Treating a substance use disorder takes a significant amount of time. Many people relapse throughout this process, and some may complete multiple treatment programs before lasting recovery is established. One way of viewing the treatment process is in phases or steps. These phases are not always linear, and they can sometimes overlap. An individual may move forward through these steps, only to then revert to an earlier phase, before moving forward again. Each person’s recovery journey is unique; the stage theory of addiction is only one model that can be used to understand the treatment process.
Various models exist describing the overall phases of treatment, but most have elements in common. The National Institute on Drug Abuse (NIDA) describes four stages of treatment: initiation, early abstinence, maintenance of abstinence, and advanced recovery.
Taking you through the process of addiction treatment
Phase 1: Treatment Initiation
This stage of treatment begins as soon as an individual asks for help. A person’s first point of contact with substance abuse treatment may be a medical doctor or mental health professional who then refers the person to an addiction treatment program. Others enter treatment through the criminal justice system. Regardless of how a person enters into treatment, this initial period tends to be characterized by ambivalence about recovery. People often feel unsure about giving up all substance use, and they may be resistant to treatment.
The first phase of treatment focuses on establishing a treatment plan and offering stability to the individual in treatment. The focus during this time is on education about addiction and the treatment options available, as well as preparation for the eventual relinquishing of all substance use. For some, this phase may include detoxification. Once ambivalence about recovery is resolved, the client is prepared to begin the next stage of the recovery process.
Phase 2: Early Abstinence
The time after establishing abstinence can involve feeling emotionally fragile, overwhelmed, and confused. An addiction can be pervasive and function as an individual’s main coping strategy in life; once substance use is taken away, it can be difficult to initially establish new, healthier ways of coping. For this reason, the Substance Abuse and Mental Health Services Administration’s (SAMHSA) treatment protocols recommend this phase of treatment focus on immediate, solvable problems, like preventing relapse and managing cravings. More emotionally difficult steps in therapy, such as discussing the underlying causes of the substance use, are generally delayed until abstinence is better established and can be maintained on a long-term basis.
Phase 3: Maintenance of Abstinence
Once lasting abstinence has been established, the therapy process can move toward recognition of how the substance abuse has negatively impacted the individual’s life. This initial period spent in therapy is typically the most intense and involved; people in this stage of therapy may be enrolled in a residential or intensive outpatient treatment program and spend several days a week in treatment if they don’t reside at a facility on a fulltime basis. Behavioral therapy can help the individual recognize how addiction contributes to the problems faced in daily life and prevents forward movement. During this phase, new life skills and coping mechanisms can be established, which will help the individual avoid relapse in the future.
Phase 4: Advanced Recovery
Recovery from an addiction is a lengthy, often lifelong, process. The longer a person lives in recovery, the easier maintenance of that recovery becomes; however, since addiction is a chronic disorder, there is no foolproof cure. Recovery must be maintained on an ongoing basis.
The later stages of recovery tend to focus less on substance abuse. Instead, they begin to focus on long-term goals and recognition of what could be lost if relapse were to occur. People in treatment for substance use may need to be integrated back into the community and their families, re-establishing relationships and identities. Letting go of guilt and shame can be an important part of this stage, as individuals learn to think of themselves as whole people, rather than in terms of extremes like “good” and “bad.” During this stage, individuals can begin to phase out of intensive treatment, spending less time in therapy on a regular basis. That being said, participation in ongoing aftercare, such as periodic therapy sessions or regular attendance at 12-Step meetings, is recommended.