Blending Perspectives and Building Common Ground. Substance Abuse Treatment and Recovery

04/01/1999

In order to understand the treatment that is needed for addiction, it is important to emphasize that medical experts today generally consider alcohol and other drug addiction to be a disease that, while treatable, is chronic and relapsing.  Because dependency on alcohol and other drugs creates difficulties in one's physical, psychological, social, and economic functioning, treatment must be designed to address all of these areas.  Addiction and its related problems can be treated successfully, but no single treatment works for all substances, nor for all substance abusers.

It is important to note that not all persons in recovery for substance abuse relapse.  Nearly one-third achieve permanent abstinence from their first attempt at recovery.  An additional one-third have brief periods of substance use but eventually achieve long-term abstinence, and one-third have chronic relapses that result in premature death from chemical addiction and related consequences.  These statistics are consistent with the life-long recovery rates of any chronic lifestyle-related illness (HHS/SAMHSA, 1996a).

Substance abuse treatment refers to a broad range of activities or services, including identification of the problem (and engaging the individual in treatment); brief interventions; assessment of substance abuse and related problems including histories of various types of abuse; diagnosis of the problem(s); and treatment planning, including counseling, medical services, psychiatric services, psychological services, social services and follow-up for persons with alcohol or other drug problems (Institute of Medicine, 1990).

Substance abuse treatment may be based on one of several traditional approaches:  the Medical Model which focuses on the recognition of addiction as a bio/psycho/social disease, the need for life-long abstinence, and the use of an ongoing recovery program to maintain abstinence; the Social Model which focuses more on the need for long-term abstinence and the need for self-help recovery groups to maintain sobriety; and the Behavioral Model which focuses more on diagnosis and treatment of other problems or conditions that can interfere with recovery (HHS/SAMHSA, 1996a).  Many programs use a combination of some aspects of the various models in order to facilitate the most appropriate treatment for the individual and to give patients options.  Others also include innovative non-traditional models of treatment such as acupuncture and traditional healing practices associated with specific cultural groups.

Treatment may occur in various settings, such as inpatient, hospital-based programs; short- and long-term residential programs; or outpatient programs; and may be augmented by self-help/12-step and other support groups.  Treatment may also use a combination of therapies, such as pharmacological therapy to treat certain addictions (for example the use of methadone for heroin addiction or the use of antabuse to treat alcoholism); use of psychological therapy or counseling, education and social learning theories; and non-traditional healing methods such as acupuncture.  Treatment may extend over the course of weeks, months, or years, depending on the severity of the problems and the level of burden created by clients' multiple disorders such as alcoholism, other drug addiction, HIV/AIDS, mental illness (especially depression), and serious physical illnesses.  The type and intensity of treatment depend on the patient's psychological, physical, and social problems; the stage (or severity) and type of addiction; personality traits; and social skills before the onset of addiction (HHS/SAMHSA, 1996a).

The concepts of treatment and recovery are not one and the same.  However, treatment is a very important part of the recovery process.  When the formal treatment component (s) are completed, whether it be outpatient, inpatient or short- or long-term residential treatment, this is not the end for anyone with an addiction problem, much less for an addicted woman with children.  Recovery is a lifelong process that takes place over time and often in specific stages.  In addition to abstinence, recovery includes a full return to bio/psycho/social functioning (HHS/SAMHSA, 1996a).

One widely accepted model of recovery, known as the Developmental Model, identifies six stages that addicted individuals must undergo for long-term recovery: 

  1. Transition, the period of time needed for the addicted individual to come to grips with the realization that safe use of alcohol or other drugs for them is not possible;
  2. Stabilization, during which the chemically dependent person experiences physical withdrawal and other medical problems and learns how to separate from people, places and things that promote substance abuse;
  3. Early recovery, when an individual faces the need to establish a chemical-free lifestyle and build relationships that support long-term recovery;
  4. Middle recovery, seen as time for the development of a balanced lifestyle where repairing past damage is important;
  5. Late recovery, during which the individual identifies and changes mistaken beliefs about oneself, others and the world that caused or promoted irrational thinking; and
  6. Maintenance, the lifelong process of continued growth, development, and managing routine life problems. 

Recovery is very complex, is not exempt from vulnerabilities, and requires a long-term commitment.  This important part of the treatment continuum must be taken into account in the design of training programs for providers of substance abuse treatment and those of child welfare services.  The complexities of recovery must be understood as well as the compelling need to address the issues of children and addicted parents and other family members.  It is often said in the recovery communities that the whole family is in recovery because many changes affecting the entire family system will necessarily occur as the recovering person embarks on this lifelong journey of well being.  However, many programs do not include a specific focus on parenting and family dynamics.

With respect to women in particular, additional problems emerge in early recovery, including problems related to parenting, to trauma resulting from physical or sexual abuse, or to mental illness.  Together with the model described above, a woman's recovery will only be successful to the extent that the other issues which precipitate or relate to the abuse of alcohol or other drugs are also ameliorated.  That is to say, if a woman who is newly drug-free returns to a hostile, abusive environment, to high levels of stress in raising one or more children alone, to unsafe housing and insecurity in the employment arena, and with minimal resources for physical and mental health care and other basic needs, recovery will be difficult.  Under such circumstances recovery will require ongoing counseling, attendance in self-help and other support groups and accessibility to other available resources.  Child welfare workers must become aware of the implications and critical importance of these factors to overall treatment for women, in particular as they relate to identifying proper services for them and their children.