The Steps to the Graduation Phase of Inpatient Addiction Rehab
As the National Institute on Drug Abuse (NIDA) notes, there are different levels of care at rehab centers. A long-term residential treatment program, which provides 24/7 care, is usually the longest type of program. The most common long-term program is called a therapeutic community (TC), and it typically lasts 6-12 months. Short-term residential treatment can range from 28 days to 90 days (and beyond). In an outpatient program, the clients live off site. Such programs vary in length of stay and intensity of rehab services.
In some instances, a recovering person may begin treatment at an inpatient center and then transfer to an outpatient program, and vice versa. There are no set rules as to the length of time or type of program. However, NIDA notes that research study findings recommend a rehab stay of at least 90 days.
When Graduation Is on the Horizon
The goal of rehab is always to help a person achieve abstinence and develop a new approach to life that supports drug-free living. For this reason, when graduation is in sight, a person’s daily itinerary may not change too much, but there is going to be a focus on developing an aftercare plan. Clients will engage in talks with different rehab professionals about their readiness to re-enter the day-to-day of family, work, or school. To illuminate this pre-graduation period, consider a hypothetical example:
Cara is 27 years old, and she is in a 90-day rehab program for heroin addiction recovery. Cara was living on her own, and plans to do so when she graduates, but does not have a permanent housing plan right now. Cara was not employed before she started rehab and will need to find a job. She is being maintained on the heroin-replacement medication Suboxone and has responded very well. Cara’s recovery has been on track with her treatment plan, and her treatment team believes she will be ready to graduate, as planned, in under three weeks. Cara’s typical day at the rehab consists of waking up at 7 a.m., going to individual or group therapy after breakfast, having an hour to exercise or practice yoga and meditation, a workshop on drug education, an hour of free time after lunch, a 12-Step group recovery meeting before dinner, and then bed at 10 p.m. Cara’s rehab center has hosted family events, and her mother, father, and sister have always participated.
- Cara needs an aftercare plan. In the time leading up to graduation, her addiction treatment team will work with her to create an effective plan that is tailored to her needs. Based on Cara’s example, at a minimum, she is going to need help creating a housing and job-seeking plan (case management services), information about how to maintain her Suboxone regimen (psychiatric support), help setting up counseling sessions with a local therapist (psychological support), information on local 12-Step meetings, and local low-cost or free yoga classes because she really enjoyed them during rehab (holistic health support).
- An aftercare plan helps a recovering person to avoid relapse, but it also provides a guide for starting a drug-free lifestyle. An aftercare plan can also help a recovering person to get through the initial period of transition from rehab back to society at large. The first 30-90 days after rehab graduation is usually when a person is most vulnerable to relapse.
An addiction treatment team, depending on the recovering person’s treatment plan, may consist of the following professionals:
- An addiction psychiatrist
- A medical doctor specializing in addiction
- A therapist or addiction counselor
- A case manager or social worker
As the graduation date nears, each of the professionals who have been involved in a client’s recovery will orient their treatment and conversation toward developing an aftercare plan. These professionals may structure their last few meetings in specific ways.
- If a client is on medication (addiction medication and/or psychiatric medication), medication management will be a key component of the aftercare plan. The treating physician will discuss next steps with the client. The physician may have a local private office and will set up an appointment, shortly after graduation, to meet there, or the physician will provide a referral. The physician will be able to monitor the recovering person’s progress and ensure that the addiction medication is not being abused. In some instances, the person will be taking a psychiatric medication, such as an antidepressant, and will need to meet regularly with the physician or psychiatrist.
- Therapists play a critical role in the aftercare planning process. As the graduation date approaches, the therapist may orient individual sessions toward strengthening coping skills. For instance, the therapist may discuss scenarios that will involve drug use cues to work on healthy responses. The therapist may also work with the client on family dynamics and how to manage interpersonal relationships. The therapist will try to ensure that clients who are nearing graduation can integrate their new skills into everyday life and relationships.
- A case manager or social worker will focus on helping the client meet basic needs, such as housing, employment, childcare, and transportation. It is critical for these basic needs to be met to avoid relapse. Irrespective of a person’s socioeconomic background, supportive services may be needed at present. Drug addiction can aggressively strip away a person’s financial resources. When clients anticipate needing assistance after graduation, it should always be discussed with a case manager, social worker, or therapist on staff.
- The therapist, case manager, or a member of the support staff may have an informational session with the graduating client. This may also happen during an exit interview. Important information to relay will include where to attend local group recovery meetings, how to contact the insurance provider (if any), numbers to call if help is needed, local community resources, and nonprofits that can provide assistance if necessary.
Rehab professionals understand that inpatient clients may have several concerns about graduation. Aftercare planning is a helpful way for clients to get organized and be ready for the transition back to everyday living. In fact, rehab programs are always mindful of the reality of graduation. Though it may not be obvious in the earlier phases of treatment, rehab centers make numerous efforts to keep clients connected to the outside world, such as through family therapy sessions (if offered) and family events on site (e.g., BBQs, picnics, and other social activities).
At graduation, individuals may recognize that their focus need not be on rehab coming to an end, but on the healthy, new experiences on the horizon in recovery.