This was part of a comment from Steven C that we converted into it’s own post. Thanks, Steven, for all your input.
By David Sack, M.D.
When a patient discovers that they have an illness, one of their first questions is, “How long until I get better?” In the field of addiction treatment, there is an ongoing debate about what the answer should be. Some feel the only way to instill hope for recovery is to define a specific endpoint at which patients can consider themselves fully recovered.
But this ignores the true nature of addiction. Unlike a cold or a broken bone, research has confirmed that addiction is a chronic brain disease akin to heart disease or diabetes. There is always hope for recovery – a hope I see fulfilled every day through education and treatment. But for hope to be authentic, it must be directed toward living a healthy, fulfilling life while managing the disease, not blind hope for curing it.
Understanding that addiction recovery is a lifelong process, it benefits patients to understand what their journey may look like. What are the stages of recovery, and how long does each take? These questions can be answered any number of ways, but the following descriptions align with the guidelines set forth by the National Institute on Drug Addiction (NIDA).
This stage begins the day the addict stops drinking or using drugs. For many, this happens in a drug or alcohol treatment program where they learn to address addiction holistically as a disease of mind, body and spirit.
In drug detox, the physiological symptoms of addiction subside in a relatively predictable period of time, but treatment of the psychological and spiritual aspects of addiction can be considerably more complicated. By learning about the disease of addiction, trying a variety of traditional and alternative therapies, participating in 12-Step recovery, and working within the family system to learn new skills, the addict builds a strong foundation for recovery.
Not surprisingly, research has shown a direct correlation between length of treatment and reduced risk of relapse. While there is no “right” length of treatment, we see the needed skill sets and insights developing at least 90 days into treatment, often through a combination of residential and outpatient treatment and aftercare. NIDA describes programs that last less than 90 days “of limited effectiveness” and recommends remaining in treatment “significantly longer.”
In early recovery, sobriety is at its most vulnerable. Drug cravings, social and family pressures, the stresses of daily life, and a host of other triggers can lead to relapse. It is during this time that the individual re-learns how to live. They develop healthy coping skills, learn how to have fun without drugs or alcohol, develop relationship and problem-solving skills, and get to know who they are sober.
Once an individual has remained abstinent for 90 days or more, the focus becomes applying the skills learned in drug rehab to every area of life. As recovering addicts reintegrate into daily life, they may feel disoriented and must look to 12-Step recovery and outpatient support to stay grounded in their recovery. The maintenance stage is also an ideal time to revisit lessons that may have been forgotten or never learned in earlier stages.
Around the five-year mark, many individuals who have maintained their sobriety report feeling “recovered.” But without ongoing maintenance relapse remains a threat, even decades later.
Advanced recovery is an ongoing growth and continuation phase. It is about enjoying life, healing relationships with self and others, and giving back. It is also a time for continuing to address co-occurring mental health disorders and other issues that drove the addiction. To combat complacency, the recovering addict must explore growth opportunities such as going back to school, advancing their career, finding new hobbies and interests, and making friends who are supportive of their recovery.
A Celebration of Life
So the answer to “How long will it take to recover?” in some ways is quite simple: It takes a lifetime. But the process itself is deeply personal, and varies in length and complexity depending on the particular individual, their support system, environmental influences, cultural context and other factors. The fortunate ones may catch on quickly and never relapse, while others may struggle for years. At core, the disease is the same.
Every individual recovers in their own way and in their own time. Typically, the early stages are the hardest until the individual stabilizes and achieves a baseline level of functioning. Addiction may be part of their life forever, but so is the new “family” created among those in recovery – one that sees each day of recovery not as an exercise in disease management but as a celebration of life.
David Sack, M.D., is board certified in psychiatry, addiction psychiatry and addiction medicine. Dr. Sack is CEO of Elements Behavioral Health, a network of addiction treatment and mental health programs. You can follow Dr. Sack on Twitter http://www.twitter.com/drdavidsack.
Importance of Willingness in Recovery
Determination to Stay Sober
If people do not have a strong desire for sobriety, it will be hard for them to maintain it. It is possible for the individual to get sober to please other people, but such recoveries tend to be short-lived. This is because staying away from alcohol and drugs is hard if people are not fully willing to do all that it takes. In order to build a successful life away from alcohol and drugs, the individual needs to be prepared to put in a great deal of effort. Those who lack willingness will not be able to summon the necessary determination.
Willingness can be defined as being eagerly compliant. It means doing something out of choice and not because of coercion. When people become willing to do something, it means their minds become more open and receptive. They may consider doing things that in the past may have appeared objectionable. Willingness means embracing change rather than fighting it.
Lack of Willingness and Recovery
It is not possible for people to find success in recovery unless they are willing to put in the necessary effort. This is because such personal change will not occur unless the individual gives their permission for it to happen. Addiction is driven by a strong urge to escape reality and hide in chemical numbness. In order for recovery to take hold, there needs to be a powerful driving force supporting it. This power is provided by the willingness to change.
Reasons for Lack of Willingness in Recovery
There are a number of reasons for why the individual may lack the willingness to stay sober:
* Some people will enter recovery because they feel coerced in some way. They may have decided to accept help because of pressure from family and friends and not because they really want to be sober. This usually means that this individual will be using recovery as a way to buy time. As soon as they feel that it is safe for them to return to their addiction they will do so.
* Many addicts suffer from ambivalence. This means that they have feelings, thoughts and attitudes that are contradictory. They may have a strong desire to enter recovery and escape the pain of addiction while at the same time having a strong desire to continue with the alcohol or drug abuse. Until this ambivalence towards substance abuse is resolved, it will be difficult for the individual to summon enough resolve to finally quit their addiction.
* Some individuals have unrealistically high expectations of recovery, and they become disappointed when things do not happen as expected. This disappointment may mean that their willingness to stay sober begins to wane. It takes time to rebuild a life away from alcohol and drugs, and if people have expectations that are too high, they will be let down.
* The individual can become stuck in their recovery, and this is a drain on their willingness. The usual reason for why people become stuck is that they are faced with a problem that they do not want to deal with. Until they face this challenge, there can be no further progress. Instead the individual either relapses or becomes a dry drunk.
* Sometimes, people in recovery will start off with a great deal of determination, but then run out of steam. This can occur if they develop pink cloud syndrome. What happens is that people can become so joyful at escaping their addiction that they lost touch with reality. Staying sober begins to feel effortless, so the individual begins to take it for granted. When the pink cloud ends, and people are once again faced with reality, they can find it hard to summon up the willingness to get back on track.
* If the individual has expectations of recovery that are too low, they may be willing to settle for very little. This is a real shame because sobriety offers some wonderful opportunities for those people who have enough willingness and determination.
* Memory can be a treacherous thing sometimes. People can forget how miserable things were at the end of their addiction. They can start to think back to those days when it felt like alcohol or drugs brought them pleasure. This is known as romancing the drink or drug, and it can sap the willingness to stay sober if it is allowed to continue unchecked.
* Some individuals will have other mental health problems as well as their addiction. If people have untreated depression, or another dual diagnosis, they will find it difficult to maintain their willingness to stay sober. This is because this other condition will make recovery unsatisfying and prevent progress.
Willingness and Hitting Rock Bottom
Rock bottom is sometimes described as reaching a point where the individual is, sick and tired of feeling sick and tired. There is no reason for why people need to lose everything in order to hit their rock bottom. They just need to reach a point where they have had enough. Some individuals will hit their rock bottom without losing very much at all. It is like going down in an elevator. It is up to the passenger to decide where they want to get off. There is absolutely no benefit from staying in the lift all the way to the bottom, because this means death.
Once the individual has fully decided that they have had enough of addiction they will have be willing to do what it takes to escape. This willingness is a force that provides them with the energy to take the correct steps to end the addiction. It means that they will be ready to make use of available resources such as rehab, therapists or addiction fellowships.
Willingness and the 12 Steps
In 12 Step groups such as Alcoholics Anonymous, they emphasize that the member needs to be willing to go to any lengths to stay sober. It is not possible for the individual to complete the 12 steps unless they have a high degree of willingness. This is because it involves taking action that the addicted mind would rebel against. The member never graduates from these 12 Step programs, so this willingness will need to be something they are able to maintain indefinitely.
Willingness and HOW
HOW is an acronym for what is needed to find success when using a self-help group. The acronym stands for:
Here, willingness is viewed as being ready to change and take risks in order to find happiness.
The Key to Willingness in Recovery
Willingness is a mental attitude that can insure success in recovery from addiction. These are its major components:
* If the individual is truly willing to escape their addiction they will do whatever it takes. It involves having an open mind about any potential resource that can help them. Those who are truly willing do not have a long list of recovery options that they are not even prepared to consider.
* Willingness involves a degree of humility. The individual no longer believes that they have all the answers. They are prepared to listen and learn from the experiences of other people.
* If the individual is willing to stay sober, they will make this their number-one priority in life. This is because they realize that making a life away from addiction requires a great deal of effort. It will not be achieved overnight. The willing individual will be prepared to devote however long it takes to rebuilding their life.
* Those who are willing to escape addiction will want to make the best use of all the available resources that can help them. They will take responsibility for their own recovery and see addiction specialists as partners there to help them. The willing individual does not passively wait for other people to fix them. They take action to make this happen.
* Willingness does not mean becoming passive. The individual still needs to question things and make decisions. It does usually mean being a bit more open-minded about possible solutions.