Recovery from Addiction

 What does Recovery from Addiction mean?

Recovery is a process of change by which individuals improve their health and wellness, live a self-directed life, and work to reach their full potential. People find Recovery everyday from a wide range of challenges, however, when most people think of Recovery, they think of the disease of addiction.

Recovery rises from HOPE. The belief that change is possible. Hope can come from amazing and unexpected places – friends, family or even a complete stranger. HOPE is the foundation of any Recovery process.

Recovery has to be a PERSONAL decision. You cannot “Do Recovery” for someone or “drag them” to a better place or “scare them into recovery.” Change must come from a genuine desire within the person.

Recovery requires total TRANSFORMATION in all areas of your life, including Mind – Body – Spirit- and Community

Recovery is CONNECTIONS. Connections with people, with new supportive communities, with yourself, with family, friends and employers in way that you have not had in a long time. In way that fosters compassion and trust and honesty. People often isolate and withdraw from the world when they are struggling. When they find sobriety and come into Recovery, they get a new chance to connect again.

Recovery takes COURAGE. Courage to face your trauma, to walk away from what you are used to, to do something scary and uncomfortable, to learn to trust again and to make yourself vulnerable.

Recovery involves MORE than just YOU – it takes a team. Family, sponsors, your new sober community, a treatment provider, a doctor, perhaps. You do not have to do it alone. 

There is no wrong way into Recovery. No wrong way to start making changes. As long as you are taking small steps, you are making progress!

Before exploring different Recovery models, let’s first take a step back and define addiction. 

Clinicians evaluate a person’s use of substances and/or problematic behaviors based on 11 key factors:

1. The substance is often taken in larger amounts or over a longer period than was intended.
2. There is a persistent desire or unsuccessful effort to cut down or control use of the substance.
3. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
4. Craving, or a strong desire or urge to use the substance, occurs.
5. Recurrent use of the substance results in a failure to fulfill major role obligations at work, school, or home.
6. Use of the substance continues despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of its use.
7. Important social, occupational, or recreational activities are given up or reduced because of use of the substance.
8. Use of the substance is recurrent in situations in which it is physically hazardous.
9. Use of the substance is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
10. Tolerance is defined by either of the following:
    • A need for markedly increased amounts of the substance to achieve intoxication or desired effect.
    • A markedly diminished effect with continued use of the same amount of the substance.
11. Withdrawal is manifested by either of the following:
    • The characteristic withdrawal syndrome for that substance (as specified in the DSM-5 for each substance).
    • The use of a substance (or a closely related substance) to relieve or avoid withdrawal symptoms.

A SUD is a progressive disorder; its effects and severity worsen over time if left untreated.

How is Addiction Similar to Other Diseases?

Addiction is similar to other diseases, such as heart, liver, or kidney diseases. Like these diseases, addiction disrupts regions of the brain that are responsible for reward, motivation, learning, judgment and memory. Left untreated, a Substance Use Disorder can last a lifetime and impact relationships, disrupt families and careers, and lead to death.

The American Medical Society and the American Society of Addiction Medicine both recognize that Addiction, just like other common diseases such as diabetes, cancer, or heart disease, is a complex combination of behavioral, psychological, environmental and biological factors. Due to the complex nature of this disease, will power alone is not enough to make significant lifestyle changes to sustain recovery. Just as one cannot “will away” their cancer or heart disease, addiction requires an individualized treatment plan that addresses core issues within each behavioral, psychological, environmental and biological factors.

Biomedical Model of Disease¹

How Many People in the United States Suffer from Addiction?

The United States is currently experiencing the greatest substance use and overdose epidemic it has ever faced, primarily due to the worldwide covid pandemic and the proliferation of highly potent synthetic opioids containing primarily fentanyl and other similar drug additives.

Statistics on this serious public health crisis in the U.S. are alarming:

• Approximately 21 million Americans have at least 1 addiction, however, only about 10% of people with addiction receive treatment.
• About 20% of Americans who have depression or an anxiety disorder also have a substance use disorder.
• Substance use disorder kills thousands of Americans every year and impacts millions of lives.

The U.S. government, healthcare systems, and nonprofit organizations continue to work on prevention and outreach to people who are struggling with this common healthcare problem. Addressing stigma is also critical to ensure that people are seeking the help they need. Recovery programs, such as inpatient and outpatient rehabilitation programs, are available in most towns and cities and many are supported by public and private funding and health insurance policies.

Inpatient vs. Outpatient Rehabilitation Programs

Inpatient and outpatient programs are both focused on sobriety & helping someone identify what lifestyle changes need to be made in order to sustain change, but each program has unique characteristics and benefits. It is important that someone entering treatment and their loved ones understand the differences before selecting a program. It is also important to research one’s insurance coverage and/or financial resources needed for either type of program.

Inpatient programs are intensive, residential treatment programs designed to treat serious addiction. The program participant lives at the facility and has a very structured day that is filled with activities intended to teach day to day sober living skills. Multiple group therapy sessions focus on helping the participant gain insight and process various core issues that enable them to continue the substance use.

Outpatient programs are part-time programs that allow program participants to stay living at home in order to keep working or going to school while attending the program. Outpatient programs have various levels of participation depending on how much support the participant needs.

1. Intensive Outpatient (IOP) – Attendance 2 days a week for 2 hours per day.
2. Substance Abuse Intensive Outpatient (SAIOP)  – Attendance 3 days a week for 3 hours per day.
3. Substance Abuse Comprehensive Outpatient Treatment (SACOT) – Attendance 5 days a week for 4 hours per day.
4. Partial Hospitalization Program (PHP) – Attendance 7 days a week for 8-10 hours per day, only returning home to sleep.

Both inpatient and outpatient programs will utilize an evidence-based treatment approaches for different types of treatment techniques, including:

• Medication Assisted Recovery (MAR) options used to promote and maintain recovery
• Cognitive Behavioral Therapy (CBT) to reframe one’s thoughts
• Motivational Interviewing (MI) techniques to promote engagement and motivation to change behaviors
• Relapse-prevention techniques
• Peer support services that rely on those in Recovery and working in the field
• Mindfulness Therapies and Relaxation and other alternative therapies for stress management
• Additional treatments depending on the individual and particular addiction

Harm Reduction Model

Harm Reduction is:

• Incorporating a spectrum of strategies including safer techniques, managed use, and abstinence to promote the dignity and wellbeing of people who use drugs
• A framework for understanding structural inequalities like poverty, racism, homophobia, classism, etc.
• Meeting people “where they are,” but not leaving them there

Harm Reduction Programs Use People First Language:

• A person is a person first, and a behavior is something that can change — terms like “drug addict” or “user” imply someone is “something” instead of someone
• Stigma is a barrier to care and Harm Reduction programs want people to feel comfortable when accessing services
• People are more than their drug use and harm reduction focuses on the whole person

Why Harm Reduction Works:

• Provides a space for people to be open about their drug use and sexual behavior so it’s not hidden, perpetuating feelings of isolation
• Values people and their expertise so they feel empowered to determine and voice their own hierarchy of need and the next steps are clear between provider and participant
• Uses evidence-based practices that have shown decreases in health and social harms
• Keeps individuals engaged in care if they re-engage risk at any stage

Harm Reduction Interventions:

• Risk Reduction: Tools and services to reduce potential harm
• (h)arm (r)eduction: The approach and fundamentals to reduce potential harm
• (H)arm (R)eduction: A philosophical and political movement focused on shifting power and resources to people most vulnerable to structural violence

Stages of Change: the Transtheoretical Model TTM

Understanding how people make changes in their life, whether to lose weight, change jobs or stop using a substance, is critical in helping someone.

One of the most respected and widely adopted models for helping individuals make lasting behavioral change is the Transtheoretical Model of Behavior Change (TTM). This model outlines various stages a person vasalates through as they contemplate and eventually start making changes. It was developed in 1983 by researchers James Prochaska and Carlo DiClemente during a smoking cessation study.

TTM operates on the assumption that people do not change behaviors quickly. Rather, change, especially habitual behavior, occurs continuously through a cyclical process. Stages of change can apply to any behavioral modification journey.

The Stages of Change have 6 distinct mindsets: precontemplation, contemplation, preparation, action, maintenance, and relapse. One may not necessarily move through the stages in a linear progression. Individuals may spend more time in one stage than another, revert back to an earlier stage, or skip a stage altogether. Everyone is different.

For each stage of change, different intervention strategies may be more effective than others at moving an individual to the next stage towards maintenance, the ideal stage of behavior.

Relapse is common. Therefore, patience and determination to reenter the Stages of Change is critical.

Stages of Change according to The Transtheoretical Model²:

• Precontemplation (“not ready”) – “People are not intending to take action in the foreseeable future, and can be unaware that their behavior is problematic”
• Contemplation (“getting ready”) – “People are beginning to recognize that their behavior is problematic, and start to look at the pros and cons of their continued actions”
• Preparation (“ready”) – “People are intending to take action in the immediate future, and may begin taking small steps toward behavior change”
• Action – “People have made specific overt modifications in modifying their problem behavior or in acquiring new healthy behaviors”
• Maintenance – “People have been able to sustain action for at least six months and are working to prevent relapse”
• Relapse – Sometimes people may feel that they can now “manage” their use, unlike the past, however quickly realize that this is not that case and will re-enter the precontemplation phase to determine if they make changes again.

The 12 Step Model of Recovery

The 12 Steps recovery model is a treatment approach created by the founders of Alcoholics Anonymous to create guidelines to overcome addiction to alcohol. The approach gained significant success in its early use such that other support groups adopted the 12 steps to their specific recovery programs.

There is no wrong way to approach the 12 Steps. Each individual must decide which components work best for their needs. Revisiting certain steps in more depth is important for some people. Daily practice and peer and community support are critical to success for most individuals.

Here is a visual representation of the categories of 12 steps:

No Matter Which Program An Individual Chooses, Taking the First Steps is Critical

No matter which treatment option or recovery program you choose, recovery from addiction is a lifelong process, similar to other chronic diseases. Medical professionals, Brain Health/Mental Health counselors, and community groups all offer treatments, programs, and ongoing support. There are many rehabilitation centers across the country. Individuals can begin their recovery at anytime, 

Catawba Valley Healthcare is here to help anyone on their road to recovery.

Contact us for help or more information today @ (828) 695-5900.

Footnotes:

1. Loay H. Abdelnour, El Nagi F., Functional Neurological Disorder Presenting as Stroke: A Narrative Review. Jan. 2017, DOI: 4172/2471-9900.1000159; Biomedical model of disease. 
2. Wayne W. LaMorte, MD, PhD, MPH, Boston University School of Public Health, Sept. 9, 2019. https://sphweb.bumc.bu.edu/otlt/MPH-Modules/SB/BehavioralChangeTheories/BehavioralChangeTheories6.html 

Additional Sources: 

1. Mayo Clinic:  https://www.mayoclinic.org/diseases-conditions/drug-addiction/symptoms-causes/syc-20365112  
2. National Harm Reduction Coalition:. Foundations of Harm Reduction – National Harm Reduction Coalition
3. Addiction Center: https://www.addictioncenter.com/addiction/addiction-statistics/#:~:text=Almost%2021%20million%20Americans%20have,over%20%24600%20billion%20every%20year