Integrative Recovery: A Stage Paradigm

Abstract

This paper outlines a 10-stage recovery paradigm (6 pretreatment and 4 treatment stages), based upon the clinical and research experience with those treated in residential therapeutic communities. Various recovery-stage formulations have been described for alcoholic abusers and smokers, largely from middle- and working-class backgrounds. However, the relevance of these formulations for other chemically dependent subgroups such as those seen in therapeutic communities (TCs) remains to be clarified. Clients in these programs are chronic abusers of all substances, but mainly opiates, cocaine, crack, marijuana, and alcohol, although multiple drug use is the rule. For most, substance abuse is embedded in a larger picture of personality disorder, social deviance, disaffiliation, and personal dysfunction. Increasing numbers are unhabilitated in that they have never acquired the behavioral skills, attitudes, or values associated with socialized living. Thus, the recovery goals in the TC extend much beyond achieving and maintaining abstinence, toward developing change in lifestyles and social and personal identities. Although derived from the TC experience, the paradigm presented has relevance for other similar subgroups of substance abusers.