We’re often asked about the natural course of recovery for someone who enters treatment as a teenager. Here’s an example, featuring  a young man who began smoking pot at 12 and entered treatment for the first time at 18, by that time for an advanced methamphetamine addiction. This in brief is what happened to him over the next 3 years.

First treatment experience: His parents, stunned to find out the extent of his drug use, convince him to enroll in a drug program, over his vigorous objections. The program they select is affordable, has a good reputation, and most important, an available bed. Despite fierce initial resistance, the youth’s attitude improves markedly. He completes the program twenty-eight days later, so changed that he actually asks to stay longer. But less than a week later he bolts, and relapse quickly follows.

Second episode: This time he resurfaces following a binge. The family pushes him into a second 28 day program, hospital-based, with the medical and psychiatric care not present in the first experience. Again, his initial reluctance quickly dissipates. Back home with the family after successful completion, he seems to do well through the summer and heads east to college with their blessing. It’s a supportive atmosphere (he even lives in a recovery-friendly dorm) but he struggles during the first year at school. Late that following summer, he admits to the family that he’s been using drugs again They were clueless.

Third episode: This one is precipitated by crisis hospitalization on the heels of a life-threatening emergency. Still under family pressure, he enrolls in a program in New York that’s later forced to close for financial reasons. He accepts a referral to a longer-term supportive residence in California. Does well, gets a year and a half of recovery under his belt. Then he begins to struggle again. Along the way, his parents learn he’s now using heroin as well as meth.

Fourth episode: This involves four months at a program in New Mexico. By now, the youth is clearly more motivated for change. Nonetheless at graduation he refuses the program’s recommendation for further residential living, and instead moves East. His opinion: he’s finally put drugs behind him. They no longer have a place in his life.

A year later, he’s still sober.

Apologies for its brevity, but this is a rough synopsis of two powerful books written by a father and son, David and Nic Sheff. I’ve stripped away the harrowing emotional narrative in order to focus attention on the ‘big picture’ of change. What can we learn from Nic Sheff’s experience? Among other things:

  1. Despite four separate treatments, this is really about a continuous process of change. The unifying force is the addict’s subjective experience. He’s changing throughout, in attitude and behavior, despite setbacks. And mostly for the better.
  2. The impact of treatment does seem to be cumulative. It would be hard to point to one treatment episode as the ‘difference-maker’. Each seems to have had some positive effect on motivation and readiness, perhaps building on previous experience.
  3. Progress is ongoing. Admittedly, it’s of the two steps forward, one step back variety. But that still qualifies as progress. It would be a mistake to interpret his experience as three failures followed by one successful treatment. That’s not really what occurs. Instead, the momentum for change is building across treatment episodes.

All in all, it’s a pretty fair description of what actually happens to many young people during the course of recovery. We start with an addict who fiercely rejects the diagnosis, and finish with someone who not only acknowledges it, but is actively living a commitment to recovery. I’m not sure we can rush this process. The point is for the addict to survive it.

And as always, in this addict’s life as in others, there’s more to be written.