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Addiction Treatment “Step-Down” Process

Jennifer Cousineau MSCP, LPCI, NCC

Medically reviewed by

Jennifer Cousineau MSCP, LPCI, NCC

January 23, 2019

The Step-Down Process of addiction treatment looks like an inverted pyramid. As a person moves farther along in this form of treatment, the curriculum becomes less intensive and scrutinized. Rarely does a person beat an addiction alone, but with treatment, there is hope.

Nearly everything in life comes in phases–a person doesn’t normally earn a million dollars overnight. Someone just graduated from college might see a more seasoned professional, and wonder “how in world do they have the nice things they do?” They got there in phases. Addiction treatment can work in a similar way through a “step-down” process. A person suffering from an addiction to drugs or alcohol might see someone else, who has lost everything due to their own addiction, and think to them self, “I’ll never be that bad.” Drug addiction can come in phases; most people don’t start out using heroin bankrupt, homeless or having panic attacks.

That same person might see a person further along in their recovery and say, “I will never be able to do that!” The step-down process of addiction treatment allows a person dealing with addiction to go through a series of recovery curriculum. Each step of the process becomes less intensive than the step before it. This will allow the individual to recover as slowly or as quickly as they are able.

An Addiction Isn’t Always Obvious

Sometimes it can be hard to tell if someone is using drugs–blood shot eyes, mood swings, and change in appetite can seem pretty obvious, especially if these changes occur out of nowhere. But what if these signs don’t just appear? What if a person uses drugs and just says that their mood swings, or tiredness due to stress from work, or school? It is easy to give the person you love the benefit of the doubt when, as far as you know, they have a history of being honest.

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What Are The Signs Of An Addiction?

Most of the time, if someone is using illicit drugs or excessive alcohol, only the people in their circle of friends knows about it. Those friends might even have gotten into drugs and alcohol alongside them, but not everybody becomes addicted. No, some people are able to leave it alone as soon as the drug becomes a problem. Even if those same friends try to approach said person with concerns about their drug or alcohol use, how can they be certain it’s an addiction? How can they be sure that their friend needs help?

The thing with addiction is that it can strike any age, at any time–but typically after prolonged use of a substance does the phenomenon of a mental and physical addiction take place. Here are a couple addiction warning signs to look for in a person’s behavior:

  • Increased drug tolerance (the need to use more of the drug to experience the same effects one used to achieve with smaller amounts)
  • Using drugs to avoid or relieve withdrawal symptoms (nausea, restlessness, insomnia, depression, sweating, shaking, anxiety)
  • Loss of control over drug use (using more than intended, unable to stop)
  • Life revolves around drug use (always thinking of using, figuring how to get more, or recovering from use)
  • Abandoning enjoyable activities (hobbies, sports, and socializing) to use drugs
  • Continuing to use regardless of negative consequences (blackouts, infections, mood swings, depression, paranoia)
    (From the U.S. Department of Health and Human Services)

What Does A Step-Down Process Look Like?

The step-down process for addiction treatment often starts off with a substance abuser, who is white knuckling life, and might not have any answers, but they know that they need to get help. The process can help a person living with an addiction deal with their problem with an intensive program that they can move through at their own pace, and will include more freedoms as you go. Here is a possible step-down scenario:

Step-1:

  • Patient Evaluation and Diagnosis
  • Group Seminar
  • Peer Evaluation
  • Detoxification
  • Medication
  • Daily Drug Testing
  • Inpatient Behavior Therapy
  • Inpatient Group Therapy
  • Healthy Living Classes
  • Relapse Prevention Classes
  • Spirituality Class
  • 12-Step Program

Step-2:

  • Patient Evaluation
  • Medication
  • Inpatient Individual Therapy
  • Inpatient Group Therapy
  • Daily Drug Testing
  • Healthy Living Classes
  • Relapse Prevention Classes
  • Spirituality Classes
  • 12-Step Program

Step-3:

  • Patient Evaluation
  • Inpatient Individual Therapy
  • Wean Off Medication
  • Weekly Drug Testing
  • Healthy Living Classes
  • 12-Step Program
  • 12-Step Sponsor

Step-4:

  • Patient Evaluation
  • Outpatient Individual Therapy
  • Outpatient Group Therapy
  • Random Drug Testing
  • 12-Step Program
  • 12-Step Sponsor

Step-5:

  • Patient Evaluation
  • Outpatient Individual Therapy
  • Relapse Prevention
  • Healthy Living Class Revisited
  • Relapse Prevention Revisited
  • 12-Step Program
  • Final Patient Evaluation and Graduation

Patient Evaluation And Addiction Treatment

Since each person is different and addictions are not all the same either, there is rarely a textbook way to help each patient. By evaluating everyone, psychologists get a chance to understand each person’s treatment needs on an individual basis. Throughout the treatment process, evaluation criteria are based on a person’s recovery progress.

Detoxification And Addiction Treatment

Detoxification is all about cleaning the drugs out of the system. This often requires lots of fluids and a healthy diet. Some people suffering from an addiction might not have eaten a good meal for weeks, because drugs and alcohol is the only resource they think about. According to the National Institute on Drug Abuse, “detoxification alone is rarely sufficient to help addicts achieve long-term abstinence, for some individuals it is a strongly indicated precursor to effective drug addiction treatment.”

Drug Testing And Addiction Treatment

Unfortunately, dishonesty can be a common character defect of a person dealing with addiction, so a drug test will speak the truth about an individual’s drug or alcohol use. Some might even go into treatment high, because of fear of withdrawal, or to get that last “fix.” In the step-down process of addiction treatment, drug testing can be used for the entirety, or might drop down to fewer to no tests.

Individual And Group Therapy And Addiction Treatment

The beauty of individual therapy is that a psychologist can get a one-on-one chance with their patients; however a person suffering from addiction might have spent a good portion of their life fearing authority, and there might have been times when telling the truth has led to more trouble. Only after a person really opens the door and becomes honest with their therapist can they reap the benefits of individual therapy.

Group therapy is typically more of a classroom setting. The therapist will have a common ground (in this case addiction) for each person to talk about. Group settings are beneficial to each person with an addiction, because it gives them a chance to hear stories from other people like them–and it helps everyone feel more comfortable telling the truth.

12-Step Program And Addiction Treatment

The 12-Step program gives a person a spiritual approach to recovery. First and foremost, a member of a 12-Step group must be completely honest, and is required to truly want sobriety. The final result from the 12-steps of recovery is to live a more humble, sober life. Some of the simple steps to get there, are turning your life over to a God of your understanding, a personal inventory to determine who you have harmed, personal house cleaning, and making reparations to those you have harmed–and it all starts with admitting that you are “powerless” over drugs and alcohol–that they have made your life “unmanageable.”

Behavioral Therapy And Addiction Treatment

The Step-Down Process fits into the Behavioral Therapy category, which is further defined by the National Institute on Drug Abuse as:

“Behavioral approaches help engage people in drug abuse treatment, provide incentives for them to remain abstinent, modify their attitudes and behaviors related to drug abuse, and increase their life skills to handle stressful circumstances and environmental cues that may trigger intense craving for drugs and prompt another cycle of compulsive abuse.”

What Happens If I Relapse?

Relapse doesn’t happen to everybody, but honesty is the best tool to ensure that you don’t become a habitual offender. If nobody knows about it, then they don’t know to help. According to the American Society of Addiction Medicine, “addiction is progressive and can result in disability or premature death.” This basically means that the illness gets worse over time, and even if a person has years of sober time, their disease is consistently getting worse.

How To Receive Information About Addiction Treatment

If you are reading this, thinking to yourself, “this is me!” You might be suffering from a drug addiction. Or maybe you’re thinking about a loved one who might need help. There is an easy solution, and we can help. Contact us today 888-979-9592 if you have questions about The Step-Down Process to Addiction Treatment! You don’t want to find out that it’s too late…

National Institute on Drug Abuse - Behavioral Therapies

American Society of Addiction Medicine - Definition of Addiction

Substance Abuse and Mental Health Services Administration - Substance Use Disorders

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