Terrence Gorski?s Developmental Model of Recovery (DMR)

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Terrence Gorski describes Recovery as a developmental process in which there are six different stages. In each stage there are tasks to be mastered and skills to be developed. If a recovering person is unaware of this progression, unable to accomplish the task and gain the skills, and/or lacks adequate treatment, that individual is vulnerable to relapse. The following is a description of Terrence Gorski’s Developmental Model of Recovery (DMR).

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Transition Stage

The transition stage begins at the point that an individual experiences an alcohol or drug related problem. Once the process of addiction progresses, the individual will design a series of strategies to attempt to control their use of their drugs and/or alcohol. The transition period ends once the individual recognizes that no matter how many strategies one devises to control their use of drugs and alcohol, these strategies are unsuccessful and make the safe, controlled use of drugs and alcohol an impossibility.

In this stage, the central symptom is loss of control. The greatest obstacle to abstinence at this stage of Recovery is the belief that an individual can control how often and how much they may drink and drug. The individual is locked in a losing battle to prove to themselves and others that they can use in a controlled manner. They may be able to prove that they can control their drug and alcohol use but not for very long.

In this stage, the individual fights accepting that they are not normal drinkers and users of drugs. As the progression of addiction causes more severe loss of control, an individual must eventually acknowledge to themselves that they’re addictive users who are not capable of controlled use. This admission does not come easily but it is a truth that must be faced and owned before an individual can move on to the next developmental stage.

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Stabilization Stage

During the stabilization period the individual encounters the physical, emotional, and psychological effects of being abstinent from all mood-altering substances. Physically, the individual in this stage contends with the medical complications of withdrawal and the medical complications of any other co-existing medical problems. Emotionally, the individual encounters the awakening emotions that were repressed as their drug and alcohol use medicated their emotions. Psychologically, the individual contends with the habituated behaviors that enabled their use of drugs and alcohol to progress, the entrenched attitudes that the individual relied on to deny and/or justify their alcohol and drug use, and the belief system that was constructed to insulate themselves from the truth about their drug and alcohol use. In addition, the individual learns to identify and manage symptoms of brain dysfunction. Finally, the individual requires help in stabilizing the circumstances of their life.

The stressors that I just listed, singularly or in combination, is what sabotages an individual’s best attempts at maintaining abstinence at this stage of Recovery. Individuals in this stage of Recovery relapse because they’re unable to cope with the stress of the symptoms of brain dysfunction and physical cravings that follow detoxification. It takes between 6 weeks and 6 months for a patient to learn to master these symptoms with the correct therapy. The correct therapy is a must for people at this stage of Recovery because the lack of stabilization management skills is the major cause of inability to abstain during this second stage.

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Early Recovery Stage

As an individual masters the stabilization management skills and transitions to the next stage, early Recovery, the focus expands from stabilization management skills to include the establishment of a life-style that is free of all mood-altering substances. An individual, must be able to critically examine their life-style: 1.) the environment in which they live, 2.) the people that they associate with, 3.) the way they structure their life activity-wise and time-wise. Hard decisions must be made about where to live, with whom to live, what friendships to maintain, what friendships to terminate, and how much time to devote to 12-Step meetings. This is the stage of development where the recovering individual stops intellectualizing what Recovery is and begins to internalize the thoughts, behaviors, values, and choices of Recovery. This internalization process takes place as an individual stops talking about what to do and begins to more and more consistently do what they are supposed to do. This stage may last from one to two years.

The reason a person may relapse in this stage is because they have not fully internalized the values and skills of Recovery in order to form a style of life that is conducive to abstinence.

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Middle Recovery Stage

Once the values and choices of Recovery have been fully internalized and so reflected by the individual’s life-style which firmly rooted in Recovery, the individual then transitions into the Middle Recovery Stage. At this point the focus of Recovery expands even more to now include examining and healing the emotional wounds from the individual’s past.

Not only does the individual continue to focus on abstinence, internalizing the values and skills of Recovery, creating the necessary life-style to support abstinence, and healing the emotional wounds of the past, the individual’s Recovery program now beings to incorporate the reestablishment of broken relationships with family members, new occupational goals, and expanded social and recreational participation. At this point of Recovery, the individual begins to venture out from the protected cocoon of the Recovery community and begins to reintegrate into community at large. Although this is a time of joy as the individual experiences more freedom than ever before since getting into Recovery, this is also a time of great stress as the individual must begin to navigate an ever expanding body of life problems in which the individual must apply their basic recovery skills.

How well the individual navigates their life problems and copes with the stress created by those life problems is the determinant of abstinence or relapse in this stage of Recovery.

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Late Recovery Stage

In late Recovery, once more the focus of Recovery expands to include the working through of those personal issues that continue to be an obstacle to the overall emotional and spiritual well-being of the individual. These issues tend to focus on 1.) healing issues in regards to one’s shame-based identity, 2.) taking ownership of and transforming the individual’s character defects, 3.) resolving areas of conflict between the individual and the significant people in their life, 4.) working through issues that pertain to the individual’s fear of trust and emotional intimacy, 5.) examine issues relevant to spiritually transformation.

The major cause of relapse during the late recovery period is either the inability to cope with the stress of unresolved personal issues or an inability or unwillingness to develop a style of personality functioning that is age appropriate.

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Maintenance Stage

The maintenance stage is the ongoing and lifelong process of continued emotional and spiritual growth and evolvement. Continued growth and development will insure the individual that they will successfully negotiate future adult life transitions, manage an ever-widening and varying series of life problems, and continue to guard against relapse. The physiology of addiction lasts for the rest of a person's life. Any use of alcohol or drugs will reactivate physiological, psychological, and social progression of the disease.