Precovery: "And Then a Miracle Occurred"


Recovery Ahead.jpg Dirk Ercken

The text, Alcoholics Anonymous, declares: "Our stories disclose in a general way what we used to be like, what happened, and what we are like now." That three-part story style has been ever-present within spiritual/religious/secular addiction recovery mutual aid groups and recovery autobiographies for almost three centuries. The middle element--the catalytic event or process propelling one from addiction to recovery--is commonly the briefest and most vaguely described within such stories. When I think about this, I am reminded of the Sidney Harris cartoon of scientists staring at an elaborate formula on a blackboard with the middle notation in the formula reading, "Then a miracle occurs." And such is the process of recovery. We know a great deal about addiction and we are beginning to map in far greater detail than ever before the pathways and styles of the long-term addiction recovery process. In my latest writings, I have described five broad stages within this process.

precovery stages.jpg

Of all these stages, it is the catalytic tipping point from addiction to recovery initiation that remains the greatest mystery. The essential ingredients within this period of recovery incubation and germination are critical to anyone concerned personally or professionally with the resolution of alcohol and other drug problems--particularly the most severe, complex and chronic of such problems. In my earlier writings and presentations I have referred to this stage as recovery priming or precovery.

There is growing interest in how this stage of change may be elicited. Hopefully, days and years of waiting for people to "hit bottom" are going to be replaced by assertive approaches to identifying, engaging and motivating people in need of addiction recovery. My earliest days as a "streetworker" (outreach worker in today's vernacular) more than four decades ago focused specifically on such work, but I did not then have enough experience to fully conceptualize what was involved in this process. Recent investigations have focused on what precisely happens within the years, months and days that precede conscious recovery initiation. What is now evident is that the process of achieving recovery for most people begins before the day of last drug use. Yet little attention has been given to this period of precovery that unfolds within the very heart of active drug addiction. Reviewing over four decades of personal and professional experience working with active drug users transitioning into recovery, I conclude that the first day of abstinence is not the first milestone of recovery initiation but the outcome of a movement towards healing and wholeness that has, in most cases, been unfolding for some time.

Precovery involves several simultaneous processes: physical depletion of the drug's once esteemed value, cognitive disillusionment with the using lifestyle (a "crystallization of discontent" resulting from a pro/con analysis of "the life"), growing emotional distress and self-repugnance, spiritual hunger for greater meaning and purpose in life, breakthroughs in perception of self and world, and (perhaps most catalytic in terms of reaching the recovery initiation tipping point) exposure to recovery carriers--people who offer living proof of the potential for a meaningful life in long-term recovery. These precovery processes reflect a combustive collision between pain and hope.

Unfortunately, it can often take decades for these processes to unfold naturally. If there is a conceptual breakthrough of note in addictions field in recent years, it is that such processes can be strategically stimulated and accelerated. Today, enormous efforts are being expended to accelerate precovery processes for cancer, heart disease, diabetes, asthma, and other chronic disorders. We as a culture are not waiting for people to seek help at the latest stages of these disorders at a time their painful and potentially fatal consequences can no longer be ignored. We are identifying these disorders early, engaging those with these disorders in assertive treatment and sustained recovery monitoring and support processes. Isn't it time we did the same for addiction?

What are you and your program doing to accelerate these precovery processes for those in the earliest stages of their addiction careers? Imagine what it would mean to these individuals, their families and their communities if we could even cut the duration of addiction careers in half. What we lack as a culture is not the technology to achieve that goal, but the collective compassion and commitment to do it.