“Recovery” from the use of alcohol or substances is a long and dedicated process requiring an individual’s commitment and action to bring wellness and healthy behaviors to the body, mind and soul, helping to restore all systems—mental and physical—to healthy functioning, as a result of abusing alcohol or other substances.

While much awareness has been raised of the growing workplace epidemic of substance use disorder in the construction industry, little is written or understood of the methodology, educational process, commitment and time it takes for an individual with the disease to “recover” oneself. Much of society, including employers, family and friends may not comprehend that individuals who suffer from substance use disorder can’t just stop using overnight by themselves. There are dangerous effects a person may experience if a sudden stop occurs on their mental and physical health that will lead them to using again.

The goal of recovery is ultimately the same for every individual, but everyone's journey is different. Each requires their own treatment and timeline to achieve and complete the recovery journey. It is often misunderstood that “getting sober and recovering oneself” is an overnight, 30-, 60- or 90-day process. There are no guarantees for how much time it will take to recover from substance use disorder. This is only the beginning of a long process to break old patterns and commit to forming more healthy and positive behaviors—breaking the negative relationship with substances. Use of the substance evolved over time and will require just as much time—or more—to overcome it.

One of the best-recognized approaches to recovery is the "Stages of Change" or "Transtheoretical" model, which can be applied to a range of behaviors that people want to change, but have difficulty doing so. This concept helps to reduce misconceptions of a complex and misunderstood process of what to expect when a coworker, family member, friend or yourself experience contemplating the decision to seek recovery. Below is an overview of the stages describing the process people must achieve in order to overcome the use of alcohol and/or substances, learning new patterns of behavior (Fig.1).

Fig. 1. Stages of Change or Transtheoretical Model

1. Precontemplation

In the precontemplation stage, people may or may not be experiencing negative impacts of their alcohol or substance use on relationships at home, or work, having no intention of changing their behavior. Also called the “denial” stage, when people use defense mechanisms and are reluctant to acknowledge there is a problem or admit that their behavior as a result of using has negative effects on themselves, families and coworkers.

They will avoid talking with others and minimize the negative impacts of their use. They will make excuses, rationalize or try to justify their negative behavior, often blaming it on others. They usually resent suggestions to seek help or change their behavior. For example, they may say they are drinking or using because of stress at work or home. They will claim it’s common to use in order to relax and minimize their use. In this stage, people may feel helpless or hopeless about their situation or overwhelmed by the energy required to make a change.

Some people in this stage may go for treatment but, often, involuntarily. They may have lost something basic or valuable to their existence—a job, money, reputation, spouse or family. Typically, it’s because family, friends, an employer or a court order has forced them into treatment. Treatment in this stage is often ineffective because individuals may still be in denial regarding their substance use disorder. People are reluctant and resistant to receiving information on substance use disorders or recovery options. Since people in this stage are reluctant to receive or get any kind of help for their substance use, it may be the beneficial for family, friends or coworkers to raise their awareness of the risks and dangers associated with their use on the job and at home. For example, engaging in delicate and empathetic conversations getting people with substance use disorder to explore the negative consequences of their own behavior can help to lay the groundwork for the second stage of recovery.

2. Contemplation

The contemplation stage is an uncomfortable process for the person with a substance use disorder. Feelings of guilt, shame, hopelessness or desperation are common as they reach this stage in their addiction. Individuals begin to recognize they may have a substance use disorder and think about wanting to seek help but are often undecided and uneducated about doing so. People may remain stuck at this stage for an undetermined amount of time—knowing they need to make a change but unready or unsure how to move forward.

It’s common for people in this stage to try to decrease substance use on their own, often planning with themselves to reduce their intake. It is common for individuals in this stage to debate internally whether they want to change, recover or restore relationships. They may be reluctant to follow through or set a definite date. When the individual in this stage starts shifting away from denial and actively thinking about their negative impacts on behavior, relationships and work, they begin focusing on solutions and slowly transition into the third stage of recovery.

3. Preparation

This step involves planning to take meaningful steps toward recovery in the near future. At the preparation stage, an individual may come to a decision to seek treatment either on his or her own, or through an intervention of employer, family or friends. Often an individual may be court-ordered for mandatory treatment if their use resulted in negative consequences.

At this point, an individual may slowly start to commit to change, preparing to act in the next several days or weeks. Although they may still be using substances in this stage, they’ve likely begun expressing to family members, friends, coworkers or employers about their plan to change their behavior—but they may still feel scared and uncertain about their choice. While it may be attractive to rush into recovery at this point, in their book Changing for Good, psychologists James Prochaska, John Norcross and Carlo DiClemente caution against this sort of sudden action and warn that those who “cut short the preparation stage” are more likely to fail and continue to use.

It is most effective to develop an action plan and identify strategies that will help the individual to overcome their substance use. This process includes examining relationships, environmental and emotional triggers that may cause the negative behavior to repeat the pattern to use. In addition, identifying lifestyle changes they’ll need to make or researching types of treatment and treatment facilities is an effective way of setting goals—an activity that helps to strengthen their commitment to change.

4. Action

The action stage is more than just getting sober or abstaining from the use of substances. The individual completely immerses into recovery. This may include committing to participate in inpatient or outpatient treatment or enroll in a short- or long-term treatment program. Alternatively, an individual may join a 12-Step group, anonymous support groups or participate in some other form of resource for recovery.

This stage is the educational, self-exploratory and action phase towards positive change. The commitment of the individual may be challenged often to act positively on what he or she has learned. The individual actively participates in making significant lifestyle changes to repair damage to the mind, body and soul, improving his or her mental and physical health, which leads to a healthier and more productive life moving forward. In addition to learning the skills and strategies of recovery, the individual also spends much time altering his or her diet, fitness and job or career plans, as well as repairing, re-establishing or forming healthier relationships. This phase requires self-discovery and evaluation, learning new positive patterns of behavior to diminish the negative patterns of substance use.

5. Maintenance

Between the action and maintenance stages, the individual completes a treatment program or other resource of recovery. In this stage the individual makes the commitment and assumes responsibility for remaining abstinent and sober. Ultimately, he or she must “maintain” the sobriety acquired during the action stage.

This is an extremely important stage and is often not taken seriously, which is why most individuals who relapse do so during the maintenance stage. Much like a person must practice a skill or trade after learning it, an individual in the maintenance stage must practice living life in recovery long-term. Fortunately, there are an abundance of resources available to help make people more successful during this stage, including aftercare, alumni programs and support groups.

6. Termination

In the termination stage, a transformation of recovery occurs for the individual. This stage is a result of the action and work performed in the action and maintenance stages. This includes the individual recovering his or her health; restoring damaged relationships or developing and maintaining newer healthy ones; working in a stable job or career; becoming financially independent; and having confidence that he or she will remain in this state of stability.

A commitment to sobriety becomes a lifelong journey. In this stage, when asked, most individuals may have no desire to return to active use and are relieved to no longer have the same negative behavior, habits or patterns, as when they were actively using substances.

Conclusion

The six stages of recovery make the process easier to understand for employers, coworkers, family and friends who don’t have prior knowledge or experience with the process of recovery of substance use disorder. These stages help clarify an individual’s experience with substance abuse disorder recovery over time and puts the recovery process and stages into perspective, making it easier to determine the best resources to use for each stage to come into total recovery and live a healthier existence mentally, physically and spiritually.