Whether you have an addiction problem, care about someone with an addiction problem or even if you work with people who have addiction problems, I think it helps to step back for a minute and understand how this problem and it’s recovery unfolds. It’s too easy to get blinkered, judgemental of ourselves and others, and not see the overall patterns of what we are looking at.
Professor John Kelly, addiction professor at Harvard Medical has produced a slide which really neatly summarises how these problems evolve and how recovery ensues. Please bear in mind that we are talking about averages here and we are talking about severe addiction problems. When you have an average, of course, there are going to be people who have very different experiences but this shouldn’t stop us from looking at averages to get an understanding of the course of recovery.
The first period that Professor Kelly described was the ‘onset’ of the problem. From the point at which it could be said that the addiction was first recognisably a problem, there was an average of a 4-5 year period where people have tried a series of self-initiated cessation attempts before they ask for outside assistance or help.
The next period could be described as an average of 8 years of Help-Seeking after which they are able to achieve full sustained recovery for more than one year. When I first heard Professor Kelly describe this he was very quick to point out that this period had a lot of recovery time in it, it’s just that it was taking this time to achieve an average of one full sustained year abstinent. On average people may have 4 or 5 treatment episodes and engagements with Mutual Help organisations ( AA, SMART etc.. ) during this stage.
5 Continuous Years of Abstinence.
During the first 5 years of abstinence, there is a need for continued care and mutual help. At the end of this first 5 years, the risk of relapse drops below 15%. This is significant because 15% of the population will develop an addiction problem so Professor Kelly has argued this is like saying that after 5 years of recovery, people return to having the same risk of addiction that the rest of the population have.
Conclusions and lessons to be learned
So, standing back and looking at this data, what conclusions can we draw?
It takes time
From the point of view of having an addiction problem, I think it is helpful to see that it takes time to get into recovery. There is this frightening saying that ‘relapse is part of the process of recovery’ and it can be disappointing to hear this. Of course, there are many people who achieve sustained recovery ‘first time’ but equally, there are many who struggle longer. I don’t think this should be very surprising. Addiction problems are the tip of the iceberg, underneath and around are many other social and psychological issues that interplay and so it really can’t be any surprise that it takes practice to get all these elements into the right alignment for recovery. If you reflect on any other skill you have developed, I bet there were times when you felt your learning was going backwards instead of forwards. The important thing here is not to feel like you just can’t get it if you have a slip or a relapse.
Overwhelmingly in this research data you can see a pathway that people with severe addiction problems are taking to come into recovery and long term remission from their problems. It’s important for everyone involved to keep the faith that this is where you are all heading.
You can see from the first period that there is this long stretch of 5 years after addiction becomes a problem but before someone seeks outside assistance. If it is apparent to the sufferer then it must also be apparent to those around them. Why is it taking so long to start asking for help? Perhaps there is still some embarrassment and shame? Perhaps friends and families think it’s none of their business. Somehow we need to make asking for help an easier thing and we should also encourage friends and families to bring this subject up. The sooner someone can get started with this, the sooner they will recover.
Family and friends
Addiction brings with it a series of crisis and during these episodes, it is very easy for any and all of us to lose hope. Looking at this outcome data you can see the evidence that the long term prognosis is in fact very good. The period that everyone must find very stressful is that middle period, averaging 8 years, where people are trying to find that first year of continuous abstinence. This is the time when there can be such tremendous recovery and hope and then, terrible setbacks. It is understandable to lose hope and feel very frustrated during this phase but it is such a shame if people can’t see what lies beyond. Ultimately, people could have any number of possible medical or psychiatric problems, addiction is just one of these, but the recovery rates for addiction are very similar for nearly any other chronic problems, medical or psychiatric. One of the statistics that Professor Kelly quotes is an outcome study ( White 2013 ) which calculated that 60% of individuals with addiction will achieve full sustained remission. Perhaps it’s the continued shame and judgement that surrounds addiction as so many still consider it a moral or character problem rather than understanding it’s medical and psychiatric dimensions. This is the time to set our sights on the long term outcome and outlook.
Carers and professionals.
From the perspective of someone who helps people with addiction problems, there are quite a few lessons here. One is the importance to try and find ways of helping people access help at earlier points. There is that beginning 5 year period where people are attempting to stop on their own before asking for help. Why aren’t they asking for outside assistance when this will so massively increase their success? I have another article about this very point so I won’t elaborate on it now but it’s worth us all reflecting on this. I would also ask people to consider how the expectation of recovery is phrased. It’s clearly important to study and discover what was working for them vs what wasn’t, but I do hear people being highly critical of treatments/people or methods as if there was ‘one’ other simple key which this new person/clinic/treatment centre can now offer. I see this in self-help groups, I see it amongst professionals and I see it between clinics. I suggest it’s important that we help people see this as a process of coming into recovery rather than one singular. To this point, it is most important that we be sure to offer the widest range of evidenced treatments rather than just one based on ‘opinions’. Let’s focus on the research evidence and share a range of skills and let’s help sufferers be less punishing of themselves and let’s help others be less punishing of them also.
It will be the focus of another article I am writing to look at how to minimise relapse.
In summary, let’s help people by sharing with them the bigger picture of this process of the recovery ‘Lifecycle’.