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.
The Stages of Recovery – Central Themes
- Transition – Recognition of Addiction
- Stabilization – Recuperation
- Early Recovery – Changing Addictive Thoughts, Feelings, and Behaviors
- Middle Recovery – Lifestyle Balance
- Late Recovery – Family of Origin Issues
- 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?” and “What should I do first?” “What should I do next?” Let’s look at each stage of the DMR starting with Stage 0 – 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 their 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 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 obstacles that force 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 often resistantly, seek help in order to solve the immediate problems.
Tasks of Transition
- Develop Motivating Problems
- Attempt Normal Problem Solving
- Attempts at Controlled Use
- Accept the need for Abstinence
- Accept the Need for Help
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.
There are five major tasks of stabilization. Let’s briefly review them.
The first task 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 (P.A.W.) has long-term symptoms and can require six to eighteen months to clear up. These P.A.W. 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.
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 obsessionwith 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 irrationalcompulsion 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 the addict, 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
- Recovery from Withdrawal
- Interrupting Addictive Preoccupation
- Short Term Social Stabilization
- Learning Non-chemical Stress Management
- Developing Hope and Motivation
Now let’s turn to the stages of early recovery, middle recovery, late recovery and maintenance.
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.
More information on the Developmental Model of Recovery is available in my new book, Recovery from Addiction: A Developmental Model, and is available from Herald House Independence Press, at www.relapse.org or 1-800-767-8181. All publications by Terry Gorski and Dr. Stephen Grinstead are published by HHIP – 1-800-767-8181. For training please contact the CENAPS office at 352-596-8000 or visit www.cenaps.com.