Abstract
This chapter discusses the various phases of treatment and course of recovery. Two illustrative phase or stage models of recovery have been described by Wallace and Rounsaville. Wallace (1992) described three phases of recovery, each requiring different tasks of the patient and therapist, which include withdrawal phase, prolonging abstinence, and pursuing lifetime recovery. Three stages of treatment suggested by Rounsaville include abstinence initiation, relapse prevention, and managing relapse. During abstinence initiation intensive treatment facilitates the development of new ways to behave and think. During this initial phase of treatment, multidimensional assessments are conducted and corresponding multidimensional treatment options are offered. Treatment recommendations are adapted to the patient's stage of motivation. Relapse prevention consists of formal relapse prevention training and the consolidation of therapeutic gains. Relapse management refers to the process of analyzing precipitants and consequences of relapse and adjusting treatment accordingly. When serious relapse occurs, treatment intensity should be increased. However, it is not recommended that previous treatment interventions simply be repeated. The withdrawal phase suggested by Wallace spans Days 1 through 14 of initial abstinence. Primary clinical tasks in this phase are assessment, stabilization, treatment retention, motivation enhancement, and relapse prevention. The “prolonging abstinence” phase spans the first 6 months of abstinence. The clinical tasks in this phase are continuing assessment, reducing risk of relapse, sustaining motivation, supporting ego functioning, and improving self-regulation. The “pursuing lifetime recovery” phase spans from 6 months and beyond. Clinical tasks in this phase are continuing assessment, fostering a stable drug-free lifestyle, relapse prevention, addressing other psychopathology, and continuing improvement of self-regulation.
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