What is recovery?

WHAT IS RECOVERY?
"RECOVERY IS A PROCESS THAT TAKES PLACE OVER TIME, IN SPECIFIC STAGES"

Abdullah Baniyameen
baniyameen@aol.com
July 1, 2009

A COMPREHENSIVE MODEL OF CHEMICAL DEPENDENCY TREATMENT EFFECTIVELY COMBINES THE BEST OF THE MEDICAL AND SOCIAL/BEHAVIORAL TREATMENT MODELS. IT IS BASED ON THE IDEA THAT RECOVERY IS A PROCESS THAT TAKES PLACE OVER TIME, IN SPECIFIC STAGES. EACH STAGE HAS TASKS TO BE ACCOMPLISHED AND SKILLS TO BE DEVELOPED. IF A RECOVERING PERSON IS UNAWARE OF THIS PROGRESSION, UNABLE TO ACCOMPLISH THE TASKS AND GAIN THE SKILLS OR LACKS ADEQUATE TREATMENT, HE OR SHE WILL RELAPSE.

THE FOLLOWING IS A DESCRIPTION OF THIS COMPREHENSIVE MODEL. IT IS CALLED THE DEVELOPMENTAL MODEL OF RECOVERY (DMR).

THE DEVELOPMENTAL MODEL OF RECOVERY:

The DMR has been devised to help recovering people and treatment professionals identify appropriate recovery plans, set treatment goals, and measure progress. The DMR describes six stages or periods of recovery.

TRANSITION STAGE:

The transition stage begins the first time a person experiences an alcohol or drug related problem. As a person's addiction progresses, he or she tries a series of strategies designed to control use. This ends with recognition by the person that safe use of alcohol and/or drugs is no longer possible.

The struggle for control is a symptom of a fundamental conflict over personal identity. Alcoholics and drug addicts enter this phase of recovery believing they are normal drinkers and drug users capable of controlled use. As the progression of addiction causes more severe loss of control, they must face the fact that they are addictive users who are not capable of controlled use.

During the transition stage, chemically dependent people typically attempt to control their use or stop using. They are usually trying to prove to themselves and others that they can use safely. This never works for very long. Controlled use is especially tough for people who are participating in criminal behavior because the high level of alcohol and drug use among their peers makes their lifestyle and use seem normal.

The major cause of inability to abstain during the transition stage is the belief that there is a way to control use.

STABILIZATION PERIOD:

During the stabilization period, chemically dependent people experience physical withdrawal and other medical problems, learn how to break the psychological conditioning causing the urge to use, stabilize the crisis that motivated them to seek treatment, and learn to identify and manage symptoms of brain dysfunction. This prepares them for the long‑term processes of rehabilitation.

TRADITIONAL TREATMENT OFTEN UNDERESTIMATES THE NEED FOR MANAGEMENT OF THESE ISSUES, FOCUSING INSTEAD ON DETOXIFICATION:

Patients find themselves unable to cope with the stress and pressure of the symptoms of brain dysfunction and physical cravings that follow detoxification. Many have difficulty gaining much from treatment and feel they are incapable of recovery.

EARLY RECOVERY PERIOD:

Early recovery is marked by the need to establish a chemical‑free lifestyle. The recovering person must learn about the addiction and recovery process. He or she must separate from friends who use and build relationships that support long‑term recovery. This may be a very difficult time for criminal justice patients who have never associated with people with sobriety‑based lifestyles.

They also need to learn how to develop recovery‑based values, thinking, feelings, and behaviors to replace the ones formed in addiction. The thoughts, feelings, and behaviors developed by people with criminal lifestyles complicate and hinder their involvement in appropriate support programs during this period. Major intervention to teach the patient these skills is necessary if he or she is to succeed. This period lasts about 1B2 years.

The primary cause of relapse during the early recovery period is the lack of effective social and recovery skills necessary to build a sobriety‑based lifestyle.

The lack of a supportive environment for recovery that many criminal offenders experience adds stress and undermines their attempts to stabilize these symptoms. They often use alcohol and drugs to relieve such distress. It takes between 6 weeks and 6 months for a patient to learn to master these symptoms with the correct therapy.

The major cause of inability to abstain during the stabilization period is the lack of stabilization management skills.

MIDDLE RECOVERY PERIOD:

Middle recovery is marked by the development of a balanced lifestyle. During this stage, recovering people learn to repair past damage done to their lives.

The recovery program is modified to allow time to reestablish relationships with family, set new vocational goals, and expand social outlets. The patient moves out of the protected environment of a recovery support group to assume a more mainstream and normal lifestyle. This is a time of stress as a person begins applying basic recovery skills to real‑life problems.

The major cause of relapse during the middle recovery period is the stress of real‑life problems.

LATE RECOVERY PERIOD:

During late recovery, a person makes changes in ongoing personality issues that have continued to interfere with life satisfaction. In traditional psychotherapy, this is referred to as self‑actualization. It is a process of examining the values and goals that one has adopted from family, peers, and culture. Conscious choices are then made about keeping these values or discarding them and forming new ones. In normal growth and development, this process occurs in a person's mid‑twenties. Among people in recovery, it does not usually occur until 3B5 years into the recovery process, no matter when recovery begins.

For criminal offenders, this is the time when they learn to change self‑defeating behaviors that may trigger a return to alcohol or drug use. These self‑defeating behaviors often come from psychological issues starting in childhood, such as childhood physical or sexual abuse, abandonment, or cultural barriers to personal growth.

The major cause of relapse during the late recovery period is either the inability to cope with the stress of unresolved childhood issues or an evasion of the need to develop a functional personality style.

MAINTENANCE STAGE:

The maintenance stage is the life‑long process of continued growth and development, coping with adult life transitions, managing routine life problems, and guarding against relapse. The physiology of addiction lasts for the rest of a person's life. Any use of alcohol or drugs will reactivate physiological, psychological, and social progression of the disease.

The major causes of relapse during the maintenance stage are the failure to maintain a recovery program and encountering major life transitions.

STUCK POINTS IN RECOVERY:

Although some patients progress through the stages of recovery without complications, most chemically dependent people do not. They typically get stuck somewhere. A stuck point" can occur during any period of recovery. Usually it is caused either by lack of skills or lack of confidence in one's ability to complete a recovery task. Other problems occur when the recovering person encounters a problem (physical, psychological, or social) that interferes with his or her ability to use recovery supports.

When recovering people encounter stuck points, they either recognize they have a problem and take action, or they lapse into the familiar coping skill of denial that a problem exists. Without specific relapse prevention skills to identify and interrupt denial, stress begins to build. Eventually, the stress will cause the patient to cope less and less well. This will result in relapse.

THE DEVELOPMENTAL MODEL OF RECOVERY COMPARED WITH TRADITIONAL MODELS:

TRADITIONAL MODELS OF TREATMENT ARE BASED ON THE IDEA THAT ONCE A PERSON IS DETOXIFIED, HE OR SHE CAN FULLY PARTICIPATE IN THE TREATMENT PROCESS.

Although this is true for many patients in the early stages of addiction who have had functional lives before their addiction progressed, it is not true for most of the criminal justice population. In addition, most traditional programs have a program format that is applied to all people regardless of their education, personality, or social skills. Patients whose needs fit within the program usually do well. But those, whose needs do not fit, such as criminal justice patients, generally do not do well.

The DMR recognizes that there are abstinence‑based symptoms of addiction that persist well into the recovery process. These symptoms are physical and psychological effects of the disease of chemical dependency. In the DMR, these symptoms must be stabilized and the patient must be taught how to manage them before general rehabilitation can take place. This model identifies the specific symptoms that a patient needs to overcome.

This model also contains methods and techniques that recognize the learning needs, psychological problems, and social skills of the patient.

POST ACUTE WITHDRAWAL:

Some of the symptoms of withdrawal from alcohol or drugs are the result of the toxic effects of these chemicals on the brain. These symptoms are called Post Acute Withdrawal (PAW). PAW is more severe for some patients than it is for others. Other factors cause stress that aggravates PAW. Below is a list of conditions affecting the criminal justice population that tends to worsen the damage and aggravate PAW.

PHYSICAL CONDITIONS THAT WORSEN PAW THROUGH INCREASED BRAIN DAMAGE OR DISRUPTED BRAIN FUNCTION:

• Combined use of alcohol and drugs or different types of drugs,
• Regular use of alcohol or drugs before age 15 or abusive use for a period of more than 15 years,
• History of head trauma (from car accidents, fights, falling, etc.),
• Parental use of alcohol or drugs during pregnancy,
• Personal or family history of metabolic disease such as diabetes or hypoglycemia,
• Personal history of malnutrition, usually due to chemical dependence,
• Physical illness or chronic pain.

PSYCHOLOGICAL AND SOCIAL CONDITIONS THAT WORSEN PAW:

• Childhood or adult history of psychological trauma (participant in or victim of sexual or physical violence),
• Mental illness or severe personality disorder,
• High stress lifestyle or personality,
• High stress social environment.

ADDICTIVE PREOCCUPATION:

The other major area of abstinence‑based symptoms is addictive preoccupation. This consists of the obsessive thought patterns, compulsive behaviors, and physical cravings caused or aggravated by the addiction. These behaviors become programmed into the patient's psychological processes by the addiction. They are automatic and can cause the recovering patient to return to use unless he or she has specific training to identify and interrupt them.

Addictive preoccupations are activated by high‑risk situations and stress. Because of the environment surrounding most criminal justice patients, they often experience high‑risk situations and stress. These situations and stresses can include:

• Exposure to alcohol or drugs or associated paraphernalia,
• Exposure to places where alcohol or drugs are used,
• Exposure to people with whom the patient has used in the past or people the patient knows who are actively using,
• Lack of a stable home environment,
• Lack of a stable social environment,
• Lack of stable employment.

TRADITIONAL TREATMENT focuses on either detoxification alone or detoxification with movement into a rehabilitation program aimed at changing the patient's lifestyle. Programs are similar for all patients. Many programs omit teaching the specific stabilization skills that are necessary before lifestyle rehabilitation can take place.

The DMR first stabilizes patients so that they can take advantage of lifestyle rehabilitation. It then places the patient into a group that contains patients in similar stages of recovery and works on tasks and skills for that stage of recovery. Specific skills are taught to identify and manage relapse warning signs.

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