Ready, Set, Go!

Preface

This book is for people in recovery. We ask and answer basic questions about addiction, relapse, and recovery. We believe addiction is a primary, chronic disease of brain reward, motivation, memory, and related circuitry, characterized by craving, loss of control, physical dependence, and tolerance. Genetics, together with bio-psycho-social-spiritual factors, account for the likelihood a person will develop an addiction or related disorder. Relapse happens: a return to drinking, using, other addictive behavior, or an increase in harm from addiction. Yet, recovery is an idea whose time has come. Recovery is a different, better way of life with purpose and meaning. We suggest addiction management as a way recovering people can maintain change (abstinence or harm reduction), reduce risks for relapse, prevent relapse, develop a recovery lifestyle, confront relapse when necessary, and achieve well-being. Current research, recognized theories, and the lived experiences of hundreds of people in recovery ground and guide book content. The book has three parts and 15 chapters. A person in recovery introduces each chapter. We show how to develop, implement, and evaluate Addiction Management Plans. Each chapter ends with Summary Statements and Addiction Management Applications. References and a list of Websites complete the book. Family and friends of recovering people will find the material useful. Addiction professionals can use the book to help clients realize recovery and prevent relapse. Are you ready? Get set. Go!

Part I. Are you ready?

Chapter 1 looks at the many faces of addiction. It reviews the descriptive, diagnostic, and researched-based definitions of addiction; it discusses addiction severity and treatment intensity. The chapter also examines the incidence and prevalence of addiction. Chapter 2 chronicles the shift from the traditional medical psychiatric model of care toward the concept of recovery. Recovery is an idea whose time has come. Having listened to the voices of thousands of recovering men and women, and building upon several Federal initiatives, we define recovery as a different, better way of life with purpose and meaning. In Chapter 3 we describe a way to manage addiction: more specifically, how to maintain change, reduce risks for relapse, prevent relapse, develop a recovery lifestyle, confront relapse, and achieve well-being. Ten constructs or major ideas make up the structure, process, and outcome for addiction management. A sample Addiction Management Plan shows how to achieve goals. Chapter 4 reviews the principles that ground addiction management. An ecological paradigm supports the structure of addiction management. Empowerment theory governs addiction management process. Evidence-based practice suggests ways to evaluate outcome and demonstrate the effectiveness of addiction management.

Part II. Get set.

Chapter 5 reviews the self construct and its role in addiction management. We examine holistic self, age, gender, race and ethnicity. We review major theories and concepts that support the self construct. Chapter 6 reviews the construct surroundings, that is, our physical and social world: people, places, and things. What is the role of surroundings in addiction management? We look at nature and technology as well as friends and family, community, society, and culture. Chapter 7 discusses the construct management: the ability to direct or handle something skillfully, effectively; to accomplish something; or to achieve one’s purpose. Management strategies direct addiction management. Do you remember the children’s book, The Little Engine That Could? When other engines refuse to rescue the stranded train full of toys and food for good boys and girls, Little Blue Engine responds: “I think I can, I think I can, I think I can.” The engine overcomes insurmountable odds and pulls the train up the towering mountain to the other side. Self-efficacy is the belief I can act effectively here and now. Self-efficacy is the dynamic that drives addiction management. In Chapter 8, we examine the origins of the idea self-efficacy and identify self-efficacy actions to achieve addiction management goals.

Part III. Go!

Chapter 9 addresses change: the first addiction management milestone. Change in this context means stopping an addictive behavior or reducing harm from addiction. And perhaps most important, as it relates addiction recovery, how do people in recovery maintain change? Risks for relapse are legion. Chapter 10 examines craving, cross-addiction, complacency, non-compliance, and co-morbidity: risks that originate in the self. We also identify risks that stem from the environment (surroundings) including cues, circumstances, and crises. Chapter 11 describes ways to prevent relapse. Relapse prevention is our second addiction management milestone. We cite the work of G. Alan Marlatt and his cognitive-behavioral theory of relapse, together with the many contributions of Terrance T. Gorski, especially The Phases and Warning Signs of Relapse. Recovery is more than stopping an addictive behavior or reducing addiction harm. Lifestyle, the third addiction management milestone, is a pattern of change over time: a different way of being, thinking, feeling, and believing together with new ways of connecting with people, places, and things. Chapter 12 explores addictive and recovery lifestyles. Relapse happens. In Chapter 13, we examine this reality. Relapse is a return to drinking, using, gambling, or other addictive behaviors after a period of abstinence. For some individuals, relapse means an increase in harm associated with addiction. Bio-psychos-social theories of addiction help explain relapse. Chapter 14 explores the construct well-being, the fourth addiction management milestone. Well-being is the capacity to affirm and advance a lifestyle with purpose and meaning. Well-being embodies wholeness and epitomizes quality of life. In our final Chapter 15, we examine the vision, mission, goals, and change mandate for 2015–2018 advanced by the Substance Abuse and Mental Health Services Administration (SAHSA) to improve the nation’s behavioral health and reduce the impact of substance abuse and mental illness in America’s communities. We also fast forward and forecast what addiction, relapse, recovery, and addiction management might look like in 2020.