Treatment Initiation - Seeking Help

The First Stage of Alcohol or Drug Abuse Recovery

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If you have decided that you need to get help for your drinking or drug abuse problem, you have already entered the first stage of recovery by admitting that you have a problem and seeking outside help.

This process—reaching out for help and seeking some kind treatment or rehabilitation—is known as treatment initiation. It is the first of four stages of recovery or rehab as described by the National Institute on Drug Abuse:

  1. Treatment initiation
  2. Early abstinence
  3. Maintenance of abstinence
  4. Advanced recovery

Denial and Ambivalence

If you are like most people who seek help for substance abuse problems, in the very early stages you probably still harbor some feelings of ambivalence about giving up your drug of choice, and you may still be in denial about the full extent of your problem.

This is common for people in the early days. If you enter a professional rehab or treatment program, the first goal of the counselor or addiction treatment specialist will be to determine if you have any denial issues or ambivalent feelings.


Denial simply means refusing to believe the reality of your circumstances. Many people new to recovery usually have some level of denial about their addiction. Denial can take many forms, from thinking that you can still control your substance use to denying that you are really addicted.

The following erroneous beliefs are typical forms of denial:

Forms of Denial

  • Believing that you are different from those "real" alcoholics and addicts.
  • Thinking that you can solve your problem by "cutting down" rather than eliminating alcohol completely. You may think that you can get your substance abuse back "under control."
  • Refusing to believe that a secondary drug is also a problem. For example, an alcoholic thinking that continuing to smoke pot is okay or a cocaine addict refusing to think their drinking is also a problem.
  • Believing that Alcoholics Anonymous or Narcotics Anonymous will not be helpful, because you are "not like those people."
  • Insisting on continuing to spend time with "friends" who agree that drugs are not a problem or who use with you.

Confront and Challenge

Any of the above forms of denial can interfere with your recovery. The goal of professional treatment programs is to break through that denial and help you see the truth about your situation. Your counselor or caseworker may challenge and confront you in an effort to motivate you to change your mind.

Your counselor may remind you of all of the negative consequences that your substance abuse has had in your life or challenge you to abstain from drinking or drugging temporarily if you believe you are not really addicted. Either way, the goal is to get you to see the truth.


If you are in the early stages of seeking help for a substance abuse problem, you probably have some ambivalent feelings about giving up your drug of choice permanently. If you are like most alcoholics or addicts, you just can't image life without ever drinking or drugging again.

Chances are you decided to seek help in the first place because you experienced some negative consequences to your drug or alcohol use. You realized you needed help, but quitting completely for the rest of your life was not what you had in mind.

The following are reasons that many newcomers to recovery have feelings of ambivalence:

Reasons for Ambivalence

  • You may turn to your drug of choice as a coping strategy and you do not yet know a better coping mechanism.
  • You may feel too weak or helpless to break the cycle of addiction.
  • You may have entered rehab because of pressure from others—such as a spouse, boss or judge—and you are just trying to keep them happy.

Getting Motivated

If you decided to seek help because you experienced some negative consequences, that may have been enough motivation to get you to admit you have a problem. But it may not be enough motivation for you to solve the problem, unless you learn new coping skills.

If you have always turned to your drug of choice in times of stress, when you want to relax, or when you are upset or angry, chances are you have ambivalent feelings about giving it up.

Encouragement and Support

Your counselor, in this early stage of treatment, will try to identify your ambivalent feelings and their underlying reasons. You will probably be asked to list your goals in life and shown how much easier it will be to meet those goals if you are living clean and sober.

Again, in the early stage of recovery and throughout your treatment process, the goal is to get you motivated to make positive changes in your life. Your treatment program is there to encourage and support your efforts to make those changes.

Return to The Four Stages of Recovery

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  1. Mercer DE, Woody GE. An individual drug counseling approach to treat cocaine addiction: The collaborative cocaine treatment study model. National Institute on Drug Abuse. Published September 1999.

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