The Importance of Aftercare in Recovery
Aftercare, continuing care, and ongoing care, the support that people continue to receive after formal treatment programs, is an important part of treatment and recovery for anyone overcoming a substance use disorder. The most crucial reason that everyone going through treatment should also participate in aftercare is that it has a significant impact on preventing relapse.
This kind of care can take a number of different forms, and like treatment itself, is most effective when individualized for each person. The main purpose of the ongoing support is to prevent relapse, but it can help in many other ways too, including improving relationships and family dynamics, finding work and housing, and managing any mental illnesses, and improving overall functioning.
The Purpose of Aftercare – Relapse Prevention
Completing a treatment program is not always enough to create long-term sobriety. Addiction is a kind of disease that is considered chronic; it can recur again in the future even after a period of wellness. Statistics bear this out and show that relapse rates for substance use disorders (between 40 and 60 percent) are similar to those for chronic physical illnesses, like high blood pressure, asthma, and type 1 diabetes.1
Addiction relapse is not necessarily considered a failure, but for the health and wellness of someone in recovery it should be avoided if possible. As a chronic illness substance use disorder needs to be constantly re-evaluated so that treatment plans can be updated and changed as needed. This is the purpose of continuing care after more intensive treatment that helps to minimize the risk of a relapse. Relapse prevention is the primary goal of aftercare.
Aftercare is Essential for Reducing Relapse
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Aftercare is important for preventing relapses, and there is plenty of research available to prove that ongoing support after formal treatment does help people to stay sober and avoid relapse. These studies show that there are many strategies that can be used in aftercare to focus on relapse prevention.
In a study of long-term abstinence from drug use published in the International Journal of the Addictions2, researchers worked with participants who had completed formal drug addiction treatment. As a part of aftercare, the participants learned to self-manage their cravings and triggers to use drugs again, became engaged in positive social networks, found drug-free activities they enjoyed, and learned and used better, healthier ways of coping with stress. These aftercare strategies helped participants avoid relapsing.
Studies have also found that aftercare services are important enough in managing and preventing relapses that they should be covered by insurance plans. In a paper titled “Relapse Prevention for Addictive Behaviors,”3 the researchers reviewed analyzed several studies and concluded that most aftercare programs effectively reduce relapse rates. Because of the positive effect of aftercare on relapse prevention, they recommended that these ongoing services become a routine part of substance abuse care and receive insurance coverage.
Another study, from Psychiatry Journal4, investigated current treatment models and outcomes for substance use disorders and determined that continuing care is absolutely essential. The authors found that formal treatment is most effective when it lasts between three and six months. They also concluded that aftercare should extend for about 12 months after treatment to see the best outcomes in terms of preventing relapse and achieving long-term sobriety.
Aftercare Includes Outpatient Therapy
There are many different approaches that can be used in aftercare in order to achieve the overall goal of relapse prevention, but the most common and useful is to engage in therapy in an outpatient setting. This can be traditional outpatient care or intensive outpatient care that provides a transition from residential care to life back at home. Most participants in drug and alcohol aftercare go through cognitive behavioral therapy, or CBT. A CBT therapist helps individuals set goals, recognize negative thoughts and behaviors, change those thoughts and behaviors, and learn how to identify and cope with relapse triggers.
Mindfulness as an element of therapy is also proving to be a useful tool in aftercare programs. A recent study called “Mindfulness-Based Intervention and Substance Abuse Relapse”5 demonstrated that mindfulness-based relapse prevention (MBRP) helped participants achieve greater long-term sobriety than other methods of aftercare. The study put participants randomly into one of three aftercare programs: MBRP, CBT with a focus on relapse prevention, and 12-step support groups.
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MBRP focuses on becoming more aware of cues that a relapse may be imminent—physical, emotional, environmental, social—and to react to them in more positive ways, thereby preventing the relapse. All three groups had similar rates of sobriety at three months, but at six months and one year, the participants in MBRP had higher sobriety rates.
Regardless of the type of therapy used in aftercare, the strategies and goals are similar and include:
- Learning more about the relapse process.
- Identifying triggers that can lead to relapse.
- Being aware of the stages of relapse and early warning signs.
- Learning strategies to prevent relapse at an early stage.
- Planning for what to do after a relapse.
- Developing relaxation strategies.
- Building self-efficacy.
- Finding motivation for staying sober.
Beyond Therapy in Aftercare – Life Skills, Family Support and Alumni Groups
While therapy is the tool most often used in aftercare and for relapse prevention, there are other strategies that can help participants avoid relapse and enhance their lives in other ways. They contribute to relapse prevention by helping each individual create a new, more functional, healthier, and more satisfying life. Some examples of other services that may be offered in aftercare include:6
- Understanding and improving family dynamics and healthy functioning.
- Developing healthy relationships and rebuilding those that have been damaged.
- Finding and using more recovery resources, like support groups.
- Developing a healthy lifestyle that includes diet, exercise, medical care, and hygiene.
- Returning to school if appropriate.
- Learning job skills or training for a new vocation.
- Finding and landing a job.
- Finding affordable housing or a halfway house.
- Developing typical life skills, like cooking, cleaning, driving, money management.
- Finding and developing spirituality.
- Working on parenting skills.
- Finding an appropriate life balance.
- Learning and practicing healthy coping strategies.
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Aftercare may also include support groups in the form of alumni programs. These are groups of people who completed treatment, sometimes together, who meet up later to socialize and support each other in a safe, sober setting. Alumni programs offer camaraderie, mutual support, and opportunities for sober fun and recreation. These are informal ways for people to stay connected and to stay accountable for avoiding relapse after treatment. Some treatment programs organize alumni groups, but individuals may also start their own groups with sober friends from rehab.
Relapse prevention is a major focus of substance use disorder treatment, but the goals cannot always be met during the time period of a formal treatment program. Furthermore, relapses are more likely to occur shortly after finishing treatment. This means that anyone who has been through treatment can benefit from aftercare. The research overwhelmingly bears this out and indicates that aftercare with a focus on relapse prevention is absolutely essential to maintain long-term sobriety.
1National Institute on Drug Abuse. Principles of Drug Addiction Treatment: A Research-Based Guide. How Effective is Drug Addiction Treatment? https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/how-effective-drug-addiction-treatment
2International Journal of the Addictions. Relapse Prevention: An Emerging Technology for Promoting Long-Term Drug Abstinence. https://www.tandfonline.com/doi/abs/10.3109/10826089409047904?journalCode=isum19
3Substance Abuse Treatment Prevention Policy. Relapse Prevention for Addictive Behaviors. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3163190/
4Psychiatry Journal. The Continuing Care Model of Substance Use Treatment: What Works, and When Is “Enough,” “Enough?” https://www.hindawi.com/journals/psychiatry/2014/692423/
5JAMA Network. Mindfulness-Based Intervention and Substance Abuse Relapse. https://jamanetwork.com/journals/jama/article-abstract/1883017
6Substance Abuse and Mental Health Services Administration. Substance Abuse: Clinical Issues in Intensive Outpatient Treatment Programs. https://www.ncbi.nlm.nih.gov/books/NBK64094/
http://www.addictioneducation.co.uk/Witkiewitz%20et%20al%202005.MBRP.pdf
