Aftercare for Recovery from Substance Use Disorders
Participants using aftercare services are approximately three times more likely to be drug-free. Moreover, they are four times more likely to be opiate-free for 26 weeks later. Interestingly, they are also five times less likely to be using any drugs weekly or more often during the 26-week period.1
Drug addiction is a growing health problem in the US. The Centers for Disease Control and Prevention (CDC) report that 48.5 million Americans have used illicit drugs or misused prescription drugs in 2016.2 Even worse, 61 million Americans admitted to abusing alcohol in the past year. Over 44 million people used an illicit or non-prescribed drug in the past year. Likewise, drug overdose caused 70,237 deaths in 2017.3, 4
Given the high rates of drug abuse and overdose deaths, it is critically important to understand strategies to prevent deaths and improve quality of life. This is also critical, considering the painfully low health literacy rate in U.S. adults.5
A Journey, Not A Destination
Addiction recovery is a continuous process. It often extends to months or years after one has successfully kicked the habit.
Recovery does not happen all at once; there are always chances that people might relapse into drug dependency following a period of sobriety.
Relapse Rates within Six MonthsEstimates suggest that between 66% and 80% of drug users relapse within six months after they received treatment at community- or hospital-based facilities. 6 Recovering drug-dependent persons also face many problems, such as handling day-to-day tasks and maintaining family and workplace relationships.
Aftercare helps them cope with physical, psychological, social, and economic issues associated with abstinence. Notably, aftercare services aid in the reintegration of drug dependents into the real world.
Aftercare is an integral part of the rehabilitation process.
It is a long-term, patient-focused intervention. It comprises medical, psychosocial, and economic programs. These programs are specially designed to maintain abstinence and reduce the risk of relapse. Likewise, they also facilitate the smooth transition of patients into independent, drug-free lives.
Aftercare is also known as recovery management or continuing care. It starts immediately after an individual has completed initial treatment for drug or alcohol addiction. Usually, aftercare services are less intense than initial drug treatment.
Unlike intermittent episodes of care with “admit, treat, and discharge” approach, aftercare focuses on long-term monitoring, recovery education, and sustained attention until no further intervention is necessary.
A large component of aftercare is the follow-up. The follow-up plan usually lasts a year. During this period, healthcare professionals, who are members of the follow-up team, record the patient’s response and adherence to treatment. This is typically done through phone calls.
The main goals of aftercare services include:7,8
Help recovering drug users cope with cravings during the period of abstinence.
Educate them about measures to reduce and manage cravings.
Provide the necessary skills and lifestyle changes to prevent relapse.
Help them find and participate in new social networks and peer-group programs under the supervision of a healthcare professional.
Encourage them to engage in educational, vocational, and social programs to aid self-reliance and smooth transition to a drug-free life.
Help them identify potential triggers of addiction and acquire coping skills to eliminate or reduce the effects of the triggers.
Develop community-based self-help support groups to facilitate social reintegration and maintain abstinence.
Improve the physical and psychological wellbeing of recovering drug dependents.
Help them live with a high degree of personal dignity and self-worth.
Impart skills to handle the stress associated with homelessness, unemployment, and unhappy relationships.
Identify the hidden psychiatric symptoms of patients and providing appropriate medical care and support to alleviate the symptoms.
Why is Aftercare Important?
The risk of relapse is exceptionally high within the first year after completing treatment. Thus, it is critically important to participate in the post-treatment aftercare program.
According to the National Institute on Drug Abuse (NIDA), a novel text-based aftercare program reduces the risk of relapse to almost half compared to standard aftercare. Likewise, another study suggests that participation in post-treatment aftercare nearly doubles the odds of abstinence from heroin. 10
Aftercare not only reduces the risk of relapse but also helps maintain treatment gains. It can also offer other benefits that ultimately support recovery.
Benefits of Aftercare
Participating in aftercare has a myriad of long-term and short-term health benefits.
For example, staying in a sober living home for at least six months has been shown to promote positive outcomes. Sober living homes are not an aftercare program, but do provide supports for people in recovery from substance abuse. People in sober living homes are not allowed to use drugs or alcohol and must share their expenses.
Likewise, one study suggests that residents in sober living have a significantly lower rate of substance use (31%). This is compared to those in the usual aftercare condition (65%). 11 The same study also notes that residency in sober living is associated with increased employment/income and fewer legal issues.
According to researchers, income significantly increased from $794 to $942 per month. Likewise, four-fifths of participants were reportedly employed based on the last assessment. Towards the end of the study, the rate of incarceration fell below 5%.
Types of Aftercare Programs
There are different types, formats, and modalities of aftercare programs, such as group counseling, individual therapy, telephone counseling, brief check-ups, and self-help meetings. These programs may be conducted in outpatient facilities, within the abuse treatment facilities, or in independent facilities.
Periodic Outpatient Aftercare
As the name suggests, periodic outpatient aftercare is conducted in an outpatient setting at specified intervals. The individual lives at home but visits the outpatient facility usually once a week. However, more visits may be necessary.
There are two modalities of counseling in periodic outpatient aftercare:
A substance abuse counselor conducts a counseling session in which individuals share their addiction-associated experiences. Participants in group counseling first learn about their addictive behavior. Then, they learn the skills necessary to break their habit.
Because humans are social creatures, working together in a group can significantly improve the participants’ sense of self-worth and confidence. It also helps stabilize, persuade, and support them.
Individuals who participate in group activities are also more likely to remain abstinent and committed to therapy. They can imitate the positive behaviors of their friends in the group and improve their social skills.
Most notably, working in a group makes participants realize they are not alone. This goes a long way in creating a positive attitude towards life and therapy.
Individual therapy has only two members: the drug-dependent individual and a therapist.
This one-on-one approach gives privacy, which helps the individual to open up about their specific problems, fears, and expectations. Moreover, one-on-one therapy promotes effective communication between the therapist and the individual. Individuals who are overwhelmed in a group may find individual therapy more effective.
An addiction recovery group refers to a group of people who work together to kick their addiction and prevent relapse. The members of the group may collaborate based on their religious or spiritual beliefs. On the other hand, some groups may be entirely secular.
Some features of recovery groups match those of group counseling such as group work and social skill development. However, these groups are typically non-professional.
Some groups may be gender-specific. For example, The Women’s Recovery Group (WRG) allows only female participants.
12-Step and Self-Help Groups
12-Step groups are based on the principles developed by Alcoholics Anonymous (AA). These groups provide free support for individuals addicted to alcohol and other drugs.
They are nonprofessional, apolitical, and have no age or education barrier for participation. Some notable 12-Step groups include Cocaine Anonymous, Crystal Meth Anonymous, Heroin Anonymous, Marijuana Anonymous, and Nicotine Anonymous.
Some alternative groups that do not follow the principles of AA include Women for Sobriety (WFS), LifeRing, and SMART (Self-Management and Recovery Training).
A halfway house is a transitional living facility that provides a safe, structured environment for people recovering from alcohol or drug addiction. In some states, people call it a sober living house or dry house.
Halfway houses either adopt a 12-Step model of treatment or informal treatment. The duration of the program is between a day and three hundred twenty days. The major benefits of this model include lower costs, a higher level of satisfaction in residents, and improved abstinence.
Residents in halfway houses learn basic self-care and money management skills. They work to understand both the positive and negative effects of their past actions.
Length of Aftercare Services
The length of aftercare services varies depending on several factors, such as the type of service, severity of the addiction, and notably, the patient’s response to the treatment.
The duration of the early recovery stage is six weeks to three months. Likewise, outpatient treatment ranges from 30 to 90 days. 12
The duration of community support is ongoing and a person may need community support programs for years. Residence in halfway houses can range from a day to three hundred twenty days.
What Does Quality Drug Rehab Aftercare Look Like?
An ideal aftercare program strictly follows the principles of effective treatment. Below are the guiding principles of effective treatment and rehabilitation:
It affects the function and structure of the brain. Thus, relapses are common even after an extended period of abstinence. Addiction is a complex yet treatable illness.
There is no one-size-fits-all treatment for addiction. The choice of treatment depends on both patient factors and drug type. An ideal treatment meets the unique individual needs of a person.
Treatment needs to be available at the time of need. Delayed access to treatment can have devastating outcomes.
Effective treatment addresses the multiple needs of the individual, such as medical, psychological, social, vocational, and legal needs.
Recovery is a continuous process that usually requires several episodes of treatment.
Patients benefit from one or more behavioral therapies, such as individual, family, or group counseling. Aftercare treatment should focus on preventing relapse, maintaining abstinence, and improving the patient’s social and family relationships.
In some cases, the use of medications may be necessary, along with counseling and other behavioral therapies.
The intensity of aftercare treatment, treatment plan, and the type of treatment should be flexible. A patient’s needs may vary with time. Thus, aftercare programs should change accordingly to meet the changing needs of the patient.
Aftercare treatment should identify and address any co-occuring mental illness.
Aftercare approaches such as motivational enhancement and incentive strategies may improve outcomes when begun early.
Patient drug use and associated behavior should be continuously monitored. Effective monitoring helps make changes in aftercare treatment when needed.
Factors that Affect the Choice of Aftercare Programs
The choice of a suitable aftercare program depends on various factors, such as an individual’s age, gender, psychological status, and unique response to a program. Some of these factors are:
Greater age at the time of enrollment into the aftercare program may increase the likelihood of complications.
Men and women may respond differently to treatment. Women with alcohol use disorder are more likely to have certain psychiatric illnesses and a higher amount of negative emotions. Thus, they are more likely to benefit from an approach that addresses substance use problems secondary to the existing psychiatric illness. Likewise, if an individual has a co-occurring mental illness, complications may occur.
Duration and Type of Primary Treatment
The type of primary treatment (in-patient or outpatient) likely affects the choice of aftercare services.
If an individual has abused more than one substance simultaneously, a specific type of aftercare program may yield better results.
For example, 12-Step Facilitation (TSF) is more effective than Structured Relapse Prevention (SRP) for those who have abused more than one substance.
TSF is an aftercare approach that considers alcoholism as a disease of the spirit, mind, and body. SRP is an outpatient counseling approach. Usually, it consists of 10 weekly counseling sessions.
Client Preference for a Particular Program
This is perhaps the most crucial factor in determining the choice of an aftercare program. Studies reveal that individuals who are enrolled in the program of their choice have lower drug use rates.
Finding the right program is crucial to achieving optimal results. It cuts down the odds of missing sessions or discontinuing the program.
Misconceptions about Aftercare
Understanding the common myths about aftercare programs is the first step in ensuring a smooth transition from intensive treatment to aftercare.
Misconceptions prevent drug-dependent people from seeking help. Moreover, they can also affect aftercare attendance, and in some cases, provoke people to quit the program.
Aftercare isn’t Necessary if You Aren’t a Hardcore Drug User
This is probably the most common misconception about aftercare programs.
First things first, “hardcore drug user” is a misnomer. Each person’s body responds differently to the same amount of drug or alcohol. What is too much for one person may be too little for another person. Thus, one should seek help whenever they feel it is necessary.
Aftercare is an integral part of the treatment process and not something only hardcore drug users need.
Aftercare Services are Expensive and Unaffordable
It is quite true that luxury aftercare facilities are beyond the reach of an average American. That said, certain facilities provide essential care that does not cost a fortune.
Outpatient facilities are usually less expensive than inpatient facilities. Moreover, the cost also depends on your needs and the services you choose.
Aftercare Programs are Exclusively Religion-Based
There are different types of aftercare programs: those based on religion, based on spiritualism, or both.
While some programs exclusively rely on certain religious beliefs, not all programs are the same. Majority of the programs are based on scientific treatment methods. Thus, this should not be a problem unless an organization forces their religious beliefs on participants.
Aftercare is an Important Step of Rehab
Aftercare is an integral component of addiction treatment. It starts immediately after the completion of intense initial treatment. The main aim of aftercare is to facilitate the reintegration of drug-dependent persons into the community. It significantly reduces the risk of drug use, relapse, and improves quality of life. No one-size-fits-all approach to aftercare currently exists.
- Factors associated with treatment outcomes in an aftercare population, https://www.ncbi.nlm.nih.gov/pubmed/15764423
- Substance Misuse and Substance use Disorders: Why do they Matter in Healthcare? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5525418/
- Drug Overdose Deaths in the United States, 1999–2017, https://www.cdc.gov/nchs/data/databriefs/db329-h.pdf
- Classes of substance abuse relapse situations: A comparison of adolescents and adults, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3031179/#R24
- Republic of the Philippines Office of the President DANGEROUS DRUGS BOARD, https://www.ddb.gov.ph/images/Board_Regulation/2006/Bd.%20Reg.%201%2006.pdf
- United Nations Office on Drugs and Crime. International Standards for the Treatment of Drug Use Disorders, https://www.who.int/substance_abuse/activities/msb_treatment_standards.pdf
- Substance Abuse Treatment for Persons With Co-Occurring Disorders, https://www.ncbi.nlm.nih.gov/books/NBK64178/
- Long-Term Outcomes of Aftercare Participation following Various Forms of Drug Abuse Treatment in Scotland, https://journals.sagepub.com/doi/abs/10.1177/002204261004000308
- The need for substance abuse after-care: longitudinal analysis of Oxford House, https://www.ncbi.nlm.nih.gov/pubmed/16843612
- Aftercare attendance and post-treatment functioning of severe substance-dependent residential treatment clients, https://www.ncbi.nlm.nih.gov/pubmed/12850905