What Is the Transitional Phase in a Chemical Dependency Group?

Universities, clinicians and researchers have developed numerous treatment protocols for recovery from chemical dependency. Most of them incorporate some form of phased treatment.
One such model is Andrew T. Martin's Care Continuum, which incorporates four phases: Primary Treatment, Extended Care Treatment, Transitional Sober Living and Sober Living. Within each of these four phases, Dr. Martin believes it is essential to address physiological, psychological and spiritual elements.
The Transitional Phase is a graduation of sorts. Addicts leave the safety of a treatment program and begin their pursuit of personal goals and community and family life.

Physiological

• The Transitional Phase assumes that certain physiological milestones have already been met. These include detoxification, screenings for neurological impairments and the availability of adequate nutrition.
  During the Transitional Phase patients, begin to coordinate their own medical care, submit weekly urine samples for testing and refine their nutritional habits in order to avoid cravings for drugs and alcohol.
  Transition is also the phase where psychotropic medications may be adjusted, and the brain is literally regenerating and repairing itself.
  Dr. Daniel G. Amen, assistant clinical professor of psychiatry and human behavior at the University of California, Irvine School of Medicine, and founder of the Amen Clinic, maintains a database of over 42,000 brain scans. Through S.P.E.C.T. imaging (specific positronic emission computerized tomography) he has been able to map areas of the brain to a variety illnesses and diseases, including chemical dependency. Dr. Amen asserts that the brain abnormalities frequently can and should be treated, just as other bodily organs that produce negative symptoms are treated.
  Dr. Amen encourages traditional treatments and medications, as well as physical activity, nutritional management and mental exercises for persons in recovery from chemical dependency.

Psychological

• The Transitional Phase assumes the addict is no longer in crisis, therapy is underway, and an arsenal of stress management techniques is available.
  Dr. Martin reports that in this phase recovering addicts grapple with learning to differentiate between abstinence and sobriety. New abstainers are not using drugs or alcohol, but may struggle daily and actively with their addictions. Sober people experience a growing comfort with abstinence and are learning to utilize their newly acquired skills to effectively decrease and manage cravings.
  One such skill is "HALT," an acronym reminding recovering addicts to manage cravings by not allowing themselves to become too Hungry, Angry, Lonely or Tired.
  Self reliance and confidence grow as addicts re-engage in jobs or begin job training programs, but the need for support from other, recovering persons, never goes away.
  Recovering addicts are frequently reunited with families and children during the Transitional Phase. They are actively engaged in expanding parenting skills, healing damaged relationships, and establishing themselves as trustworthy.
  Attending support meetings and finding a mentor are necessary to long term success. In time, these recovering addicts may become mentors, themselves, and may accept leadership roles in their sobriety-support groups.
  The Transition Phase is also a time for recovering addicts to get involved in a community by voting, joining a sober neighborhood group or befriending sober neighbors. Old drug-using or drinking-related social connections may be highly toxic to an addict, making this a necessary time for forging new relationships.

Spiritual

• The spiritual aspect of the Transitional Phase is broadly defined. For some addicts it may mean involvement with a traditional religion. For others it may be as simple as developing a reverence for the emotional needs of others, developing an ecological commitment or cultivating a sense of humility.
  Millions of addicts have been aided in the quest for sobriety by 12 Step Programs, such as Alcoholic Anonymous or Narcotics Anonymous. For those people, the Transitional Phase is typically when they address steps four through seven. These steps are: "Made a searching and fearless moral inventory of ourselves," "Admitted to God, ourselves and to another human being the exact nature of our wrongs," "Were entirely ready to have God remove all these defects of character," and "Humbly asked Him to remove our shortcomings." These four steps, along with all the 12 Steps, originated in the book, "Alcoholics Anonymous," originally printed in 1939, under the author's name, "Bill W." There have since been dozens of new editions, reprints and adaptations, but the 12 Steps of the Alcoholics Anonymous Program have remained largely in tact.

Timing

• There is debate within the clinical community about the duration of the various treatment phases. Traditionally, chemical dependency treatment programs were designed with specific time lines allotted to each phase. Individual addicts, however, may not fit those prescribed time frames. Some clinicians recognize the need for greater flexibility but grapple with the logistics of how to staff fully individualized programs. Still others are developing innovative treatment protocols that allow recovering addicts to move through the treatment phases at their own pace. In Andrew T. Martin's Care Continuum, for example, the Transitional Phase may last anywhere from 61 to 365 days.

Living Sober

• Recovering addicts who live sober understand that they have an incurable condition (sometimes called a "disease" or an "illness"), like diabetes or arthritis, that must be managed effectively for the rest of their lives. They understand the dangers in their worlds that may trigger cravings. Areas that recovering addicts must carefully navigate include physical pain, emotions, certain prescription medications, locations where they once used chemicals, people who use drugs or drink excessively, excess cash, exhaustion and dishonesty. Perhaps the most insidious pitfall is The Wellness Syndrome. This happens when an addict has been sober for a long period of time, feels healthy and appears successful in life and relationships. Gradually, or sometimes suddenly, the addict may slip back into using drugs or alcohol, often when he least expects it, and must re-start the healing process.