Recognize the Problem: Awareness can come in many ways and many guises from the person themselves becoming more aware of their internal state (usually of dysphoria) to outside circumstances and people weighing in (the extreme being “an intervention” or planned intercession by family/friends/interventionist). Alcoholics Anonymous and many of the “12-step” programs recognize the concept that the true alcoholic or drug addict must “hit their bottom” of low functionality in order to experience a psychic change significant enough for sobriety to ensue. Studies clearly demonstrate that incurring a significant physical illness as a result of addiction (e.g., liver cirrhosis in the case of an alcoholic) may be enough of a trigger for the person to stop using (see Dr. George Vaillant’s book “The Natural History of Alcoholism, Revisited ”). “Motivational Interviewing (3rd Edition, 2013)," invented by Dr’s Miller and Rollnick in the early 90’s, delineates a structured approach to ascertaining a person’s “willingness to change.” The take-home point is that the clinician’s non-judgmental approach is key. Even when a formal intervention occurs, the participants present their viewpoint objectively (i.e., not moralizing) to the one being intervened upon (see “No More Letting Go” by Debra Jay).
Have a realistic “Plan A” and be willing to change to Plan B if necessary. One good example would be “an outpatient detox” whereby detox med’s are used in the doctor’s office in conjunction with non-medicine interventions (like attending 12-step meetings, psychotherapy, etc.) in order to clear the potentially harmful chemical or chemicals from the person’s system. Unfortunately, even when well-intentioned and planned out, the success rate is low given the risks involved, and degree of non-medical monitoring necessary (e.g., it is often wise to involve a family/friend significant other to delve out the medications). Last but not least the type of patient involved must be taken into account, who by the very nature of his or her disease up until that point has been notoriously unreliable, and thus may not make a suitable candidate for a medically supervised but nevertheless outpatient-type detox.
Pick a reasonable detox plan in general: So, based on the clinical picture and family/friend support system, it may be more desirable to do an inpatient (hospital-based) detoxification than an outpatient setting. Also the length of detox may vary (often depending on the type of substance used and duration of its use) from literally hours or days (most often short-acting addictive substances like ethanol or commonly “alcohol”) to weeks or even months (e.g., a person who has for years been on high doses of benzodiazepines type tranquillizers like Klonopin, Valium or Xanax).
Get your support System Lined up: The usual suspects are gleaned from family and friends to “12-step” or recovery-based support personnel. Oftentimes, a supportive person who themselves has experienced (and hopefully recovered from) drug or alcohol dependence is key, and likewise well-place are those connected to the addicted patient who themselves may have a medical background (e.g., nurse, physician or counsellor/therapist).
Do not look back while taking your recovery in an orderly sequence: Thus “the drill” may properly consist of detoxification (inpatient or outpatient) ----→ residential halfway-house (with daily programming) -→ outpatient IOP or intensive outpatient groups several times per week--→outpatient psychotherapy +/- 12-Step or “other” self-help group (Rational or Smart Recovery). As already alluded to, the more “acute” part of these steps may take days-weeks while the whole process is best considered to last literally a life-time.
I refer the interested reader to my remarks in the book “Recover to Live” by Christopher Lawford Published 2013.