduce activities that can spread disease, such as sharing injection equipment and engaging in unprotected sexual activity. Participation in treatment also presents opportunities for screening, counseling, and referral for additional services. The best drug abuse treatment programs provide HIV counseling and offer HIV testing to their patients.
Drug injectors who do not enter treatment are up to six times more likely to become infected with HIV than injectors who enter and remain in treatment. Drug users who enter and continue in treatment reduce activities that can spread disease, such as sharing injection equipment and engaging in unprotected sexual activity. Participation in treatment also presents opportunities for screening, counseling, and referral for additional services. The best drug abuse treatment programs provide HIV counseling and offer HIV testing to their patients.
Family and friends can play critical roles in motivating individuals with drug problems to enter and stay in treatment. Family therapy is important, especially for adolescents. Involvement of a family member in an individual’s treatment program can strengthen and extend the benefits of the program.
Receiving treatment and not using drugs is an essential step, but it is not enough for complete recovery.
Recovery is a process of change that takes place over a period of time. Undergoing treatment is just the first step in the recovery process and not an end in itself. The primary treatment program only stabilizes the client, the major part of recovery starts later. The recovery process proceeds differently for each client and the same client may find it easier to change in certain areas than others. Recovery requires giving up alcohol/drugs as well as initiating qualitative changes in lifestyle. Both these aspects of recovery need to progress hand in hand as they support, complement and sustain each other. Progress in one aspect without the other does not lead to complete recovery. For example, if the client is drug–free, but is demanding, irritable and does nothing worthwhile throughout the day, it means that he/she has not really recovered.
Recovery involves working through many of the problems in the drug user’ thoughts, behavior, functioning, relationships and lifestyle. To work through these problems while maintaining abstinence is not easy. The person’ attitude, actions, reactions and responses need to change.
Abstinence–The Stepping Stone to Recovery
Being drug–or alcohol–free is the foundation on which recovery rests. A structured treatment program is necessary to strengthen the commitment to remain abstinent. It should help the person–overcome denial, understand the damage caused by addiction and look forward to a meaningful future without drugs/alcohol. The client should understand the chronic, permanent nature of the disease and the need to completely give up drugs of all kinds as well as alcohol. Drugs that are medically prescribed must be used only under specific instructions by a physician. The client must follow a daily routine to sustain recovery and remain ever watchful of threats to his/her abstinent state. As abstinence is crucial to recovery, it may be necessary to slow down other aspects of recovery if action on those fronts puts the abstinent person at risk for relapse. For instance, accepting a challenging job assignment early in recovery ought to be discouraged as it may trigger a relapse–if the person will not be able to cope with the demands and stresses of the new job. Once abstinence has been established and coping strategies have been strengthened, he/she may be ready for such an assignment.
Five Pillars of Recovery
Complete recovery involves changes in five major areas of life: physical well–being, work routine, healthy relationships, personality changes, and meaningful leisure activities
i. Physical Well–Being
Health, which is totally neglected during the days of drug use, becomes an important concern in the early part of recovery. While on the one hand continuing health problems can increase the person’s frustration, on the other hand an improvement in physical well–being can motivate him/her to greater efforts in other areas. As a counselor, you can provide some common sense directives to help in the client’s improved health:
Establishing a regular meal routine with at least three balanced meals a day is important. Excessive smoking, too many cups of coffee or tea, and frequent consumption of junk food are to be avoided, as they reduce appetite and increase restlessness. Maintaining regular sleep hours (at least 7–8hours every night) is necessary. While toomuch sleep can make the person lazy and dull, too little can make him/her tired and irritable. If medications are given to stabilize sleep patterns, care should be taken to prescribe medications with low addictive potential, and they should later be tapered off systematically. An exercise routine or a brisk walk of at least 10–15 minutes each day should be encouraged. Exercise keeps away dullness and lethargy, and improves physical fitness. Taking pride in physical fitness is a strong motivator to staying alcohol or drug–free. Bathing daily, dressing neatly, shaving regularly etc. are activities that may seem commonplace. Yet, due to the client’s dysfunctional lifestyle, even these need to be stressed upon.
Physical problems like gastritis, neuritis, respiratory infections or needle abscesses may need to be treated. Drug abusers tend to postpone seeking help for health problems, and are irregular with medications even when they do. The counselor needs to be on his/her guard, for physical pain and discomfort can often trigger a relapse.
ii. Productive Work Routine
It is employment that gives the recovering client a sense of fulfillment as well as financial independence. It also does wonders for his/her self–esteem. If nothing else, it keeps away boredom and gives the client something to occupy themselves with. Many drug abusers are unemployed or employed well below their potential, without a sense of regularity and permanence. These clients need help and encouragement from the counselor to find employment opportunities and handle job interviews. Vocational training may also need to be considered.Even when employed, the client may need the counselor’ help to work with the right attitude, involvement and commitment. Poor interpersonal skills and poor judgment of one’s ability can create problems in the workplace. Problems created during the days of active addiction–the memos, absenteeism records, etc. may also need to be dealt with. Work and financial stability are closely linked. Budgeting, prioritizing expenses, and saving a sum regularly, are part of the financial discipline that the client needs to follow.
iii. Meaningful Relationships
The few relationships that the client managed to retain in spite of the addiction need to be revived and/or maintained.
iv. Positive Personality Changes
Personality changes are indispensable to qualitative recovery. Negative personality traits have to be identified and worked on. Wishful thinking, impulsiveness, excessive and inappropriate expressions of anger, and indiscipline are commonly present. Presenting the client with information, through lectures or printed material, as well as providing testimonies of others in recovery can help him/her work through and change some of these undesirable responses. It is equally important to focus on the client’s positive qualities and achievements. It is on the strength of these positive qualities that he/she begins to view himself/herself as a valuable person, and it is these qualities that change the way others view him/her.
Reviewing progress periodically, helping the client become aware of his/her personality strengths and building on them is very important for recovery. Building a value–based lifestyle is essential to the user’ continued recovery. A clear understanding of what is ethical and what is not, is important. Respecting others? needs and feelings, honesty, accepting responsibility, and above all not participating in anti–social and criminal activities influence the quality of recovery. Many clients find that belief in a Higher Power gives them tremendous support. It can also add a sense of urgency and purpose to efforts to alter the client’ personality traits. A routine of just repeating the serenity prayer reminds him/her of what he/she can and cannot do, thus making a difference to the way he/she deals with problems. The act of surrender to the Higher Power and asking for His help is a lesson in humility, even while increasing the client’ confidence to cope with problems.
v. Experiencing Pleasure Without Drugs
Learning to have fun and enjoy oneself without drugs/alcohol is something the client must do. As leisure and fun were always associated with alcohol/drugs, having fun differently now may seem strange. It will take a while before the client spontaneously participates in social activities and enjoys them. Going back to the client’ past history and identifying activities that he/she used to enjoy prior to addiction is a good starting point. A list of activities can be readily generated even otherwise–playing games, reading, meeting friends, music etc. Yet, even if he/ she has done it all before, effort is needed to revive these activities. For instance, it has probably been months since he/she showed up for tennis practice and the old partners may no longer be available.
Reading books may be difficult as the client’ attention span is shortened. He/she may have long ago lost touch with non–drug using friends and may not even know if they still live in the same town. For every activity, there may be some problems like these, which makes this area a difficult one to deal with.
Abstinence–The Stepping Stone to Recovery
Being drug–or alcohol–free is the foundation on which recovery rests. A structured treatment program is necessary to strengthen the commitment to remain abstinent. It should help the person–overcome denial, understand the damage caused by addiction and look forward to a meaningful future without drugs/alcohol. The client should understand the chronic, permanent nature of the disease and the need to completely give up drugs of all kinds as well as alcohol. Drugs that are medically prescribed must be used only under specific instructions by a physician. The client must follow a daily routine to sustain recovery and remain ever watchful of threats to his/her abstinent state. As abstinence is crucial to recovery, it may be necessary to slow down other aspects of recovery if action on those fronts puts the abstinent person at risk for relapse. For instance, accepting a challenging job assignment early in recovery ought to be discouraged as it may trigger a relapse–if the person will not be able to cope with the demands and stresses of the new job. Once abstinence has been established and coping strategies have been strengthened, he/she may be ready for such an assignment.
Five Pillars of Recovery
Complete recovery involves changes in five major areas of life: physical well–being, work routine, healthy relationships, personality changes, and meaningful leisure activities
i. Physical Well–Being
Health, which is totally neglected during the days of drug use, becomes an important concern in the early part of recovery. While on the one hand continuing health problems can increase the person’s frustration, on the other hand an improvement in physical well–being can motivate him/her to greater efforts in other areas. As a counselor, you can provide some common sense directives to help in the client’s improved health:
Establishing a regular meal routine with at least three balanced meals a day is important. Excessive smoking, too many cups of coffee or tea, and frequent consumption of junk food are to be avoided, as they reduce appetite and increase restlessness. Maintaining regular sleep hours (at least 7–8hours every night) is necessary. While toomuch sleep can make the person lazy and dull, too little can make him/her tired and irritable. If medications are given to stabilize sleep patterns, care should be taken to prescribe medications with low addictive potential, and they should later be tapered off systematically. An exercise routine or a brisk walk of at least 10–15 minutes each day should be encouraged. Exercise keeps away dullness and lethargy, and improves physical fitness. Taking pride in physical fitness is a strong motivator to staying alcohol or drug–free. Bathing daily, dressing neatly, shaving regularly etc. are activities that may seem commonplace. Yet, due to the client’s dysfunctional lifestyle, even these need to be stressed upon.
Physical problems like gastritis, neuritis, respiratory infections or needle abscesses may need to be treated. Drug abusers tend to postpone seeking help for health problems, and are irregular with medications even when they do. The counselor needs to be on his/her guard, for physical pain and discomfort can often trigger a relapse.
ii. Productive Work Routine
It is employment that gives the recovering client a sense of fulfillment as well as financial independence. It also does wonders for his/her self–esteem. If nothing else, it keeps away boredom and gives the client something to occupy themselves with. Many drug abusers are unemployed or employed well below their potential, without a sense of regularity and permanence. These clients need help and encouragement from the counselor to find employment opportunities and handle job interviews. Vocational training may also need to be considered.Even when employed, the client may need the counselor’ help to work with the right attitude, involvement and commitment. Poor interpersonal skills and poor judgment of one’s ability can create problems in the workplace. Problems created during the days of active addiction–the memos, absenteeism records, etc. may also need to be dealt with. Work and financial stability are closely linked. Budgeting, prioritizing expenses, and saving a sum regularly, are part of the financial discipline that the client needs to follow.
iii. Meaningful Relationships
The few relationships that the client managed to retain in spite of the addiction need to be revived and/or maintained.
iv. Positive Personality Changes
Personality changes are indispensable to qualitative recovery. Negative personality traits have to be identified and worked on. Wishful thinking, impulsiveness, excessive and inappropriate expressions of anger, and indiscipline are commonly present. Presenting the client with information, through lectures or printed material, as well as providing testimonies of others in recovery can help him/her work through and change some of these undesirable responses. It is equally important to focus on the client’s positive qualities and achievements. It is on the strength of these positive qualities that he/she begins to view himself/herself as a valuable person, and it is these qualities that change the way others view him/her.
Reviewing progress periodically, helping the client become aware of his/her personality strengths and building on them is very important for recovery. Building a value–based lifestyle is essential to the user’ continued recovery. A clear understanding of what is ethical and what is not, is important. Respecting others? needs and feelings, honesty, accepting responsibility, and above all not participating in anti–social and criminal activities influence the quality of recovery. Many clients find that belief in a Higher Power gives them tremendous support. It can also add a sense of urgency and purpose to efforts to alter the client’ personality traits. A routine of just repeating the serenity prayer reminds him/her of what he/she can and cannot do, thus making a difference to the way he/she deals with problems. The act of surrender to the Higher Power and asking for His help is a lesson in humility, even while increasing the client’ confidence to cope with problems.
v. Experiencing Pleasure Without Drugs
Learning to have fun and enjoy oneself without drugs/alcohol is something the client must do. As leisure and fun were always associated with alcohol/drugs, having fun differently now may seem strange. It will take a while before the client spontaneously participates in social activities and enjoys them. Going back to the client’ past history and identifying activities that he/she used to enjoy prior to addiction is a good starting point. A list of activities can be readily generated even otherwise–playing games, reading, meeting friends, music etc. Yet, even if he/ she has done it all before, effort is needed to revive these activities. For instance, it has probably been months since he/she showed up for tennis practice and the old partners may no longer be available.
Reading books may be difficult as the client’ attention span is shortened. He/she may have long ago lost touch with non–drug using friends and may not even know if they still live in the same town. For every activity, there may be some problems like these, which makes this area a difficult one to deal with.
Abstinence is one important part of recovery. Using the definition of “Return to health”, recovery refers to the process of learning to overcome behaviors that have caused us to become alienated and have cost us our self–esteem. This important phase begins with abstinence however it also involves learning new habits of honesty and improving our ability to have healthy relationships. To learn these new behaviors, many may find it useful to become involved in working the steps in a 12–Step Program, joining a program, gaining an ongoing support group or getting into therapy to learn the skills to improve their life. Recovery gives our bodies time to heal from the debilitating physical effects of chronic alcohol or drug use. Fortunately, once they stop using, most people fully recover their physical health.
Some chemically dependent people are so overwhelmed by their obsession to use that they do not believe they can live without using. They are so terrified of giving up their addiction that even intervention won’t help. These are the individuals who end up sacrificing family, friends, careers, property, self–esteem, sanity–everything to continue using. Their way out of the disease is often institutionalization and ultimately, premature death. Other chemically dependent individuals have extreme difficulty in overcoming denial. But they can be reached, intervention and treatment can help break their denial and aid them in getting help. Many types of treatment are available, and a knowledgeable counselor can aide in finding the appropriate level of care needed. Help is available.