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The cognitive challenge is to indicate that negative feelings are not signs of failure, but a normal part of life and opportunities for growth. Helping clients feel comfortable with being uncomfortable can reduce their need to escape into addiction. Recovery is a process of personal growth in which each stage has its own risks of relapse and its own developmental tasks to reach the next stage [ 2 ].

The stages of recovery are not the same length for each person, but they are a useful way of looking at recovery and teaching recovery to clients. Broadly speaking, there are three stages of recovery. It is commonly held that the abstinence stage starts immediately after a person stops using and usually lasts for 1 to 2 years [ 1 ].

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The main focus of this stage is dealing with cravings and not using. These are some of the tasks of the abstinence stage [ 2 ]:.

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There are many risks to recovery at this stage, including physical cravings, poor self-care, wanting to use just one more time, and struggling with whether one has an addiction. Clients are often eager to make big external changes in early recovery, such as changing jobs or ending a relationship.

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It is generally felt that big changes should be avoided in the first year until individuals have enough perspective to see their role, if any, in these issues and to not focus entirely on others. The tasks of this stage can be summarized as improved physical and emotional self-care. 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. Dealing with post-acute withdrawal is one of the tasks of the abstinence stage [ 1 ]. Post-acute withdrawal begins shortly after the acute phase of withdrawal and is a common cause of relapse [ 17 ].

Unlike acute withdrawal, which has mostly physical symptoms, post-acute withdrawal syndrome PAWS has mostly psychological and emotional symptoms. Its symptoms also tend to be similar for most addictions, unlike acute withdrawal, which tends to have specific symptoms for each addiction [ 1 ]. These are some of the symptoms of post-acute withdrawal [ 1 , 18 , 19 ]: 1 mood swings; 2 anxiety; 3 irritability; 4 variable energy; 5 low enthusiasm; 6 variable concentration; and 7 disturbed sleep.

Many of the symptoms of post-acute withdrawal overlap with depression, but post-acute withdrawal symptoms are expected to gradually improve over time [ 1 ].

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Probably the most important thing to understand about post-acute withdrawal is its prolonged duration, which can last up to 2 years [ 1 , 20 ]. The danger is that the symptoms tend to come and go. It is not unusual to have no symptoms for 1 to 2 weeks, only to get hit again [ 1 ]. This is when people are at risk of relapse, when they are unprepared for the protracted nature of post-acute withdrawal. Clinical experience has shown that when clients struggle with post-acute withdrawal, they tend to catastrophize their chances of recovery. They think that they are not making progress. The cognitive challenge is to encourage clients to measure their progress month-to-month rather than day-to-day or week-to-week. In the second stage of recovery, the main task is to repair the damage caused by addiction [ 2 ]. Clinical experience has shown that this stage usually lasts 2 to 3 years. In the abstinence stage of recovery, clients usually feel increasingly better.

They are finally taking control of their lives. But in the repair stage of recovery, it is not unusual for individuals to feel worse temporarily. They must confront the damage caused by addiction to their relationships, employment, finances, and self-esteem.

They must also overcome the guilt and negative self-labeling that evolved during addiction. Clients sometimes think that they have been so damaged by their addiction that they cannot experience joy, feel confident, or have healthy relationships [ 9 ]. These are some of the developmental tasks of the repair stage of recovery [ 1 , 2 ]:. Clinical experience has shown that common causes of relapse in this stage are poor self-care and not going to self-help groups. The growth stage is about developing skills that individuals may have never learned and that predisposed them to addiction [ 1 , 2 ].

The repair stage of recovery was about catching up, and the growth stage is about moving forward. Clinical experience has shown that this stage usually starts 3 to 5 years after individuals have stopped using drugs or alcohol and is a lifetime path. This is also the time to deal with any family of origin issues or any past trauma that may have occurred. These are issues that clients are sometimes eager to get to.

But they can be stressful issues, and, if tackled too soon, clients may not have the necessary coping skills to handle them, which may lead to relapse. These are some of the tasks of the growth stage [ 1 , 2 ]:. Understand how negative familial patterns have been passed down, which will help individuals let go of resentments and move forward.

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  • The tasks of this stage are similar to the tasks that non-addicts face in everyday life. When non-addicts do not develop healthy life skills, the consequence is that they may be unhappy in life. When recovering individuals do not develop healthy life skills, the consequence is that they also may be unhappy in life, but that can lead to relapse. In late stage recovery, individuals are subject to special risks of relapse that are not often seen in the early stages.

    Clinical experience has shown that the following are some of the causes of relapse in the growth stage of recovery. They start to go to fewer meetings. They take on more responsibilities and try to make up for lost time. In a sense, they are trying to get back to their old life without the using.

    They stop doing the healthy things that contributed to their recovery. They think it is almost embarrassing to talk about the basics of recovery.

    They are embarrassed to mention that they still have occasional cravings or that they are no longer sure if they had an addiction. This section is based on my experience of working with patients for more than 30 years in treatment programs and in private practice. Experience has shown that most relapses can be explained in terms of a few basic rules [ 4 ].

    Teaching clients these simple rules helps them understand that recovery is not complicated or beyond their control. The most important rule of recovery is that a person does not achieve recovery by just not using. Recovery involves creating a new life in which it is easier to not use. When individuals do not change their lives, then all the factors that contributed to their addiction will eventually catch up with them.

    Rather than seeing the need for change as a negative, they are encouraged to see recovery as an opportunity for change. If they make the necessary changes, they can go forward and be happier than they were before.