Addiction Recovery is a Process

Eleven months into Stevie’s outpatient treatment, he had five consecutive months without using alcohol and my wife and I had to make a tough decision: should we let him go on a once-in-a-lifetime overnight class trip? We were, of course, extremely nervous about letting him go but he had lived up to the promises that he had made to us about not drinking. We decided to let him go.

The first night, he drank a bottle of Jack Daniels. We got a call from our niece, who was also on the trip. She told us he was unconscious and taken away on a gurney to the local ER. Then her phone died and we heard nothing for seven excruciating hours.

The next morning, he called and told us he was safe. Then he spoke the most beautiful words that I have ever heard in my life. Barely audible, he said: “Dad, I am powerless over alcohol, please get me a bed at “ABC” Treatment Center.”

No seventeen-year old uses the word “powerless” and no seventeen-year old asks for residential addiction treatment without going through a massive personal transformation. He had done some great addiction recovery work.

I never liked the word process. To me, process meant slow, wishy washy, and unclear. However, looking back, Stevie’s recovery was absolutely a process.

I would describe his process as follows:

• Initially, he fought hard against outpatient addiction treatment. He told us that we, his parents, were the problem and not him.
• Two months into his outpatient treatment, a fabulous speaker and former NBA player, Chris Herren, came to our local High School to talk about his near-fatal drug addiction. Stevie identified with Chris and asked me to watch the Chris Herren ESPN 30 for 30 TV special with him. This was the first small recognition on Stevie’s part that there might be a problem.
• Over the first six-months, Stevie had bouts of trying to abstain from drinking and then drinking again. During this period, he was working with a counselor, doing peer group meetings, and doing classwork at the treatment center to learn about addiction. I believe that he mostly wanted to get his parents off of his back and resume with his previous social life. However, he did do the work.
• At the six-month mark, as a consequence of a significant relapse, we seriously considered sending him away to residential treatment. This had a big impact on him and he agreed to go to Alcoholics Anonymous (AA) and to make a bigger commitment to his outpatient treatment. At the time, he was not fully convinced that he had an addiction problem. He was mostly trying to avoid this big negative consequence from his drinking.
• At the eleven-month mark, he relapsed on the class trip. He asked to go to residential treatment.
• During months twelve to eighteen, he learned a lot at residential treatment (28 days) and at a very structured after-care program (3 months). He committed himself to working hard on his recovery and stayed away from his friends during post High School senior summer.
• At the eighteen-month mark, he stopped going to counseling and to AA. He relapsed. After that relapse, he was upset with himself and told us that he wanted to live and he would do the work to maintain his recovery. He told us that he owned his recovery and that we should back off. This moment was a clear sign of his recovery commitment.
• Over the next six-years, he attended AA regularly. He decided that he would make a career of helping others achieve recovery. After college, he worked for a year on potentially ground-breaking addiction brain research. He then got trained as a Certified Peer Recovery Coach and currently works in the treatment industry. He has over six years of continuous sobriety.

As we were going though these up and down moments and events, the process seemed all over the place to me. The setbacks, in particular, crushed my confidence and hope. I just could not really grasp what was happening as it was unfolding because I did not know where we were or where we were headed. I was blind. I did not have a framework to understand the process.

It turns out that two world-class researchers, James Prochaska and Carlo Di Clemente, developed the Transtheoretical Model for the change process for addiction recovery – The Stages of Change. When I read that research for the first time, I couldn’t believe how closely Stevie’s recovery, and most people’s recovery, followed their model. Had I been exposed to this simple model early in the process, I would not have been so confused and unclear about what was happening.

The Stages of Change (high level)

Pre-contemplation 

The person with the addiction does not recognize that there is a problem and has no intention to change behaviors. 

Contemplation 

The person is becoming aware that there is a problem and begins to think about changing, cutting down, moderating or quitting the addictive behavior.  

Preparation 

The advantages of change begin to outweigh the positives of continuing substance use. The person may already be attempting to reduce or stop on their own. They begin to set goals and share these with others. 

Action

At this stage, people are actively modifying their habits and environment. 

Maintenance

Maintenance, also called recovery, is characterized by making substance free behavior a way of life. The person is fully engaged and committed to their new behaviors and preventing relapse. 

Relapse

Relapse is not a stage of change but often a part of the change process.  Relapsing and recycling through the stages can occur frequently.

This easy-to-read framework will allow you to understand where your child is in the process and where he/she is headed.  Importantly, it will give you insights about what your role can and should be at each stage.  It is a must read:

https://www.verywellmind.com/the-stages-of-change-model-of-overcoming-addiction-21961