The toughest part of trying to recover from alcohol and drug use disorders comes during this stage when a number of issues make it difficult to focus on learning to live a sober life and make trying to stay clean and sober a struggle. It is the second of four stages of recovery or rehab defined by the National Institute on Drug Abuse:
Treatment Issues
If you have entered a specialized alcohol and drug treatment facility or you are getting professional help from a physician’s office or outpatient clinic, you will work with trained addiction specialists, which can include counselors, physicians, psychiatrists, psychologists, nurses, and social workers. In the early abstinence phase of your treatment, they will help you recognize the medical and psychological aspects of alcohol and drug withdrawal, identify triggers that prompt you to use drugs or alcohol, develop techniques of avoiding triggers and learn to handle cravings without using. Physicians also focus on the physical harm caused by poor nutrition associated with heavy drinking. In the early phase of alcohol abstinence, B vitamins, magnesium, zinc, C vitamin D, and omega3 fats need to be restored. Research has found that that people with alcohol use disorder frequently have a poor nutritional status that influences both physical and psychological health and can contribute to difficulties resisting alcohol during recovery. A critical part of recovery is establishing a good diet that replaces the empty calories of alcohol. Following are some of the issues that your counselor will try to help you with during the early abstinence stage of recovery:
Addiction and Associated Symptoms
If you have sought help to quit drinking or doing drugs, chances are you have developed some level of chemical dependence or addiction to your drug of choice. Your counselor will help you identify behaviors you have exhibited that could be considered addictive, such as how much time and effort you have put into pursuing your drug and your continued use in spite of negative consequences. Your counselor will also discuss the health effects that can be caused by your substance abuse, and by your withdrawal from it. If you were an intravenous drug user, for example, your counselor will try to determine if you have engaged in other high-risk behaviors and if you may have contracted the HIV virus.
Relapse Triggers
It’s likely that during your substance abusing days you associated your drinking or drug use with certain people, places, and things. Perhaps you always stopped by the same bar or you only used drugs when around certain people. You may have had a favorite glass you drank from or a favorite crack pipe. All of these can be triggers that can cause you to relapse. It is absolutely critical to your continued abstinence that you avoid the triggers and other high-risk situations. Your counselor will help you identify the people, places and things that you associate with your drug use and help you develop strategies for avoiding these triggers. The caseworker or counselor will also help you learn to develop alternative responses to high-risk situations when they do occur, such as someone offering you drugs or being in social situations where alcohol will be served.
Filling the Time
If you are seeking help for an alcohol or drug problem, you probably spent a great deal of time with your drug of choice. One of the symptoms of addiction is the amount of time the drug use assumes in the individual’s life. Once you quit, there will be a void in your daily schedule and/or a sense of loss. You may be used to a daily schedule that is chaotic and disorganized, due to your drug pursuits. You may find it difficult to imagine what you will do now that you are no longer using drugs or drinking alcohol. Your counselor will work with you to develop a daily or weekly schedule to help you begin to structure your time and to replace your drug-seeking and using activities with healthy alternatives. Order and structure can help to lessen the risk of relapse.
Craving and Relapse
Not everyone experiences cravings during early abstinence, but for those who do, it can become overwhelming. Craving is a strong urge to return to drinking or using drugs. Craving can be both physical and psychological to the point that you can become obsessed with thinking about using again. The counselor will help you recognize what a craving feels like and help you find ways to cope. This might involve such things as psychological strategies, nutrition, and medications.
Coping strategies: This often involves learning to “sit the craving out.” You do not have to respond to the urge in a self-damaging way. Your counselor may help you find other ways to manage such as distracting yourself until the craving passes. Nutritional therapy: It is not uncommon for people entering alcohol recovery to have deficiencies in nutrients such as protein, B vitamins, and zinc. Nutritional approaches aim to help correct these deficiencies to decrease alcohol cravings and improve recovery success rates. Medications: Your doctor can also prescribe medications to help reduce cravings for alcohol. Naltrexone, Campral, and Antabuse are the three medications currently approved by the FDA for the treatment of alcohol use disorder. Other medications such as Topiramate, baclofen, selective serotonin reuptake inhibitors (SSRIs), and ondansetron may also be used off-label.
Social Pressures
For many people who have alcohol or substance use disorders, their entire social life revolves around their drinking buddies or drug-using friends. After you enter recovery, you may find that most, if not all, of your friends were other people with alcohol use or substance use disorders. These friends can put a tremendous amount of pressure on you to relapse. They may not want you to recover, because if they accept that you have an alcohol use problem, that means that they probably are, too. Consequently, they may blatantly or subtly try to sabotage your recovery. Your counselor will strongly encourage you to avoid your old friends at all costs during early abstinence. You will be encouraged to make new, sober friends. You will also be encouraged to participate in support groups, such as Alcoholics Anonymous or Narcotics Anonymous, where you can develop positive relationships with drug-free and recovering people.
Post Acute Withdrawal Symptoms
The physical withdrawal symptoms from quitting alcohol and drugs go away in a relatively short time, usually less than a week. But many people will experience long-lasting changes in mood, affect, and memory throughout early abstinence. If you develop any of these symptoms during your treatment, your counselor will try to help you realize that they are the result of your alcohol or drug use, that they can’t be self-medicated, and, like cravings, will pass.
Use of Other Drugs
You may decide that you are really only addicted to your drug of choice, although you frequently use another drug or drugs as well. If you used cocaine, for example, you may not consider your alcohol consumption to be at a problem level. Or if you were a problem drinker, you may consider smoking marijuana to be less harmful. During your treatment, your counselor will encourage you to achieve total abstinence. Here are the reasons that total abstinence is critical to your recovery:
Other drugs, such as alcohol, can trigger a craving for your drug of choice.You might transfer your addiction from one drug to the other.If you continue using, you will not learn how to cope without mood-altering aids.
Getting Through Early Abstinence
This stage of recovery is not easy, which is why few manage to accomplish it without help. If you are in a professional treatment program, you will receive the support and encouragement you need to make it. You will set and meet goals that are necessary for your continued recovery. Your counselor will help you establish a drug-free lifestyle that involves participating in support groups, avoiding social contact with drug-using friends, avoiding high-risk situations and triggers, and replacing your former drug-related efforts with healthy recreational activities. You will be given the tools you need to live a clean and sober life. Return to The Four Stages of Recovery
