Gaining the ability to stop abusing drugs is just one part of a long and complex recovery process. When people enter treatment for a substance use disorder, addiction has often taken over their lives. The compulsion to get drugs, take drugs, and experience the effects of drugs has dominated their every waking moment, and abusing drugs has taken the place of all the things they used to enjoy doing. It has disrupted how they function in their family lives, at work, and in the community, and has made them more likely to suffer from other serious illnesses. Because addiction can affect so many aspects of a person’s life, treatment must address the needs of the whole person to be successful.1
“Recovery” – What exactly does that look like in the world of drug rehabilitation and treatment? Well, a working definition of recovery, as offered by the Substance Abuse and Mental Health Services Administration (SAMHSA), is “a process of change through which individuals improve their health and wellness, live self-directed lives, and strive to reach their full potential.” It is built on access to evidence-based clinical treatment and recovery support services.
Key Contributors to a Healthy, Happy Life
As already stated, for recovery to be most successful, the “whole person” must be taken into account – that is, consideration must be given to the condition and treatment of every aspect of the person’s life.
As such, SAMHSA has delineated four major dimensions that support a life in recovery:
- Health – overcoming or managing one’s disease(s) or symptoms. For example, abstaining from use of alcohol, illicit drugs, and non-prescribed medications. Making informed, healthy choices that support physical and emotional well-being.
- Home – having a stable and safe place to live.
- Purpose – conducting meaningful daily activities, such as a job, school volunteerism, family caretaking or creative endeavors, as well as the independence, income and resources to participate in society.
- Community – having meaningful relationships and social networks that provide support, friendship, love and hope.
The individual’s overall psychological state of mind (i.e., a positive view of self and surroundings) can’t be emphasized enough. Not to slight the physical health, social support system, and basic/practical needs, but very careful and intentional consideration must be given to the person’s state of mind.
In that vein, perhaps the two most essential elements to a healthy state of mind are: Hope and Resilience.
“Hope” – the belief that challenges and conditions can be overcome – is foundational to recovery.
“Hope” – the belief that challenges and conditions can be overcome – is foundational to recovery. A person’s recovery is built on her strengths, talents, coping abilities, resources and inherent values. It is holistic, addresses the whole person and her community, and is supported by peers, friends and family members.
The process of recovery is highly personal and occurs via many pathways. It may include clinical treatment, medications, faith-based approaches, peer support, family support, self-care and other approaches. Recovery is characterized by continual growth and improvement in one’s health and wellness that may involve setbacks. Because setbacks are a natural part of life, resilience becomes a key component of recovery.
“Resilience” refers to an individual’s ability to cope with adversity and adapt to hardship or change. Resilience develops over time and gives an individual the capacity not only to cope with life’s challenges, but also to be better prepared for the next stressful situation. Optimism and the ability to remain hopeful are essential to resilience and the process of recovery.
Any factors that foster hope and support resilience are, therefore, highly desirable – dare we say, necessary – for the effective treatment and the long-term recovery of an individual in returning to his authentic self.2
Co-occurring Disorders: Frequently, Multiple “Brain” Issues Are Involved
Compared with the general public, people with a mental health condition are more likely to have a substance use disorder; likewise, people with a substance use disorder are more likely to have a mental condition. About 45% of Americans seeking drug rehabilitation treatment have been diagnosed as having a “co-occurring disorder” (COD) – that is, diagnosed as having more than one unhealthy condition, such as a substance use disorder and a mental health condition. These situations are commonly referred to as having a “dual diagnosis.”
In treating such complex health needs, SAMHSA has supported an “integrated” treatment approach (that is, a strategy that takes into account all of the patient’s existing health conditions, and viewing treatment from the perspective of multiple fields of expertise). As such, integrated treatment requires collaboration across disciplines and planning that addresses both mental health and substance abuse – each in the context of the other disorder. Such treatment planning should be patient-centered, addressing the individual’s goals, and utilizing treatment steps that have been agreed to by the person being treated.
Integrated treatment is found to be associated with lower costs and better outcomes, such as:
- Reduced substance use
- Improved psychiatric symptoms and functioning
- Decreased hospitalization
- Increased housing stability
- Fewer arrests
- Improved quality of life3
For best results, integration of treatment should include the entire family – not just the patient with the substance use disorder and/or mental health condition. Treatment for family members used to be separate or distinct, but now we are learning the importance of family therapy for the successful healing and wholeness of everyone involved. Integrated treatment should seek to: a) understand the impact of substance abuse on families taken as a whole; b) recognize that family members need treatment in the context of the family as a whole; and c) appreciate the value of family therapy in treatment and integrate their interventions with the greater good of the family.4
Assessment and Treatment: A “Cookie Cutter” Approach Just Doesn’t Work
Individual paths to recovery differ, and packages of treatment and supportive services for mental health conditions and substance use disorders should be tailored to fit individual needs. For many people with behavioral health problems, the most effective approach often involves a combination of counseling and medication. Supportive services, such as case or care management, can also play an important role in promoting health and recovery.
Regardless of whether treatment involves individual counseling, group counseling, medication treatments, or supportive services, it is essential the treatment be evidence-based (that is, scientifically or empirically proven to be effective based on clinical trials or studies). Such treatment may be offered by care providers either individually or jointly. Depending on the type of service, some or all of these can be offered in a variety of settings.3
Initially upon entrance, screening and assessment are used to make two essential decisions:
- Is the individual stable enough to remain in an outpatient setting, or is the need for more intense care indicated?
- What services will the patient need?
To answer either question, a provider must first determine the scope of the patient’s health concerns and circumstances, including her physical and mental status, living situation, and the support she has available to face these problems. The assessment process should determine any pre-existing medical conditions or complications, substance use and mental health history, level of cognitive functioning, and prescription drug needs.
Once admitted to treatment, a patient needs regular reassessment as reductions in acute symptoms of mental distress and substance abuse may precipitate other changes. Periodic assessment will provide measures of patient change and enable the provider to adjust service plans as the individual progresses through treatment.5
A Wide Variety of Services Should Be Considered and Accessible
Since the conditions and circumstances can vary so much from one patient to another, the best programs incorporate a variety of rehabilitative services into their comprehensive treatment regimens. Treatment counselors may select from a menu of services for meeting the specific medical, psychological, social, vocational and legal needs of their patients to foster their recovery from addiction, such as:
- Cognitive Behavioral Therapy – seeks to help patients recognize, avoid and cope with the situations in which they are most likely to abuse drugs.
- Contingency Management – uses positive reinforcement, such as providing rewards or privileges for remaining drug-free, for attending and participating in counseling sessions, or for taking treatment medications as prescribed.
- Motivational Enhancement Therapy – uses strategies to evoke rapid and internally motivated behavior change to stop drug use and facilitate treatment entry.
- Family Therapy (especially for youth) – approaches a person’s drug problems in the context of family interactions and dynamics that may contribute to drug use and other risky behaviors.1
Oftentimes, individuals with COD need a range of services besides those specifically for substance use disorders and mental health conditions. A couple of the more generally prominent needs include housing and case management services to establish access to community health and social services. In fact, these two services should not be considered ancillary, but key ingredients for patients’ successful recovery. Without a place to live and some degree of economic stability, individuals with a COD are likely to return to substance abuse or experience a return of mental disorder symptoms; they often require a wide variety of services that cannot be provided by a single program.5
Trying to Understand the Complicated Nature of Recovery
Yes, the process of recovery is indeed complex – multilayered and multifaceted.
The personal steps that an individual experiences in the process of recovery may be said to include:
Individuals typically progress and regress in their movements through these stages. While these phases can be applied to a patient, they may also apply to each member of that individual’s family; not everyone in the family would necessarily be at the same stage at the same time in the course of the patient’s recovery – indeed, the entire family’s recovery. The therapist involved would need to address where each family member is at, for that plays an important role in appropriate assessment and treatment decisions.
The progressive levels or stages of an individual’s recovery may also be described this way:
- Dry abstinence – the stage when the patient must cope with problems revolving around the cessation of substance use; this would include withdrawal, sudden realization of the actual damage intoxication has caused, and the shame that follows.
- Sobriety, or early recovery – during this stage, the patient concentrates on maintaining freedom from substances. Bit by bit, the individual is helped to substitute health‐sustaining behaviors for relationships and circumstances that encourage substance use.
- Advanced recovery – in the stage, the patient shifts from receiving support to a deeper examination into the personal issues underlying the addictive behavior. Trust and intimacy are re‐established, and the individual moves from termination of intense therapy to less frequent visits or re-evaluations.
Recovery will, however, be a lifelong process for one who has experienced addiction; while life can be reclaimed and restored to a large extent, there is no definitive completion date.
In the context of a patient’s entire family, these phases of healing toward “wholeness” may be noticed:
- Attainment of sobriety – The family system is unbalanced but healthy change is possible.
- Adjustment to sobriety – The family works on developing and stabilizing a new system.
- Long‐term maintenance of sobriety – The family must rebalance and stabilize a new and healthier lifestyle.4
1 “Drugs, Brains, and Behavior: The Science of Addiction”, National Institute on Drug Abuse, https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery , (July 2014).
2 “Recovery and Recovery Support”, Substance Abuse and Mental Health Services Administration, http://www.samhsa.gov/recovery , (October 5, 2015).
3 “Behavioral Health Treatments and Services”, Substance Abuse and Mental Health Services Administration, http://www.samhsa.gov/treatment , (October 19, 2015).
4 “Substance Abuse Treatment and Family Therapy”, National Center for Biotechnology Information, http://www.ncbi.nlm.nih.gov/books/NBK64269/ .
5 “Substance Abuse Treatment for Persons with Co-Occurring Disorders”, National Center for Biotechnology Information, http://www.ncbi.nlm.nih.gov/books/NBK64182/ .