Stages of recovery. Stages of bio-psycho-social recovery (recovery) for patients with addiction stage of recovery “Transition”

Stages of recovery Stages of recovery used in a rehabilitation program. The separation of stages helps to improve the assessment of the patient’s condition by workers and by the patient himself in the recovery process. So that there is no confusion. The stages of rehabilitation may differ from the stage of recovery.

Stage 1 “Transition”.

First stage includes work on recognizing powerlessness over the problem of alcoholism and drug addiction, recognizing the loss of control over the problem.

Many, even admitting their powerlessness over the problem, try to control their use by reducing the dose, setting the time and timing of possible use. Even when entering rehabilitation, the addict is motivated not by complete recovery and stable remission, but by reducing the dose for further use.

This stage ends with the recognition of powerlessness over alcohol and drugs, and the lack of desire to control drug use. An addict who seeks help does not always have an idea why he lost control, why drug use cannot be stopped, and why all attempts to overcome cravings ended in failure. Our task is to help in realizing the problem and accepting it as something that has already happened. In AA communities, these symptoms are called fatigue fatigue. It is important for us that sobriety is not just a healing of wounds, but a way of life.

Stage 2. "Stabilization"

Stabilization. Healing from damage caused by use.

During the second stage - stabilization— we already understand that we have big problems with mind-altering substances, and that we need to completely stop using them, but we are not yet able to do this. During stabilization we are recovering physically from the effects of drug use. Withdrawal syndrome lasts individually for each person; for some it may take a month, and for others much longer. This period is the most difficult, as there is a struggle with oneself, how to resist the first glass or injection.

At this stage, after the body has recovered from withdrawal, addicts experience mental distress and emotional mood swings. This stage is one of the most important in the rehabilitation process, for which maximum resources are involved. Work with psychologists, group therapy, and occupational therapy.

Stage 3 Early recovery

The third stage is early recovery: this is a time of internal change. At this stage, we learn to live in society and feel comfortable abstaining from psychoactive substances. The craving for alcohol and drug use weakens, and we delve into the problem that led us to addiction and how it affected us.

We learn to overcome feelings of shame, guilt and remorse. The task of this stage learn to cope with your problems without turning to drugs. Early recovery ends when we are ready to begin applying what we have learned to improve other areas of our lives.

Stage 4. Average recovery

During mid-recovery, the fourth stage, we learn how to repair past damage and find balance in life.

We learn that full recovery means “applying these principles (the sober living skills we learned in early recovery) in all we do” (in the real world of everyday life). During the period of average recovery, repairing relationships with people becomes a priority. We overestimate our significant relationships, particularly with family and friends, as well as our careers. If we find ourselves unhappy in any of these areas, we accept it and plan to do something about it. In AA terms this is called “making amends.” We realize that we have harmed other people. We want to take responsibility and do everything we can to make amends. Average recovery ends when we achieve a balanced and stable life.

Stage 5 (not for everyone)

During the fifth stage - “late recovery”. Our task is to focus the children’s attention on overcoming obstacles to a new “sober” life, which were formed since childhood. Long before a person became addicted. Many drug addicts come from dysfunctional families. (Families where parents did not fulfill their parental responsibilities).

Due to the lack of proper upbringing, the child was not able to acquire the standard skills in order to be happy. The purpose of the center, if necessary, is to show a person about possible adult problems caused by growing up in a dysfunctional family, and to help to recover in this area, to resolve current problems, despite the obstacles caused by how the parents raised them.

Stage 6: Maintenance

The final part of recovery is “maintenance.” Those undergoing a course of recovery from drugs or alcohol receive the necessary information on how to move on with their lives, how to overcome obstacles and maintain sobriety. At the final part of the recovery process, the addict’s task is to put all the information received into practice. Constantly working on oneself and current problems makes it possible to become more resistant to the problems of alcoholism and drug addiction, and the ability to self-develop in society.

STAGES OF RECOVERY table

Stages of recovery	Main theme
Transition	Stop trying to control your alcohol or drug use.
Stabilization	Healing from damage caused by use
Early recovery	Internal changes (changes in thoughts, feelings and actions related to alcohol and drug use).
Average recovery	External changes (correction of lifestyle disorders caused by addiction and development of a balanced lifestyle).
Late recovery	Outgrowing the limitations of childhood
Maintenance	Living a balanced life and continuing to grow and develop

Additional: growing up in a dysfunctional family This is a small society in which strict parenting is encouraged, strict rules and destructive behavior are encouraged. In such a family there is no respect, no recognition of merit, no encouragement of the individual. The final part. Socialization. We hold various events that help you plunge into real life without drinking alcohol and drugs; Below is a video of an excerpt from the event at the New Hope Center now called “Helping Hand.”

Although the nature of alcoholism has been well studied by specialists, it is difficult to treat for at least two reasons.

1. This is a disease in which there is no criticism of its presence or it is very superficial, despite the obvious harmful consequences. After all, craving for alcohol is one of the main signs of alcohol addiction. Therefore, very often patients do not want to be treated.
2. There is no universal “pill” for alcoholism, similar to, for example, insulin, which saves the lives of diabetics.

Think about the terrible numbers of official statistics on alcoholism in the Russian Federation:

• the presence of 5% of alcoholics and 10-11% of drunkards only according to state medicine, and how many people receive drug treatment in commercial medical centers on anonymous terms in order to avoid drug registration?
• How many people, in principle, do not seek such help for various reasons (fear of losing their job, ending up in a mental hospital, homeless people, and so on)?

In fact, the statistics of drunkenness and alcoholism are at least two times higher in sad terms. This means that every tenth resident of our country has serious problems with alcohol, and every fifth will develop them in the near future.

Alcoholism

This is a serious disease, and its treatment is difficult work. But recovery is possible and even inevitable if all instructions are followed and the need for treatment is realized by the patient himself and his immediate environment. True treatment for alcohol addiction is impossible without creating changes in the psychological, social and spiritual spheres of the patient, which requires the help of all his loved ones to create motivation and conscious activity, although medications for alcohol addiction also play an important role.

Picture of addiction

Most alcoholics behave in approximately the same way at the beginning:

At first they drink only on major holidays with friends, and allow themselves too much after persistent persuasion, then they become “friends” by the presence of a bottle and persuasion is no longer needed, after which they themselves are the initiators of various events, but certainly with drinking.

Reasons to drink

there are a wide variety of:

• salary,
• prepaid expense,
• end of the working week,
• chance meeting,
• business trip,
• the need to relax.

Such a person’s social circle includes new people and they, as a rule, like to drink; sober friends first fade into the background, and then are completely forgotten. Such a person no longer expects to communicate with friends without alcohol.

He may say that he drinks out of necessity, “it’s inconvenient to refuse,” “I need to treat him,” “tradition,” without noticing and not wanting to admit that there are more and more such reasons, unjustified reasons.

While waiting for a drink, a person’s behavior changes. A drinker or drinker noticeably perks up, becomes more cheerful, fusses more, trying to finish things off as quickly as possible in order to sit down at the table and drink quickly. There is only an approving attitude towards everything that is or may be connected with the consumption of alcoholic beverages.

Alcohol addiction

Such a person jealously protects his drinking buddies. He not only does not recognize them as alcoholics, but on the contrary finds many positive qualities in them. What prevents this is perceived from the negative side. Even a novice alcoholic hates talking to others about his regular abuse, defending his “rights” to drink in every possible way.

The feeling of coziness and comfort comes to him precisely in a state of intoxication. In a sober state, a drinker always lacks something, he is not at ease.

“Facts” about the benefits of alcohol are invented and presented as evidence: doctors recommend it in small doses, it relieves feelings of fatigue and emotional stress, increases performance, and so on. Such a person cannot be convinced that alcohol does more harm than good. There is a restructuring of life values ​​and moral principles. Everything that promotes drinking is assessed only positively, and everything that hinders it is assessed sharply negatively.

Work, family, children, family responsibilities interfere with drinking and become a burden. Each dose of alcoholic drinks affects and gives euphoria only for a certain period of time, so you have to drink more often.

For an alcoholic, the taste and even the type of alcohol are not important; the strength of the alcohol consumed is much more important. Even slight intoxication creates an irresistible attraction that an alcoholic, unlike a drunkard, cannot control.

This alcoholic craving usually arises only from a certain triggering intoxication, for which a certain dose of alcohol is needed, and everyone has their own portion. Almost every alcoholic assures that he “knows his limits,” but once he starts drinking, he can’t stop.

Symptoms

• Nausea and vomiting disappear when taking excessive doses of alcohol. The amount of alcohol consumed increases by 2-5 times. Drinking sessions are becoming more frequent. A hangover syndrome (alcohol withdrawal) occurs. It is different from a simple hangover after drinking too much alcohol. Weakness and malaise in this case are transformed into complete weakness.
• The symptom of shaking hands is replaced by tremors of the whole body. In alcoholics with a hangover, headaches, unlike a simple hangover, do not develop as often. It can occur due to head injuries or exacerbation of hypertension. Another symptom is prolonged insomnia, with characteristic manifestations in the form of nightmares and sweating.
• Hangover syndrome is dangerous because the consequences of chronic alcohol intoxication manifest themselves in damage to all organs and systems without exception. This is evidenced by exacerbations of existing diseases or even the emergence of new ones (pancreatitis, pneumonia and others).

Attention!!!

Severe alcohol withdrawal is often the “turning point” when an alcoholic can be persuaded to seek medical help for the first time. If a person feels comfortable, at best he will say that “we’ll go get checked someday” or refuse the conversation altogether.

The influence of addiction.

Let's try to see how much time a day it takes us to perform certain ordinary daily duties?

Let's say I draw this approximate picture:

• work (plus travel to work) - 10 hours,
• sleep - 8 hours, household chores (cooking, shopping, raising children) - 3 hours,
• leisure (TV, computer, reading) - 3 hours.

Total -24 hours. How does an alcoholic's time management change? Addiction “eats up” more and more time that a sober person devotes to doing important things. Behavior at home, work, and relationships with loved ones suffer. Even an alcoholic’s sleep may be longer, but it is physically incomplete and more reminiscent of anesthesia. That is, alcoholism impoverishes the usual role repertoire in all spheres of life, from the most subtle (leisure time and communication within the family), then work (where a person is increasingly either hungover or drunk) and ending with the most biological (sleep, sex , food).

That is, a person has a lot of sober and independent time. An alcoholic practically does not have it. Moreover, his roles are mixed - he allows himself to go to work drunk, and does housework as frivolously as if he were spending his leisure time. After all, a sober person at work doesn’t love, for example, his cat? And for a patient with alcoholism it turns out something like this. In the stage of mental dependence (the beginning of the formation of alcoholism), the patient does not yet develop work-related problems, since he can abstain from drinking at work. But he is always looking forward to the evening when no one will interfere with his drinking. But in the family, problems already arise when every evening you have to see a constantly drunk husband or wife. In patients suffering from alcoholism, the psyche gradually begins to change, everything goes backwards.

In the first place is alcohol and everything connected with it. For example, a patient works as expected all week and looks forward to the weekend. But not to go fishing or to the country, to spend more time with my wife and children, to do household chores, but to indulge in alcoholic libations! With the onset of the first day of the work week - Monday, an alcoholic in an absolutely broken state goes to work, already dreaming of an evening when he can get over his hangover, and on the weekend again “have a blast.” What does this mean? Yes, that only one “drip” is good for breaking a binge and relieving a hangover. But for real recovery from alcoholism, anti-alcohol treatment in the form of “filing” and “coding” is not enough. Due to the fact that the goals and objectives in the life of a patient with alcoholism are violated and disintegrate in all areas of spending time, a mandatory condition for recovery will be undergoing rehabilitation with psychotherapy and developing sober leisure skills. Preferably with the help of loved ones. Even if a person has completed a short course of withdrawal from binge drinking (for example, in a hospital) and received anti-alcohol treatment for a specified period, his condition is very unstable. Addiction penetrates deeply into the psyche and continues to lie dormant there. Part of the psyche becomes “empty” for a long time, “dead” - having not yet learned to live soberly. Therefore, many who have undergone such treatment for a long time complain of a feeling of melancholy, emptiness, and loss of meaning in life. If a person does not work on himself at this time, he feels that he has received only “hopeless sobriety,” and this is a sure path to a breakdown.

Even if a person tries to formally continue a sober life, he will perceive the usual home and work environment as a depressing routine and desire inside for his treatment to be “appreciated” by others as some kind of feat, and immediately. He can also perceive any approval at this time as recognition of his own “heroism”, consider that he has “already recovered” and try to “thank” himself a little with alcohol. And with established alcoholism, the transition to “cultural drinking” is impossible in principle, and everything usually ends in an even more severe binge and a feeling of greater emptiness after leaving it.

Attention!!!

The “point” of detoxification and prescription of anti-alcohol treatment is a convenient moment to obtain consent from the patient for the need for further psychotherapeutic and rehabilitation work, and regular visits to the doctor. Therefore, specialists in “helping professions” (psychotherapists and psychologists) begin to work with patients even during the “dig out” after heavy drinking. At the same time, you can use 100% the property of alcoholics, which is more developed in them than in mentally healthy people: due to the constant chaos of life, alcoholics have better short-term planning skills. But they require skillful external leadership.

Funnel of addiction.

This is a loop, a “vicious circle” of breakdowns and exits from binge drinking, with which the biography of most alcoholics is so rich. Why does this happen and what can be done about it? We understood from the previous chapters that alcohol affects all components of a person’s life without exception - physical, mental, social, spiritual. This already speaks to the need for comprehensive treatment, and not just a “drip” or “filing” as a way to recover from alcoholism.

The first use of alcohol by a person does not yet indicate the development of addiction, but shows us the person’s psychological readiness for regular alcohol consumption. Then comes the so-called “deaf period” with a gradual increase in quantity and dosage. This first forms a psychological dependence (craving), and then a physical one (hangover).

Problems appear (physical, psychological, social, spiritual) on an increasing scale. But, as we understand, there is also the opportunity to seek medical help. And here there is one important secret of recovery. According to experts, about 50% of patients agree to maintain sobriety after withdrawal from binge drinking. Of these, approximately 35% agree to undergo discharge or outpatient anti-alcohol treatment (various options for “filing” and “coding”) Of these people, only 1% agree with the need to work with people in “helping professions” and undergo it. Their remissions are the longest and most persistent compared to those who are going to rely on “willpower”, which is overestimated in our society, or hope for the miracle of “coding”.

For the last two categories, the picture is much more predictable. After some time, such a person tells himself and others that he is “already healthy” (and many people around him believe). Then he tries to allow himself to drink “culturally” or “under special circumstances” (which is basically impossible). He does not undergo psychotherapeutic work and evaluates many, in principle, ordinary life events as reasons worthy of drinking alcohol.

He has not been involved in rehabilitation and does not quite know how a sober life is led (he has very simplified ideas about it). He does not understand that life goals should not be replaced (even with the help of sobriety), but rather realized, and does not have a long-term plan for their implementation. As a result, it usually ends in a more severe breakdown, prolonged binge drinking and yet another expensive treatment.

Attention!!!

In order to treat alcoholism with the least losses, it is best to stop the “funnel of addiction” either at the “deaf stage” (domestic drunkenness without the development of addiction, measures are mainly educational), or at the stage of the first problems arising after the elimination of binge drinking (referring the person to psychotherapy and rehabilitation measures) .

Stages of recovery.

Recovery begins with the start of treatment. A few words about the treatment of alcoholism in a clinical setting. If the patient retains sufficient intellectual abilities, successful treatment of alcoholism is possible on an outpatient basis, without hospitalization. However, the risk of loss of mental potential and personality destruction due to alcoholism is very high, and if possible, it is always better to begin treatment in a specialized drug treatment hospital. After all, even among normal, healthy people, not everyone is able to find creativity in themselves and develop it. Family plays a huge role in recovery. Often the patient’s relatives are sure that only a doctor should be involved in treatment. However, as experience shows, family and friends surrounding an alcoholic are codependent people. These people should also actively

participate in the treatment process, read the necessary literature, communicate with psychologists, understand the symptoms of the disease and support the patient during treatment. Quite often it happens that even after successful completion of treatment, the family treats him as an alcoholic. It is important that changes on a subconscious level occur not only in the person who has given up, but also in his loved ones. Otherwise, old habits will contribute to a breakdown. It is necessary to understand that alcoholism is a chronic disease, therefore it will not completely disappear, but will exist either in the form of exacerbations or remissions. The attitude and willpower after successful treatment allow the patient to remain in a state of remission indefinitely.

Inpatient treatment for alcoholism has the following advantages:

• isolation of the patient from most external factors influencing the treatment process.
• depriving the patient of the opportunity to obtain alcohol.
• providing a full range of necessary medical care.
• continuous monitoring of the patient’s condition to make the necessary adjustments to treatment.

In an inpatient setting, it is possible to carry out all the necessary diagnostic procedures for a complete examination of the patient’s condition. Based on them, the most appropriate individual course of treatment is selected. The procedures for anti-alcohol therapy are fully controlled, and if necessary, the course of treatment is adjusted. Inpatient treatment is extremely necessary in severe cases. These include, for example, the presence of third or second degree alcoholism in the patient, and the identification of serious concomitant diseases.

Delirium tremens and other manifestations of conditions close to critical also require treatment in a hospital. It is inpatient treatment that can guarantee the safest passage of the most painful stage of giving up alcohol, while the period of overcoming the consequences of binge drinking (withdrawal) is reduced, and you can begin treatment measures faster. This enhances the effectiveness of the treatment course. Despite the achieved reduction in treatment time, the required stay in a hospital for alcohol dependent patients cannot be less than 5 - 7 days. Naturally, increasing the duration of inpatient treatment increases its effectiveness and has a beneficial effect on the patient’s condition. To overcome the consequences of heavy drinking, the necessary detoxification procedures are carried out.

Typically, for alcohol addicts in a hospital setting, 2-3 droppers are prescribed daily. At the first opportunity, a set of tests is carried out. First of all, they check the liver, kidneys, and cardiovascular system.

Blood tests are prescribed - general, biochemical, urinalysis. The patient and his relatives undergo the necessary additional consultations with

Doctors - specialists. A psychiatrist - narcologist, based on the obtained “picture” of addiction, prescribes and implements a treatment program together with the patient, involves a psychologist (psychotherapist) in the treatment process, issues instructions and recommendations for the patient’s loved ones. Specialists provide assistance to the patient in independently understanding the causes the occurrence of the disease, actively involve the addict in the processes of resolving these problems. For this purpose, individual and group motivational classes are conducted. This significantly increases the patient’s conscious ability to resist addiction, and the effectiveness of anti-alcohol therapy increases.

After completing a course of inpatient treatment, the patient is not left alone with his problems. The attending physician directs him to comply with the rehabilitation therapy program and draws up anti-relapse instructions for relatives to prevent a possible breakdown, and a mandatory consultation plan is drawn up.

Treatment of alcoholism in a hospital setting lays a solid foundation for successfully overcoming harmful cravings, and creates the prerequisites for the establishment of an unlimited period of sobriety. After undergoing inpatient treatment, the patient himself and his family and friends can receive the necessary consultations from a narcologist, psychotherapist, and, if necessary, receive help in a critical situation or psychological support.

Very often in our country, the measure of recovery from alcoholism is compliance with sobriety for a period of one year. And the most common way of prescribing anti-alcohol treatment is also for one year. Is it correct?

There are a lot of such patients; without conducting sobriety tests, you can with a high probability tell how the events of their life will develop further. At the beginning, such “simply coded” patients feel fear of alcohol. This atmosphere restrains the patient and his body gradually begins to recover. Patients feel much better. Numerous days of sobriety do not pass in vain - performance improves. The approval of others causes the return of abilities lost due to abuse.

Acquaintances, observing such a person sober, wanting to provide him with support, often praise him. The “former” alcoholic cannot help but like this and becomes his vital necessity. In reality, this achievement of his in the struggle for sobriety is nothing special; the immediate superior can only note that now the patient can “work like everyone else.” But especially at first, everyone claims that this is good, because before this was impossible. They nobly strive to demonstrate to the alcoholic that he can experience the life of a full-fledged person. This is undoubtedly correct. That is, in such a patient the fear of drinking alcohol is deeply hidden, it is turned into feelings of rejection, disgust, hatred, thanks to this the patient’s well-being and attitude towards others are at their best. This combination creates the illusion of “flight.” Those who have embarked on the path of sobriety often recall the feeling of joy of their first months without alcohol. At this time, “forgotten” mental sensations appeared again, headaches stopped bothering them, blood pressure normalized, and what they used to consider incurable disappeared.

And most importantly, control of sobriety allowed me to restore self-respect. Relationships in the family and at work have changed for the better. It’s strange and sad, but these positive aspects of the struggle for sobriety in life provoke breakdowns. The fact is that a person who has fallen into the insidious network of alcohol addiction develops an altered value system. Such a person will never be able to fully receive joy from what he has and has achieved - he will always be missing something in everything. Can you guess what? That's right, sensations that sobriety cannot give...

If a patient strives to learn the science of sobriety and works on himself, seeks help, searches for his spiritual path, participates in rehabilitation programs - he knows this, and with this knowledge he is armed and reliably protected from breakdowns. But, think about it, how many of the millions who come to a narcologist for one year of sobriety do this? The prices for alcoholism treatment procedures are not scary. They filed, coded, the relatives and the patient himself calmed down, a year will pass (or maybe even less) - the period of sobriety will end...

So what is next?

That is, in the treatment of alcoholism, at least 6 stages of recovery of varying quality can be distinguished:

1. “transition”, recognition of alcohol problems, willingness to seek medical help.
2. physical stabilization (from 3 to 10 days from the start of treatment).
3. early recovery (3-6 months of sobriety) - unstable stabilization.
4. average recovery (up to 18 months of abstinence) - restoration of mental and social functions impaired by alcohol.
5. late recovery (from 3 to 5 years of sobriety) - stable remission.
6. spiritual growth and purification (lifelong). That is, in the proper treatment of alcohol addiction, we slowly and gradually move from physical to mental, then to social and spiritual growth.

Attention!!!

Achieving any of these stages already contributes to a person’s recovery from alcohol addiction. Do not be overly afraid of relapses - this is the nature of all chronic diseases. A patient with alcoholism is not “crazy” from an everyday point of view, and with modern medical capabilities, even in difficult cases, achieving the highest stage of recovery is a completely realistic, although not the most quickly achievable goal.

I decided to attach the famous article by James E. Massman.
I propose in this thread to talk about my observations of my condition during the process of “sobriety.” For beginners, I think this will be very useful.

Recovery from alcoholism has previously been described as a model of denervation hypersensitivity. Likewise, and presumably on the same basis, a recovering alcoholic may experience a wide variety of physical and emotional symptoms and symptom complexes, ranging from annoying to frightening. They are usually accompanied by significant anxiety: the recovering alcoholic fears that he will develop a serious illness. All of these symptoms should receive medical evaluation to rule out other disease processes, but sometimes a pathological case is identified. The realization that these symptoms are normal in the recovery process and not related to another illness has brought great relief to many patients: the anxiety and fear have disappeared. In particular, as the author learned, impotence, so often experienced by men, causes great anxiety, leading in two cases to suicide.

Men who realize that this symptom can be treated quickly and effectively overcome their anxiety about it. Unfortunately, knowledge of the existence of common symptoms of recovery is virtually absent among recovering alcoholics, as well as among doctors and staff of health recovery programs who exist to help the former.

As you know, recovery from alcoholism does not end after the patient is discharged from a medical institution: it is a long process of adaptation and development and usually the emergence of a new and positive lifestyle. The beauty of this development, although painful, was experienced and witnessed by many. While these social and psychological changes are fairly well known, there are a number of physical changes, or symptoms, experienced by a recovering alcoholic that are not as well recognized. Some of these symptoms are pleasant, but most cause distress to the patient, loved ones, and friends.
For example, one of the symptoms of recovery is highly distressing and is the reason why some recovering alcoholics commit suicide, even though the situation they are in is common and can be treated relatively easily. During my three years of work as a physician in the alcoholism department of the Naval Hospital and the Alcoholism Treatment Center in San Diego, I first noticed the recurrence of symptoms and symptom complexes in former patients.

In my search for means to understand the meaning of these symptoms and to treat patients accordingly, I have not found material on these symptoms in the literature on alcoholism. I believe that knowledge of the prevalence of these symptoms is a necessary part of the scientific "baggage" of professionals involved in the treatment of alcoholism; this will allow them to alert their patients to the existence of these symptoms, which will eliminate, or at least reduce, the anxiety that accompanies these symptoms in patients. Moreover, it is important to note that a recovering alcoholic may experience these symptoms well into recovery; they do not occur during the detoxification period, but may appear for several months and even up to two years after the start of sobriety.

These symptoms may be the result of the body's slow return to a normal physiological state after suffering for months and years from exposure, but they may also be associated with serious disease conditions not necessarily caused by alcoholism, and which need to be competently assessed medically rather than simply ignore.

Thus, appropriate treatment of concomitant diseases can be started immediately. Moreover, if medical examination does not reveal the presence of processes associated with other diseases, the patient can be reassured that the symptoms he is experiencing are the result of the body returning to a normal state and that with an appropriate diet and the intake of the necessary vitamins and minerals, they will immediately disappear. To my knowledge, there is no way to speed up recovery and thereby reduce symptoms; the only proper treatment seems to be time combined with reassurance and support.
Central nervous system sedatives alleviate symptoms, but the dangers of using these medications in recovering alcoholics have been established, and symptoms will return after a period of absence.

Since the central nervous system is one of the body systems most affected by the effects of , the symptoms of recovery are most pronounced in this system.

Recovery from alcoholism is described as a model of denervation hypersensitivity in relation to the overactivity and hypersensitivity of both the motor and sensory aspects of the nervous tissue during the period of recovery from alcoholism. This process appears to continue for months after appropriate detoxification and manifests itself in the form of various nerve impulses entering and exiting. The most commonly reported symptom of recovery in this area is extreme fatigue. significantly impairs normal dreaming sleep, so that after months or years of use the brain becomes very tired. Therefore, recovering alcoholics often feel extremely tired at various times during the day, especially in the afternoon after lunch and at the end of the day. There may be a need to recommend that recovering alcoholics spend part of their midday time taking a short nap.

Many patients find this therapy extremely helpful in maintaining their daily activities. Many spouses are concerned that their recovering spouse, coming home, lies down on the ottoman and sleeps until late in the evening, then goes to bed and sleeps until the morning, and thus does not participate in family affairs. It is therefore important for patients, as well as their families and employers, to know that this level of fatigue is normal and that a state of increasing alertness and activity will return after a few months.

Similarly, in the early stages of recovery, patients experience vivid dreams, usually vividly colored and exciting. These dreams range from beautiful and detailed to terrible nightmares. Some patients experience nightmares during the day in the form of short sleep or a trance-like state between periods of normal activity. Memory lapses are also common and distressing and confusing to patients who cannot understand why they forget appointments, commitments, and promises without taking medications. These memory lapses are usually limited and relatively short in duration. Incoming or sensory nerve stimuli also increase over long periods of time. As the middle ear heals, dizziness is common. It can be gradual or sudden at the beginning and is also extremely unpleasant and annoying. Deviations can be stimulated by activities, for example, being in a moving elevator, etc. or occur spontaneously.

As stated, it may take several weeks or months of sobriety before these symptoms appear, causing distress in the patient, who may imagine that he has a brain tumor or some other disease.

If these symptoms are caused by recovery from alcoholism, they will also subside spontaneously without significant treatment. Hearing becomes more acute during the first few months of recovery. Patients do not tolerate irritating and common sounds of traffic and crying children. It could also be the opposite: "I thought I had a new stereo receiver. I'm hearing new sounds." In one case, the patient did not hear the mid- and high-pitched sounds that were noted on his audiograms during many years of heavy drinking. However, in the last four years of sobriety, his audiograms show normal sound perception.

As with hearing, visual acuity increases during recovery from long periods of drug-induced depression. Many patients note the unusual beauty and brightness of light and color, being enchanted by the spectrum visible in photographs, paintings, at sunset, emanating from flowers, etc. Driving at night is a problem for some people because the lights of an approaching car are often very irritating due to the hypersensitivity of the optic nerve tissue or vision centers. A number of patients claim that during use they had difficulty choosing lenses for glasses, but during recovery their vision generally improved and difficulties with glasses disappeared. The taste becomes more and more pleasant, but sometimes not pleasant. Skin sensitivity also increases, and severe itching in the calves and ankles can be very bothersome, often disturbing sleep. To alleviate this condition, small doses of Thorazine can be used, however, in this case, time is a decisive factor, and after 3-6 months the itching suddenly stops.

Old wounds that were relatively infrequent during periods of heavy drinking now cause severe pain that does not go away with mild painkillers. Older fractures in particular can be very painful, interfering with daytime activities and sleep. Back pain is a common symptom that can be explained relatively easily. During drinking, the sensory nerves that protect the back were anesthetized, resulting in small injuries, and now the bones begin to ache during the treatment. Muscle pain and abdominal cramps are also equally common complaints. One of the more common symptoms associated with the release of nervous energy is muscle cramps. They most often occur during rest and relaxation.

Cramps usually occur in the legs. Sharp spasmodic twitching of the calf muscles or thigh muscles can cause confusion and embarrassment during receptions, at parties, etc., also when the patient falls asleep, the spasms bring him anxiety. When going to bed, there is usually a slight spasmodic twitching of the whole body. It occurs in a more severe form in the recovering alcoholic and often renders him completely awake, often occurring several times during the night and even early in the morning. The danger here is that the patient may resort to using sleeping pills in order to prevent this condition, which leads to the risk of acquiring a bad habit. Instead of these medications, you can drink warm milk with honey or herbal soothing tea (valerian, mint, etc.) with honey.

I am not a psychiatrist, but I think that some symptoms arise on an emotional or psychiatric basis, they may also be caused by physiological changes in the brain and/or endocrine glands that cause so-called emotional problems or deviations from normal behavior. For example, there is often a strong desire to sleep and bursts of activity.

The patient may indulge in his hobby or work in an avid manner for long periods of time. Likewise, he can sleep through the entire weekend. As with other symptoms, these symptoms will soften and disappear over time. Periods characterized by the manifestation of violent energy and great activity are also often observed. They are often associated with significant mood changes, which is also normal.

The state of euphoria may last for days, weeks or months, which may be unexpectedly followed by shorter periods of depression. Very characteristic is a long period of euphoria, beginning during sobriety and lasting three or more months, abruptly interrupted by several days of deep depression. This cyclical mood swing continues over the following months with gradually decreasing extremes, and mental balance is slowly restored. And again, this is the norm.

The danger here is that the patient will take either tranquilizers prescribed by a well-intentioned doctor in order to return to normal, or mood-lifting drugs to relieve depression.

Both of these methods are extremely harmful. The addiction to tranquilizers is common, and for some reason, recovering alcoholics who take mood-enhancing drugs commit suicide. Again, these symptoms are outbursts of emotional fluctuations for which time is the only known and safe method of treatment. It is hoped that by this time the patient will have achieved self-control and will receive support and strength from other people. Sober and dry intoxication can also be based on this. Emotional outbursts are also common, and both the patient and loved ones should be prepared for them if this symptom occurs.

Alcoholics Anonymous often refers to “fifty-yard dash syndrome,” where a patient begins to engage in a hobby or activity with great enthusiasm and suddenly finds that his interest in it quickly wanes and the attempt to do something stops. Sometimes this impulse of strong passion for something leads to rapid disappointment. Hopefully, being aware of this symptom will prevent any serious side effects. Also common among recovering alcoholics is severe mental agitation and the desire for unexpected purchases. For example, one patient said that he was planning to buy a used car, but instead returned home with a new Cadillac. It is hoped that the patient and his family will wait for such symptoms to subside over time.

A range of related symptoms occur in the gastrointestinal system. Appetite often increases, and the patient finds that in addition to three meals a day, additional food is required to satisfy hunger. Sometimes this is associated with excessive weight gain. In this case, there is no need for sophisticated diets and no need to take pills, but it is recommended to follow a diet that provides the required amount of vitamins, minerals and nutrients. Conversely, many recovering alcoholics lose weight despite significant increases in food intake.

I have no immediate explanation for this symptom except that it is caused by an increased need for food in the body, and especially the brain, as well as increased physical activity and some emotional instability. One patient I know lost about 35 feet of weight despite eating a lot of food. A thorough medical examination did not reveal any pathology.

The weight loss stopped suddenly after 6 months, and the patient gradually began to gain weight to a level that would satisfy any insurance company. Along with this, many recovering alcoholics experience a redistribution of body weight. Some patients with large bellies find that their belly shrinks while their upper body becomes wider. Food abuse is common. For some, this manifests itself as a desire to consume more sugar. Hypoglycemia is a common and long-term problem for many recovering alcoholics, and this condition may be exacerbated by consuming regular sugar, while consuming protein foods allows for a slower release of sugar and prevents insulin and sugar imbalances. Again, in this case, an appropriate diet is recommended.

Other food abuses include increased consumption of vegetables and fruits. Many recovering alcoholics abuse carrots, consuming pounds of carrots in one week. Recovering alcoholics often bring home large quantities of oranges. Apparently this also applies to other citrus fruits and potatoes. Many foods can fall into this high consumption category, and people seem to have different cravings for different types of food.

Undoubtedly, all this is explained by the need experienced by the body for certain things that were absent from the diet during drunkenness, and also as a result of insufficient absorption, and are now required for recovery. Symptoms of pancreatitis may persist for some time in the initial stages. They usually appear as a mild, dull pain, similar to a toothache, in the joints of the ribs and lower back.

Like all symptoms of recovery, these symptoms should be evaluated by a competent physician. If the test is negative, the patient can usually be confident that these symptoms will subside in time. Increased work endurance is likely due to improvements in the cardiovascular system, as well as the skeletal and muscular systems.

The heart, which beat unevenly and intermittently during the period of drunkenness, now returns to its normal rhythm. Blood pressure becomes normal. Chest pain, which may not necessarily be associated with heart pathology, also subsides. The condition of the skin reflects a large number of physiological changes. Some of them are pleasant, others cause suffering. For example, acne is a common problem for many people recovering from alcoholism and is obviously distressing for men and women in their thirties. This is probably explained by the fact that the gastrointestinal tract can now absorb dietary fat in normal quantities, whereas during the period of drunkenness it passed relatively unabsorbed. The skin cannot cope with this oil, hence the appearance of acne. Treatment with appropriate soaps and lotions helps, but the skin returns to normal over time. The positive thing about this symptom is that the skin becomes softer and more pleasant over time. Hair quality also improves. Body hair may also increase. Men with previously deprived breasts may develop some chest hair. The pubic hair also becomes normal. Oily hair is often less troublesome, while dry and brittle hair is more attractive and pliable.

Many people during periods of drunkenness complain of contact allergies of various types. The most common of these is wool allergy. Many of my friends were able to wear wool suits and clothes again, and their allergies to them went away.

The feeling of intense cold in the calves, feet and hands, which may be caused by neurological, skin or vascular reactions during the period of drinking, passes, and the hands become warm and moist, and the feet return to normal temperature. The purple tint of the feet, so often observed in people who drink, takes on a normal pink color. Hair on the fingers and toes also begins to grow back. This is likely due to both increased blood circulation in these peripheral structures and increased metabolism in the tissues. Women who experienced spontaneous abortions and other problems associated with childbearing during their drinking period can now have a child at a normal term.

Similarly, frequent menstrual irregularities disappear and menstruation becomes normal. negatively affects sperm physiology; many men suffering from infertility during a period of drunkenness contacted me about this after a year and a half of sobriety.

The most important and sometimes life-threatening symptom of recovery is impotence, although it is usually temporary and, with appropriate help, may not pose a major threat. Many men, in order to establish a connection with women, resort to, which eliminates prohibitions, taboos, acquired either by themselves or imposed on them by society. And now that this drug is missing, prohibitions and taboos begin to operate. This period of time is very difficult for many men to endure.

Many men have told me about their inability to achieve an erection despite the attractiveness of their partner or the desire of both partners. A person without prejudice endures this situation with humor, while the opposite person is seized with panic. I know one man who, thinking that he would have impotence permanently, decided to deal with it by self-destruction. This is a very difficult case. However, it is hoped that men who find themselves in this situation will have an understanding partner who will treat them with compassion and empathy and help them both get through this difficult period of time.

In more severe cases, appropriate advice can be resorted to, although none of my patients needed this. Also, short periods of relative impotence may occur for no apparent reason. With a loving, caring partner, this symptom will lessen over time.
Most of the recovering alcoholics I know have successfully overcome this symptom and now feel that their sex lives have become incredibly wonderful, and they now experience much greater joy from sexual intercourse than when they resorted to alcoholism. Their partners were also very pleased with the significant increase in their male power. If this issue is approached wisely, increased potency can be one of the most significant incentives for a recovering male alcoholic. Increased sexuality enhances his masculine essence, which manifests itself in increased business activity and sociability. All this greatly contributes to the emergence of self-esteem, which is so vital for any person.

The opposite of an understanding partner is one who is unwilling to help. Especially if the person in recovery is in the early stages of impotence, covert or overt ill-will can be extremely detrimental and increase naturally occurring anxiety to incredible proportions, as well as increase impotence in future contacts. I must equally acknowledge the importance of both the loving and caring partner and the opposite one whose behavior is detrimental to the person in recovery.

It is believed that many recovering alcoholics do not suffer from this symptom, but this does not mean that this situation is common. The appearance of impotence is often noted and it can cause emotional distress, which should be paid special attention to. Several recovering female alcoholics have also complained to me that they experience a similar symptom, but the nature of my professional association with mainly male patients prevents me from studying this aspect of sexual problems.

It takes at least one year for the body to return to its normal physiological state. Even if laboratory tests, external examination and other studies do not show any abnormalities after a period of six weeks to two months after detoxification, the body's systems cannot be considered to have returned to a completely normal state after this period.

Also, to return to a similar normal emotional and psychological state requires at least two years, provided that the recovery program is completed. These emotional changes do not occur completely spontaneously; they require the help of other people - Alcoholics Anonymous, doctors and caring, loving people and household members.

Great patience from spouse, children and co-workers is necessary and, I repeat, comfort, support and encouragement are key factors in helping the strengthening, recovering alcoholic reach his full potential over a period of time.

Longtime members of Alcoholics Anonymous state that as they continue in their recovery program, they continue to recall times in their lives when they experienced continued growth, emotional maturity, and physical improvement that lasted for many years. years of their sobriety. These are some of the most beautiful parts of recovery from alcoholism. It is not necessary to become an alcoholic to experience these wonderful aspects of life, but for many, the crisis in life caused by abuse has become an incentive to engage in an ongoing and constant process of growth; Unfortunately, the average person does not have such an incentive.

In conclusion, it is necessary to re-emphasize what I said earlier. The symptoms described should be considered normal symptoms of recovery, but they may also reflect significant pathological changes that are not necessarily associated with recovery from alcoholism. They should be examined by a competent physician to rule out the possibility of an underlying condition. In the absence of significant results and abnormalities determined by laboratory tests, there is a high probability that these are normal symptoms of recovery. If the symptoms persist, it is necessary to undergo a second medical examination.

In this lecture, we will get acquainted with the process of recovery from chemical addiction, learn the stages or stages of this process, determine what tasks need to be solved at each stage, and outline a plan for our further actions. Let's start with the question: what is recovery?

Let's imagine a person's personality in the form of a circle, which consists of the following spheres:

physical, mental, emotional, social, spiritual. Chemical dependence is a disease that causes loss of control over the use of alcohol and other drugs. In turn, this leads to problems in all areas of human life. During the recovery process, an alcoholic or drug addict goes through the stages from destructive addiction to full physical, psychological, emotional, social and spiritual health. Recovery is a meaningful, comfortable life without the need to use chemicals. Cleanliness and sobriety are more than just restoring what has been destroyed. It is a new way of life that promotes a continuous process of personal growth. The healing process for no one is accomplished in one day, it is a long process that goes through certain stages or phases. The evolutionary model of recovery embraces growth through movement and change. It is a consistent effort to acquire new skills and abilities. We can recover by starting with simple abstinence and achieving meaningful, comfortable sobriety.

The healing process is based on a number of concepts:

1. Recovery is a long-term process."
2. Recovery requires complete abstinence from alcohol and other drugs.
3. There are basic principles that govern the recovery process, which include the 12 step program."
4. The better we understand and accept these principles, the easier it is for us to recover.
5. Understanding alone does not lead to recovery.” It is necessary to use new knowledge in life.
6. Success in recovery depends on how a person copes with the tasks (problems) that come his way without using drugs or alcohol

The healing process goes through a number of stages,

Transitional stage

At this stage, a person realizes that he has serious problems due to the use of chemicals. He realizes that he can no longer live like this.

Stabilization stage

Recognizing the fact of your illness, accepting responsibility for your recovery, recognizing the need to do something.

• Early recovery stage.

  A process of internal change is taking place. At this stage, we learn to feel comfortable in sober life. The physical craving passes. We are beginning to learn more and more about the nature of the disease. We gain the ability to solve the problems of using chemicals. This stage ends when we begin to put into practice what we have learned through working the 12 step program.

• Medium recovery stage.

  At this stage, there is a reassessment of relationships in the family, with friends, and compensation for the damage caused to us and others in a past life. This stage ends when stability and balance appear in the lifestyle.

• Late recovery stage.

  The late recovery stage solves three important problems:

  1. Identification of problems that arose in adult life as a result of growing up in a dysfunctional family.
  2. Getting rid of complexes that appeared before chemical dependence developed.
• The stage of maintaining sobriety and cleanliness.

  This period is accompanied by personal growth and daily work on the recovery program.

  Let's look at the table that defines the tasks at each stage of recovery.

Stage name	Main goals
1. Transitional.	Refusal of attempts to control drug use -
2. Stabilization.	Restoring the body from the consequences of consumption.
3. Early recovery.	Internal changes. Changing our thinking, feelings, and actions regarding use*
4. Average recovery.	External changes. Repairing the damage done to our way of life.
5. Later	Overcoming children's complexes and
recovery.	shortcomings.
6. Maintaining sobriety.	Balanced life. Personal growth and development.

Let us consider in more detail how changes occur at each stage, how the bio-psycho-socio-spiritual model of a person’s personality changes.

Stage 1. Transitional stage.

The main question at this stage is: “Am I sick or not?” You shouldn't answer this question alone. At this stage, we can go through attempts at temporary abstinence in order to then “control” the use, through the analysis of our beliefs: “I don’t have such a problem, because now I don’t use...”, “now I know what the consequences will be.” and I won’t use...”, “I can handle it myself”, in order to recover, it is necessary to change the position: from the position “everything is fine with me” - to the position “I am a chemically dependent person”, “I am an alcoholic ", "I'm a drug addict." We need to accept help from other people. This stage ends when we recognize the need for help and seek it.

Stage 2. Stabilization stage

During this stage, the focus is on physical recovery from withdrawal symptoms. As a rule, this problem is solved by a medical procedure for cleansing the body of drugs or detoxification. Problems with sleep and memory go away; clarity of thinking appears; awareness of your feelings. During periods of low stress, withdrawal symptoms are less severe. If the stress level increases, the syndrome returns. Emotions become either reactive or completely frozen, clarity of thinking is lost: “The brain goes on a lunch break.” Many people mistake the effects of long-term withdrawal (subacute hangover/withdrawal syndrome) for mental illness.

Treatment of long-term withdrawal symptoms,

1. Attend AA and NA groups.
2. Communicate with your sponsor.
3. Use the slogans of the 12 step program: “First things first”; “Call your sponsor before, not after; “Wait for a miracle” and others.
4. Fill your time with activities.
5. Organize balanced meals 3 times a day.
6. Give yourself enough time to rest and sleep.
7. Do physical exercise"
8. Learn techniques for dealing with stress.

Let's move on to mental health. The main goal of mental healing during the stabilization stage is to stop experiencing mental preoccupation with the use of the chemical substance. Cravings are a serious problem during this period. Drug use has damaged the brain to the point where it becomes dominated by self-destructive thoughts. Cravings arise as a result of such thoughts. To understand the nature of this phenomenon, it is necessary to understand the sources of thrust formation. This may be the result of the following factors:

1. Euphoric memories of use (the “good old days” syndrome).
2. Obsessive thoughts about the possibility of using a substance.
3. Inability and unwillingness to deal with your problems.
4. 0freedom from the feeling of responsibility for your recovery.
5. Compulsiveness, irresistible attraction, rash actions.

This can be avoided if you recreate the medical history in all its details. This is an objective, critical attitude towards the period of use. An alcoholic or drug addict tells his story in groups, thereby destroying the effects of these factors and gaining experience in solving his problems, at the same time creating his own story of recovery.

We become convinced that withdrawal symptoms can be overcome, and we become convinced that life is getting better. If you follow the principles of the 12-step program, then anxiety, obsessive thoughts, and compulsive behavior go away. We begin to believe that recovery is possible. We are increasingly interested in the nature of our disease, but there is still a lot of work ahead. This is an indication that we are ready to enter the next stage of recovery.

Stage 3. Early recovery.

At this stage of recovery, the main role is given to “Understanding and Acceptance”, i.e. Attitudes, views and concepts regarding use change. Our understanding of addiction and the role addiction plays in our lives is changing. In early recovery, the emphasis is on correcting the mindsets associated with our addiction.

What is the problem with thinking? In irrational thoughts, uncontrollable feelings, defeatist, self-destructive actions.

Work on 12 helps in overcoming these problems — step program.

In early recovery, we learn the vocabulary necessary to understand and describe what happened and what we need to do to maintain positive change, begin to learn about our addiction and what we need to do to stay sober and clean. At this stage, two types of changes are assumed: in the sphere of feelings. beliefs, motivation and changes in the process of understanding the laws and principles of addiction. We can judge that our understanding is adequate if we are able to prove to others that we are chemically dependent people when they try to convince us otherwise. Acceptance of chemical addiction is the ability to remember and think about what happened during our period of use without experiencing pain. This is an emotional process of releasing the feelings of shame, guilt and pain that we accumulated during the period of use. Many people in recovery carry these negative feelings for years. That is, they can live comfortably, but when they start talking about their past, the feelings of guilt and shame return. Many of us try to cope with these feelings by trying not to remember the events that caused these feelings, and this helps for a while, but eventually the feelings of pain, shame and guilt return. Freeing yourself from these painful feelings is the goal of emotional recovery at this stage. Painful feelings are the result of traumatic memories that we refuse to talk about. We often brush aside the facts, considering these events to be insignificant and meaningless. We may say to ourselves: “I was drunk or on drugs then. Why bother now when I’m sober and clean.” However, what happened has long-term emotional consequences. Pain seems to be recorded and registered in our subconscious, and in the future, any situation can trigger the memory mechanism, and then painful feelings will return to us. Painful memories persist despite attempts to suppress them in our minds, and every time they surface, we get into the habit of blocking them out. Unfortunately, this does not solve the problem of final memory and painful feelings will return again and again.

Let's look at four ways to free yourself from these memories:

1. Listen to other people's stories.
2. Tell your stories
3. Participate in the psychotherapeutic process.
4. Work according to the 12-step program, paying special attention to steps 4 to 7.

Stage 4. Moderate recovery.

At the stage of average recovery, we move on to external changes and begin to restore those areas of life that were destroyed by our addiction. At this stage, much attention is paid to our social health. It's not an easy process, but if we keep working hard, we can bring new meaning, purpose and happiness into our lives. If in early recovery the focus was on staying clean and sober, e.g. We lived a “one day” program, mastering the skills necessary to maintain sobriety, then at the stage of average recovery we turn our attention to a lifestyle that does not always bring us satisfaction. The main problem of this period is overcoming the “defeatism.” We are disheartened to discover that internal change is not the end of the healing process, but only the beginning of fundamental changes in our lives. During this period, we are faced with the main question - the question of choice: to build a new lifestyle according to the principles of the 12-step program or to avoid any changes in life. Those who have the courage to move forward are ready to face reality. They are ready to find purpose and meaning in life and sobriety. To make the right choice, we need:

• firstly, a firm conviction that restoration of what was destroyed in the past is possible, and that building a new, better life is also possible;
• secondly, we also need to believe that change comes at a price, but change is worth the price.

Once we have faith that a balanced life is possible, we can make the choice to move forward. At this stage of recovery, we move out of the “victim” role. We have a choice.

The goal of this stage of recovery is to “make amends.” And although we are not to blame for having a disease, we are responsible for our recovery, A In the process of this work, the 8th and 9th steps of the program are invaluable assistants.

By balancing our lives, we begin to enjoy life in all areas: physical health, psychological health, which is characterized by clarity of thinking, the ability to reason logically, manage feelings and emotions, the ability to determine what we feel, and the ability to express these feelings appropriately to other people. We are able to sincerely evaluate ourselves: “Who am I? What do I deserve in life? In the social sphere, we learn to function in family, intimate relationships, and communicate with friends. We learn to cope with the ups and downs of everyday life. Job satisfaction provides a sense of purpose and meaning. We develop a relationship with a Higher Power. We learn to trust ourselves enough to accept the consequences of our decisions.

Stage 5. Late recovery.

Its main goal is liberation from childhood problems. Those of us who grew up in healthy families move through late recovery quickly, without complications." For those who grew up in dysfunctional families, the process is more difficult. More typical problems of late recovery:

1. Inability to solve one’s own personal problems, although similar “other people’s” ones are being solved.
2. Inability to manage feelings. Most of us either “turn off” our feelings in a stressful situation, or react reactively, violently, and hypersensitively.
3. Rigidity of habits. Reluctance to change your behavior.
4. The need to care for others and save others.
5. The need to fit in, to do what other races expect.
6. The need to appease others. "Peace at any cost."
7. The need for defiant behavior, violation of rules.
8. The need to blame others for our own problems.

There are no special steps to solve these Problems. Only indirectly do the 4th and 5th steps relate to these problems. What needs to be done during the late recovery stage is:

1. recognition of childhood problems and their identification;
2. gaining knowledge about the family model;
3. restoration of childhood history;
4. establishing connections between childhood problems and adult life problems;
5. lifestyle change.

When this work is completed, we move on to the final, sixth stage - stages of maintaining sobriety and cleanliness. This stage lasts a lifetime. At this stage, work is underway to create a high-quality lifestyle. The process of growth and development continues. If we have reached this stage, this does not mean that we do not have difficulties. Work on their coping continues using a 12-step program.

Recovery is a process of change. Changing yourself can be an exciting journey. This lecture shared the experiences of many recovering chemical dependants, and you can benefit from them.

Used in a rehabilitation program. The separation of stages helps to improve the assessment of the patient’s condition by workers and by the patient himself in the recovery process.

Stage 1 of recovery “Transition”.

First stage includes work on recognizing powerlessness over the problem of alcoholism and drug addiction, recognizing the loss of control over the problem.

Many, even admitting their powerlessness over the problem, try to control their use by reducing the dose, setting the time and timing of possible use. Even when entering rehabilitation, the addict is motivated not by complete recovery and stable remission, but by reducing the dose for further use.

This stage ends with the recognition of powerlessness over alcohol and drugs, and the lack of desire to control drug use.

An addict who seeks help does not always have an idea why he lost control, why drug use cannot be stopped, and why all attempts to overcome cravings ended in failure. Our task is to help in realizing the problem and accepting it as something that has already happened. In AA communities, these symptoms are called fatigue fatigue.

It is important for us that sobriety is not just a healing of wounds, but a way of life.

Stage 2 of recovery. "Stabilization"

Stabilization. Healing from damage caused by use.

During the second stage - stabilization- we already understand that we have big problems with mind-altering substances, and that we need to completely stop using them, but we are not yet able to do this. During stabilization we are recovering physically from the effects of drug use. Withdrawal syndrome lasts individually for each person; for some it may take a month, and for others much longer. This period is the most difficult, as there is a struggle with oneself, how to resist the first glass or injection. At this stage, after the body has recovered from withdrawal, addicts experience mental distress and emotional mood swings. This stage is one of the most important in the rehabilitation process, for which maximum resources are involved. Work with psychologists, group therapy, and occupational therapy.

Stage 3. Early recovery

The third stage is early recovery: this is a time of internal changes. At this stage, we learn to live in society and feel comfortable abstaining from psychoactive substances. The craving for alcohol and drug use weakens, and we delve into the problem that led us to addiction and how it affected us. We learn to overcome feelings of shame, guilt and remorse. The task of this stage learn to cope with your problems without turning to drugs. Early recovery ends when we are ready to begin applying what we have learned to improve other areas of our lives.

Stage 4. Average recovery

During mid-recovery, the fourth stage, we learn how to repair past damage and find balance in life.

We learn that full recovery means “applying these principles (the sober living skills we learned in early recovery) in all we do” (in the real world of everyday life). During the period of average recovery, repairing relationships with people becomes a priority. We overestimate our significant relationships, particularly with family and friends, as well as our careers. If we find ourselves unhappy in any of these areas, we accept it and plan to do something about it. In AA terms this is called “making amends.” We realize that we have harmed other people. We want to take responsibility and do everything we can to make amends. Average recovery ends when we achieve a balanced and stable life.

Stage 5 (not for everyone)

During the fifth stage - “late recovery”. Our task is to focus the children’s attention on overcoming obstacles to a new “sober” life, which were formed since childhood. Long before a person became addicted. Many drug addicts come from dysfunctional families. (Families where parents did not fulfill their parental responsibilities). Due to the lack of proper upbringing, the child was not able to acquire the standard skills in order to be happy. The purpose of the center, if necessary, is to show a person about possible adult problems caused by growing up in a dysfunctional family, and to help to recover in this area, to resolve current problems, despite the obstacles caused by how the parents raised them.

Stage 6: Maintenance

The final part of recovery is “maintenance.”

Those undergoing a course of recovery from drugs or alcohol receive the necessary information on how to move on with their lives, how to overcome obstacles and maintain sobriety. At the final part of the recovery process, the addict’s task is to put all the information received into practice.

Constantly working on oneself and current problems makes it possible to become more resistant to the problems of alcoholism and drug addiction, and the ability to self-develop in society.

Recovery stage	Main theme
Transition	Stop trying to control your alcohol or drug use.
Stabilization	Healing from damage caused by use
Early recovery	Internal changes (changes in thoughts, feelings and actions related to alcohol and drug use).
Average recovery	External changes (correction of lifestyle disorders caused by addiction and development of a balanced lifestyle).
Late recovery	Outgrowing the limitations of childhood
Maintenance	Living a balanced life and continuing to grow and develop