It’s one thing to recognize a need for getting sober; it’s entirely another to know how to go about it. While recognizing that there’s a problem is half the battle, there’s still half the battle to follow if the person wants to manage the problem and achieve recovery.
It can be intimidating to know what steps to take to get sober. Some people might hope for a quick fix without knowing everything involved in overcoming addiction. Others may be halted in their tracks by not knowing what to do first. In either case, it can be easy to get lost along the way if the person doesn’t know the complications that may arise and the tools and factors that can help meet those challenges. With a guide that includes the various steps required to fully support the path, the journey to addiction recovery can be much more straightforward, less frightening, and more likely to result in a positive outcome.
The First Half of the Battle: Recognizing the Need to Get Sober
The first step to getting sober is recognizing and admitting that the person has a problem with alcohol or drug abuse. This can be challenging, as denial is a common response to the idea that the individual has lost control of substance use. Nevertheless, there are some measures through which the individual can determine whether substance abuse has become a problem. These are based on the Diagnostic and Statistical Manual of Mental Disorders, which outlines the factors used to diagnose substance use disorders. These include:
- Inability to control the amount, length, or frequency of substance use, or to stop use altogether
- Substance use interfering in personal responsibilities, relationships, and other activities
- Continued substance use despite physical or mental health problems, or other consequences
- Cravings for the substance or withdrawal symptoms if the substance use is stopped
These and other signs can indicate that substance abuse is an issue. This determination makes it possible to move on to subsequent steps that can help the person interrupt the abuse cycle and get sober.
Once it has been determined that the person needs to get sober, the next step is to reach out for help. There are various sources of support that can help the individual get started in seeking the treatment needed to overcome addiction and get sober.
Stopping substance abuse is not a journey that must be undertaken alone. In fact, getting and staying sober is more likely when the person has a trusted support system to help maintain motivation. A study from Substance Abuse indicates that having support from others can improve a person’s chances of engaging in and completing detox and treatment for addiction.
Friends and Family
Some people may need to reach out for personal support that can help them maintain the strength to get help. This can be from a trusted family member or friend whom the individual knows will support the journey to become sober.
The individual must be cautious in selecting family or friends to reach out to. Often, when people become addicted to drugs or alcohol, their circle of friends and the family they associate with slowly change to include only those who enable or encourage the substance abuse. Others may want to help but operate in a codependent relationship with the individual, making it harder to quit. In some cases, reaching out for people who can help may also mean avoiding people who are more likely to get in the way of the individual stopping substance use.
If the person doesn’t have friends or family who are able to support the process to get sober, another direction to reach out for support is to find medical or addiction treatment professionals who can direct the person toward resources for recovery. These professionals are able to connect the person with needed services, and they can also provide diagnoses of substance use disorders, including addiction, as well as co-occurring disorders that may contribute to the issue.
With professional support, the individual is more likely to be able to find a treatment program that aligns with the specific factors and elements of that individual’s substance use issues. This, in turn, is more likely to result in the person getting sober and staying that way longer.
Finding the Right Treatment Program
As described by the National Institute on Drug Abuse, no one treatment is effective for all people who are undergoing substance abuse treatment. Because of this, it’s important to make sure that a treatment program that fits the individual’s needs is found. There are multiple factors to consider in making this decision, including the qualifications of the program itself and the individual’s level of substance abuse and readiness to change.
First and foremost, the individual should find a treatment program that has a track record of resulting in positive outcomes for clients. This is most likely to occur in programs that provide services and therapies based on research. Research-based treatment elements are those that have, through scientific studies, shown the ability to respond to the realities of addiction as a chronic brain disorder, and therefore give the best chance at preventing relapse to substance use.
As mentioned in an article from Health Policy, the field of addiction treatment is increasingly moving toward basing treatment on evidence of its ability to support recovery from addiction. Treatment specialists tend to agree that continuing to implement this type of treatment is in the best interest of those who are struggling with substance abuse and addiction.
Degree of Addiction
Another element to consider when selecting treatment is how severe the person’s addiction is. If the substance use disorder is diagnosed as mild, the person might be able to do well in an outpatient program that provides a few hours of treatment per week. On the other hand, for severe addiction issues, sobriety may only result from a fully managed residential program. Others may need hospitalization and medical intervention.
The professional providing diagnosis can help to assess this through the American Society of Addiction Medicine’s criteria that determine the level of care most suited to the individual’s needs. By using the dimensions of assessment, the treatment professional can determine the level of care needed for the individual, within the following range:
Readiness for Change
There is another factor that might change the treatment program requirement for some individuals: the person’s readiness to change. If the severity of a person’s disorder is not enough to warrant residential treatment, but the person is extremely resistant to change or lives in an unsupportive environment, it may be necessary to opt for a residential program to provide extra support and prevent relapse.
As explained and elaborated by the National Institute on Alcohol Abuse and Alcoholism, relapse prevention is the main goal of all addiction treatment. For that reason, if the individual is not ready or willing to stop substance abuse, part of the treatment program is to develop and support that willingness and readiness by providing a level of care that improves the individual’s motivation and commitment to sobriety.
Withdrawal: Getting through the SymptomsWithdrawal is sometimes considered to be the most challenging part of rehab. The symptoms of withdrawal can be extremely uncomfortable to deal with, and urges to start using the drug or alcohol again can sometimes be overwhelming. However, knowing what to expect and what help is available can make it easier to take the process in stride and make it through to the other side, getting sober for the first time.
The Detox Process
When the body is in the process of eliminating a psychoactive substance, it’s called detox. During this process, the brain and body, which have become used to and dependent on the substance’s presence, most often have some degree of negative reaction to the loss as the systems and pathways that have been disrupted by the substance use adjust to the fact that it’s gone.
During detox, these systems take time to return to functioning on their own. In the meantime, discomfort occurs as a side effect of the fact that the brain and body aren’t working properly for a while. As the drug is removed from the system and these pathways start working properly again, the withdrawal symptoms begin to subside and the person begins to feel better. In the meantime, though, the symptoms can be extremely uncomfortable and even dangerous. Relapse can very easily happen at this point, as the person struggles to deal with the discomfort. For this reason, support can be extremely beneficial during this stage.
As described by the National Institute on Drug Abuse, medically supported detox can make the withdrawal process easier by offering ways to minimize the discomfort and risk caused by the withdrawal symptoms. For example, in the case of an individual who is stopping long-term, heavy alcohol use, treatment professionals can provide medications that can help to avoid the serious symptoms that can occur through alcohol withdrawal, such as potentially life-threatening delirium tremens. Symptoms of delirium tremens include:
- Extreme confusion
- Delirium and hallucinations
- High fever and high blood pressure
Medical support can also carefully wean the person off certain substances slowly, helping the brain and body adjust to the loss of the substance more gradually and minimizing some withdrawal symptoms. These benefits not only ease the discomfort of the detox process, but also help to prevent relapse during this challenging part of treatment.
Choosing the Appropriate Therapy
Getting sober isn’t the end of the process. The next step is to do what it takes to stay sober: attend, commit to, and complete a treatment plan. This is the specific collection of therapies and treatments that are selected for the individual to meet the needs created by that person’s journey into and through substance abuse.
Again, no one treatment is effective for all people; circumstances call for meeting the person where they are rather than expecting all people to be able to respond to generic treatment programs.
The Personalized Plan
Reputable, research-based treatment programs select therapies and plan treatment to match the individual’s personal needs. For example, a veteran with PTSD who is abusing cocaine isn’t going to have the same needs as a stay-at-home mom who is struggling with alcoholism. When the person first enters a treatment program, a treatment professional makes a thorough diagnosis to determine what the individual’s specific needs are and then selects therapies based on those needs. Some of the therapies that may be selected from include:
- Cognitive Behavioral Therapy: to help individuals recognize what triggers their cravings and either avoid those situations or find other responses to them besides giving in to cravings
- Motivational Therapy: methods to keep the person committed to staying sober, such as rewards for staying sober over a certain time period
- Family Therapy: for individuals who are dealing with family issues that contribute to continued substance abuse, including enabling behaviors and codependency
- Interpersonal Therapy: for people who don’t have a good support network to learn how to build friendships and provide mutual support to one another
Many other options exist. Through exploring the person’s individual circumstances, a treatment program can be created to meet individuals who are struggling with substance abuse where they are, with what they need.
A Consistent Relationship through Treatment
One of the most effective ways to make sure the plan fits the person’s needs is to keep it flexible. That way, if the person’s needs change or new levels of need are determined, the plan can be adjusted easily to meet the new requirements. An article from the American Psychiatric Association asserts that monitoring the individual’s progress during treatment and providing adjustments to therapy as needed is more likely to result in the individual getting and staying sober.
This is most easily achieved if the person’s treatment team is managed by a single caseworker who can track all treatments and therapies, make sure they’re compatible, and advocate for the person when changes are needed. Again, a reputable treatment program will provide these specialists to keep the person on track, find new directions when needed, and thereby improve the chances that treatment will result in continued sobriety after the program is over.
Building Support for Recovery
Support isn’t just needed to get a person started on the path to recovery from addiction. As stated above, support can help the individual stick to treatment through the duration of the program. In addition, having a support network once treatment is over can ease the transition from rehab back to daily living. This support fosters the motivation and self-confidence needed to stay sober for the long-term.
For most people in treatment, returning to daily life means returning home to family. Because of this, the strongest element of a social support system for these individuals can be the family itself. However, sometimes family is also the source of certain issues relating to substance abuse.
To resolve these issues and help the family become a strong base of support for the recovering individual, family therapy is often included in a personalized treatment plan. Details of how this is applied are provided by the National Institute on Drug Abuse. Through family therapy, the client and loved ones can:
- Resolve conflicts that may have contributed to the start of or continued substance abuse
- Become educated about addiction and the ways the family can support sobriety
- Identify and manage situations of enabling or codependency
- Help all parties understand what to do once treatment is completed to maintain recovery
Some individuals do not have a circle of friends who are able to provide the social support network needed. This can occur for several reasons, including:
- Conflict with family or friends that has created a rift
- Individuals who have few social skills or have never had a strong network of friends
- A circle of friends or family members who have encouraged or even supported substance abuse
In the case that the person does not have a reliable circle of friends, a personalized plan may include interpersonal therapy, which can help the individual build a social network. This research-based technique has been shown to support sobriety; one study from Substance Abuse shows that women struggling with alcoholism and depression who participated in interpersonal therapy were able to give up alcohol and maintain sobriety longer than those who didn’t.
Mutual Support Groups
Many research-based, reputable treatment programs include mutual support groups – also known as 12-Step or peer support programs – as part of the treatment plan. These programs offer multiple benefits for individuals in treatment, including:
- Resources for further education on substance abuse
- Information and understanding from other people in treatment
- Accountability to keep sober
- Sources of social support both within rehab and after treatment completion
Along with these benefits, 12-Step programs and other forms of mutual support groups can increase the likelihood of achieving and maintaining recovery from substance abuse. Research from the Department of Veterans Affairs demonstrates that people who participate in 12-Step programs tend to have better outcomes than those who don’t.
Aftercare: A Lifeline after Treatment
The hope is that the individual will be ready to reenter typical daily life after treatment is over and manage the symptoms of the substance use disorder, staying sober for the long-term. The reality is that many situations can make it hard to reintegrate into normal life without some hiccups and potential for relapse. For individuals who are determined to have a high risk of relapse, aftercare can be a lifeline, making it easier to stay afloat in recovery and avoid returning to substance use.
Once the treatment program is complete, the ideal is that the individual is reassessed to determine whether the therapies involved have decreased the person’s relapse risk and to what degree. If relapse risk continues to be high, but the person is still expected to return to life outside of treatment, aftercare plans can be added to the treatment plan to help with the transition. These aftercare elements can include:
- A step down to a less rigid but still appropriate level of continued treatment
- Residence in a sober living home with others who have completed rehab to support ongoing sobriety
- Motivational programs and therapies to help the person keep up the resolve to stay sober
- Alumni programs to keep the individual connected to treatment resources and professionals
- Continued membership in 12-Step or other mutual support groups
If a person has been in a residential program but still has a relatively high relapse risk, one option is to step the person down into a partial hospitalization or intensive outpatient program, which enables the person to return to daily life while still getting a more intense level of care. This can assist in integrating the person slowly back into a daily routine while giving more time to practice the skills needed to stay motivated and remain sober.
The person can then continue to step down to less intensive treatment levels, enabling continued support until the person has the confidence to stay sober with a minimum of treatment support.
Programs like sober living homes, motivational phone calls, alumni programs, and mutual support groups provide a level of support that can continue either in the short-term or as needed for the rest of the person’s life. As explained by a study from the Journal of Substance Abuse Treatment, even something as simple as a motivational texting program for teens can provide a higher chance of avoiding relapse to substance use.
Because addiction is a chronic condition for which relapse is always a possibility, maintaining connections with resources in the months and years after treatment can help to sustain the commitment to sobriety. This support can refresh and update the skills and tools that are most likely to help people who have achieved recovery stay sober for the rest of their lives.
These steps, when taken with commitment and hope, can result not only in achieving sobriety, but also in making sure it will be possible to maintain a productive, sober lifetime of recovery.