Stages and Styles of Addiction Recovery

Stages and Styles of Addiction RecoveryDr. Ernie Kurtz and I, during the last years of his life, spent considerable time exploring the varieties of addiction recovery experience, including variations in the stages and styles of addiction recovery. For me, this exploration of stages and styles began in 1974 when I heard John Wallace present a paper at the Alcohol and Drug Problems Association meeting in Minnesota. The presentation stunned me with its clarity and potential clinical import. Wallace first stated that alcoholics frequently develop a preferred defense structure (PDS) (e.g., denial, minimization, projection of blame, intellectualization, etc.) to sustain excessive drinking and escape its growing consequences.

That starting position was not a new idea to most of us in the audience, but Wallace went on to say that the same PDS that supports drinking may be used as strategic coping mechanisms through the early stages of recovery and that prematurely confronting this brittle, recovery-sustaining PDS could trigger a resumption of drinking. That denial and minimization (of the problems facing the just-sobered), black-white thinking (e.g., “all of my problems are related to my drinking; all I have to do is not drink and everything else in my life will be fine”), and other defense mechanisms could be allies in the recovery process was a striking concept and one pregnant with implications for clinical practice—practices which at the time consisted primarily of verbally confronting such defensive gambits.

But then Wallace laid out the third paradox of recovery: the same PDS that supported alcoholism and that could be reframed to support early recovery must be eventually abandoned in later stages of recovery. In Wallace’s view, the latter transition was crucial to fully stabilize recovery, as well as enhance maturity and quality of life in long-term recovery.

I have been closely observing the addiction recovery process for half a century. I have been struck by two extremes: people whose fragile recovery is forever frozen at a primitive stage of development, and people who go through metamorphic changes that transform their character, values, and the quality of their interpersonal relationships. In the former, drug use has ceased or radically decelerated in frequency, intensity, and consequences, but this change remains nested within the same self-centeredness, resentfulness, dishonesty, and intolerance that often characterizes active addiction. This former pattern has been referred to as the “dry drunk” syndrome. In the latter style, the radically altered person-drug relationship is accompanied by dramatic enhancements in global health and functioning, as well as changes in character and identity—changes AA co-founder Bill Wilson characterized as “emotional sobriety.”

It is easy to cast these widely varying styles of recovery into the boxes of bad and good, but time and experience have softened that view for many of us as we have come to see how each style can exist within the same persons (and within ourselves) at different stages of the long-term recovery process. Also of note is that the executive brain functions of some people may have been severely and even permanently damaged from addiction, precluding tolerance of the ambiguity and more complex decision-making of the transformative style of recovery.

Today’s guiding mantra is “whatever it takes—recovery by any means necessary under any circumstances.” While we can deeply admire those in recovery who have used the recovery experience as a catalyst for personal transformation (via humility, gratitude, tolerance, service, etc.), we can also admire those who must tenaciously cling to those crude early defenses as a way to “keep the plug in the jug.” Both are deserving of respect and admiration.