Summary: You know if you’re making progress in addiction treatment when you meet the goals you set for yourself, in collaboration with your treatment team, at the beginning of your addiction treatment program.
Key Points:
- Your goal for treatment may be abstinence from drug or alcohol use. When you maintain abstinence for a period of time, you know you’ve met your first goal and know you’re making progress in addiction treatment.
- You may have additional goals, such as improving or repairing relationships with loved ones, spouses, partners, friends, and family. When you take specific goals toward restoring those relationships, you know you’re making progress.
- Additional goals may include returning to work or returning to school. When you find a job, volunteer in a work setting, or take a vocational training or an academic class, you know you’re making progress in addiction treatment.
Treatment for Addiction: What’s Your Goal?
Treatment for addiction is most often progressive, organized from most intensive to least intensive treatment to treatment, with increasing levels of independence.
But let’s dispense with any confusion about the words we choose to discuss this topic.
If your goal is abstinence, then the metric is simple. You either are or aren’t using drugs or alcohol. And that’s how you know if you’re making progress in addiction treatment. If you’re using, you’re not making progress.
However, that’s an oversimplification, because abstinence is not the only important component of addiction treatment.
For most, the goal is more comprehensive, inclusive, and expansive. In addition to the goal of abstinence, treatment goals include words like sobriety and recovery. It may come as a surprise to some that abstinence, sobriety, and recovery are not necessarily synonyms. It may also come as a surprise that there are different ideas about what two of those words – sobriety and recovery – mean in actual practice in the real world.
Let’s take a moment and look at how one of the most respected and influential voices in the history of treatment defines the core aspects of addiction treatment. Collectively, the individual components of treatment – which include abstinence and sobriety – add up to more than the sum of its parts.
They add up to what we call recovery.
Here’s how the Hazelden Betty Ford Foundation defined recovery in 2007:
“A voluntary maintained lifestyle characterized by sobriety, personal health, and citizenship.”
Then, the American Society of Addiction Medicine (ASAM) published this comprehensive definition, which includes and integrates the fundamental components of the definitions above:
“An active process of continual growth that addresses the biological, psychological, social and spiritual disturbances inherent in addiction. Recovery must include: (1) the aim of improved quality of life and enhanced wellness as identified by the individual, (2) an individual’s consistent pursuit of abstinence from the substances or behaviors toward which pathological pursuit had been previously directed or which could pose a risk for pathological pursuit in the future, (3) relief of an individual’s symptoms including substance craving, (4) improvement of an individual’s own behavioral control, (5) enrichment of an individual’s relationships, social connectedness, and interpersonal skills, and (6) improvement in an individual’s emotional self-regulation.”
We share those definitions not to fully endorse one or the other, but rather to show that in the 21st century, there are a variety of definitions of recovery. Each stresses some elements over others, while some, like the one from the ASAM, attempts to integrate all approaches to recovery into a single catch-all definition.
At Honu House, we recognize the validity of all paths to recovery, and default to the Hazelden Betty Ford Foundation definition, above.
For the rest of this article, we’ll look at how a holistic, integrated, abstinence-based, 12-step focused addiction treatment program might define progress for someone in addiction treatment.
Stepping Down, Stepping Up, Moving Through Levels of Treatment
In mental health and addiction treatment, there are generally four levels of care.
1. Hospitalization.
Short-term, designed for emergency crisis stabilization. Typically lasts four to ten days.
2. Residential treatment.
Longer-term, designed to give you time and space to achieve recovery goals and prepare for independent living. May last from one to six months, depending on various factors.
2. Partial hospitalization treatment.
This is roughly halfway to independence. You’re required to participate in a full day of treatment, but you may live off-site and take actual steps toward independence. May last several months.
3. Intensive outpatient treatment.
This is about 3/4ths of the way to independence. You’re required to do at least a half day of treatment – sometimes more, sometimes less, depending on the treatment center – but you’ll probably live off-site, and be actively involved in finding a job, volunteering, or taking vocational or academic classes to prepare to return to home and work and/or school. May last several months.
4. Outpatient, ongoing, aftercare.
After intensive outpatient treatment, many treatment centers have a level of outpatient care called aftercare or ongoing care. When you reach that phase of treatment, you may be totally on your own – but with a toolbox full of effective relapse prevention and recovery friendly skills – or you may continue to participate in an organized treatment program that’s far less immersive and intensive but equally engaged in your ongoing success.
When you’re in a program with those levels of care, you know you’re making progress in addiction treatment when the clinical staff move you from a more immersive to a less immersive level of care, in a process called stepping down. In other words, you know you’re making progress in addiction treatment when you step down though the levels of care, from immersive, 24/7 supervision toward partial of full independence.
Now we’ll share what the step-down process might look like at a holistic, abstinence-based, 12-step focused treatment center that uses a similar template for levels of care, but labels them differently, and may not match those levels of care precisely.
Making Progress, Meeting Goals, Creating and Living a Life Without Alcohol and Drugs
The content below is based on what you might experience if you commit to residential treatment for alcohol or drug addiction. At the theoretical treatment center below, treatment occurs in four stages. Stage one is the beginning, when you initiate treatment and start to define your goals for recovery and life. Stage four is when you’re close to full independence: you’ve met your goals, you’ve taken the proactive steps required by the treatment center. You may be back working, back at school, back living independently, or some other combination of the three, but you’re still – most importantly – working your recovery program.
Stage One: Goals Required to Meet Criteria to Move to Stage Two
- Minimum of 30 days treatment
- 24/7 staff supervision
- Complete of all mandatory programming
- Complete a one week digital detox
When these basic goals are met and maintained, you may earn privileges before moving to stage two:
- Visitors permitted during visiting hours after 2 weeks
- Approved outings with AA or NA sponsor after 2 weeks
When you meet and maintain the previous goals, then successfully engage in community support, you may move to the next stage of treatment.
Stage Two: Goals Required to Meet Criteria to Move to Stage Three
- Successful completion of 30 days of treatment
- Completion of detoxification (all substances)
- Completely tapered off narcotic medication
- Active participation in all mandatory programming
- Active engagement in community based recovery:
- Attendance and participation in Alcoholics Anonymous (AA)
- Attendance and participation in Narcotics Anonymous (NA)
- Find and actively engage with a sponsor (AA or NA)
- Actively engage in Step Work (AA or NA)
- Demonstrate motivation and initiative in practicing recovery tools independently, such as:
- Stress management
- Mindfulness
- Meditation
- Nature based activities
- Daily exercise/activity
- Experiential activities
- Recovery homework assignments
- Show up on time and prepared to participate in all programming without prompting/reminding
- Complete community responsibilities – i.e. chores, etc. – without prompting/reminding
Stage Three: Privileges Earned By Meeting Criteria to Move to Stage Three
- Option to engage in independent nonclinical activities that support recovery rather than center-facilitated nonclinical activities. Earned alternatives include activities such as:
- Meeting with a sponsor
- Doing community service
- Taking classes/returning to school
- Most treatment centers require advanced planning and approval to replace a center-facilitated nonclinical activity with an independent nonclinical activity. How far in advance and specific procedures will vary by location and policies.
- You may no longer require 24/7 monitoring and supervision
- You may have independent time in living space or activity spaces
- May be allowed to go shopping or do other basic errands without supervision
At this level, in most cases, treatment center staff require drug testing and full search of person/personal belongings after periods of independence, when you have unsupervised contact with people outside the treatment center.
Stage Three: Goals Required to Meet Criteria to Move to Stage Four
- Successful completion of 60 days of treatment
- Consistently engage in independent self-care and recovery focused activities. Daily habits must be:
- Demonstrable
- Verifiable
- Approved by staff and clinicians
- Shows responsible, effective time management:
- Prompt
- Prepared
- Proactive
- Active participation in community recovery/step work:
- Goes to meetings
- Meets with sponsor
- Progressing through steps
- Consistent proactive participation in community living activities:
- Chores
- House meetings
- Daily group activities
- Active and contributing member of recovery peer group
- Supports peers with words, sentiment, and behavior
- Models recovery lifestyle
- Develops understanding of service mentality
- Demonstrates leadership and initiative:
- Volunteers to help other individuals
- Volunteers to help in general recovery community
Stage Four: Privileges Earned By Meeting Criteria for Stage Four
- At this stage, with the approval of treatment center clinicians and staff, you may opt out of official clinical and nonclinical programming for:
- A paid or unpaid job where:
- You must show up on time
- Do required work for required time
- Meet the expectations of coworkers, managers, supervisors, possibly customers if job requires interaction
- Educational pursuits or vocational trainings that:
- Align with recovery goals
- Promote recovery goals
- Move you toward independence
- At this stage, to continue treatment while pursuing independence, you may be required to:
- Meet with the psychiatrist/therapist/clinician at least once a week
- Check in with case manager once a week
- Go to five (5) or more community support meetings per week, i.e. AA or NA
- Participate in house meetings, unless at approved activity, class, or work off-site
- Return to residence by curfew
- Follow all house rules
- A paid or unpaid job where:
Most treatment centers, even at this stage of independence, will require you to keep doing house chores and participating in group activities such as weekend outings when they don’t conflict with pre-approved work or classes.
- In some treatment centers you may be allowed:
- A personal vehicle
- To run personal errands
- Overnights away from residence
- At this stage, you must:
- Demonstrate a consistent commitment to the recovery lifestyle
- Demonstrate appropriate and consistent self-care practices
- Promptly and effectively communicate to treatment center staff where you are and what you’re doing at all times
In virtually all treatment programs, despite earning significant privileges and advancing through the stages/levels/phases of treatment, you will still be subject to searches of your person, personal belongings, and personal room at any time, and you may be tested for drugs or alcohol at any time, even at this advanced stage of your treatment.
Finally, when receiving treatment in a progressive, step down system of stages like the one we describe above, virtually all residential treatment programs have a policy like this:
If you don’t consistently meet expectations at your new level, you may be required to return to a previous level, most often with clear restorative goals defined by your entire treatment team, i.e. staff, clinicians, supervisors, directors.
Finding Success: You Define Your Goals, Clinicians Help You Make Progress
Each treatment center does things differently, within general parameters affected by local, state, and federal law, insurance coverage, and other factors not always directly related to whether you’re making progress in addiction treatment.
The ultimate goal of addiction treatment is to live a full, fulfilling, self-directed life without the use of alcohol and drugs. We know from experience that while abstinence and sobriety are the measurable foundation of a life without alcohol and drugs – i.e. the recovery lifestyle – there are additional factors that contribute to a full and fulfilling life.
Those include things like improved relationships, the ability to work and/or learn, ongoing physical health, ongoing emotional wellness, and developing a mentality and point of view that values service, compassion, and respect. Those last three may seem superfluous, but we’ll wager that if you indeed made progress in addiction treatment at any time in your life, there was a person involved that offered you those three things – and we encourage you to see that as an important benchmark of treatment success.
