Aftercare: Supporting Long-Term Recovery from Addiction
What happens when addiction treatment ends? Aftercare is an integral part of any high-quality treatment program, and it’s designed to help with sobriety in the challenging early weeks and months of recovery.
An aftercare plan is a comprehensive, individualized plan that’s set in place once treatment is complete. The aftercare plan involves components that continue to meet physical, mental and spiritual needs as early solo recovery begins.
According to a study published in the Journal of Studies on Alcohol and Drugs, for each consecutive month of participation in an aftercare plan, the likelihood of staying sober increases by 20 percent.1 Engagement in aftercare, the study found, was the single most important predictor of abstinence.
Aftercare and the Abstinence Stage of Recovery
An article published in the Yale Journal of Biology and Medicine identifies three stages of recovery.2 The first stage is abstinence, which begins when use of substances stops and lasts somewhere between one and two years. The second stage is the repair stage, during which there is a refocusing on restoring life and honing the strategies, skills and lifestyle needed for long-term abstinence. This takes another few years. And the third stage is the growth stage, which is a lifelong endeavor that involves refining skills and striving toward authenticity and authentic happiness.
During the abstinence stage, the focus is on coping with cravings and staying sober. This stage involves working on a number of important tasks:
- Accepting that you are addicted
- Practicing honesty with yourself and others
- Develop coping skills for dealing with triggers like cravings, stress and negative emotions
- Becoming active in support groups
- Staying vigilant for signs of emotional relapse
- Creating a positive support system and ending toxic relationships
- Developing and pursuing interests and hobbies
- Creating balance in life, including plenty of time for rest and relaxation
- Coming to see yourself as a non-user
Aftercare is designed to help throughout the first stage of recovery once treatment is complete. Aftercare also helps develop the urgent, critical skills needed to maintain abstinence outside of the highly supportive treatment setting.
Typical Components of an Aftercare Plan
The aftercare plan will include a range of components, each designed to address a particular area of unique needs. These are some of the most common components included in aftercare plans.
During treatment, a variety of issues and faulty thought and behavior patterns that led to abuse drugs or alcohol are identified. Therapy begins working to resolve issues and develop healthier patterns of thinking and behaving.
These are all very complex issues, and the time spent in treatment typically isn’t enough time to thoroughly explore and create change around them. That’s why ongoing therapy in some form is usually part of the aftercare plan. People who complete an inpatient program will typically be referred to an intensive outpatient or outpatient program that provides considerably more freedom but still offers a high level of structure and support. For those completing an outpatient program, ongoing individual therapy is often recommended.
Family involvement in treatment and recovery is a major predictor of success. Family therapy is a staple in a high-quality treatment programs, because family is typically the front line of support in life. However, familial relationships are complex, and there’s often a great deal of dysfunction in the family system. Addiction can be both a symptom and a cause of this dysfunction. Living with a person who has an addiction takes a toll on family members’ physical and mental well-being, and they often develop unhealthy coping strategies. They may unwittingly enable the addiction in an attempt to keep the peace or reduce the chaos.
Family therapy helps families identify and work through these issues and develop healthier, more honest ways of interacting and communicating with one another. Family therapy in treatment is meant to get the family stabilized to reduce household stress and decrease the risk of relapse after rehab. But many families need ongoing therapy to continue working on difficult issues.
Family members should consider individual therapy to help them identify their own faulty thought and behavior patterns and make positive improvements in their own lives. Because children of an addicted parent are more likely to abuse substances themselves later, individual therapy can help children change unhealthy behaviors and thought patterns and develop the coping skills they need to make healthy choices in the future.
Nearly every aftercare plan will include participation in a support group. Daily support group meetings provide structure and support in early recovery, and they promote mindfulness and personal responsibility. Support groups provide opportunities to develop healthy relationships with other non-users, and they help reduce feelings of isolation in recovery. According to a literature review published in the journal Substance Abuse and Rehabilitation, participating in a support group reduces substance abuse, eases cravings, and improves self-confidence and self-efficacy in recovery.3
While 12-step support groups like Alcoholics Anonymous are popular and effective, alternatives do exist:
- SMART Recovery focuses on motivation, coping skills, managing emotions and living a balanced life.
- The Secular Organizations for Sobriety (SOS) takes a science-based approach to recovery that draws on self-empowerment.
- LifeRing Secular Recovery focuses on developing and sharing strategies for living an abstinent and purposeful life.
- HAMS: Harm Reduction for Alcohol helps people make positive changes based on personal goals through elements like setting goals, making action plans and learning to cope without alcohol.
Family members also benefit from joining a support group for families who have been touched by addiction. These include popular groups like Al-Anon for adults and Ala-Teen for the children of addicted parents. Support groups reduce feelings of isolation and provide a safe place to express difficult emotions and work through a variety of issues unique to families in recovery. They also provide a place to share resources, celebrate milestones, and support others just beginning their recovery journey.
Some people need or want to move into a sober living home after treatment. Sober living environments are far more homelike than treatment environments, and they provide more freedom while still offering more structure and support than traditional living situations. Residents in a sober living home must follow certain rules, and they may be required to honor a curfew. They all participate in maintaining the household, including doing chores, paying rent and bills and preparing meals. This helps them develop essential life skills and experiences.
Sober living provides a strong foundation for recovery for those who need a little extra support after treatment. A study in the Journal of Psychoactive Drugs found that a sober living situation after treatment promotes long-term sobriety, increases employment and reduces symptoms of mental illness.4
For individuals suffering from homelessness or those with an unsafe or unstable home life, housing assistance may be needed after treatment. Housing assistance may include help finding a safe place to live, identifying resources for help with paying rent or bills, or finding an appropriate sober living facility.
An important focus in treatment is helping people identify their strengths, skills, talents and values and set goals to help them achieve an ideal life. In some cases, these might be educational goals. Educational assistance can take many forms, including helping with finding a GED or Ph.D program or identifying sources of financial aid.
Addiction can make it hard to find and maintain a job, and it can wreck an employment record. Vocational rehab helps individuals gain the skills they need to find and keep a job or get their career back on track. It often includes career counseling, which involves a variety of assessments that help identify the kinds of jobs that are a good fit for talents, skills, personality and interests. Other aspects of vocational rehab may include resume writing, interviewing practice and workplace or interpersonal skills development.
Some people enter treatment with legal troubles, from divorce and custody issues to criminal charges stemming from the addiction. Legal assistance can help individuals determine their rights, find an affordable attorney and navigate the legal system.
Mental illnesses like anxiety and depression commonly co-occur with addiction and getting mental illnesses under control is essential for successful recovery. This may involve medication, counseling or a combination of these. Once treatment is complete, maintaining good mental health is an important factor in preventing relapse. For those affected by mental illness, the aftercare plan will include ongoing monitoring of the condition and any medications that are being used to treat it.
Aftercare is dynamic. To be effective, it must evolve with the changing needs of the individual in recovery. To ensure continued relevance, aftercare plans are overseen by a case manager who will periodically review the plan and make any needed changes. Case managers become the point of contact in the event you need anything recovery-related in the months after treatment.
Aftercare Helps Prevent Relapse
The overarching goal of aftercare is to prevent relapse, which is a recurrence of an addiction after a period of recovery, characterized once again by compulsive use despite negative consequences. A single instance of using can quickly lead to a relapse of the addiction if it’s not addressed swiftly. The whole point of treatment -and the focus of early recovery- is to develop and practice essential coping skills and strategies and create a healthy lifestyle that promotes and fosters abstinence.
However, relapses can and do happen despite following the aftercare plan. It’s important to note that relapse is considered to be a normal part of recovery and an opportunity to develop missing skills. Approaching a relapse with a positive attitude is important for getting back on track quickly -and stronger and more motivated than ever.
Following an aftercare plan is the best way to help ensure abstinence during the first, challenging stage of recovery. The aftercare plan is designed just for you, and following it reduces your risk of relapse and improves your chances of enjoying successful recovery for the long-haul.