Prevent Relapse Through an Aftercare Plan
Detox and rehabilitation are the core components of addiction treatment. But once you complete rehabilitation, you need support to stay sober as you return to a daily routine.
More rehabilitation programs are helping clients create an aftercare plan, which provides social and medical support to avoid relapse or return to a different level of care in the event of a relapse. Aftercare should transition an individual out of a higher level of professional attention, like in a rehabilitation program, into an independent, substance-free lifestyle.
Aftercare as a Core Component of Addiction Treatment & Recovery
Medical science understands addiction as a chronic disease of the brain, requiring ongoing care from doctors, counselors, and other medical experts.
The standard course of treatment begins with detox, which overcomes the body’s physical dependence on substances. This is followed by behavioral therapy in a rehabilitation program. But what happens after rehabilitation?
Aftercare has become a crucial component of drug treatment. This part of addiction recovery involves creating a plan to stay sober, which includes housing arrangements, emergency contacts for support, mutual support group meetings, counseling sessions, and doctors’ appointments.
The National Institute on Drug Abuse (NIDA) lists the core components of addiction treatment as:
- Behavioral counseling.
- Medication like buprenorphine to manage detox in some cases.
- Medical devices that may assist with detox.
- Evaluation and treatment of co-occurring disorders like depression or anxiety. Managing these issues with counseling and medication as needed.
- Continued follow-up care to prevent relapse
The final point (continued follow-up care) is part of an aftercare plan. Since addiction is a chronic condition, symptoms will change or recur, as they do with other chronic conditions like diabetes or heart disease. While behavioral therapy in rehabilitation will help you understand the symptoms of addiction and triggers for maladaptive behaviors, aftercare helps you manage these with a long-term plan.
As the importance of aftercare is highlighted, more addiction treatment specialists are creating these treatment plans at the beginning of the rehabilitation process and modifying them as needed. Starting an aftercare plan as part of the rehabilitation intake process helps case managers, medical professionals, and you understand the importance of this step in the process.
What Goes Into an Aftercare Plan?
Creating an aftercare plan helps you understand the risks of relapse and why staying sober is so important. Your aftercare plan will serve as the foundation you can rely on in ongoing recovery. This plan is critical in the early stages of recovery.
Aftercare is a specific component of continuing care for substance abuse recovery, involving a list of emergency contacts, supportive friends and family, daily routines like exercise and group meetings, and regular appointments with clinicians.
Questions a case manager can ask a client while creating an aftercare plan include:
- Why is it beneficial for you to stop abusing drugs or alcohol and stay sober?
- What are your life goals?
- Who else benefits from you remaining sober? Your children, spouse, and colleagues?
- What aspects of your life are touched by addiction? Your physical health, your long-term career goals, or your finances?
- What impact do you think sobriety will have on your job and daily life?
These questions can help clients understand their own goals, and they can help case managers, social workers, and administrators understand if there is ambivalence about treatment. If there is, the answers can guide counselors to help clients overcome that ambivalence and find motivation to change.
Working on an aftercare plan during intake can help both clients and medical professionals understand how to approach recovery in ways that address the full picture. As many as 45 percent of people who struggle with addiction have a co-occurring disorder, so creating a long-term plan to manage mental and emotional health will aid in behavioral change.
Components of a Strong Plan
The five pillars of a strong aftercare plan are:
- Coping strategies to manage social and emotional triggers for drug abuse relapse.
- Relapse prevention, which includes managing stress and daily risks.
- Goals for sobriety like finding employment or educational opportunities.
- Continued therapy, including peer support and individual therapy.
- Establishing a sober life through a daily routine that includes sober activities and new social supports.
Although NIDA states that staying in a 90-day rehabilitation program creates the best foundation for long-term sobriety and recovery, many people are unable to attend programs for more than 30 days. Aftercare is even more important in these instances because it offers other levels of ongoing holistic care.
Statistics show that 54.7 percent of participants in 30-day treatment programs remain sober in follow-up reports, while 84.2 percent of participants who received treatment for more than one month reported sobriety in follow-up checks. Aftercare can extend treatment for more than most 30-day programs.
What Aftercare Is Not
While creating an aftercare plan should be individualized based on specific client needs, you may still be unsure what this entails. To understand aftercare, it can also help to understand what it is not.
- Aftercare is not a one-on-one session once per month to check in. Though ongoing individual therapy can be part of an aftercare plan, it is not the whole plan.
- Aftercare is not just sending the client to a peer support group meeting once a week or less. There need to be many aspects to a full plan.
- Aftercare is not a straight line out of rehabilitation. Relapse may occur, and part of aftercare planning is learning how to deal with relapse if it does happen.
About 40 to 60 percent of people who go through detox and rehabilitation to overcome substance abuse will relapse at least once. This is in line with relapse rates for other chronic illnesses, but the danger of relapsing back into drug or alcohol abuse is high due to the physical, mental, and social consequences.
Overdose is likely with relapse since people often take prior levels of drug doses. With a reduced tolerance level, what used to be a standard dose can quickly result in overdose, which could be fatal.
Reducing the risk of relapse is vital to avoid this situation. And this is the ultimate goal of a strong, personalized aftercare plan.
While there isn’t a set aftercare timeline for everyone, most aftercare plans are designed to last at least one year. Oftentimes, the daily routine that is created with an aftercare plan will serve as a basis for a lifetime in recovery.
People don’t stop engaging in the healthy habits they have established at the one-year mark. They may continue them for years or even the rest of their lives.
Sober Living Homes as Support Systems in Aftercare
Sober living homes are group housing situations, often overseen by an on-site manager, that provide a safe living space that is free from alcohol and drugs.
Many people who struggle with drug and alcohol abuse struggle with housing. They may be homeless; their families or friends may be unsupportive; or there may be other emotional triggers at home that may lead to relapse.
A sober living home provides safe housing while allowing the person a greater level of individual freedom to find work, engage in educational opportunities, and create a daily routine. As long as you follow the sober living home’s rules — like remaining drug-free, submitting to routine drug screening, attending peer support meetings, and going to house meetings when required — you can live in the home as long as you need that form of support.
The concept of sober homes has extended to other specific groups. For example, sober fraternities and dormitories are becoming important safe living spaces for sober students in college. States and local governments are also creating laws to manage sober living homes, ensuring they have a high standard of safety.
Mutual Support Groups Help Those in Recovery & Their Loved Ones in Aftercare
A core component of aftercare involves ongoing support. While some people may be able to complete rehabilitation and receive support only from their current family members and friends when they enter a sober lifestyle, most people benefit from meeting regularly with peers who have gone through similar experiences. In this safe environment, peers can discuss their struggles in addiction recovery and create solutions together.
A study of Alcoholics Anonymous programs found that 84 percent of 1,410 participants reported positive effects at an 18-month follow-up point. At a 3-year follow-up point of participants in an AA program, 60 percent were considered in remission from addiction, and 84 percent were psychologically stable.
Overall, participation in peer support groups has been found to support ongoing recovery.
An aftercare plan can also include information on group or mutual support for friends and family members. Addiction has serious emotional impacts on the person struggling with the condition as well as their loved ones. Groups like Al-Anon offer support for family and close friends of those in recovery.
When you make a list of these programs in your aftercare plan, you can offer suggestions to loved ones who may have suffered while you were living in active addiction. With proper support, everyone in your life can recover together.
Understanding Relapse Prevention
The overall purpose of an aftercare plan is to reduce the risk of relapse, but it is also important to know that relapse is not failure.
Many people who are overcoming addiction struggle with relapse. Your aftercare plan needs to include a strategy to deal with relapse if it does occur. You may return to rehabilitation, make an emergency appointment with your doctor or therapist, talk to a spiritual or religious leader, call your sponsor, or use any combination of other steps that will provide appropriate care and support.
Some people choose to return to active treatment, including detox, if they relapse. Others may enter intensive outpatient treatment or choose another path. Returning to a more intensive level of treatment can help you focus on problematic behaviors, so you are better equipped to deal with temptations and triggers when they arise.
The level of treatment that is needed following a relapse will largely depend on the severity of the relapse. A one-time lapse will not necessarily require the same level of treatment as a month-long relapse.
Putting It Together
It’s best to work on aftercare planning with your primary therapist. They can help you identify behaviors, habits, and scheduling that will best support your life in recovery. Your therapist can also help you identify individuals who can keep you accountable, particularly in early recovery.