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The Stages Of Alcoholism And Recovery

Are you thinking about quitting drinking?

To better understand what it will take for you to get sober, you may be interested in learning a bit about something called TTM to help you to understand the alcohol recovery stages.

What is TTM?

TTM is an abbreviation for the transtheoretical model. It is also known as the “stages of change” and has been the subject of various self-improvement books, including “Changeology” and “Changing to Thrive.” TTM describes the steps that you will likely go through to get from where you are now to being clean and sober. These six stages of alcoholism and recovery will give you a better understanding of the road ahead that will lead to your ultimate success.

Who came up with TTM?

Two psychologists and their colleagues came up with TTM in the 70s. They based their work on a variety of psychological theories. They were able to distill these many theories down to six simple stages.

Here is how you can thrive with the stages of change.

The stages of TTM are as follows:

  • Precomtemplation
  • Contemplation
  • Preparation
  • Action
  • Maintenance
  • Termination

By understanding this natural progression that occurs for many people on the path towards sobriety and recovery, you can make the best decisions possible to move forward quickly and safely.

1) Precomtemplation is before you are ready.

The first stage that you will be in is pre-contemplation. At this point, you are not ready to take action and make a change in your life. If you are drinking too much, alcohol is causing problems for you in your life, but you have no intention to look for a way out yet.

2) Contemplation is the “getting ready” stage.

When you reach this second stage, according to the transtheoretical model, you are getting ready to make a significant change in your life. You are contemplating the pros and cons of your harmful drinking. If you are familiar with the 12 steps of Alcoholics Anonymous, you may think of this as being the first step. At this stage, you admit to yourself that there is a problem. However, you may choose a different recovery path from the 12 steps because you decide not to consider yourself to be powerless as the first step of AA states.

3) The preparation stage is when you are ready.

At this stage of TTM, you are finally ready to take action and do what you need to do to change your life. If you are drinking too much, you are now looking for answers. It’s not easy quitting an addiction. There is nothing wrong with asking for help. At this stage, you are researching the subject and looking for the best way to move forward. You may consider going to detox and rehab. Or, you could try an alternative solution, such as the Sinclair Method. TSM uses the medication, naltrexone, to help you gradually reduce your drinking. Another consideration is therapy. You may want to find out if there are psychologists in your area who specialize in addiction and alcohol use disorder. If there is not a psychologist nearby, you may want to consider an online therapist. Telemedicine is flourishing in the field of psychology and psychotherapy. Going beyond telehealth is something called Prescription Digital Therapeutics, using a phone app to provide FDA approved and doctor-prescribed digital therapy. Digital therapeutics has the additional benefit of keeping you connected at all times to your doctor through your ongoing progress.

4) Now is the time to take action.

The fourth stage is the action stage of TTM. When you are in stage four, you are taking action towards recovery and sobriety. You may have checked into detox to start treatment. Or, you have filled a prescription for naltrexone, which you will take an hour before your next drink if you are following the Sinclair Method to avoid alcohol withdrawal and alcohol abstinence syndrome. If you choose to attend 12-step meetings or another type of meeting, such as Smart Recovery, LifeRing or Celebrate Recovery, you may be going to meetings now and planning out your weekly meeting schedule. Whatever form of treatment you choose, I recommend that you also see your doctor for medical management and that you also go for therapy. Fortunately, doctor visits and therapy sessions are now available online. Whatever path you decide to take, you are currently doing something about your problem.

5) Maintenance of your new recovery.

In stage five, you are continuing to do what is working for your alcohol recovery. You establish new and healthier habits that promote your program of recovery. This stage may last for six months to a year or two. Of all the TTM stages, this may be the most important. Some people say that it is easy to get sober but hard to maintain sobriety. During this stage of maintenance, you will see what works best for you and stick with it. Persistence is the key to success here. There is a saying in AA groups that some members get sober and then float away on a pink cloud. Some people even refer to this as Pink Cloud Syndrome. People who suffer from Pink Cloud Syndrome may believe that they have found a cure for alcoholism. Now it is time to move on with their lives. If you are feeling great and uplifted in the early days of your recovery, be careful. You may be floating on that pink cloud, and that is fine. Just be careful not to give into Pink Cloud Syndrome. You must stick with your program of treatment and recovery and see it through. Especially in this fifth stage of maintenance, your persistence in staying on track is critical.

6) Termination or transcendence beyond active addiction.

In this final stage of TTM, you have moved beyond the temptation to return to drinking. You are living your new life of recovery and success. In 12-step groups, members believe that there is no cure for alcoholism, so that they may disagree with this sixth stage. When you have been sober for a long time, and you don’t think much about having a drink, it can be more of a matter of semantics whether you consider yourself to be recovering or recovered. You may find it interesting that proponents of the Sinclair Method refer to it as a “cure” for alcoholism. Saying that there is a cure is a controversial statement. Yet, experts who recommend TSM and call it the cure for addiction to alcohol still insist that patients follow the program for life. They say that if you were once addicted to alcohol, you could become addicted to drinking again. So, even if you have been sober for many years, you must still maintain a level of vigilance. You may consider yourself cured as long as you understand that the risk of your addiction returning is always there.

Addiction to alcohol can go into remission.

Experts often compare addiction to other illnesses to provide a better perspective. When they want to emphasize the importance of ongoing treatment and lifestyle changes, they compare addiction to diabetes or high blood pressure. This comparison to chronic disease processes can make the point that ongoing medical management is necessary. When it comes to the opioid crisis, some addiction specialists have compared opioid addiction to HIV. The point is that HIV was initially a terminal disease with no treatment. Many patients considered an HIV diagnosis to be a death sentence. Now, HIV is very treatable. The medical community considers it to be more of a chronic illness than a terminal one. With medication-assisted treatment, opioid addiction is also far less deadly. We should keep in mind that there is also a medication-assisted treatment for alcoholism. Naltrexone is an opioid blocking medication that is available in a daily tablet or a monthly injection, Vivitrol. The Sinclair Method protocol uses naltrexone to treat alcohol use disorder. Doctors also prescribe and administer Vivitrol monthly to patients who drink to help them quit.

Addiction is a serious condition.

We might also consider comparing addiction to cancer. Not all cancer is terminal. With aggressive treatment, cancer can go into remission. That means that it is gone, and the patient can go on with their lives. Yet, it does not mean that the patient can just forget about it. Unfortunately, when the disease is in remission, it can come back again. So, is a successfully treated cancer that goes into remission ever considered to be a cure? Doctors typically think of five years or more of no reoccurrence to be a cure. It may be useful to think of alcoholism, and addiction in general, this way. If you do not drink excessively for five years or more, you may think of yourself as being cured of alcoholism. Yet, you should be aware that your risk of going back to active alcohol addiction is higher than someone who has never had an alcohol addiction.

I believe that we should compare addiction to more severe disease processes for the patient’s benefit. Patients are often relieved to find out that they are physically healthy after a run of heavy drinking or drug use. Yet, they do not consider their addiction to be as dangerous of a problem as it is. Maybe if more patients saw their addiction as being as serious as a heart attack, they would be more concerned about keeping up with medical treatment and therapy.

Is addiction a disease?

There has been debate and discussion for decades about addiction being a disease or not being a disease. Experts from multiple fields in medicine and psychology have also debated over the definition of addiction. Is it psychological? Are there physical changes in the brain? Can addiction be treated with therapy alone, or does it require medical treatment? I believe that we have to go with the scientific evidence and clinical experience that medical treatment does work well for certain types of addiction. In addition to medication-assisted treatment, which works very well for opioid and alcohol addiction, we now also have a new technology known as prescription digital therapeutics. PDT works on a patient’s digital device that they already carry with them.

So, while the debate over what words and definitions to use for addiction goes on, we must be practical in our thinking about providing effective treatment for alcoholism and drug addiction. If we are to provide medication-assisted treatment and prescription digital therapeutics, we must do so within the context of clinical medicine. Therefore, we must also accept that alcoholism and various other types of drug addiction are medical disorders that benefit from medical treatment. Seeing addiction in this light will help change the addiction treatment industry to move in the direction of providing better medical care for patients.

Are people who get treatment for alcoholism and addiction clients or patients?

In the rehab industry, the “patient” vs. “client” issue is an ongoing debate, as well. Do we call the people who are admitted to rehab patients, or do we call them clients? It may not seem like an important distinction on the surface. Many workers in the rehab business use both terms interchangeably. However, the difference is critical. By calling people who are in treatment for addiction clients, we are minimizing the involvement and importance of doctors and medical science in their treatment. It is the medical doctors who must manage medication-assisted treatment and make sure that patients who will most benefit from medication get the treatment that will work best for them. Psychologists and psychiatrists can tailor customized therapy programs for individual patients to help them get through the transtheoretical stages so that they may stay clean and sober for many years. And, for the new technology of prescription digital therapeutics to be used, doctors and other specialized healthcare workers be there to administer this new form of medical treatment.

We can integrate addiction treatment with the stages of alcoholism and addiction.

Sometimes, it can seem like there are various factions in addiction treatment at war with each other. It looks like each group claims to have the one answer to solving the problem. The 12-step proponents may argue that abstinence and the steps are the only way. Psychologists and medical doctors, on the other hand, say that the 12-steps are unscientific and unproven. The fact is that we must work together and see the value in many different approaches to treating addiction. There is no one-size-fits-all solution. Everyone is different and deserves treatment as an individual. An essential principle behind the 12-steps is that of open-mindedness. By being open-minded, we can better understand the value of different perspectives in addiction treatment. There is value in group support programs. And, there is value in using medical treatment. Another critical area to consider is that of harm reduction. Harm reduction is the act of providing support for a person who is in the first stage of TTM, precontemplation. It means keeping that person alive and safe while they are in active addiction. By working together to integrating harm reduction with medical treatment, psychotherapy, and peer support and being open-minded to new ideas, we can be best prepared to help individuals to navigate through the stages of alcoholism and addiction successfully.

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