Addiction Recovery

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What is addiction recovery?

Among those who work in the treatment industry or have been through an addiction treatment program, one will often hear the question, “Are you in addiction recovery?” In the most general sense of the term, being “in recovery” means recovering from a type of addiction (e.g., substance abuse addiction, gambling addiction, food addiction, and internet addiction) after having completed a treatment program. As defined by the Substance Abuse and Mental Health Services Administration (SAMHSA), addiction recovery is “a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.” Completing a treatment program is just the beginning.

Addiction Recovery is a lifestyle that embraces the process of making healthy choices rather than destructive decisions that impact one’s personal and professional realms. It’s a commitment to building upon a foundation of wellness, health, and abstinence from drugs, alcohol and addictive behaviors. Many individuals celebrate their sobriety birthdays, which mark a milestone of every year that they have stayed sober from alcohol and/or other drugs. A sobriety birthday, also referred to as a sobriety anniversary, sober anniversary, or recovery anniversary, usually commemorates the last day someone had a drink or used a drug, but it could also mean someone’s first day in treatment.

What to expect within the first year of addiction recovery

Sober living is complete lifestyle change, and for many, this will require some major adjustments as they get used to living without drugs and alcohol. Don’t compare your recovery journey to others; everyone’s path is different, but there are some common struggles that individuals in recovery will face to some degree.

First three months
The first three months will be a period of developing new habits and attending therapy sessions, whether they are individual or group counseling sessions with a substance abuse counselor. Individuals will reinforce what they have learned in treatment by sticking to a healthy diet as recommended by the dietician and forming new relationships in an alumni aftercare program, a 12-step fellowship group or other addiction recovery groups. Individuals in addiction recovery are strongly encouraged to be active in the recovery community by giving back (i.e., sharing their experiences with those who are in treatment or in recovery, volunteering as a sponsor in 12-step groups, etc.).

Many individuals experience an emotional rollercoaster as they adjust to new beginnings. Feeling comfortable in one’s own skin without the mask of addiction is a completely different experience as they cross into the unknown frontiers of sobriety and wellness. The emotional upheavals experienced by individuals in addiction recovery render them vulnerable to relapse as they face past ignored responsibilities and raw emotion, which could engulf them in anxiety. Conversely, they may also experience life through rose-colored lenses by feeling invigorated. Their sense of rejuvenation could lead to major decisions which might potentially overwhelm them if they haven’t been grounded in their new sober life yet. In this stage, individuals are still honing the skills they learned in treatment as they navigate through life with new coping mechanisms.

Three to six months
A false sense of confidence is common among those in addiction recovery. Once they feel established in their new schedule and routine, they may feel like they can handle a drink or two with some old drinking pals. During this second phase of recovery, many people overestimate their ability to manage triggers and temptations when they feel strong enough to be around familiar surroundings. It’s important to continue maintaining the schedule established with one’s substance abuse counselor and to stay active in the addiction recovery community on a consistent basis.

Between the first and sixth month, forming new relationships with others in the recovery community is vital in the first year of addiction recovery and will make all the difference in relapse prevention. Learning to trust others by being vulnerable and transparent builds bridges between oneself and others, and it allows recovery community members to help one another in times of distress. Rather than being self-reliant and living in isolation, people learn how to be interdependent by letting others in and receiving help. Connection is the opposite of alienation, which is the breeding ground for addiction.

Six months to a year
At six months, many feel like they have already adjusted to their new lifestyle. As a precaution, individuals should stay alert at all times as they monitor their own sobriety and continue building on the foundation of sobriety and recovery. Friends and family members will start to see a new transformation in their loved ones if they haven’t already noticed the changes yet. When new healthy habits begin to take root in someone’s life, a transformed identity will emerge and inspire others to seek help for drug and alcohol addiction. It’s important to keep in mind not to compare your journey to another; holding unrealistic expectations about your own recovery will hold you back from personal growth and will only serve to discourage you.

Recovering from a relapse after treatment

Understanding the principles of relapse
The four main ideas of relapse prevention are as follows: (1) relapse is a gradual process with distinct stages; (2) recovery is a process of personal growth and milestones, and each stage of recovery has its own risk of relapse; (3) the main tools of relapse prevention are cognitive-behavioral therapy and mind and body relaxation, and (4) relapses can be described in terms of a few basic rules (Melemis, 2015).

Recognizing the signs before relapse happens
Relapse is not an overnight phenomenon. Between the time that someone completes addiction treatment and the moment when he or she uses or picks up a drink again, there is a period of emotional relapse that occurs in the early stage of addiction recovery. Since using and drinking are not part of a sober person’s consciousness, the individual will usually deny potential emotional and behavioral traps that may set them up for failure in the future. Examples of emotional relapse may include emotional suppression, social isolation, skipping meetings, holding back at meetings, and poor self-care. Prolonged periods of emotional relapse produce feelings of restlessness and dissatisfaction, which may prompt individuals to start thinking of ways to escape.

Mental relapse is the internal conflict between two opposite ideas before a relapse occurs. When individuals in addiction recovery start to brainstorm ways to escape, they also know full well that going back to drug and alcohol abuse is the last thing they want to do, considering how far they have come to achieve sobriety. However, the longer they stay in mental relapse, the more it erodes their determination to stay sober. Signs of mental relapse include the following: cravings for substance use and alcohol; reminiscing past relationships and places where drug and alcohol use occurred; trivializing consequences of past substance use; lying, bargaining and scheming; and planning a relapse.

A distinction is made between physical “lapse” and “relapse.” A physical lapse is the initial drink or drug use after a period of abstinence, and physical relapse is the return to uncontrolled substance use (Menon & Kandasamy, 2018), which starts with a mental relapse of obsessive or uncontrolled preoccupation with using. Most physical relapses occur during a “relapse of opportunity,” a window of opportunity during which the user believes he or she can get away with substance use. When clients or patients complete an addiction treatment program without adequate coping skills, they are more likely to stay in mental relapse that will eventually lead back to substance use.

How to deal with setbacks after a relapse
A setback is a behavior that moves an individual closer to relapse (Melemis, 2015). Setbacks don’t always result in relapses, but they put individuals at high risk for relapse if those in recovery exhibit the following behaviors:

• They do not set strong healthy boundaries
• They don’t ask for help
• They don’t avoid high-risk situations
• They don’t practice self-care

How one thinks about the relapse will make a difference in how one bounces back from a setback. The meaning attached to it (i.e., “I relapsed again, therefore I must be a failure. I don’t think I can stay sober”) can lead to more relapses and a greater sense of failure (Melemis, 2015).

Instead of seeing setbacks as failures, as most people in recovery tend to be hard on themselves, it would be more beneficial to evaluate the causes for setbacks, such as lack of planning or insufficient coping skills. Investing more time in planning and honing the skills learned in treatment will set people up for success, and with the help of a cognitive-behavioral therapist, clients can start to feel a greater sense of confidence and accomplishment.

One of the most common interventions utilized by therapists is the Relapse Prevention (RP), a cognitive behavioral approach which examines an individual’s relapse determinants, which are environmental and emotional factors associated with relapse. Classified as intrapersonal or interpersonal, relapse determinants include levels of self-efficacy, coping ability, cravings, emotional states, and outcome expectancies (Menon & Kandasamy, 2018). Those who return to substance use are usually motivated by the desire to regulate emotions (whether to reinforce positive feelings or escape negative emotion) or they may have certain expectations about an outcome after drinking or using. Individuals who are successful in utilizing coping strategies are likely to experience higher levels of self-efficacy and confidence; those who lack coping skills in response to cravings and urges are likely to report lower levels of self-efficacy. In cognitive-behavioral relapse prevention therapy, clients are given the tools to better manage their cravings and may learn more effective ways to avoid high-risk situations in the future.

Recovery support services and groups

Recovery-oriented models of care assist individuals in addiction recovery to regain function in areas that have been severely impaired by drug and alcohol abuse. Studies show that even after individuals achieve abstinence, many find it challenging to function in the domains of employment, education, family/social networks and housing (Laudet & White, 2009). Treatment drop-out rates have been linked with client dissatisfaction with the scope of services available to them. Studies show that one-third of those who dropped out would have stayed in treatment if the provider addressed broader needs by delivering services other than treatment for substance use disorders (Laudet, Becker & White, 2009).

Addiction Recovery services and support groups are established by SAMHSA to promote recovery in the following domains:

• Health and resilience
• Housing
• Employment, education and other life goals
• Social supports in the community

Health and resilience
Behavioral health treatment found in addiction treatment centers promotes health and resilience by helping individuals with substance use disorders and mental illnesses find relief from substance abuse addiction. For example, dual diagnosis treatment incorporates medical detoxification with substance abuse counseling to address co-occurring disorders; clients may receive pharmacotherapy to help manage symptoms of substance use disorders while they receive cognitive-behavioral therapy that addresses underlying emotional and mental disorders associated with substance use. Psychosocial interventions such as cognitive-behavioral therapy and adjunct holistic therapies in alcohol and drug treatment help clients achieve sobriety and long-term recovery.

Housing
Recovery housing provides a safe, substance-free living environment for those who are in recovery and to stabilize those who are at risk for homelessness. Affordable housing, food stamps, veterans’ benefits, childcare assistance, low-income energy assistance, discharge planning, and case management services are some of the programs surrounding housing support services for individuals in recovery. SAMHSA’s housing programs include PATH, CABHI, GBHI-SSH, TIEH, and SOAR.

Employment, education and other life goals
Individuals in recovery may face challenges such as barriers to employment and education due to criminal convictions, financial and legal complications, stigma, and gaps in employment history. Substance abuse counselors can help reduce those barriers by assisting individuals in job coaching, skills training and referrals to local community colleges that participate in the Collegiate Recovery Program. Some nonprofit organizations such as Recovery through Entrepreneurship assist those in recovery with their employment goals. Individuals may also discover meaningful hobbies through holistic therapy and carry out their newfound passion after treatment by joining interest groups in the community. Family education, counseling and group therapy help clients to strengthen and rebuild their relationships with loved ones who have been negatively impacted by substance abuse.

Social supports in the community
Alcoholics Anonymous (AA) is one of the most well-known mutual-help organizations, which are formed to provide free services that socially support individuals in their ongoing recovery and management. Support group members benefit by sharing their experiences with peers who may be going through similar challenges. Mutual-help organizations are not limited to twelve-step programs like AA or Narcotics Anonymous (NA). They also include non twelve-step programs like SMART Recovery or religious programs such as Celebrate Recovery. Twelve-step programs like AA and NA are the most accessible community-based organizations internationally. Scientific evidence suggests that participation in 12-step groups helps to reduce substance use and boosts levels of self-efficacy, enhances coping skills, and promotes stronger camaraderie with others who have similar recovery goals. Forming bonds with other addiction recovery peers helps individuals to sever ties with former social networks associated with old addictive behaviors.

References

1 Laudet AB, Becker JB, White WL. (2009). Don’t wanna go through that madness no more: quality of life satisfaction as predictor of sustained remission from illicit drug misuse. Subst Use Misuse. 2009;44(2):227–252.

2 Laudet, A. B., & White, W. (2009). What are your priorities right now? Identifying service needs across recovery stages to inform service development. Journal of substance abuse treatment, 38(1), 51–59. doi:10.1016/j.jsat.2009.06.003

3 Melemis S. M. (2015). Relapse Prevention and the Five Rules of Recovery. The Yale journal of biology and medicine, 88(3), 325-32

4 Menon, J., & Kandasamy, A. (2018). Relapse prevention. Indian journal of psychiatry, 60(Suppl 4), S473– S478. doi:10.4103/psychiatry.IndianJPsychiatry_36_18

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