The National Institute on Drug Abuse lists four stages of rehab: treatment initiation, early abstinence, maintaining abstinence and advanced recovery. These apply specifically to cocaine, although the same basic principles apply to all substance abuse.1
When you complete rehab for substance abuse or other addictive behavior and enter subsequent stages of recovery, you may know what to expect during the first few days and weeks. However, recovering from alcoholism or drug addiction is different for everyone, as is the roadmap to recovery. Just as your treatment progressed according to a tailored program specifically designed for you, it is reasonable to expect your pace of recovery will depend on many factors. These include your degree of commitment, emotional and psychological state of mind, physical condition, strength of support networks, living conditions and employment situation. For most people, recovery from substance abuse is a lengthy process in which improvements in other areas of functioning do not necessarily follow abstinence. With that said, research indicates many recovering addicts share the same concerns. A study of 356 people in recovery from substance abuse assessed their concerns at different stages.2 At less than six months, six to18 months, 18 to 36 months and three years, the top five concerns were as follows, respectively:
Recovery from substance use: 49.9%, 43.2%, 52.7%, 34.1%
Employment: 31.1%, 36.2%, 35.1%, 34.1%
Family and social relationships: 19.8%, 23.5%, 23.0%, 24.4%
Education and training: 17.9%, 16.0%, 23.0%, 14.6%
Achieve and enjoy improved, “normal” productive life: 17.0%, 19.3%, 26.8%, 27.9%
Stages of Recovery: Early Abstinence
This period of treatment lasts from preliminary establishment of client motivation to abstain to about three months into recovery, assuming the client makes reasonable progress. Many inpatient treatment programs have a duration of 90 days, which covers this entire stage.3 A collaborative effort between the addiction team and client includes:
- Recognizing the medical and psychological aspects of withdrawal
- Identifying triggers for alcohol or drug use and developing techniques for avoiding them
- Learning how to handle cravings without using3
After a client has transitioned from inpatient care with a treatment team responsible for the daily schedule, it may seem a little overwhelming to plan one’s own day. In the beginning, arranging a reasonable schedule is important. Some people may need to attend 12-step meetings three times a day in the first few weeks to get through this difficult transition period.
Another vital step in the early weeks is to find a sponsor by attending a few different meetings and seeing how you relate to various individuals. In Alcoholics Anonymous, an alcoholic who has made some progress in recovery shares his or her experience on a continuous, individual basis with another alcoholic who is attempting to attain or maintain sobriety.4 It’s important to keep in mind that sponsors are not trained psychotherapists. They cannot or should not assume this responsibility. It is essential to see a psychotherapist if you have continuing care or aftercare as part of your overall treatment program. If not, call your treatment facility and ask for a referral.
Early Recovery Challenges
Returning home causes a major shift in family situations. The daily family routine may impact a person’s recovery schedule and jeopardize progress. It is best to have a conversation with your spouse or partner right away about the importance of sticking to a recovery schedule. At work and home, avoid tackling too many projects, because attempting too much too soon can lead to relapse.
Many people experience feelings of depression during the early stages of recovery, generally in the first year. When depression occurs, it not only can interfere with recovery, but also the ability to participate in treatment. Don’t be overly distressed about feeling blue during the first few weeks of recovery — your body and brain are reacting to the absence of alcohol or drugs. However, if your depression gets worse, bouts of sadness are lengthy or you have thoughts of suicide, get in touch with your doctor or therapist immediately. You can also call the 24-hour National Suicide Prevention Lifeline at 1-800-273-8255 and a trained advisor will recommend the nearest crisis center.
Relapse Risks
Due to the brain’s neuroplasticity, interventions such as intensive psychotherapy can retrain the brain during and after addiction recovery. While retraining the brain and rebalancing biochemistry is possible, the previous neuropathways between addiction and pleasure will always exist. As a result, it does not take much to trigger relapse.5
When you were at the treatment facility, your addiction counselor helped you identify people, places and things associated with substance use and worked with you on developing strategies for avoiding these triggers. You need to continue working on these strategies with your psychotherapist and at 12-step meetings. That way, if a high-risk situation occurs, you’ll be able to counteract it with a healthy, alternative approach.
Although relapse is more likely during the first 90 days of recovery, the danger is always there. If things are going smoothly, it is possible to feel a little overconfident. You may think you can hang out at your local bar again and drink with buddies — just once — promising yourself you’ll only drink coffee or a soft drink. The only way to guard against relapse is to actively work through recovery every day. Recognize there will be good days and bad days when everything seems to go wrong. Relapse rates for people with substance use disorders are similar or higher than relapse rates for chronic medical illnesses. For example, the relapse rate for drug abuse is 40% to 60%, 50% to 60% for hypertension and 90% for alcohol abuse.6,7 If you have ever suffered from substance abuse, it is essential you abstain from drugs and alcohol for the rest of your life.
Maintaining Abstinence
Generally speaking, this stage of recovery begins four months after rehab. During this period, a recovering addict continues to work on abstinence strategies to avoid environmental triggers, recognize psychosocial and emotional triggers and develop healthy coping mechanisms to handle daily stress. One of the key factors in preventing relapse is retaining a humble attitude toward the power of addiction and not taking abstinence for granted. Personal vigilance against relapse is paramount. Vitally important is continued participation in self-help groups, in which you honestly share feelings and thoughts to help prevent relapse.8
Advanced Recovery
Long-term recovery from addiction requires a lifelong commitment to changing one’s lifestyle. To maintain abstinence and attain a satisfying, fulfilling life, an individual has to establish healthy relationships, eat nutritiously, get adequate rest and exercise and work on resolving personal problems. After an individual establishes this healthy lifestyle, he or she must live it on a daily basis.9
Once you have attained your first-year anniversary of sobriety, feel free to celebrate this milestone. Rejoice in your sobriety and live in the present, happy and joyful each day in recovery! Keep in mind you need to continue working through the steps. Recovery is all about continuity and doing what works for you. It’s also a lifelong promise.
- An Individual Drug Counseling Approach to Treat Cocaine Addiction: Chapter 6. National Institute on Drug Abuse website. https://archives.drugabuse.gov/TXManuals/IDCA/IDCA8.html Accessed December 15, 2016.
- Laudet AB, White W. What are your priorities right now? Identifying service needs across recovery stages to inform service development. J Subst Abuse Treat. 2010;38(1):51-59. doi:10.1016/j.jsat.2009.06.003.
- An Individual Drug Counseling Approach to Treat Cocaine Addiction: Chapter 8. National Institute on Drug Abuse website. https://archives.drugabuse.gov/TXManuals/IDCA/IDCA10.html Accessed December 15, 2016.
- P-15 Questions & Answers on Sponsorship – Alcoholics Anonymous. Alcoholics Anonymous website. http://www.aa.org/assets/en_US/p-15_Q&AonSpon.pdf Accessed December 15, 2016.
- Neuroplasticity and Addiction Recovery. Psychology Today website. https://www.psychologytoday.com/blog/ending-addiction-good/201302/neuroplasticity-and-addiction-recovery Published February 5, 2013. Accessed December 15, 2016.
- Drugs, Brains, and Behavior: The Science of Addiction, Treatment and Recovery. National Institute on Drug Abuse website. https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery Updated July 2014. Accessed December 15, 2016.
- Alcohol Relapse. Alcohol MD website. http://www.alcoholmd.com/alcoholrelapse.htm Accessed December 15, 2016.
- An Individual Drug Counseling Approach to Treat Cocaine Addiction: Chapter 9. National Institute on Drug Abuse website. https://archives.drugabuse.gov/TXManuals/IDCA/IDCA11.html Accessed December 15, 2016.
- An Individual Drug Counseling Approach to Treat Cocaine Addiction: Chapter 10. National Institute on Drug Abuse website. https://archives.drugabuse.gov/TXManuals/IDCA/IDCA12.html Accessed December 15, 2016.
