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Recovery from Addiction

Reviewed by Psychology Today Staff

Recovery from addiction is not only possible, it is the rule, rather than the exception. According to the latest U. S. National Survey on Drug Use and Health, more than 75 percent of people addicted to alcohol or drugs recover—their condition improves and substance use no longer dominates their life. That is not to say that recovery is easy. It is often a long and bumpy path, and relapse is nearly inevitable—but that doesn’t spell the end of recovery. There are coping strategies to be learned and skills to outwit cravings, and practicing them not only tames the impulse to resume substance use but also gives people pride and a positive new identity that hastens recovery.

There is no one pathway to recovery. Only 1.0 percent of people receive substance abuse treatment as an inpatient or outpatient at a specialty facility. Some people seek medical treatment at a hospital. Others seek help from an outpatient mental health facility. Many choose to recover without using any clinical services. The single most popular path is the use of peer support groups in the community.

Recovery Timeline

Recovery starts immediately with stopping use of a substance. For many of those who are addicted, enduring even that action is unimaginable. And yet, it is just the first step. What must follow is the process of behavior change, through which the brain gradually rewires and renews itself. That process can take months, or more. And there are many ways to accomplish that.

At what point is someone considered recovered from addiction?

There are no lab tests that define recovery and no universally agreed-on definition of recovery. For many experts, the key components of addictive disorder are compulsive drug use that continues despite detrimental consequences, and the development of cravings with the inability to control use. Addiction develops over time, in response to repeated substance use, as the action of drugs changes the way the brain responds to rewards and disables the ability to control desire for the drug.

Under all circumstances, recovery takes time because it is a process in which brain cells gradually recover the capacity to respond to natural sources of reward and restore control over the impulse to use. Another widely applied benchmark of recovery is the cessation of negative effects on oneself or any aspect of life. Many definitions of recovery include not only the return to personal health but participation in the roles and responsibilities of society.

Subscribers to the disease model of addiction generally believe that recovery extends well beyond any benchmarks to be a lifelong process. Nevertheless, data show that five years after substance use is stopped, the risk for relapse is no greater than for anyone else in the general population.

How long does recovery take?

The first step in the recovery process is stopping drug use. The endpoint is voluntary control over use and reintegration into the roles and responsibilities of society. Shortly after substance use is stopped, people may experience withdrawal, the onset of unpleasant physical and psychological symptoms —from irritability to shakiness to nausea; delirium and seizures in severe cases. The symptoms can last up to a week or more.

Recovery hinges on successfully changing many deeply rooted behaviors, and how long that takes—months or years—depends on many factors for each individual; most important are avoidance of people and places where drugs are used, having supportive connections with others, learning new strategies for coping, and the availability of opportunities for developing or reconnecting with other interests and sources of reward. Behavioral therapy can be helpful. Relapse is common and experts see it as an opportunity for learning about and overcoming impediments to change.

The Recovery Process

Research and clinical experience have identified a number of factors that promote recovery. Because people's surroundings silently but strongly shape thinking and behaving, it is essential to arrange the environment one inhabits to support the shifting of habits of thought and behavior—avoiding high-risk situations, developing new sets of friends. Another is reorienting the brain circuitry of desire—finding or rediscovering a passion or pursuit that gives meaning to life and furnishes personal goals that are capable of supplanting the desire for drugs. A third is establishing and maintaining a strong sense of connection to others; support helps people stay on track, and it helps retune the neural circuits of desire and goal-pursuit. Learning new coping skills for dealing with unpleasant feelings is another pillar of recovery.

Does recovery always require treatment?

Recovery always requires changing behavior, learning new coping skills, and finding new sources of interest. Many do it without seeking clinical treatment or using external services of any kind. Whatever the pathway of recovery, whether participation in mutual-help groups or use of clinical services of any kind, the instruments of recovery are always the same, as summed up in the acronym CHIME: Connecting with others, developing Hope and optimism, creating a new Identity, discovering a renewed sense of Meaning and purpose, and Empowerment, the sense of self-efficacy that comes from learning skills for mastering challenges.

Is it possible to do it on my own?

Many people believe that they are powerless to change their own addictive behavior, and often it is a belief that keeps people addicted. The evidence shows that every day, people choose to recover from addiction on their own. One way or another, they learn and deploy a set of skills that help them get through the strong cravings and urges of the difficult early stages of recovery. Some of the most helpful strategies for dealing with cravings are summarized in the acronym DEADS.

• Delay. Cravings diminish and disappear in time unless attention is focused on them. Negotiating with oneself for a delay of use, which doesn’t deny the possibility of future use, and then getting busy with something else, capitalizes on the knowledge that cravings dissipate in about 15 minutes.

• Escape. Planning in advance a way out of high-risk situations—whether an event, a place, or a person—helps support intentions in the face of triggers to use.

• Avoid/accept. It’s helpful to understand that cravings are normal, and the discomfort will pass. Strategically avoiding potentially problematic situations altogether,

• Distract. Quickly interrupting thoughts of using is important. Saying a mantra, substituting thoughts of recovery goals, praying, reading something recovery-related, reaching out to someone supportive—all are useful tactics.

• Substitute. Turning to another activity—listening to music, going for a walk—when an urge hits can maintain recovery.

Support Systems for Recovery

Sustaining behavior change until new patterns become ingrained is difficult under the best of circumstances. In leaving addiction behind, most people have to restructure their everyday life, from what they think about and who they spend time with and where, to how they use their time, to developing and pursuing new goals. The shifts in thinking and behavior are critical because they lay the groundwork for changes in brain circuity that gradually help restore self-control and restore the capacity to respond to normal rewards.

Further, the behavior change requires constant decision-making often in the presence of deeply rooted desire for the drug escape, before most people have acquired belief in themselves and a complete set of coping skills to help them through the challenges. That makes self-trust one key to quitting, something that tends to be in short supply among those who have previously tried to quit and failed. There are many types of support to call on to help shore up resolve. Any and all are useful

Do 12-step programs help?

Many find in 12-step programs—Alcoholics Anonymous (AA) and Narcotic Anonymous (NA) are among the best known—a caring, supportive community willing to pull each other through the temptations, the self-rebuke, and the hopelessness that especially mark the early stages of recovery. They also value having role models of recovery and someone to call on when the recovering self is an unsteady newborn. Whatever the stress relief that comes from being in a group, many others are not comfortable with the religiosity, the steady focus on the dangers of relapse rather than on growth, or the subscription to powerlessness of AA and NA. Data show that the programs are helpful for some but not for everyone. Addiction treatment is not one-size-fits-all.

Peer or mutual support is not restricted to AA or NA; it is available through other programs that similarly offer regular group meetings in which members share their experiences and recovery skills. SMART Recovery is a secular, science-based program that offers mutual support in communities worldwide as well as on the internet and has specific programming for families. All Recovery accommodates people with any kind of addiction and its meetings are led by trained peer-support facilitators. Women for Sobriety focuses on the needs of women with any type of substance use problem.

What role do family members play in recovery?

Addiction doesn’t just affect individuals; addiction is a family affliction. The uncertainty of a person’s behavior tests family bonds, creates considerable shame, and give rise to great amounts of anxiety. Because families are interactive systems, everyone is affected, usually in ways they are not even aware of. When a person goes into treatment, it isn’t just a case of fixing the problem person. The change destabilizes the adaptation the family has made—and while the person in recovery is learning to do things differently, so must the rest of the family learn to do things differently. Otherwise, their behavior is at risk of cementing the problem in place.

For starters, family members need to learn what the risk factors for addiction are and the internal and external struggles an individual faces in recovering from addiction, and they need to understand their own complex emotional reactions to the entire experience. Because recovery involves growth, families need to learn and practice new patterns of interaction.

Another one of the most important ways to support recovery is to understand that multiple relapses over a number of years are typically part of the process. They are not occasion for blame or despair but for encouraging resumption of recovery. Families can develop awareness of a loved one’s emotional, environmental, and social triggers of substance use and manage those. Because of the way addiction changes the brain, one of the best ways to help when loving someone with an addiction is to provide frequent feedback and encouragement, planning small immediate rewards every day for any positive changes. Studies show that families that participate in treatment programs increase the likelihood of a loved one staying in treatment and maintaining gains.

Relapse

Not only is addiction relapse common, relapse is not considered a sign of failure. In fact, people in recovery might be better off if the term “relapse” were abandoned altogether and “recurrence” substituted, because it is more consistent with the process and less stigmatizing.

Recovery from addiction is not a linear process, and increasingly, relapse is seen as an opportunity for learning. Relapse is now commonly considered a stage of change. Studies show that those who detour back to substance use are responding to drug-related cues in their surroundings—perhaps seeing a hypodermic needle or a whiskey bottle or a person or a place where they once obtained or used drugs. Such triggers are especially potent in the first 90 days of recovery, when most relapse occurs, before the brain has had time to relearn to respond to other rewards and rewire itself to do so. Learning what one’s triggers are and acquiring an array of techniques for dealing with them should be essential components of any recovery program.

Will I always be in danger of relapseing?

The world of addiction is deeply divided on this issue, and conflicting information abounds. Those who subscribe to the belief that addiction is a brain disease see it as a lifelong condition posing the ever-present danger of relapse, even after decades of remission. Those who view addiction as a condition that has been learned so deeply it is wired into the neural circuity see recovery very differently; they consider it a process of growth and development and regard relapse as a sign that the person has more relearning to do to accomplish rewiring of the brain. They do not minimize the difficulties in overcoming addiction but feel the belief that “once an addict, always an addict” is harmful as well as incorrect.

The fact is that people change and grow, and there is hard evidence—some of it reported by scientists who subscribe to addiction-is-a-disease thinking—that the brain changes that are the hallmark of addiction are reversible after substance use is stopped. Moreover, the fact that the vast majority of those addicted in fact recover gives the lie to the belief that people are powerless to conquer addiction. According to the National Institute on Alcoholism and Alcohol Abuse, 75 percent of alcoholics recover without treatment. People who believe they are powerless and will always be struggling with addiction wind up fulfilling that prophecy; their belief exacerbates the negative self-talk that often accompanies addiction and traps them in it.

What is the risk of relapse?

According to the National Institute on Drug Abuse, an estimated 40 to 60 percent of people trying to quit use of drugs, and 50 to 90 percent of those trying to quit alcohol, experience at least one slip up in their first four years of recovery. Many experience more than one. Return to use is most common during the first 90 days of recovery. Relapse carries an increased risk of overdose if a person uses as much of the drug as they did before quitting.

Nevertheless, experts see relapse as an opportunity to learn from the experience about personal vulnerabilities and triggers, to develop a detailed relapse prevention plan, and to step up treatment and support activities.

The most common causes of relapse include:

• exposure to environmental cue related to drug use

• stress

• interpersonal difficulties

• peer pressure

• lack of social support

• pain due to injuries or medical problems

• lack of a sense of self-efficacy

• positive moods.

Rebuilding Life

Gaining the skills to avoid relapse is a necessary part of the recovery process. However, focusing on the fear of relapse is not enough. At least equally necessary is developing in a positive direction out of the addiction. Recovery is always developmental. The key is cultivating new goals and taking measures to move towards them. The motivational force of new goals eventually helps rewire the brain so that it has alternatives to the drive for drugs. It’s hard to leave addiction behind without constructing a desirable future.

What is the difference between remission and recovery?

For all practical purposes with regard to drug use, the terms remission and recovery mean the same thing—a person regaining control of their life and reversing the disruptive effects of substance use on the brain and behavior. The Diagnostic and Statistical Manual of Mental Disorders (DSM) avoids the terms addiction and recovery. Sustained remission is applied when, after 12 months or more, a substance is no longer used and no longer produces negative life consequences.

Studies of outcome of addiction treatment may use one term or the other, but they typically measure the same effects. Still, some people in the addiction-treatment field reserve recovery to mean only the process of achieving remission and believe it is a lifelong enterprise of avoiding relapse. Recovery suggests a state in which the addiction is overcome; clinical experience and research studies provide ample evidence.

Will brain function return to normal?

There is hard data showing that the changes to the brain’s neurotransmitters and neural circuits that turn repeated substance use into addiction can be reversed after cessation of drug use, even in the case of addiction to methamphetamine. That is because the brain is plastic and changes in response to experience—the capacity that underlies all learning. Recovery, like addiction itself, relies on neuroplasticity. In one set of studies looking at some measures of dopamine system function, activity returned to normal levels after 14 months of abstinence. Over time, reward circuits regain sensitivity to respond to normal pleasures and to motivate pursuit of everyday activities. Areas of executive function regain capacity for impulse control, self-regulation, and decision-making.

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