What sobriety actually looks like after the first year

There is another story of recovery: A little bit less dramatic one which includes a gradual process of change. Hitting rock bottom, intervention, treatment, and going to the first meeting with the first chip. Tears of gratitude and steady return to the normal life. Although this picture of recovery exists and should definitely be taken into account, it doesn't answer the question raised by the recovering addicts. Namely, it does not touch upon the problem which seems to be even more difficult than any other one.

First year of abstinence is considered to be the hardest part of recovery, and indeed it is quite hard. Withdrawal symptoms, initial cravings, restoring lost trust and adapting to the functioning in the society without the support of substances consumed before is a really tough task to do. But there is another problem which arises a bit later – and probably goes unnoticed due to the dramatic character of the previous one. It is the problem of building an ordinary life and finding oneself in it.

Recovery in its initial stages is all about the maintenance of the sobriety. And indeed, it is rational because this is the main goal of the person who seeks for recovery, so he or she has to devote the majority of their time to maintaining it. All kinds of programs, groups, sponsor, meetings, check-in, and other various kinds of activities serve as tools helping to stay sober.

However, there comes a period when priorities change. The struggle of the recovering person is not about maintaining sobriety anymore, but about building the life worth living. This is precisely that point where many of them face the difficulties of their own. It is natural that the emotions, which were suppressed during addiction, return. The relations ruined during the period of active addiction do not get better magically right after the person becomes sober. There may appear some problems concerning work and money. The picture of the self and the life which was built on the basis of the addiction and the use of substances is gone now, and there is nothing to replace it yet.

The research on substance abuse and mental health provides a fairly coherent picture of factors which ensure long-term recovery. Long-term recovery requires more than a mere will; it requires organization, community and the reconstruction of sense of purpose. Having a network of positive supportive social connections, ideally fellow recovering people, has been found to correlate strongly with long-term success in overcoming addictions. This may be one of the reasons why peer support system incorporated into AA and NA has proven to be quite durable despite the lack of clinical proof of effectiveness of the 12-step method.

Sense of purpose plays an important role as well. People in long-term recovery emphasize how vital it is to have things to live sober for, meaningful work and relationships and a sense of contribution to something bigger than yourself. This sounds like a rather soft factor, but scientific research confirms its significance as well. Meaning and purpose are protective.

Another surprising finding is the importance of accountability structures. The people who continue to maintain some formal system of check-ups, such as weekly meetings, regular therapy or medication-assisted treatment monitoring, do better than those who "graduate" from such structures and go solo. Recovery is not a completed project. It is a maintenance project.

There is one more factor which has proved to contribute to long-term recovery according to scientific research. Those who sponsor others in long-term recovery, who volunteer in various treatment facilities and help others tell their stories and thus aid those at early stages of recovery achieve much higher levels of satisfaction and have lower risk of relapses. It seems that there is something about the experience of being useful to somebody else, especially in your former weak spots, that reinforces the feeling of recovery and goes far beyond the cognitive level.

The Substance Abuse and Mental Health Services Administration defines recovery as a process of personal transformation which allows people to develop healthy lifestyle, live self-directed lives and become who they want to be. Four main factors which contribute to recovery according to SAMHSA are health, home, purpose and community. All these factors take time to develop and are far away from people at the early stages of sobriety.

First of all, it is important to say the following: Relapse is a rather common phenomenon for the treatment of the addiction problem. As shown by the researches, the relapse rates for substance abuse disorders can be compared to those for chronic disorders, such as hypertension or asthma; it can be somewhere from 40 to 60 percent. It does not mean that recovery does not work. It only means that addiction is a chronic disease and it may take several tries to stabilize.

Speaking of the relapse as "failure" is considered one of the most harmful stories about recovery. First of all, it is not a failure. It only means that the treatment chosen by the patient is not effective and should be changed. Patients, who had experienced a relapse and returned to the treatment program, usually succeed much better than those who succeeded the first time. The reason for that is they got the experience and understand what does not work for them.

It does not mean that relapse is tolerable and its consequences are minor. However, the feeling of guilt and judgment towards themselves after it is one more barrier for returning to the treatment program, that is why the story should be changed.

Usually people, who are sober for ten, fifteen or twenty years, tend to describe their lives in very ordinary terms, and that is exactly what it is. They have jobs and relationships, they do whatever they like and have interesting, difficult and even boring days. They attend the meetings if they want to or refuse. They create new relationships and destroy the ones that cannot be kept. They learn who they are, when they stop being addicts and it takes years to do it.

Also, people can tell you that there were moments in the second or third year of recovery, when it was more difficult than in the first year. When all the structure is gone and they have to deal with everything on their own. When it is not something which brings pleasure anymore but just routine. When they have to face reality and handle it without having an escape method.

What makes people stay sober during such times is the same as what made them become sober – people around them. Connection. Not to be alone with all the issues. Using all the resources they managed to find helpful: Sponsor, therapy, support groups, medication assisted treatment or some combination of these.

There is an opinion that people in recovery ask each other the following question: Do you miss using? And the answer is quite complicated and can be both "yes" and "no". People in recovery miss not the substance itself but the things it gave to them: Relief, absence of difficult emotions, ease in socializing. So, building the life in recovery includes learning how to satisfy all these needs in different ways. Not using any substitutes but satisfying these needs.

Building connections, finding meaningful activities, feeling physically and mentally well – none of these things is guaranteed. But it happens to people, who continue to build their life and ask for help when they need it.

This article was written in cooperation with Tom White