The Second Stage Of Recovery – Early Abstinence From Substances

If you have committed to getting help for your substance abuse or addiction and have sought professional treatment, you will soon begin a phase of your rehabilitation known as early abstinence or early recovery/abstinence.

The toughest part of trying to recover from alcohol and/or drug problems comes during this stage when a number of issues make it difficult to focus on learning to live a life of abstinence and recovery and make trying to stay clean and sober a struggle. It is the second of four stages of the recovery process as defined by the National Institute on Drug Abuse.


Treatment Issues 

If you have entered a specialised alcohol and drug rehabilitation program or you are getting professional help from your GP or Drug And Alcohol Service, you will work with trained addiction specialists, which can include counsellors, Doctors, psychiatrists, psychologists, nurses, and social workers depending on what services you need. Not all will be within the same organisation and may need to be referred to other outside organisations.

In the early abstinence phase of your recovery, they will help you recognise the medical and psychological aspects of alcohol and/or drug withdrawal, identify the triggers that prompt you to use drugs or alcohol, develop techniques of avoiding triggers and learn to handle cravings without using or drinking. They may also ask you to see a Doctor or Nurse who may prescribe you a substitute medication such as Methadone. Sometimes there’s a waiting list depending on where you are in the country as it can vary between different NHS trusts or organisations. You can find out more information about the science behind addiction and medication assisted treatment (MAT) here in our previous article.

The following are some of the issues that your Keyworker or health professional will try to help you with during the early abstinence stage of recovery in order to minimise the risk of relapse or overdose.


Addiction & Associated Symptoms 

If you have sought help to quit drinking or using drugs, chances are you have developed some level of chemical dependence (addiction) to your drug or alcohol of choice. Your Keyworker will help you identify behaviours 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, what positive steps you are pursuing to fill the time that would otherwise be spent on drugs or drink to do positive things like volunteer or work, take part in a hobby or interest, make new friends outside of your known drug or drink circle and plan strategies to ensure that when you get a craving or desire to use or drink, you can manage them more easily until it has subsided. They may feel intense initially however they will slowly get easier as time goes by.

Your Keyworker will also discuss the health effects that can be caused by sustained substance abuse, and possibly by your withdrawal from it if you stop too quickly however this isn’t always applicable to all substances so seeking professional help is always best. If you were an intravenous drug user, for example, your Keyworker will try to determine if you have engaged in other high-risk behaviours and if you may have contracted the HIV virus or Hepatitis. They will also be able to ensure that any ulcers or infections from using are also managed and if possible, treated.

As with all of these treatment issues, the goal of the Keyworker is to educate you about the risks and dangers so that you can begin to make more healthy choices in your life that will be implemented on an ongoing basis.


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, on paydays or in certain places. You may have had a favourite glass you drank from or a favourite 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 that have caused you to use or drink in the past. Your Keyworker will help you identify the people, places and things that you associate with your drug use or drinking and help you develop strategies for avoiding these triggers.

The Keyworker 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 drink or drug of choice. One of the symptoms of addiction is the amount of time the drug or drink use assumes in the user’s life.

Many addicts organise their entire daily routine around obtaining, using and recovering from the effects of their drug or drink.

Once you quit using or drinking, 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 disorganised, due to your substance pursuits. You may find it difficult imagining what you will do now that you are no longer using drugs which can cause you to panic or worry that you cannot and will not cope. This is untrue as long as you implement other positive pursuits instead as mentioned above.

Your Keyworker will also 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/drinking activities with healthy alternatives. Order and structure can help to lessen the risk of relapse.

You can create a daily recovery plan to maximise your time, help you identify areas where you might struggle with cravings or temptations and help you stay on track and progress. You can find our comprehensive guide here. You can also download our planner templates on our downloads & media page here.


Craving and Relapse 

Not everyone experiences cravings during early abstinence, but for those who do, it can become overwhelming quickly. Cravings are a strong urge to drink or use drugs. Craving can be both physical and psychological to the point that you can become obsessed with thinking about using again and even convince yourself it would be a god idea. You must remind yourself of all the negative consequences your use has in your life and others and remember these feelings will pass with time.

The Keyworker will help you recognise what a craving feels like and learn that it is temporary and will pass. More importantly, your Keyworker will try to help you learn that you have choices; you can choose to “sit the craving out.” You do not have to respond to the urge in a self-damaging way and can use coping strategies instead.

The longer you remain abstinent, the fewer cravings you will have and the less intense they will become. But if you give in to the urge, they will remain strong and means you will have to start from the beginning again.


Social Pressures 

For many alcoholics and addicts, 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 alcoholics or addicts. These “friends” can put a tremendous amount of pressure on you to relapse so that things don’t have to change and continued use can carry on. Most, if not all of these people will not be involved in your recovery afterwards and are best avoided to ensure you don’t relapse.

They may not want you to recover, because if they accept that you are an alcoholic or an addict, that means that they probably are, too. Consequently, they may blatantly or subtly try to sabotage your recovery.

Your Keyworker will strongly encourage you to avoid your old friends at all costs during early abstinence. You will be encouraged to make new, sober and clean friends. You will also be encouraged to participate in support groups such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) where you can develop positive relationships with drug/drink free and recovering people who will have your recovery in mind and will want the best for you.


Post Acute Withdrawal Symptoms (PAWS)

The physical withdrawal symptoms from quitting alcohol and/or drugs go away in a relatively short time, usually less than a week. But many alcoholics and addicts will experience long-lasting changes in mood, energy levels and memory to name just a few throughout early abstinence. Symptoms can include but are not limited to anxiety, depression, sleeplessness, sweating, shaking, vomiting and nausea, dizziness, thirst or hunger, aching body and memory loss or confusion. These symptoms are known as “withdrawal symptoms” and may include other symptoms not listed here.

If you develop any of these symptoms during your treatment, your Keyworker will try to help you realise that they are the result of your alcohol or drug use and are not independent, fundamental problems. You will learn that these symptoms can’t be self-medicated and will only become worse with further drug use or drink. And like cravings, they too shall pass.


Use of Other Substances 

You may decide that you are really only addicted to your drug of choice, although you frequently use another drug(s) or alcohol 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 weed to be having a negative impact on your life or a gateway drug to your “problem” substance(s).

During your treatment, your Keyworker will encourage you to achieve total abstinence. Here are some of the reasons that total abstinence is critical to your recovery:

  • Other drugs, such as alcohol, can trigger a craving for your drug(s) of choice
  • You might transfer your addiction from one substance to the other
  • If you continue using, you will not learn how to cope without mood-altering aids and may cause you to return to using substances days, weeks, months or even many years later!

Although your current use of drugs or alcohol may not currently be a problem, if continued, they could quickly become substitutions for your drug of choice or drag you back into the habits that caused you to use and/or become addicted in the first place. Addicts have my nature, addictive personalities so getting drawn back into your current lifestyle is easier and quicker than you may realise.


Getting Through Early Abstinence 

This stage of recovery is not easy, which is why few manage to accomplish it without help or if they do, it is short lived and many will end up relapsing which can leave to jails, mental health institutions or death. If you are in a professional treatment program, you will receive support and encouragement you need to make it. You will set and meet goals that are necessary for your continued recovery.

Your Keyworker 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 and live a positive, productive life.

You will be given the tools you need to live a clean and sober life.


Drug Or Alcohol Tolerance

Tolerance basically means that the longer you use alcohol or drugs, your body requires more of the substance to achieve the same effects like they did initially. After you initially stop using your substance, your body’s ability to cope with the “normal” dose or amount you would use drops quickly, even after a couple of days. This is why it can be extremely dangerous for those who relapse to overdose or die is higher than those who continue to use or drink. That’s why we recommend that if you do relapse that you do the following to reduce the risk of overdose or death:

  • Use a smaller amount than you would normally as you can’t know how much or little your tolerance has dropped and you don’t know how strong the substance is you are using just by looking at it
  • Try and use the same dealer each time, if you do use a new dealer, use the above suggestion for the reasons listed
  • Prepare it yourself so you know how much you are using and that the equipment is clean and has not been used before
  • Don’t use alone, just in case you do overdose so that someone can call for an ambulance and help you should you need it
  • Try to keep an emergency Naloxone (Narcan) kit nearby that is complete, unbroken, in date and ensure that people around you know how to use it should you or someone else overdose. You can get these from your nearest Drug And Alcohol Service along with the training to use it properly. You can find your nearest service in our help and support page. Remember to check the expiry date regularly. If your kit is out of date or due to expire soon, return it to your service and they will exchange it for a new one. Keep it nearby at all times and likewise, if you do overdose and use your kit, remember to get another one as soon as possible, just in case you or someone else overdose again in the future.

They can look like this, this is the injectable version

Or they can look this this, this is a nasal spray version.

Adapt Pharma Marks One-Year Anniversary of NARCAN® Nasal Spray (naloxone  HCl) 4mg Launch in the United States

You can find more information about Naloxone (Narcan) & overdose emergencies here.

Published by Drink ’n’ Drugs

Providing useful, relevant, up to date information and support for those suffering from active addiction or those who are in recovery.

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