What Are the 5 Stages of Recovery?

You never know what that one thing might be that will spark someone’s desire to enter treatment for a drug or alcohol addiction.

Image for post
Image for post
Photo credit: Shutterstock

By Michael Brown

You never know what that one thing might be that will spark someone’s desire to enter treatment for a drug or alcohol addiction. Although the toll that addiction takes on an individual’s life is well documented, each person reaches that moment of truth in his or her own unique way. Everyone’s turning point or “bottom” is different.

Regardless of how long it takes for someone to reach the point when they are willing to consider getting help, when they have arrived at this juncture it is cause for celebration and hopefulness. The process will vary for each person based on certain variables, but generally will proceed along a continuum that involves five stages of recovery. There is no way to force this process upon the individual with the substance use disorder, it is a path they must embrace and commit to on their own.

What Are the Signs of a Substance Use Disorder?

There are usually precursors, the signs that begin to crop up that may indicate a loved one may be struggling with a substance use problem. The early signs are often subtle and easily missed, but as the substance abuse escalates the behavioral, psychological, and physical signs of the substance use disorder become evident.

When the warning signs of addiction become more prominent, disruptive or disturbing behaviors begin to penetrate the family dynamic. These signs might include:

  • Lack of concern about personal appearance or hygiene
  • Neglecting obligations and responsibilities
  • Hanging out with a different crowd
  • Change in eating or sleeping habits
  • Money or property disappearing
  • Physical signs of addiction, such as hand tremors, constricted pupils, chronic constipation, drowsiness, bloating, weight loss
  • Psychological signs such as mood swings, irritability, angry outbursts, confusion, depression
  • Secretive behavior
  • Theft of medications from medicine cabinet or alcohol from liquor cabinet
  • Withdrawing from friends and family
  • Declining academic or job performance
  • Legal problems, such as a DUI
  • Financial problems, loss of job

The Effects of Addiction

According to a study published by the National Institute on Alcohol Abuse and Alcoholism, more than 23 million adults in the U.S. are struggling with substance abuse problems. These staggering statistics reveal a national problem that can impact both the physical and mental health, in addition to the indirect effects of addiction. Some of the effects of addiction include:

  • Kidney disease
  • Heart disease
  • Respiratory disease
  • Liver disease
  • STDs
  • Malnutrition
  • Depression
  • Anxiety disorder
  • Psychosis
  • Memory problems
  • Impaired cognitive functioning
  • Damaged brain connections
  • Loss of employment
  • Damaged relationships
  • Divorce and custody issues
  • Accidental injuries
  • Assault or trauma
  • Financial difficulties
  • Overdose death or alcohol poisoning
  • Increased suicide risk

Drug and alcohol abuse can take a devastating toll on an individual’s life. Thankfully, many of the above negative effects of substance abuse can be reverse or prevented through a comprehensive treatment program.

What Are the 5 Stages of Recovery?

Stage One: Pre-Contemplation

During this first stage of recovery, the individual is still using the substance of choice and is still in active denial about it. They may be experiencing several negative consequences of the addictive behaviors, with relationship problems, trouble at work, legal issues, or financial difficulties, but haven’t yet committed to making a change. However, at some point during stage one, a shift occurs from being in denial about the problem to becoming aware that their substance use is problematic and an actionable step must take place. Ever so slowly the individual will become willing to take that first step.

Stage Two: Contemplation

Stage two features an important change in focus from self to how the addiction is impacting loved ones, sometimes as a result of an intervention planned by their loved ones. Negative consequences can act as motivators to begin to actively study about the disease of addiction and to start gathering information about detox and addiction treatment. However, in stage two they typically continue the substance use. They talk about quitting at some point, but it is usually a vague comment without a time reference or real commitment. Toward the end of stage two, the addict begins to shift from knowing they need to take action to taking actionable steps.

Stage Three: Preparation

No longer in denial, stage three marks the turning point when the individual enters the active recovery mode. During this stage the individual is processing, preparing for what a life in recovery will look like. Some during this stage will reach out to people in their life who have been in recovery from drug or alcohol addiction to ask about how it works, which can be a source of encouragement and support. Some may gradually reduce consumption or shift to a less powerful substance prior to entering a treatment program. Stage three culminates with the individual admitting they need help and actively seeking a program.

Stage Four: Taking Action and Early Recovery

This early phase of recovery involves taking decisive action and admitting themselves into a rehabilitation program. They readily begin the recovery process, starting with detox and then entering a rehab in hopes of overcoming the addiction and turning their life around. In treatment, the individual will engage in multiple therapies each week that equip them with the recovery and coping skills they will need going forward. The individual will usually engage in a recovery community for added support. While stage four is a positive development in the recovery process, it is also one with significant challenges, as learning to live life without the crutch of a substance is difficult in early recovery. During stage four relapse is very common, as recovery skills are not yet fully developed.

Stage Five: Active Recovery and Maintenance

Stage five represents the point when recovery has progressed to the point when the individual is now enjoying sobriety. The individual now accepts that they must be ever vigilant about guarding their sobriety by avoiding triggers and accessing their support system regularly. They understand that they will always be an addict and respect the power of addiction as something they must continue to actively manage for the rest of their life. During stage five the individual is constructing a new sober lifestyle, has made some new sober friendships, and has established healthy new habits. Continuing care efforts support this stage, such as ongoing outpatient therapy and recovery meetings.

How Can You Support Your Loved One in Preparing for Treatment?

As your loved one progresses toward entering a treatment program there are some supportive actions you can take. Helping overcome the barriers to treatment and exhibiting a sincere desire to be a support during and after treatment will be so appreciated.

Many who enter into the 5 stages of recovery get stuck in stage one or two. The obstacles that stand in the way to taking the next step may include:

  • Fear of stigma
  • Financial concerns about the cost of rehab
  • Worry about the impact on work of taking an extended leave
  • Feelings of ambiguity about sobriety

Helping the individual overcome these barriers to treatment might include the following efforts:

  • Contact the insurance carrier to learn about the coverage for treatment and related services. Have the representative help determine out of pocket costs so there is adequate time to plan and prepare financially.
  • Consider accompanying the loved one to tour some rehabs being considered. There you can help them obtain important details about each facility that will help in making the final decision.
  • Encourage the loved one to discuss the need for a leave of absence with their human resources department. The information will be kept confidential per federal protections (Americans with Disability Act).

Once the individual has entered treatment, be an ongoing source of support for them. Participate in the family group or couples counseling sessions and offer to be an available support for them once they leave treatment.

What Does Addiction Treatment Look Like?

Once someone reaches stage four he or she is ready to embark on treatment. The first decision to be made when the person reaches stage 3 is to determine which level of care is appropriate for their specific recovery needs. Some individuals will benefit from an outpatient program that allows them to live at home and continue to work. Outpatient programs are an excellent setting for those who have a fairly new substance use disorder. Others will have a more serious addiction, which dictates the need for a residential setting.

INTAKE. After deciding on the rehab format, the next step involves the intake team at the treatment center. During the assessment the individual will participate in an interview, providing important information about the substance use history, mental health history, and health history. This helps the clinical team predict the time needed for detox and for the treatment period.

DETOX. The detox and withdrawal phase of treatment helps the individual adjust to the withholding of the substance and then stabilize. Withdrawal symptoms range from mild to severe depending on various factors, and will be addressed through medications.

THERAPY. One-on-one talk therapy is a central aspect of addiction recovery, as it helps the individual change dysfunctional thoughts and actions that perpetuated the addiction cycle. Also, therapy helps individuals process any underlying psychological issues.

GROUPS. Group therapy is a core treatment element, as these sessions provide peer support. Topics of discussion revolve around recovery and participation is encouraged.

MEDICATION. One of the treatment elements may involve medication-assisted treatment. MAT can help sustain recovery while reducing the risk of relapse. Medications may also be prescribed to assist individuals with a co-occurring mental health issue.

COMPLEMENTARY ACTIVITIES. Balance is achieved through the integration of recreational activities, holistic therapies, and experiential activities. These can help to provide some relief from the recovery work while enhancing the clinical results.

The process will look slightly different for each individual, but the five stages of recovery are predictive of the person first considering giving up their substance of choice and then progressing to the stage when they will embrace treatment and a new life in recovery.

Photo: Shutterstock

Get the Medium app

A button that says 'Download on the App Store', and if clicked it will lead you to the iOS App store
A button that says 'Get it on, Google Play', and if clicked it will lead you to the Google Play store