A Lifelong Commitment
Recovery is not a process that takes place solely within the confines of a four or six week treatment program; recovery is an ongoing process that will last a lifetime. The steps taken immediately following treatment, especially in the early months, can make a significant difference between permanently staying sober and an endless cycle of relapse and rehab. Aftercare is the next step following the completion of formal treatment.
Aftercare Programs Vary
While the fundamental goal of aftercare is to prevent relapse, aftercare programs may vary greatly depending on the individual and treatment program. For some individuals, a weekly, counselor-led group provides needed support and referrals following the successful completion of rehab. These group meetings are an opportunity for individuals to form close, supportive bonds with both their counselor and fellow group participants.
Other individuals may first benefit from transitional living once they complete their rehab program. Transitional living can be especially beneficial for individuals who complete intensive in-patient care but are not yet ready to transition to independent living. Regular meetings with a sponsor are also an important part of aftercare.
Who Needs Aftercare?
More than 23.5 million Americans struggle with addiction and substance abuse. Unfortunately, only 2.6 million Americans – barely 11 percent – will receive treatment in a specialized rehab center. (1) While the need for addiction treatment is great, the need for aftercare is just as strong. Even after completing rehab, many individuals continue to struggle with substance abuse.
Aftercare is a critical step in addiction treatment and essential to reducing the risk for relapse. There are 8400 new drug users each day, more than half of which are under the age of 18. (1)
Today, addiction specialists recognize that relapse is a hallmark symptom of addiction. Individuals with co-occurring disorders are at increased risk for relapse and will benefit greatly from aftercare relapse prevention programs:
- Over 8.9 million Americans suffer from co-occurring mental disorders and substance addiction.
- However, only 7.4 percent of these individuals receive treatment for both conditions, and over half of all individuals receive treatment for neither condition.
- Adults with mental illness are more likely to binge on alcohol (30 percent versus 24 percent) or report heavy alcohol use. (2)
By providing continuing counseling, support groups and transitional living, aftercare programs add an extra level of accountability that help prevent individuals from returning to old habits of substance abuse. Aftercare provides a safe environment for individuals to connect with recovering addicts, access to motivational speakers, practical guidelines for coping with stress and daily challenges, and the invaluable guidance of a sponsor.
Aftercare programs will also benefit family members and other loved ones. Aftercare services may include one-on-one counseling sessions for spouses, parents, partners and children. Group therapy meetings, as well as educational meetings about co-occurring disorders and addiction, providing important resources and support for families. Family members may also choose to attend 12-step meetings of Alcoholics Anonymous or Narcotics Anonymous that are tailored to the family members of recovery addicts. These meetings are a safe place for family members to share their experiences and receive advice and support.
Creating The Right Plan
An effective aftercare plan must be tailored to each aspect of an individual’s life. This plan is typically the joint creation of an individual and their drug counselor or addiction specialist prior to discharge from an in-patient treatment facility. The complexity of this plan depends on an individual’s personal needs, the home and community to which an individual is returning, and the perceived risk for relapse. Chance is the enemy of recovery success, without a plan in place, it is all too easy to “slip-up” and fall back into old habits. Aftercare plans leave nothing to chance.
Aftercare Plans: Basic Steps
While no two plans are identical, the following basic steps are typically included:
- Participate in Continual Care Therapy: On-going therapy sessions allow individuals the opportunity to continue to work on underlying issues that may have caused the addiction. Newly recovering individuals are more likely to continue attending recovery programs, such as AA or NA meetings, when there is a third-party to hold these individuals accountable.
- Learn About Triggers: Individuals learn how to identify and cope with triggers through lectures, workshops, and group and individual therapy sessions. A myriad of environmental, social and psychological factors can trigger a return to substance abuse. The sudden death of a loved one, the loss of a job, the flashback to an abusive situation, or simply an unexpected emotion or sensation can drive individuals back to substance abuse. While individuals may initially begin identifying these triggers during in-patient rehab, a return to independent living can often trigger new problems. This is why identifying and understanding these triggers is a key part of aftercare.
- Cope with Stress and Cravings: Following rehab, individuals may face many situations that they did not previously consider during rehab. Even “positive” experiences, such as starting a new job or moving into a new home can lead to stress and trigger cravings. Aftercare services also include learning coping skills to deal with stress and to learn to effectively handle cravings. Attending regular counseling sessions and support groups provides important structure in an individual’s life; when stress occurs, individuals can access this supportive structure and reduce the risk for relapse.
- Relapse Prevention: No one is perfect; even with the best intentions, a relapse can occur, whether it is sipping an alcoholic beverage or smoking a joint. These “lapses” may seem minor, but they can quickly trigger a downward spiral towards substance abuse and relapse. A key component to every aftercare plan is a ‘what to do’ plan in the event of a relapse. This includes list five individuals to contact (e.g., sponsor, sober friend) and five steps to take to avoid continued use/abuse (e.g., immediately attending a meeting, asking a sober friend for a ride away from the bar/house). Thinking through the outcomes of relapse and creating a plan to address a slip-up helps to reduce the risk for serious relapse.
Aftercare: When to Choose Transitional Living
For some individuals with a supportive home environment, returning home following treatment is a positive choice. From friends and family to coworkers and neighbors, people who will support their recovery surround these individuals. These individuals also have access to an outpatient continuing care program, such as regular group meetings, counseling sessions and sponsor meetings. Other individuals, however, may face very different circumstances when they complete in-patient rehab.
They may be without a job or financial resources to care for themselves; they may lack a home or the home environment may be extremely negative for their long-term sobriety. Other individuals may simply feel they are not ready to return to the ‘real-world’ and feel overwhelmed by this reality. For these individuals, transitional living can help bridge the gap between rehab and independent living.
Extended Care Explained
Extended care patients typically live in a home-like environment that is carefully supervised. If they feel the temptation to slip up and start drinking or using drugs, a drug counselor, therapist or even a fellow house-member is ready at a moment’s notice to help the individual recommit to sobriety. Benefits of transitional living include access to counseling and a house manager; in many cases, this house manager may be a former client or addiction specialist.
Individuals also benefit from round-the-clock support; there are daily group meetings and informal opportunities to discuss hopes, fears and feelings, and to work out problems. Residents provide emotional support and encouragement, creating a strong sense of community and fellowship. While transitional communities are less structured than addiction treatment centers, they still provide critical stability and a fixed set of rules that must be followed.
House members typically share in chores, such as cooking and cleaning. These chores create an important daily routine that provides structure for an individual coming out of rehab. House members must also follow rules, such as a regular curfew, and attend all required household meetings.
In addition to daily chores, individuals in transitional living will also have the opportunity to take life-skills classes. These classes range from resume workshops to parenting basics. The classes are designed to help individuals learn life skills that may never have been mastered due to past struggles with addiction. Additionally, for individuals who are unemployed, transitional living homes provide an affordable living situation and critical stability during the job search process.
Keys to Success:
Honesty, Openness and Willingness
Treatment for addiction cannot be “done” for someone else; even the best programs and rehab centers will prove unsuccessful if an individual is not open and committed to the program. Honesty, openness and willingness are key to aftercare success.
- Do some soul-searching: Facing “past demons”, and being honest about the emotions that surface can be incredibly painful and difficult. Doing some soul-searching and embracing the results may be unpleasant, but necessary. This may mean creating a long-list of experiences to talk to the counselor about, sitting in a quiet corner and writing a “life history’, or simply being honest about the real causes for past problems. Taking an objective view of the past and sharing these insights with a drug counselor or therapist is very important to aftercare success.
- Listen and observe: Be open to learning from the experiences of others. Even when the topic or experience does not seem relevant (e.g., discussion about prescription drug abuse when someone is struggling with alcohol addiction), it is always possible to extract valuable information and learn from others’ experiences. Listening and observing during meetings and group counseling is just as important as sharing personal experiences, thoughts and feelings.
- Share thoughts, feelings and experiences: Initially, sharing may be painful, embarrassing or downright awkward. Some individuals may be eager for the relief that comes with sharing personal pain, while others may only want to share “half-truths” and avoid the most painful experiences. A refusal to share openly and honestly with a counselor or support group will only set individuals up for failure and sabotage recovery efforts. A willingness to try, even when sharing is uncomfortable is important.
Aftercare: Next Steps
Recovery will not happen overnight. Even with strong aftercare programs and transitional living, some individuals may still relapse, especially in the early weeks or months immediately following rehab. For example, a survey of Alcoholics Anonymous members found that 3 out of every 4 members admitted to relapsing within the first year of their recovery. However, after five years, the relapse rate dropped to 7 percent. (3) This statistic illustrates the importance of aftercare and continuing the commitment to sobriety, even when relapse occurs.
Relapse is Not Total Failure
Relapse does not mean that aftercare is a failure; it simply means that individuals need to get back on track. Sobriety must be addressed one day at a time. A supportive aftercare program, such as transitional living, will make it easier for individuals to stay committed to their long-term sobriety goals. For individuals with co-occurring disorders, aftercare also provides an important opportunity to receive integrated care that considers both an individual’s psychological disorder, such as depression or anxiety, as well as an individual’s addiction to alcohol or drugs.
Aftercare works. For example, the rate of alcohol dependence and abuse has decreased from 18.1 million Americans in 2002 to 16.7 million Americans in 2011. (1) While there are many reasons for this decrease, one factor is the increasing role of aftercare in treatment programs. For individuals who are unemployed, transitional living residences provide affordable housing and a stable environment during the job search process. From group meetings to transitional housing, as more individuals take advantage of aftercare programs, more individuals will be able to achieve and maintain sobriety, even if a relapse does occur.