Individuals who complete the very early stages of a treatment program for a substance use disorder are often very tempted to make the determination that their struggle is over.
This is particularly true of individuals who complete a detox program. Detox simply assists a person in negotiating the withdrawal process and avoiding relapse during this very acute recovery stage. Detox must be followed by more intensive therapy, but even this is not enough. The majority of professional sources indicate that some type of aftercare is necessary following the acute stage of recovery in order for an individual to be successful on a long-term basis.
The term aftercare in the context of substance use disorder treatment refers to additional treatment that an individual participates in once they complete a formal program. Aftercare is needed for those who participate in either inpatient or outpatient treatment programs.
Types of Aftercare
The basic elements of an aftercare program include the following:
- Therapy: Therapy consists of formalized treatment programs based on psychological principles that are delivered by a trained, licensed, mental health professional, such as a psychologist, counselor, social worker, etc. There are a number of different schools of therapy that can be applied to substance use disorder treatment. The most common form of therapy used in addiction treatment is Cognitive Behavioral Therapy. Therapy can be delivered on an individual basis (one client with one therapist), a group basis (more than one client treated by one therapist in the same session), or performed in a combination of individual and group sessions. Group therapy can consist of a number of different types of groups, ranging from marital or couples therapy to formal groups.
- Social support groups: These groups are not run by professional mental health workers but by individuals who are suffering from the same issue. The most well-known of these groups are 12-Step programs, such as Alcoholics Anonymous, Narcotics Anonymous, Cocaine Anonymous, etc. Other types of social support groups that are not based on the 12-Step program exist.
- Medical management: This type of aftercare treatment involves care from a psychiatrist or addiction medicine physician. These individuals typically do not engage in much formal psychological therapy or counseling but instead administer medications to help the individual control cravings for drugs and alcohol and to address other issues, such as depression.
- Treatment for co-occurring disorders: An individual who is diagnosed with a substance use disorder and some other mental health disorder at the same time is classified as having co-occurring disorders. Because individuals are more successful in recovery if both diagnoses are treated at the same time, specialized care is used for these individuals.
- Complementary therapies: Other types of aftercare treatments that do not fit neatly into the above categories can include mindfulness meditation programs; participation in physical activities designed to assist individuals with substance use disorders, such as yoga, martial arts, etc.; and other types of complementary and alternative forms of intervention, such as wilderness therapy, music therapy, art therapy, etc. Most of these programs are designed to work with formal treatment programs, and they are not typically considered to be standalone aftercare treatments.
Discussion of aftercare include any of the above approaches or combinations of any of the above.
Does Aftercare Work?
The vast majority of sources, both older and more recent, such as information provided by the Substance Abuse and Mental Health Services Administration (SAMHSA), indicate that overall relapse within the first year to two years following initial recovery occurs in nearly 50 percent of all individuals trying to recover from substance use disorders.
The National Institute on Drug Abuse (NIDA) reports that relapse rates for substance use disorders are similar to the relapse rates observed for other medical conditions that have a significant behavioral component to them (e.g., hypertension or diabetes). Again, these relapse rates are generally around 40-50 percent. Thus, many sources suggest that relapse is often part of the process of getting better, and individuals learn from relapses and move on to become stronger in their recovery. However, the goal of substance use disorder aftercare treatment is to avoid relapse.