The Many Roads to Long-Term Recovery

Sam Pirozzi EdD, LCADC, LMFT, LPC – 
Dr. Sam Pirozzi is a New Jersey licensed professional mental health counselor, marriage & family therapist and licensed clinical drug and alcohol counselor, with more than 35 years of experience. He has worked in a variety of settings as a clinical and executive director, including outpatient and in-patient mental health and drug and alcohol treatment programs, private practice, universities and hospitals. He is the Executive Director of Straight and Narrow Inc. one of the oldest and largest in-patient and outpatient drug and alcohol treatment facilities in New Jersey. Straight & Narrow is a  Catholic Charities agency headquartered in Paterson, N.J.  The agency has a staff of 300  and provides services for approximately 1,000 individuals a day.


During my forty years as a professional in the field of addiction treatment I have spoken to hundreds of men and women in recovery, always curious, what made the difference between their continued use or choice to take the path to recovery. For each individual there are unique factors but several common themes continued to surface; these themes appears to be, experienced in different ways by different individuals. I have witnessed three general themes that emerge and seem to be consistent for many in long term recovery. These themes are: continued clean time with the establishment of a support system, an acceptance of a lifestyle change, and the experience of a significant life changing event leading to an openness in exploring an aspect of themselves that had previously been off limits.

Clean time is defined differently by various individuals or groups associated with addiction treatment and recovery programs.  Some discount an individual who is on medication assistant treatment like methadone, suboxone or naltrexone as being clean. Other very conservative individuals may include the addiction to nicotine as an exclusionary factor. Although, I understand the validity of many of these viewpoints, for this article I will include all of the examples cited as individuals in recovery. I base my thinking upon the belief that the primary characteristics of active addiction are; the inability to remain abstinent, the lack of behavioral control, the craving for the substance of use, the lack of awareness of significant life problems and the lack of a healthy emotional response to life situations. Personally, my view is that if an individual addresses these issues successfully whether they are on medication assistant treatment or not seems to be a moot point.  The overall lasting change in mind, body and spirit is that which is celebrated.

A critical next step after acknowledging ones’ problem is preparing for the path to recovery with the establishment of clean time. Some people may require medical detoxification, which is a significant step that allows the body to begin the healing process.  The likelihood that one will remain clean just after detoxification is slim. Anyone who has been around addiction and recovery for just a short time knows that this step, yet crucial, is usually not enough for most to maintain long term recovery. Recovery is directly related to the length of time a person is away from their substance of abuse, positive changes in their belief system and making the necessary lifestyle changes required to sustain this state of well being.

The first reoccurring theme reported, is the establishment of a support system. Significant emphasis is placed on the establishment of a positive recovery network, a social support group knowledgeable of substance use disorders, a life lived while in active addiction, and the consequences suffered as a result.  Gaining a sense of belonging for some whom may have isolated themselves for so long provides the opportunity to identify with one another, normalize experiences and create motivation for everlasting change. For countless individuals in recovery having this support system in place is essential for their continued success.  This level of understanding is often found within mutual support groups like 12 step programs, and yet others find this support within their family, friendships and religious practice participation.

The key, I believe is establishing relationships that are supportive, knowledgeable, honest, meaningful, caring, compassionate and reciprocal.  One individual shared about her network of peers that she established after completing a long term residential treatment program.  Twenty years later they still remain friends and are instrumental in each other’s recovery process.  Even though they did not see each other frequently they always remained in constant communication and had the comfort of each other’s nonjudgmental support.  Alternatively, others may find this support within the fellowship of their Alcoholics or Narcotics Anonymous 12 step groups or other mutual support groups.

Another frequent emerging theme is the acceptance of a lifestyle changes. This seems to have a lasting positive impact on individuals in maintaining long term recovery, although difficult and awkward for some who have had significant interpersonal collateral damage. The significant change in lifestyle is a practice that may begin in rehab and continue after discharge. Some of the lifestyle changes reported includes the adoption of healthy patterns of exercise and having a regular schedule of either educational, vocational or recreational activities and for many attendance at mutual support groups.  Living a life that provides stability, with a predictable routine which also includes regular doctor visits, a well balanced diet, establishing healthy sleeping patterns that allows for quality sleep and awake time, all promote a healthy lifestyle change.

Establishing a consistent sleep pattern in early recovery is significant to the attainment and maintenance of one’s long term recovery. Some individuals reported struggling with the development of healthy sleeping patterns after years of substance use.  They talked about various medical, clinical and behavioral options available.  Some required professional consultation by an addiction specialist utilizing several behavioral methods such as meditations, sleep apps and scheduled exercise to coincide with improvement in their sleep. Others reported their history with addiction and current state of recovery to their health care professional and found medical alternatives to be safe and beneficial.   Suggestions like nonprescription approaches such as melatonin have yielded successful results for some and others have been prescribed medications such as Trazodone to assist with the development of healthy sleeping patterns.

The last most frequent theme reported is the experience of a significant life changing event. Most individuals often talk about a significant life event that made the difference. Frequently, it was something very subtle, like someone providing a compassionate, caring but firm offer to help when they felt helpless. The life experience provided an opportunity to realistically confront their unhealthy thinking and behavioral patterns that reinforced their substance use and to find hope.

One individual shared their experience of being in the same environment as a group of young adults with developmental disorders. He and the others were at a Catholic Charities owned lake that hosted outings for young adults in rehabilitation for addiction and young adults with developmental disorders who resided at a group home. He stated that although the groups did not interact and were at different parts of the lake it was significant enough for him to question what he was doing to himself and to begin a more determined meaningful path to recovery. Others have spoken about “being just sick and tired of being sick and tired”. These moments often lead to an openness to explore the possibility of a “ah ha” moment or the point of enlightenment.  Their experience seems to be a turning point that establishes insight and the desire to return to or establish a healthy value system, the opportunity to see themselves and their circumstances differently.

This openness has also allowed some individuals to accept the fact that their addiction may be more complicated and include an undiagnosed mental health disorder. Understanding that a pattern of relapse was related to an untreated mental health disorder has provided answers to a pattern of moralistic and judgmental thinking that continued to feed their addiction.

Individuals in long term recovery are very open to sharing their experiences. This is part of the success of the self help movement.  The similarities and differences in their stories still amazes me, and the varying degree of consequence which was required to inspire change.   One individual may have had to face heartbreaking experiences while another simply missed work as a result of their substance use and turned the page. As an addiction’s professional I needed to learn very early on that I did not have right nor the knowledge to know who would benefit from treatment and who may not. Today’s medication assistant and evidence based treatments have helped the profession provider turn a corner.  I understand it is my responsibility to be open to each individual and their unique story and the  new treatment alternatives that may play a part in the path to recovery for men and women in need.

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