This post covers the last three stages in the Prochaska-DiClemente change model, the Maintenance, Relapse, and Termination phases. How these are approached depends upon the action method you choose, and whether your goal is abstinence or moderation of your addiction. As are the other stages, these are fluid, and should be looked upon as a continuum, not as though they are hard-and-fast categories.
Maintenance – learning to live
After a few months of action in your chosen method, you’re starting to feel pretty good about yourself again. “Unconditional Self-Acceptance,” which we haven’t mentioned yet, but will be in important tool in your program no matter which one you choose, will have really kicked-in, and you should be starting to do some long-term goal-setting. Your emphasis here is in truly making the new thought processes you are learning such a part of you that using just isn’t something you can conceive of doing any longer. You are becoming a different person, and life without your drug-of-choice is something you can not only conceive of, but you are actually planning it.
You have learned how to cope with urges, and their getting further apart and far weaker then they were when you first stopped using. The tools you learned for coping with them should be part of who you are now, and should come into play automatically. An athlete practices over and over to make routine movements, like a gulf swing for instance, part of “muscle memory,” something they don’t think about, their body just does it, consistently. The tools you have learned and practiced for urge control should be just like that, they kick-in automatically whenever called for.
Relapse prevention is a key in this stage. You are building healthy relationships with others, some recovering, some not, and you are seeking support from an ever-growing circle of friends and acquaintances. You don’t want to return to your “old life,” and are learning to make the changes within yourself that will make such a return if not impossible, than at least highly unlikely. At some point during this stage, most of us suddenly realize that they haven’t had an urge to use for quite some time. Oh, the thought might pass through our head, but before it becomes an urge it is turned into a diaphanous phantom by our new belief system, and it simply vanishes, perhaps accompanied by a chuckle, or satisfied smile.
It’s not urges that are the biggest danger at this stage, but learning how to deal with the every-day frustrations of life, or living life on life’s terms. As we discussed in an earlier chapter, the bio-physical part of becoming substance dependent changes your dopamine response and limbic system forever. As a substance dependent person, you are simply more susceptible to the stresses of everyday life than are those who have not been dependent. The old joke in AA is: When a “normal” person has a flat, they call Triple-A, when a drunk has a flat, they call the suicide prevention hotline.” There is a grain of truth to that, and the addict must learn to deal with frustrations and resentments, and we do that by changing our thought process, which alters our belief system, and keeps our stress level down.
It’s usually not life’s “boulders” that are most likely to bring about relapse, studies show, it’s the cumulative effect of the “pebbles” we encounter on a daily basis that are really the most dangerous. Each little resentment, each little “she should do this,” or “he shouldn’t have said that,” or “this should have been this way” is what does us in. “Must,” have to” and “should” beliefs are what we are learning to control at this stage, because getting them under control will go a long way towards preventing relapse. I have personally known several people, and heard of many others who were sober in AA for long periods of time, ten -fifteen – twenty years and longer, going to meetings all the while, who got some petty resentment or other over something minor someone did or said, and they ended-up relapsing over it. There is just no reason for things like that happening, and they won’t as long as you choose a recovery method that is designed to deal with the minor resentments we all face from time-to-time.
Relapse: The option you don’t want to exercise
I said this before, and I will say it again: Relapse is not a requirement in any recovery program that I’m aware of! If you have decided that abstinence is your goal, and that is your choice, not a foregone conclusion, by the way, a relapse, or “slip” which is a common euphemism for it, does not constitute an excuse for an extended period of using. It also is not a reason for you to indulge in self-reproach or guilt. You are learning new skills, a whole new way of living, and sometimes, in spite of our best efforts, we make mistakes. If properly handled, mistakes are sometimes very valuable learning experiences.
Using, when one is sober for some period of time, is always a choice, always! According to studies, most relapses occur in the first five years of recovery, with the vast majority occurring in the first year, especially within the first three months. This is the period of time in which we are staying sober mostly on the strength of the resolution that moved us into the action phase to begin with. We are just beginning to use the tools of the method we have chosen, and are experimenting with a new way of living. We are also just learning to except ourselves the way we are, as worthwhile human beings, and it’s vitally important that we don’t let a single setback, or even a series of them, derail us from the effort we are undertaking. We must consider setbacks as a possibility that could happen as part of the natural change cycle we are going through.
In any case, a slip or relapse is NOT an excuse to declare your attempt at change a failure and give up. Rather, you should examine the experience honestly, with an eye towards what caused it, what were the precipitating events, what were your beliefs about them, and what might have been askew with those beliefs. Sometimes, you have to go back to your CBA, perhaps there is still something lurking in your mind that still sees a long-term advantage to continuing to use. It doesn’t matter what your conclusion is, as long as you learn from the experience.
If your chosen change method includes a group of some kind, either face-to-face or online, or a counselor, discuss your slip honestly with others; bring it up yourself without being asked. Listen; really listen to the feedback you get. Often others see and recognize things that we do not, but we must be open to conclusions that might be hard for us to accept, especially when they contradict things that we “know” to be true about ourselves, or about the world around us.
Termination: Moving on with our lives
I wish the researchers, Prochaska and DiClemente had used the word “Graduation,” it’s a much more pleasant word, but there is a point at which you will become an ex-user, and go on with your life. Yes, I know, 12-step recovery programs all tell you that you never recover, you are never cured, and you can never, ever stop coming to meetings. Problem is, the studies do not support any of those statements. 75% of recovered substance abusers never went to more than one or two 12-step meetings in their entire lives, and they did just fine. Thousands of people have recovered using self-help groups other than 12-step, and have gone on with their lives. In fact, 12-step is the only recovery program that inculcates lifetime meetings, and in every single study, it’s the least effective program there is.
Most recovered substance abusers worked at some sort of program, either self-directed or with help, for periods ranging from nine to twenty-four months, with the average being about eighteen months. By that time, old behaviors and ideas have been replaced with new ones, and the person who used and abused drugs and alcohol simply no longer exists. Some people, at this point, enjoy working with others, and continue in some capacity with their chosen support groups, starting new meetings, facilitating meetings, etc. just for the satisfaction that working with others brings, some write books, but most just go on with their lives as productive men and women.