An important consideration in providing treatment for substance use disorders is what happens after the inpatient treatment period has ended. Sometimes the transition from fulltime treatment back to the person’s normal daily life can be a challenge, reintroducing exposure to triggers and temptations. When a person needs guidance and support in avoiding relapse during this part of the recovery process, as most recovering individuals do, aftercare can help.
Aftercare provides vital services to help a person make this transition while receiving the support and tools needed to maintain recovery
Overview of Aftercare
According to the National Institute on Drug Abuse (NIDA), 40-60 percent of people relapse to substance use after treatment. These numbers are similar to relapse rates for other chronic illnesses like asthma, which require continued care after treatment to maintain recovery. Substance abuse is no different in this respect – continued care after treatment should be considered part of the treatment plan in order to minimize the chance of relapse.
To help provide this needed service, experts like the Substance Abuse and Mental Health Services Administration (SAMHSA) recommend that treatment follow a full continuum of care – that is, care that reflects the requirements of each stage of treatment, as well as the particular needs of the individual. The continuum begins when a person first enters treatment, and provides the particular services that are needed throughout the treatment process.
As part of the continuum, aftercare includes services provided after formal treatment is completed that can help a person manage the transition out of rehab and back to daily life.
Primarily, these aftercare services are designed to reinforce the lessons from rehab and prevent relapse to drug or alcohol use during the vulnerable period of time right after rehab.
- Elements of Aftercare
Various studies, such as one from Society, demonstrate that some people don’t feel prepared to re-enter the world after substance abuse treatment for various reasons, fearing that they will relapse because of numerous circumstances. The main goal of aftercare is to help with this issue and provide relapse prevention.
To help meet this goal, various programs provide the following elements that contribute to preventing relapse, among others:
- Motivation to avoid relapse
- Accountability for behavior and to avoid substance use
- Social support and guidance
- Feedback during high-risk situations
The various programs included in aftercare services provide all of these elements to one degree or another. Which service is appropriate depends on the individual’s particular daily challenges, risk factors for relapse, and needs.
- Who Benefits from Aftercare?
People who have a higher risk of relapse benefit most from aftercare to help them manage the cravings and triggers that may lead to drugs or alcohol again. There are a number of risk factors for relapse, such as stress, which is discussed in a study from Psychopharmacology.
In addition, a higher risk of relapse may be found in people who have:
- A family history of addiction or mental illness
- Existing prior drug abuse and relapse
- Other existing mental health disorders
- Difficult home, family, work, or social environments
- Lack of purpose, few extracurricular activities, and unemployment
- Lack of motivation to complete recovery
While those with higher risk factors may benefit the most, every person in recovery can benefit from aftercare. Each person may encounter issues after treatment that increase stress or trigger cravings. Aftercare can make it easier to manage those issues as they arise.
A number of aftercare options are available to fulfill the goals of relapse prevention and meet the challenges of relapse risk, such as:
Intensive outpatient programs: These programs are often used as immediate follow-up care to inpatient treatment for those with high relapse risks. In intensive outpatient treatment, as described by SAMHSA’s Treatment Improvement Protocols, the person in recovery spends nine hours per week or more attending continuing treatment programs, including group therapy sessions, presentations, educational programs, occupational therapy, and other sessions that reinforce the skills and information learned in rehab, and provide a source of accountability for the person in maintaining sobriety.
Sober living homes: Some people are at higher risk of relapse if they return to their normal home environment or neighborhood. In this case, living in a place that provides accountability for continued abstinence from substance abuse can help. Sober living homes provide an environment where people can live in a community with other people who are recovering from substance abuse. These homes provide rules and structure around doing chores, participating in meetings or sessions, and verifying abstinence from drug or alcohol use. According to a study from the Journal of Psychoactive Drugs, this kind of living situation can help high-risk populations avoid relapse as they transition out of residential care.
Self-help or 12-Step groups: Many people are aware of groups like Alcoholics Anonymous or Narcotics Anonymous, but they may not understand their full value in addiction treatment. As part of an aftercare program, these groups can provide much-needed social support from others in recovery who have succeeded in facing the problems that arise after treatment. Participation in these groups sometimes begins during treatment, but it is an important element of aftercare. The groups provide continued motivation, education, and social support for ongoing recovery.
Motivational programs or Contingency Management: For those who need an outward source of motivation to continue avoiding relapse, programs like Motivational Interviewing and Contingency Management can provide goals that make people more willing to stay abstinent. Motivational Interviewing and other programs follow up on a regular basis, offering motivation, feedback, and advice about particular challenges. Contingency Management provides a reward structure, such as vouchers for goods and services, for proof of continued sobriety. Research, including an article from the Archives of General Psychiatry, shows that these programs can be particularly helpful in preventing relapse and keeping people in treatment.
Alumni programs: Treatment programs that maintain connections to former clients provide a continued source of support that can be helpful to those who want to stay connected with treatment center staff, meet other people in recovery, continue getting information on recovery, and attend fun events. These connections provide motivation and self-confidence based in the knowledge that the end of treatment doesn’t mean the end of the support offered. In turn, this can keep the lessons learned from rehab fresh in clients’ minds and maintain commitment to continued recovery.
How Long Does Aftercare Last?
According to a study reported on in Psychology Today, more than two-thirds of people who complete treatment relapse within the first year after treatment. However, the longer a person can avoid relapse after treatment, the more likely that person is to remain in recovery for the long-term. For this reason, aftercare for at least a full 12 months after treatment is ideal to prevent relapse during this vulnerable period of time.
While not all aftercare programs last this long, there are elements that can continue through this period and beyond. For example, a person can remain in a 12-Step program for as long as desired, and many alumni programs continue year after year and can be accessed for as long as the person wishes to be involved. Even if the more intense elements end within a few months to a year, these continuing elements of aftercare in the years following treatment can provide continued motivation and support that help to maintain recovery for the rest of the person’s life.