20 July 2022
As most readers of this blog are interested in addiction, this entry will focus on research outlining the stages of recovery from that condition. Although published in 2015, the work from which I draw, much of what follows, is new to me, and I believe, to the SMART Recovery community with whom I’m associated. There may well be opposition to these proposed stages, but they are based on empirical and field-based evidence and, as such, deserve consideration. For anyone not familiar with the distinction between sobriety (abstinence) and recovery, there are two sequential blogs, Sobriety versus Recovery, I & II (1, 8 July, 2020) beginning here: https://understandings.ca/2020/07/01/sobriety-versus-recovery-i/
Melemis (2015) outlines the stages of recovery as part of a larger plan. The purpose of his paper was to help those in recovery avoid relapses and sustain recovery. He defined recovery as “a process of personal growth with developmental milestones. Each stage of recovery has its own risks of relapse” (Melemis, 2015, p. 325). Notice that addiction is not mentioned anywhere in that definition. The stages of recovery vary in length, depending on the person recovering. The names Melemis assigned to the three stages are abstinence, repair, and growth. We look at abstinence this week.
The abstinence stage typically lasts 1 to 2 years. The primary goal is learning to deal with urges and maintaining abstinence. Melemis (2015, p. 328) listed tasks associated with abstinence:
Please note that each task begins with a verb, or action, which must be taken or done i.e., accept, practice, develop, become, understand, get rid of… This is a time of doing. What seems to be underlying those doings is the seeding of an internal cultural revolution: you are changing where, how, with whom, and why you live. As anyone involved in the addiction community knows, abstinence is difficult and fraught with hazards. These are hazards noted by Melemis:
It’s interesting to see how Melemis summarized this section. The key? Self-care, especially physical self-care, which is arguably the by-product of better emotional/intellectual self-care.
One important phase mentioned above deserves more explanation. That phase is post-acute withdrawal syndrome (PAWS). Melemis (2015) describes acute withdrawal symptoms as primarily physical. That’s what differentiates acute withdrawal from PAWS. PAWS is primarily psychological and emotional symptoms including “...1) mood swings; 2) anxiety; 3) irritability; 4) variable energy; 5) low enthusiasm; 6) variable concentration; and 7) disturbed sleep” (Melemis, 2015, p. 328). He notes that the overlap of these symptoms with those of depression is substantial but, unlike depression, the symptoms of PAWS should dissipate with time. Unfortunately, PAWS can endure for as long as two years with symptoms appearing and disappearing.
There are two issues arising from PAWS: 1) you are at greater risk of lapsing (or relapsing) while experiencing these symptoms and 2) this means, that if you’re tracking your progress (good idea!) do it month-to-month and not day-to-day or week-to-week as the latter periods are two narrow and you’ll grow discouraged.
I’ll end this blog with his own warning: “Clinical experience has shown that recovering individuals are often in a rush to skip past these tasks and get on with what they think are the real issues of recovery. Clients need to be reminded that lack of self-care is what got them here and that continued lack of self-care will lead back to relapse” (Melemis, 2015, p. 328, bold emphasis added).
While this may look like a short blog, there are more concepts included than in most blogs, but with fewer descriptions. Why? As above, these are doing concepts, for action, not just contemplation. For those wanting to integrate the bullet lists above, try copying them onto your phone, or a list you keep in your pocket. Look at that list a couple times each day and ask yourself, Am I doing this well? Am I giving it my full effort?
Dan Chalykoff is working toward an M.Ed. in Counselling Psychology and accreditation in Professional Addiction Studies. He writes these blogs to increase (and share) his own evolving understandings of ideas. Since 2017, he has facilitated two voluntary weekly group meetings of SMART Recovery. Please email him (danchalykoff@hotmail.com) to be added to or removed from the Bcc’d emailing list.
References
Melemis, S. M. (2015). Relapse prevention and the five rules of recovery. Yale Journal of Biology and Medicine 88, pp. 325-332.
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