Category Archives: Resources

Medication Assisted Treatment

Traditionally, drug and alcohol addiction treatment involves abstinence, behavioral therapy, and therapy. It does not traditionally involve other drugs. However, some traditions inevitably fade away, and in the case of drug and alcohol addiction treatment, the tradition is currently fading. Medication assisted treatment (MAT) combines the traditional method with the use of medications. MAT is most commonly applied to opioid addiction treatment, but has proven to be effective for alcohol addiction treatment as well.

The idea of including medicine in addiction treatment is not new. Methadone was developed in the 1930s and introduced to the US in 1947. Marketed initially as a kind of cure-all for anything painful, methadone was soon recognized as a powerful tool in addiction treatment. Methadone treatment is essentially drug replacement, except the addict will not feel high from methadone, only satisfied chemically. Combine this with traditional forms of addiction treatment, and you have MAT.

medication-assisted-treatment

A History of Success

In 1994, the California Department of Alcohol and Drug Programs conducted a study on substance abuse treatment. The study mainly focused on the costs of treatment, however one of the findings of the study reads: “Patients in methadone maintenance showed the greatest reduction in intensity of heroin use, down by two-thirds, of any type of opioid addiction treatment studied.”


Methadone remains the most popular medication for opioid addiction treatment.  While effective, regarding MAT, some other less-addictive medications are also utilized:

  • Buprenorphine – Similarly to methadone, this is an opioid agonist, which means it blocks the effects of opioids in the brain. The user will not feel high, but will have their bodily craving of opioids taken care of. Buprenorphine is much less addictive than methadone, and has been proven to be nearly as effective, with fewer side effects.
  • Naltrexone – This is also an opioid agonist, but has proven to be effective in treating alcoholism as well. Regarding its use with alcoholism, because of the constant availability of alcohol, there is an injectable form of naltrexone called Vivitrol, which lasts for a month between injections.
  • Disulfiram – Approved by the FDA in 1951 and still effective today, this medication prevents alcohol breakdown in the liver, causing the user to vomit any and every time alcohol is consumed. The medication is rather effective for obvious reasons, but can be damaging to the esophagus (again for obvious reasons). Disulfiram is currently being studies as a possible treatment for cocaine addiction as well.
  • Acamprosate – Used primarily to combat alcoholism, this medication reduces the cravings for alcohol. It is a newer drug, (FDA approved in 2004), and is used similarly to Disulfiram, except acamprosate will not induce vomiting upon the consumption of alcohol.

The Harvard Medical School Study

Less than one year ago, the results of a long-term study on medication assisted treatment were published. Harvard Medical School, as well as McLean Hospital, led the study over the course of three and a half years. Buprenorphine was the medication applied, and the group consisted of over 650 opioid-based painkiller addicts. The results, according to Dr. Roger Weiss, one of the study’s conductors, “are cause for optimism,” and according to Dr. Jennifer Potter, the results “represent an important first step toward understanding the course of dependence on opioid pain relievers, and for identifying factors associated with longer-term recovery.”


After 18 months of MAT, here are some pertinent results from the study:

  • Over half of the patients (51.2%) reported abstinence after 18 months.
  • Nearly two-thirds (61.4%) of the patients reported abstinence after 42 months.
  • After 42 months, less than 10% of patients were scientifically diagnosable as dependent.
  • Patients not involved in MAT but rather in traditional treatment reported much less success.

With proper administration and regulation, medication assisted treatment proves to be more effective than non-medicated treatment. Steps are being taken in the right direction. More and more professionals every day are recognizing the benefits of MAT.


If you think Medication Assisted Treatment is for you, Call us to get into the best MAT Addiction Treatment Center Today!

dual-diagnosis

Dual Diagnosis – Mental Illness and Addiction

dual-diagnosisAddiction to a substance is a disease that involves both mind and body. A mental illness occurs only in the mind but can affect the body as well. Even at first glance one can see the relationship between the two. It is similar to the square and the rectangle. All addictions are illnesses but not all illnesses are addictions. Evidence shows though that having a mental illness increases the likelihood of being addicted to a substance, and vice versa known as Dual Diagnosis.

In fact, those who have ever had a mental illness in their lives consume nearly 70% of all the alcohol bought, 84% of all cocaine, and 68% of all cigarettes. This is according to the National Bureau of Economic Research, an organization that tracks sales of all types. At any point, less than 25% of Americans have a diagnosable mental illness. While that still is a lot of people, it sheds light on just how many addictive substances those with mental illnesses consume.

Why the co-occurrence?

This question is much like the chicken and the egg. Does mental illness cause addiction or does addiction cause mental illness? Having both an addiction and a mental illness is known as having a dual diagnosis. Like many diagnoses, there is a wide range of intensity. Someone who develops depression as a result of being an alcoholic has a dual diagnosis, and so does someone who has schizophrenia and uses heroin as a self-medication. Obviously the two treatment plans would differ greatly, but nevertheless each person suffers from dual diagnosis.

Approximately 40% of those with a mental disorder also abuse substances. Mental disorders can arise from prolonged substance abuse, but self-medicating with drugs or alcohol in order to combat a mental illness happens as well.

One is a catalyst for the other.

According to Foundations Recovery Network, when dealing with dual diagnoses, “symptoms of one disorder trigger the other.” Though it may come off as harsh, they offer some examples of how addictions and mental illnesses can co-occur and catalyze each other. One example is how drug abuse increases the risk of being the victim of a violent crime, which itself can lead to PTSD or depression. Another example is how unprotected sex and/or sharing needles during drug use can lead to HIV or Hepatitis C, which in turn can (and probably will) cause severe depression and grief. Depression actually is very common in substance abusers, as many drugs actually cause it, i.e. alcohol, crystal meth and ecstasy.

The National Institute on Drug Abuse puts it well: “Both drug use disorders and other mental illnesses are caused by overlapping factors such as underlying brain deficits, genetic vulnerabilities, and/or early exposure to stress or trauma.”

Treating a Dual Diagnosis

Because both addiction and mental illness are serious conditions, having a dual diagnosis requires careful attention. First, a detoxification is recommended, especially one that is inpatient. Due to the instability of dual diagnoses, a constantly monitored environment is probably best. Next, rehabilitation should occur. This would be therapy, group and solo discussion, exercise, diet… anything that assists in the process of cleaning up. After that would come medication, which must be carefully administered due to the nature of the issue.

Finally, the maintenance of sobriety and clean mental status is handled with self-help and support groups, along with strong willpower and determination. For detailed and in-depth information on dual diagnoses, including finding specific self-help and support groups, click here and visit Double Trouble in Recovery.

Naloxone: Overdose-Reversal Medicine

Overdose-reversal medicine does not exist for all types of drug overdoses. For example, alcohol poisoning is not reversible via medicine, and other than stomach pumping and/or induced vomiting, cannot be stopped once set in. LSD overdoses cannot necessarily be reversed via medicine, however benzodiazepines (strong sedatives) have been shown to reduce agitation associated with having them. Cocaine overdoses, while not reversible, may be treated with benzodiazepines, as they lower the heartrate.

Opiate overdoses, however, are reversible via medicine. A small sigh of relief since they account for approximately 30,000 deaths annually, and are the leading cause of accidental death in the United States. Naloxone (marketed as Narcan) is essentially the wonder-drug in the world of unfortunately inevitable opiate overdoses.

What is Naloxone?

naloxoneIn the late 1950s and early 1960s, a lab technician named Jack Fishman was working in New York City for a private employer. He invented naloxone originally as a product meant to prevent constipation caused by opiate use. Naloxone is an opioid antagonist, which means it blocks the opioid receptors in the brain, negating the effects of the opiate altogether. Before long it was “standard treatment for opioid overdose in every ambulance and emergency room across the country.”

Standardized under the name Narcan, it has reversed over 20,000 overdoses since 1996 in the United States alone. Police began carrying Naloxone around 2010, and its effectiveness has been proven. During the 2014 Boston Red Sox World Series parade in downtown, Quincy police saved a 20-year-old woman from overdosing on heroin. Boston actually serves as an excellent example of Naloxone’s effectiveness. Over four years, Boston police reversed 211 overdoses from 221 times administered. That’s a success rate of over 95%.

Saving Lives

In 2014, the FDA approved Evzio, which is essentially Naloxone in a hand-held auto-injecting device. Previously, it had to be administered manually into the blood. Aside from being much easier to administer, Evzio is faster-acting since it is administered so quickly. Then, in 2015, the FDA approved Narcan nasal spray, making the overdose reversal process that much simpler. Both have been proven to be 100% effective.

Another giant step in the right direction was taken in 2015. The Clinton Foundation and Adapt Pharma, the manufacturer of Narcan, announced that each and every high school in the country could receive an overdose reversal kit free of charge.

Narcan saves, but isn’t the answer.

Take the case of Michael Meeney as a solid example of Narcan not being the complete solution. On February 18 of this year, Meeney shot heroin on a public bus in Philadelphia. He shortly thereafter overdoses, falling out of his seat and collapsing to the ground. Next thing, a police officer administers Narcan. Michael Meeney is saved.

Once saved, Meeney is arrested for the four bags of heroin on his body. Within weeks, Meeney suffered from severe withdrawal in prison. He has been in and out of jail for drugs and/or failure to appear since. Narcan can save your life from a heroin overdose, but only beating heroin can save you from heroin. If you or a loved one is struggling with a heroin problem speak to a medical professional or call us today to speak to a addiction treatment specialist.

Inpatient Drug Rehab Group Session

What is Inpatient Drug Rehab?

Entering inpatient drug rehab for drug or alcohol addiction is a step in the right direction, but it can be daunting, especially if you don’t know what to expect. Most inpatient drug rehab programs last from two to three months. Your chances of a successful recovery go up the longer you stay in the facility.

Starting the Inpatient Drug Rehab Process

Detox happens before addiction treatment really begins. It lasts for five to seven days and occurs under careful supervision. Detoxing from some substances, like alcohol, can present serious risks, so detox often takes place in a detox clinic intended for that purpose alone. Detox removes all traces of drugs or alcohol from the patient’s system, so he can enter rehab clean and sober.

Why did you begin using drugs in the first place?

Inpatient Drug Rehab Intake Process

Intake Process

The first step in any inpatient drug rehab program is a patient evaluation. The evaluation lets the treatment team assess the extent of each patient’s physical addiction and identify any mental or physical health issues that need to be addressed. With the evaluation complete, an addiction treatment plan can be put into place. Each patient needs their own drug treatment plan, tailored to their unique needs.

You will learn what caused you to start using. More important than why you began using is learning what you can do to prevent your using in the future. This involves learning coping skills so you can deal with the stresses of daily life, the triggers that cause you to run back to drugs, techniques you can use to prevent and overcome drug cravings. Don’t think that just because you get clean and go through treatment that somehow the drug cravings will magically disappear. It doesn’t work that way. For some newly-recovered individuals, they may not experience drug cravings for a long time, while others get them right away or frequently. In some cases, drug cravings go away and recur months or years later. But you will learn how to combat them, and it’s important that you pay special attention to those skills and techniques — because you will need them the rest of your life.

Outlining your Inpatient Treatment Program

Your drug treatment program will consist of individual and group counseling, educational lectures and activities, physical exercise and group activities, family counseling (if appropriate), entertainment and other events. The program will seek to restore balance in your mind-body-spirit, so that you are able to leave treatment and resume your life — albeit with a lot of changes. You will have to give up your drug-using friends, quit frequenting places where people use drugs and alcohol. Instead, you will be making new friends, among who will be your allies in your support group meetings. It is through the strength and assistance of these members of your support group that you will be able to weather and endure the many challenges that come your way following treatment when you are in recovery. They are your lifeline, your own personal insurance policy to help you keep on the path of abstinence.

Drug rehab also includes a thorough and intensive discussion and preparation of a relapse prevention plan. During this phase, you learn how to identify triggers or stressors that prompt a return to using, and develop a plan to counter those triggers. These include actions on how to deal with problems and situations that are bound to occur once you leave treatment and are in recovery. The focus is on freedom from alcohol and drug use as well as lifestyle changes.

Relapse prevention also encourages you to participate in 12 step recovery groups as an immediate and ongoing part of your recovery. To begin to put what you’ve learned during drug rehab to practice, you need the support of friends and allies. Some of these allies may be people you met during treatment and with whom you have a lasting and permanent bond. Your family, friends and allies will be there to help you get through the tough times ahead, when you need someone who understands what you’re going through and can help you over the hurdles.

What to Expect in Inpatient Drug Rehab?

Residential inpatient treatment centers are very structured and organized, with similar activities and therapies in most centers. This minimizes stress and uncertainty among residents, and also allows for the safest and most supportive environment for healing and recovery. Depending on the setting and the amenities offered, daily activities may vary.

The Morning

Sleeping in is not part of the program, so expect to rise early in the morning to enjoy a healthy breakfast. Some programs offer morning classes such as yoga or meditation to help you begin the day in a relaxed state of mind. Part of the treatment and recovery process centers on developing new, healthy habits that are intended to become routine in post-discharge life.

Inpatient Drug Rehab Group Session

Group Session

There is often a group session first thing in the morning, led by a counselor or therapist that focuses on topics related to the treatment process, the 12-step program, addiction and recovery. A significant focus during treatment is on achieving clarity about the issues, people and surroundings in your life that have fueled the desire to abuse drugs or alcohol. These daily meetings, in the safety of a controlled therapeutic environment, will help you to begin to recognize patterns of behavior you can change or certain triggers to avoid post-treatment.

The Afternoon

The middle of the day provides the most intensive treatment. After a healthy lunch, it is typical to begin a series of therapeutic sessions. These often include:

  • Individual behavioral therapy. Cognitive Behavioral Therapy (CBT) is one of the most effective methods used in addiction treatment centers. CBT hones in on your behavioral responses to specific triggers. Once those are identified, the therapist will guide you toward new, healthier responses to those triggers. The one-on-one therapy sessions provide a safe environment for you to feel free to open up and share your fears and concerns, allowing the therapist to provide tools and alternative behavioral responses to these sources of anxiety.
  • Group therapy. Participation in group sessions provides a certain camaraderie, as all participants have experienced the struggles of addiction. It can be very beneficial to the participants to share their personal stories with one another to allow for emotional healing. The group members often develop a sense of fellowship during the weeks in rehab, and as trust grows they become more open in their sessions and develop a sincere compassion and understanding for each other’s battles.
  • Specialized Sessions. Some treatment centers provide specialized therapy sessions. These could be tailored for anger management, stress management or grief counseling, offering coping techniques to help improve your ability to handle issues in a controlled manner rather than feeling the need to use drugs or alcohol.
  • Family therapy. Family support can be a crucial treatment element, which is why most drug treatment centers include it in their programs. Addiction affects the entire family, often culminating in destructive codependency, enabling behaviors or intense anger and resentment. During the family therapy sessions, many issues are resolved and feelings are addressed. Intrinsic to the long-term success of any substance abuse treatment program, family participation factors heavily in future support for the addicted person after they are discharged.

In addition to therapy, rehabs may also host speakers who share their own stories, offering residents a sense of hope about their own future. Sometimes the speakers delve into practical issues like rebuilding careers post-treatment, or simply offer inspirational speeches to help lift spirits.

Some drug and alcohol treatment centers have various supplemental therapies available, offering more of a variety of options.

Alternative therapy forms may include:

  • Art or music therapy
  • Dance therapy
  • Biofeedback
  • Neurofeedback
  • Exercise programs
  • Equine therapy

There are usually a couple of hours of free time available in the afternoon to be used however the resident chooses. Activities like pool or ping-pong, basketball, soccer and volleyball may be offered, and some facilities may have a swimming pool. Some people choose to spend free time reading or journaling and others may use the time for prayer or meditation.

The Night

After dinner, there may be another short group session. Typically, a 12-step program is available in the evenings, which is highly recommended. The meetings provide a safe, respectful and anonymous environment in which fellowship can be fostered — which serves as an intrinsic element for long-term sobriety.

Bedtime is encouraged to be at a reasonable hour, as healthy habits are being cultivated during the inpatient drug rehab program. By getting enough sleep, clients are more alert and have more energy to experience peak participation in daily treatment.

How to Get the Most Out of Inpatient Drug Rehab:

  1. Do what is suggested of you. You might never have touched a horse, but if equine therapy is suggested for you, try it. If you are asked to keep a journal, do it. If you’re asked to draw a picture of your feelings, what do you have to lose? Remember, you signed up for this! While some of the things you’re asked to do might seem silly, they are designed to work together to help you develop the resilience to live addiction free. Try everything. It just might work.
  1. No matter how you feel, stay in treatment. If there is one thing addicts hate, it is feelings. Emotions are not something addicts are equipped to deal with. In speaking with your therapist and uncovering the reasons you needed addiction to cope with your feelings, you will walk through uncomfortable places. Don’t give up. This is part of the process and it will pass. Sometimes too, good feelings will come up. After detox and a short period in treatment, addicts often feel so much better physically that they think they are “cured” and ready to go home. Just like the negative feelings, the “pink cloud” of health is an experience that is short-lived too. Don’t think that just because you’ve felt good two days in a row that you are prepared for all that life will throw at you outside the treatment setting. Listen to the facility staff. If they say to stay, even though you feel great, believe them that you’re not ready to go, especially if you’ve only been in treatment a few weeks.
  1. Use the safety of the treatment center to your advantage. At the treatment center, there are no parents, bosses, spouses, children, or others placing demands on you. You will be provided with all your basic needs and a supportive community. You will not walk through your old playgrounds where you know every dealer or bar on the street. You will be surrounded by people who genuinely care about you and your recovery. Don’t squander this gift. Use this time selfishly – to focus on you and what you need to overcome your addiction. The safety of residential treatment will undoubtedly be one of the greatest gifts you receive from treatment.
  1. Expect feelings to arise. Addicts use substances and behaviors to push away feelings. Without those substances and behaviors, feelings are going to come up. They will at times seem overwhelming. You will be uncomfortable and you will not like the experience. But with each experience, you will become stronger and more capable of understanding and moving through your emotions. In a short time, you will begin to experience pleasurable emotions – joy, self-respect, and a sense of well-being. This too is part of the process.
  1. Don’t judge your process. Someone else in inpatient drug rehab with you is going to be richer, smarter, prettier, or get better faster than you are. Alternatively, there are going to be people who are worse off than you and you might be tempted to feel superior. Let the judgment go. You are who you are. They are who they are. You’re on different paths. The truth is you are neither the highest nor the lowest form of life on the planet; you’re just a person doing the best you can under very trying circumstances. If you have to cry, cry. If you want to scream, do it. If you find yourself feeling inferior or superior, tell your therapist about it. Then move on. Judgment only gets in the way of the work and of your recovery.

If you or a loved one is struggling with drug or alcohol addiction, inpatient drug rehab may be the best option. Inpatient drug rehab allows people with addictions to get away from their drug filled surroundings into a sober and safe environment. Speak to your doctor or a drug treatment counselor about getting into an inpatient drug rehab program suited for you.

heroin-addicts

Heroin Addicts Can Get Help

heroin-addictsA variety of effective treatments are available for heroin addicts, including both behavioral and pharmacological (medications). Both approaches help to restore a degree of normalcy to brain function and behavior, resulting in increased employment rates and lower risk of HIV and other diseases and criminal behavior. Although behavioral and pharmacologic treatments can be extremely useful when utilized alone, research shows that for some people, integrating both types of treatments is the most effective approach.

The National Institute of Mental Health estimates that around 4.2 million people over the age of twelve have experimented with heroin at some point during their lifetimes. Around one-fourth of people who try heroin develop a crippling addiction to the substance, and there are around 900,000 chronic heroin users in the United States. Heroin is a difficult drug to overcome, but heroin addiction treatment is the first step towards recovery. Several types of treatments can be undertaken to successfully overcome a heroin habit, although heroin addiction treatment success rates vary widely by treatment center or clinic.

How Heroin Affects your Brain

To understand heroin addiction treatment, it is important to understand how heroin affects the brain. When heroin enters the brain, it devolves from its current state back into morphine. Morphine binds to the receptors in the brain that are involved in the perception of pain and reward—opioid receptors. This action causes a sense of euphoria to engulf the user. When the drug wears off, the feeling goes away. It is this longing for the euphoric state induced by heroin that makes it so addictive. This state is described by addicts as a feeling of happiness and well-being. When the body adapts to the presence of the drug, the user will experience symptoms of withdrawal until more of the drug is used.

Most heroin addicts realize that they cannot kick the habit on their own, because addiction to opioids is a disease in much the same way diabetes is a disease. Several heroin addiction treatment options can help the heroin addict return to a healthy, normal life.

Options for medication assisted treatment (MAT):

The most common medications used in treatment of opioid addiction are methadone and buprenorphine. Sometimes another medication, called naltrexone, is used. Cost varies for the different medications. This may need to be taken into account when considering treatment options. Methadone and buprenorphine trick the brain into thinking it is still getting the problem opioid. The person taking the medication feels normal, not high, and withdrawal does not occur. Methadone and buprenorphine also reduce cravings. Naltrexone helps overcome addiction in a different way. It blocks the effect of opioid drugs. This takes away the feeling of getting high if the problem drug is used again. This feature makes naltrexone a good choice to prevent relapse (falling back into problem drug use). All of these medications have the same positive effect: they reduce problem addiction behavior.

These medications are not used on their own to overcome addiction but are offered in conjunction with counseling and a support network of friends or family when possible. Medications can be given as an inpatient or outpatient treatment, and the type of program that is used can have a big impact on completion and success. When it comes to heroin addiction treatment success rates, as part of an outpatient treatment, medication therapy has a 35 percent completion rate, while the completion rate for a residential program was as high as 65 percent, according to the Substance Abuse and Mental Health Services Administration.

Talk to an Addiction Counselor

An addiction counselor or your doctor can be instrumental in helping you determine which heroin addiction treatment option is the best for you and your particular situation. Regardless of which option you choose, statistics show that overcoming heroin addiction is easier when the condition is approached as a chronic disease and treated with both medication and counseling. Having a good support system in place during heroin addiction treatment is also important, including support from family and friends who understand what you’re going through.

According to the Harvard Mental Health Letter, opiates are “outranked only by alcohol as humanity’s oldest, most widespread, and most persistent drug problem.”  This problem, particularly in America, is growing exponentially as more doctors turn to opiate-based medications for pain.  Columbia University researchers found that, “opioid addiction had tripled over a 10-year period, with the proportion of Americans reporting abuse or dependence increasing from 0.1% of the population in 1991–92 to 0.3% in 2001–02. The 2009 National Survey on Drug Use and Health found that nearly two million Americans were dependent on or abusing prescription pain relievers — nearly twice as great as the number of people addicted to cocaine.”

Get the Help You Need

Treating addicts with 30-day programs is a horrendous idea,” Adi Jaffe, Ph.D., executive director of Alternatives Behavioral Health and a lecturer at UCLA “Almost nobody changes a habit in 30 days. The National Institute on Drug Abuse has long recommended a minimum of 90 days’ residential treatment. Most people don’t get that, and rehab for a month is just not enough.

“The longer the addiction and the more entrenched, the longer you need to be away from it. You need to give yourself time for all the physical aspects of the addiction, the cravings and triggers to wane. After your mind has quieted down, you can start adapting new routines. Otherwise, you will jump right back into your old routines — that’s all you know how to do.”

The success rate for many rehabilitation programs is less than 25 percent, according to Jaffe. But heroin addicts, and their loved ones, should not be discouraged if their first effort to quit does not succeed, he says.

“A misconception is that addictions are almost impossible to overcome. If you fail one rehab with one version of treatment, it doesn’t mean you can’t get better,” he says. “It means you have to try again. Instead of blowing $80,000 on a month of rehab in Malibu, focus on the treatment you’re going to get and not the catered food or the ocean views.”

Inpatient Drug Rehab Intake Process

The Stages of Recovery

stages-of-recoveryNobody wakes up in the morning and says, “Hey I’m going to be an addict”. But unfortunately this happens to people all over the world. While they did not ask to be an addict they do make the choice to continuously feed their addiction. If you’re ready to admit you have a problem with drugs or alcohol here’s how to get going on the road to recovery with the stages of recovery.

 

Stage 1: Pre-contemplation

Addicts / Alcoholics in this stage may be aware that there are consequences related to their addiction, but tend to minimize or justify their choices, seeing more benefit than demerit. Not a great deal of desire to change and to an outside observer, it may seem as if the addict is drifting through life, quite unconsciously.

Stage 2: Contemplation

Addicts / Alcoholics in the contemplation stage have become aware of the greater impact of their addictive behaviors, yet are uncertain if it is worth the effort to effect change. They may be open to considering change “someday.”

In advance of stage three, a decision is made and an understanding found that the consequences overshadow perceived benefits. Behavioral change becomes a possibility. It is not a “one and done” decision, but rather a process over time.

Stage 3: Preparation

At this stage Addicts / Alcoholics begin to see that they are responsible for their choices and have the power to make life-changing decisions. They need to do it for themselves, but need not do it by themselves. They set an intention to gather resources, whether it is in the form of therapeutic intervention, 12 step meetings or other sober supports. They set a timeline and may make a verbal or written commitment.

Stage 4: Action

In stage four, Addicts / Alcoholics take the actual steps to engage in positive mental, emotional and physical change by engaging in addiction recovery, not just abstinence from their drug(s) of choice, but a “life makeover” that could include developing a fitness plan, dietary adaptation, as well as time with positive people and activities that are heart- and soul-nourishing. This is a good time to “re-write” their life story, reminding them that their history is not their destiny.

Stage 5: Maintenance

Addicts / Alcoholics in the maintenance stage have become able to sustain these patterns. T can beI liken to a fitness routine. On the first day of workout at a gym, you are not as strong, flexible and energetic as you will be a year later. The more you practice, the easier it gets. People are more aware of triggers and stressors that could lead to relapse. It is more than merely a rote exercise, but rather an integrated aspect of themselves.

Stage 6: Termination

At the termination stage people can gaze into the mirror and behold a new man or woman.  This is when the Addict / Alcoholic proclaims, “I no longer want to be that guy.” They consider it unthinkable to return to their former lifestyle. It is also a good time to imagine anything worth losing their sobriety over. At this point, most say no. Even in the face of major loss, they know that if they maintain their resolve to remain clean, they can enjoy a new life.

Although the Stages of Recovery is an orderly approach to understanding recovery, it doesn’t exist in a vacuum and is not always linear. People can move back and forth through the stages of recovery and relapse is always possible. Relapse should be viewed not as failure, but as a re-set and renewal of determination.