Recovery is a process of progressive growth and change.
Just as children must progress through various stages of childhood and adolescence to become adults, chemically dependent people must progress through various stages of recovery in order to achieve a meaningful and fulfilling sobriety.
The Developmental Model of Recovery (DMR) suggests a new understanding for relapse. Just as children who try to run before they can walk tend to fall down, chemically dependent people who skip critical stages of recovery tend to relapse. This way of understanding relapse enhances relapse prevention therapy by adding the proactive approach of identifying current growth oriented recovery tasks to the previous methods of learning to identify and manage relapse warning signs.
The Stages of the DMR The DMR consists of six progressive stages of recovery – transition, stabilization, early recovery, middle recovery, late recovery, and maintenance. Each stage has a primary focus. During transition the primary focus is upon recognizing the addiction and developing the motivation to become abstinent. The primary focus of stabilization is recuperation from the physical, psychological, and social damage caused by addiction. Early recovery focuses upon identifying and changing the deeply entrenched patterns of thoughts, feelings, and behaviors that drive people back into the addiction. Middle recovery revolves around issues related to lifestyle repair and the development of a balanced and health promoting lifestyle. Late recovery focuses upon the resolution of family of origin issues that create pain and problems in recovery. Maintenance is the lifelong process of growth and change needed to keep from relapsing back into the addiction.
The Stages of Recovery – Central Themes
1. Transition – Recognition of Addiction
2. Stabilization – Recuperation
3. Early Recovery – Changing Addictive Thoughts, Feelings, and Behaviors
4. Middle Recovery – Lifestyle Balance
5 . Late Recovery – Family of Origin Issues
6. Maintenance – Growth and Development
The DMR can be viewed as a system for prioritizing problems. It helps recovering people to answer the questions:
- “Where should I start?”
- “What should I do first?”
- “What should I do next?”
The DMR is flexible.
Having a primary focus for each stage of recovery doesn’t mean that other issues are ignored. It means that emerging problems are dealt with in the context of the current stage of recovery. Marital problems, for example, can occur at any stage of recovery, but would be dealt with differently in the context of each stage.
- During stabilization the marital problems would be used to mobilize a family intervention designed to motivate the addict into treatment.
- In stabilization, a short-term “no divorce” contract would be negotiated and the couple would agree to defer in-depth work on the relationship until stabilization is complete.
- In early recovery both the addict and their spouse would be focused upon looking at how their marital problems are a reflection of lingering patterns of addictive thoughts, feelings and actions.
- In late recovery the marital issues would be explored as a reflection of the family of origin problems of both partners.
- During maintenance, the issues would be explored in a developmental life stage context.
The DMR also allows the recognition of complicating factors that prevent people from successfully completing the current recovery tasks. These complicating factors, which range from depression to severe unexpected life problems, must be dealt with in order for people to move ahead in recovery.
- Active Addiction Active addiction is the period of time when most addicted people believe that they are social drinkers or recreational drug users who are in control. They are getting the effect that they want from the alcohol and drug use, believe they are in control, and don’t see any problems that result from their addictive use. By the end of this stage they recognize that they are addicted, not in control, and need to abstain from alcohol and other drugs in order solve the immediate problems created by their drinking and drug use. This leads them into the transition stage of recovery.
- Transition Transition begins when the addiction starts to cause problems that force the addict to make a new evaluation of the relationship between alcohol and drug use and life problems. At the beginning of this stage most addicted people believe that they are a social drinker or a recreational drug user who is in control. By the end of this stage they recognize that they are addicted and not in control and need to abstain. In between these two points the addict experiences a painful inner conflict between the addictive part of themselves that wants to keep believing they are social drinkers and recreational drug users, and the sober reality-based part of them that believes they are addicted or at least on the road to addiction. There are four major tasks of transition. The first is to develop motivating problems that force addicts to recognize that something is wrong and motivate them to take action. Since, at this stage of recovery, most addicts don’t believe that their problems are related to alcohol or drug use, they attempt normal problem solving designed to solve the life problems caused by their addiction without dealing with the alcohol and drug use that is causing the problems. As this normal problem solving repeatedly fails, they are forced to see the relationship between alcohol and drug use. They can see that their problems are partially the result of drinking and using drugs. They start to see that they are using too much, of the wrong kind, too frequently. This launches most addicts into serious attempts to control chemical use by regulating how much, how often, and what kinds of chemicals they use. Because addiction is a disease marked by loss of control, these attempts fail. These repeated failures to control their use can cause serious demoralization that forces many addicts to accept the need for abstinence. Unfortunately, most addicts try to abstain without help and become overwhelmed by symptoms of physical and psychological withdrawal, social pressures, and an avalanche of problems that were created by their addictive use. These problems don’t end when they stop drinking and drugging; they follow them into sobriety and make it difficult to stay in recovery. When these solo efforts at recovery fail, they realize that they cannot maintain abstinence alone and accept the need for help. At this point many reluctantly and are often resistant to seekinf help in order to solve the immediate problems.
Tasks of Transition
1. Develop Motivating Problems:
2. Attempt Normal Problem Solving
3. Attempts At Controlled Use
4. Accept the need for abstinence
5. Accept the Need For Help
Stabilization The primary focus of stabilization is recuperation from the physical, psychological, and situational damage caused by the addiction. During this period most recovering people have difficulty thinking clearly, managing their feelings and emotions, controlling their behavior, and coping with crisis that was caused by the addiction. The treatment during stabilization is problem oriented, directive, and immediate. Abstinence is established and immediate crisis situations are identified. Concrete strategies for crisis stabilization are developed, and the recovering person is closely supervised and supported in executing the strategy. The five major tasks of stabilization are recovery from withdrawal, interrupting addictive preoccupation, short term social stabilization, learning non-chemical stress management, and developing hope and motivation The first step in stabilization for many addicts is to recover from withdrawal.
There are two types of withdrawal. Acute withdrawal has short-term symptoms that clear up in three to five days and include insomnia, agitation, irritability and tremulousness. Post-Acute withdrawal (PAW) has long-term symptoms and can require six to eighteen months to clear up. These PAW symptoms include difficulty in thinking clearly, managing feelings and emotions, remembering things, and sleeping restfully. At times of low stress the symptoms improve greatly. During periods of high stress the symptoms return. If chemically dependent people experience extended periods of high stress they may develop accident proneness and severe symptoms that lead to physical or emotional collapse.
To recover from acute and post acute withdrawal requires abstinence from alcohol and other drugs, knowledge of the withdrawal symptoms and how to manage them in a sober state, proper medical management and a structured recovery program that includes education, Twelve Step Group involvement, and proper diet and exercise to aid recovery of the brain and relieve stress. A medically supervised detoxification program may be needed if the physical symptoms or acute withdrawal become so severe the person cannot function normally.
As the withdrawal clears up, most addicts need to interrupt addictive preoccupation that is composed of euphoric recall, positive expectancy, obsession, compulsion, and craving.
- Euphoric recall is a form of irrational thinking that focuses upon the positive memories of alcohol and drug use, while blocking out the negative memories.
- Euphoric recall leads to the positive expectancy that chemical use may be “good for me” in the future.
- This leads to obsession with the memories of “how good it used to be” and fantasies of “how could it be in the future.”
- Thinking about the positive effects of alcohol and drugs can trigger an irrational compulsion to use or reactivate a physical craving.
Chemically dependent people who maintain sobriety learn to interrupt addictive preoccupation. They analyze their past chemical use to stop the euphoric recall. They stop thinking about how wonderful it would be to use chemicals in the future to stop the positive expectancies. They talk openly about their obsessions, compulsions and cravings with other people who are supportive of their recovery.
As addictive preoccupation subsides, short-term social stabilization is achieved by putting a bandage on serious problems with marriages, jobs, friends, and the law. This is not a time for permanent long-term solutions. It is a time for emergency action to prevent future losses and buy time for recovery.
For most addicted people, alcohol and drugs are their only tools of stress management. In order to stabilize they must learn non-chemical stress management. As chemically dependent people stabilize, they develop hope and motivation and begin to believe that recovery is possible. They can see that there is a way to get well by investing time, energy, and resources in the recovery process.
The Tasks of Stabilization
1. Recovery From Withdrawal
2. Interrupting Addictive Preoccupation
3. Short Term Social Stabilization
4. Learning Non-chemical Stress Management
5. Developing Hope And Motivation
Now let’s turn to the stages of early recovery, middle recovery, late recovery and maintenance.
During early recovery the automatic and habitual thoughts, feelings, and actions related to the addiction are identified and changed.
- The process begins by understanding that addiction is a chronic, progressive, and eventually fatal disease that has recognizable signs and symptoms.
- This leads to recognizing the personal symptoms of addiction and becoming convinced that “I have it!”
- Recognition usually activates shame, guilt and nagging pain that must to be resolved on an emotional level by accepting the reality of the disease and coming to believe that it is okay to have it.
- With acceptance comes the willingness to identify and interrupt addictive patterns of thinking, feeling, and acting (addictive TFA’s).
- This leads to the need to learn non-addictive ways of thinking feeling and acting – in short, non-addictive ways coping with the problems of life. We must learn to deal in a sober and responsible way with life on life’s terms in order to cope with the problems of life without the need for alcohol and drugs. Eventually recovering people begin to challenge their fundamental values and assumptions about the need for and importance of alcohol and drug use in their lives.
- This results in developing a sobriety centered value systemthat causes them to lose the desire to ever use alcohol and drugs.
The Tasks of Early Recovery
1. Understanding Addiction
2. Recognizing Addiction
3. Accepting Addiction
4. Identifying & Interrupting Addictive Thoughts, Feelings, and Actions
5. Learning Non-chemical Coping Skills
6. Developing A Sobriety Centered Value System
Middle Recovery The primary focus of middle recovery is on repairing lifestyle damage caused by the addiction to work, social, family, and intimate lives. We also develop a balanced and health-promoting lifestyle by making long-standing changes in marriages, relationships with children, careers, and social lives. Up until this time the primary focus has been on learning how to stay sober while putting band-aides on other lifestyle problems and leaving them as a second priority.
Middle recovery begins by resolving the demoralization crisis that results from becoming aware of how much work remains to be done in recovery. At the end of early recovery the craving has been broken and a new set of sobriety-centered thoughts, feelings, behaviors, and values have been learned and internalized. The person has a strong foundation in sobriety that will allow them to make deep and long-lasting lifestyle changes.
It is discouraging to realize that, in spite of all the hard-won internal changes, there are many critical changes in relationships and lifestyle that still need to be made. Many recovering people become discouraged and stop their ongoing recovery process by resisting further growth. Others have the courage to move ahead. They are willing to confront the reality of their lives and to pay the price necessary to develop a balanced lifestyle.
The first step is repairing addiction-caused social damage by reviewing the damage their addiction has done to their families, coworkers, and friends. They then approach each person, acknowledge their responsibility in creating these problems and offer to do whatever is necessary to fix the damage.
The next step is to build a balanced lifestyle needed to live a meaningful and fulfilling life. This often involves changing jobs or careers, renegotiating marriages and friendships, and exploring the basics values upon which the previous lifestyle was built. When this task is complete most recovering people have a meaningful and productive job, a satisfying marriage or love relationship, a productive relationship with a number of family members and relatives, a solid twelve step recovery program with a good sponsor and numerous friends in the program, and a number of friends and associates who are not involved in the Twelve Step Program.
The Tasks of Middle Recovery
1. Resolving The Demoralization Crisis
2. Repairing Addiction Caused Social Damage
3. Building A Balanced Lifestyle
Late recovery begins when people are unable to build a comfortable and balanced lifestyle because of unfinished business from childhood. It ends when recovering people resolve their family of origin problems and are able to approach adult living without being affected by irrational childhood beliefs. Some people move through late recovery quickly and with little pain. For others the process is longer and more difficult because they were emotionally, physically, or sexually abused as children, or never developed adequate social skills.
- Late recovery begins with the recognition that childhood issues are affecting the quality of recovery. They can see that they are blindly repeating self-defeating habits that they learned as children. They began to see that the only way out is to learn about family of origin issues by getting accurate information about how childhood experiences can affect their quality of adult sobriety.
- The next step is the conscious examination of childhood by writing a detailed childhood history and reviewing it with a therapist, sponsor, and/or recovery group.
- This history identifies repeating self-destructive patterns of irrational thinking, emotional mismanagement, and self-defeating behaviors that were learned as children. Knowledge of these patterns gives the power to choose to continue in self-destructive patterns or to change.
- This knowledge must be applied to adult living in order to consciously connect what they learned as children to how they are mismanaging their lives as sober adults.
- This leads to lifestyle change. These deeply ingrained self-defeating habits will not disappear simply because we understand how they were developed. We must decide to change our lifestyles, set goals, develop action plans, and enlist the help of others.
The Tasks of Late Recovery
1. Recognition That Childhood Issues Are Lowering The Quality Of Recovery
2. Learning About Family Or Origin Issues
3. The Conscious Examination Of Childhood
4. Identification of Self-defeating Patterns
5. Application To Adult Living
6. Lifestyle Change
Maintenance is a life-long process designed to prevent the tendency to relapse into old patterns of thinking, feeling, and acting that can set the stage for a relapse to addictive use.
- The first task of maintenance is maintaining a recovery program that promotes prompt identification and management of problems.
- Next is a policy of effective day-to-day coping. People in maintenance are not free from problems, but they have learned how to manage problems efficiently without having to resort to alcohol or drugs. One AA member put it this way. “I measure my recovery not by how many problems I have, but by how well I manage the problems that I do have.”
- The next task is continued growth and development. The human mind, when free from alcohol or drugs, is designed to seek truth. Human beings continue to grow and change from the time we are conceived until the time we die. We are not free to choose whether we grow and change, we are only free to choose the direction of that growth and change. Addiction creates the innate tendency to grow in negative and self-destructive ways. For most recovering people positive growth and change requires constant attention to the details of life and living.
Staying sober for a lifetime requires effective coping with life transitions and complicating factors. All people move through different periods of adult development that present different problems and challenges. In late recovery, people develop a sense of what normal adult development is all about and anticipate the changes they will undergo, as they grow older. They learn to accept each progressive stage of maturity with a sense of serenity. They surrender gracefully the ways of youth while embracing the ways of maturity.
The Tasks of Maintenance
1. Maintaining A Recovery Program
2. Effective Day-to-Day Coping
3. Continued Growth And Development
4. Coping With Life Transitions And Complicating Factors
Using The DMR
The DMR is a flexible tool that can be used in a variety of ways. Counselors can learn to help clients evaluate their stage of recovery and establish treatment plans. The DMR can also form the basis of a powerful self-care technology that can enhance, but not replace, the working of the Twelve Steps. By learning about the stage and tasks of the DMR, many recovering people can develop effective recovery plans and make better decisions about what type of professional help is needed. The DMR is a powerful tool that is needed to move the changing field of chemical dependency treatment into the future. For more information please contact the CENAPS office at 352-596-8000 or visit CENAPS. Publications for RPT are available at www.relapse.org or 1-800-767-8181.