Six Phases of Addiction Treatment

Emergency room is only the beginning of a long, multi-phased treatment for addiction.

Roughly speaking, any case of addiction can be classified into one of the six phases. The sixth phase is Relapse, which occurs as soon as the patient uses the substance that originally caused the addiction problem. After each relapse, the same set of 5 steps can be followed.

Six major phases of addiction

1. EMED: Emergency and Acute Care

The goal of the EMED phase is to save the patient’s life. This ranges from interventions in the emergency room or in the place of drug use during an overdose, to stabilizing major organ system function (especially respiration, heart function, kidney function, liver function and GI), treating bacterial/viral/fungal infections that may include sepsis, addressing orthopedic emergencies, and stabilizing the patient neurologically. Importantly, EMED also includes emergency psychiatric with a focus on suicide prevention, sedation, and acute management of a psychosis, a major depressive episode or PTSD.

2. MD: Medical Detox

MD consists of medication-assisted detox and management of acute withdrawal symptoms. 24-hour medical supervision and full or partial hospitalization are important parts of this phase.

3. PAS: Post-acute Stabilization

PAS is perhaps the most challenging part of treatment, as it can go on for up to 12 months. Stabilization here refers roughly to restoring the normal range of neurotransmitter levels in the patients’ brain. This corresponds to achieving the goal of restoring basic eating, sleeping, physical activity, cognitive, and social function. In most cases, PAS occurs during the first 1–2 months of inpatient residential treatment, and includes medication, individual therapy, and group therapy in a living-assisted environment.

4. ERem: Early Remission

ERem stage is characterized by remission of withdrawal symptoms, cravings, and associated behavioral problems. The treatment at this stage includes medication management, individual therapy, group therapy, participation in community 12-step groups, random drug testing, living in a sober supportive environment, physical exercise and re-integration into society. During this stage, it is important to address medical and psychiatric co-morbidities of addiction. At this stage, patients should be screen for a variety of potential health problems, which should then be prioritized and a plan of care developed to address them. Such health problems may include psychiatric conditions (depression, anxiety, PTSD, schizophrenia, ADD/ADHD), infectious diseases (HIV/AIDS, syphilis, Hep A/B/C, TB), chronic conditions (high blood pressure, heart disease, high cholesterol, diabetes, asthma or COPD, obstructive sleep apnea, liver damage, endocrine dysfunction, cancer), reproductive health problems. The plan of care can also include skin care , dental care, vision care, and orthopedic care.

5. CRem: Complete Remission

CRem is the final stage and marks self-sustaining, effective management of the underlying chronic condition. In addition to the improvements in ERem, CRem is additionally characterized by higher levels of cognitive and social function that include complete return to work or study, independent and sustainable housing, a functioning social support network, and both platonic and romantic intimate relationships. Continuing recovery program at this stage should include medication management, individual therapy, participation in community 12-step meetings, random drug testing, and physical exercise. During this stage, the patient received the care necessary to address the wide range of health issues that were identified in ERem.