Why Aftercare is Important

Why Aftercare is Important

Authored by Pin Ng PhD

Edited by Hugh Soames

Reviewed by Michael Por, MD

Aftercare

Aftercare and Long Term Recovery

Overcoming an addiction is one of the hardest things anyone can do. It is not just a case of seeking help, getting treatment and then being addiction-free. Recovery, and staying clean, is a life-long process.

Getting clean, even in a controlled and supported rehab environment, is hard, but as many know, the most challenging part is staying clean afterwards. The quality of aftercare an addict receives after detox and rehab is one of the best indicators of whether they will successfully stay sober.

What is aftercare

Aftercare, as the name suggests, is the care that follows detox and rehab. Once the drug is fully out of the system, the journey to a drug-free life is far from over1https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1852519/. Addiction changes the brain’s pathways and wiring. The brain is remarkably resilient and can create new pathways, but that addiction wiring will remain and can be reactivated, even after a lengthy period of being clean.

Aftercare will cover the transition from being an inpatient, receiving round the clock care, to living a normal, drug-free life. It will include continued treatment, activities, and support to help the addict cope with the triggers and cravings they will inevitably face, helping them lead a fulfilled life outside the facility.

Everyone will have a different aftercare plan, depending on their needs. However, the National Institute on Drug Abuse’s research suggests that most people will need at least 90 days of treatment, and that longer treatment periods tend to have better results.

Why is aftercare important

Sadly, for most people, getting clean will not be enough. Detox in a facility is one thing, but they find that when they return to their lives that the stresses and temptations that caused the addiction in the first place still remain.

It is estimated that between 40% and 60% of addicts will relapse at least once. But high-quality aftercare will help to lower that risk, so having a good aftercare plan is vital.

This is equally true for those that can return to a different or supportive environment. An addict will learn a lot about themselves during rehab, and may discover that even the most supportive relationships they have will have changed, perhaps creating new stresses and challenges. Good aftercare will help former addicts navigate a life that is totally different to what they knew before.

A structured aftercare program helps a former addict remain clean, by helping them adapt to changes, and learning to manage the challenges they face without returning to addiction.

What does aftercare look like?

It’s impossible to accurately describe what aftercare will look like for everyone. The journey will be unique to meet the needs and demands of the individual addict. However, it is likely that most people’s journeys will have some similar characteristics.

First, most people can probably expect a continuation of the support they had in rehab. This will include therapy, medical supervision, support groups and activities. The key difference will be that they are no longer an inpatient.

Second, it’s likely most people’s aftercare will be tapered in some way, starting with heavy support and gradually reducing it as they adapt to their new lives and are able to become more self-reliant to successfully navigate a drug-free life.

For many, they will start with an intensive outpatient program. As the name suggests, these will feature a lot of support. Indeed, the most intensive ones are sometimes termed ‘partial hospitalization programs’ since, although they are still outpatient programs, they will require near full-time attendance.

Aftercare will sometimes include a sober living facility. These vary in their nature, sometimes having addiction professionals living there, and sometimes just being a group of addicts who support each other. These will retain some rules and structure from rehab, but, like other aftercare, it is a taper, so the addict can start moving towards a normal life.

And finally, treatment will be ongoing. It is likely that therapy, both individual and group, will continue in some form, although perhaps not as frequently as in rehab. And it’s likely that support groups will be a key feature. The best known of these are the 12-step programs, like Alcoholics Anonymous or Narcotics Anonymous. However, there are many similar groups that offer a safe, supportive environment for addicts to share and help each other.

The facility is also likely to have some form of alumni group, which will be a forum for continued mutual support and might offer access to help from the facility when needed.

What to look for in aftercare

It’s important to start thinking about aftercare as soon as possible. Although seeking help for addiction is the most important first step, making sure the aftercare is right is a close second.

A key factor is ensuring that the aftercare is holistic2https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2556949/. It needs to not just help the addict recover and avoid relapse, but also to help them lead a healthy, fulfilled life.

Aftercare should have elements that help with the addict’s health, physical and mental, addressing any co-occurring conditions. It should help ensure the former addict is in a healthy environment, this might include providing support to find the right accommodation, but can also include things like family therapy to help loved ones better support them in recovery.

Aftercare should help the addict find a new sense of purpose. Many good aftercare plans will feature activities that seem unrelated to addiction treatment, for example interest groups or hobbies, that help to provide not just diversions, but also meaning, for the addict.

It’s also important to look for aftercare that will be consistent with rehab. Just as you would expect addiction professionals to manage rehab, you would expect professionals managing the aftercare process, ensuring a safe and supported recovery journey.

Sober Living and Secondary Rehab Aftercare

A sober living facility, or secondary rehab, is a secondary stage of treatment after being in primary rehab treatment. Whilst you can learn the basic tools of recovery in an inpatient rehab or residential setting, often these tools can be quickly lost on return to the stresses and strains of your home community, without appropriate aftercare. A sober living house or secondary rehab is a bridge between the ideal environment of a residential drug and alcohol rehab and ‘real life’. In recovery, many people hear the term ‘a bridge to normal living’, and this is essentially what sober living and secondary rehab provide.

Because addiction is a chronically relapsing condition, recovery must be maintained. Usually this means seeing a programme through to completion. If you are in a residential rehab or sober house then you should see it through to the end. When you leave, maintenance of your recovery means going to supports groups like NA and AA. The last stage, relapse is not inevitable. It is what happens if you don’t maintain your recovery.- Alastair Mordey, Alpha Sober Living

Many people worry about staying sober after rehab, because for many, it’s a life and death matter, and a sober living house can act as an integral step in transitioning to lifelong sobriety. While some people may want to head straight home to their family and friends after rehab, this is recipe for quick relapse. Rushing home after rehab often unravels the good work at primary rehab as those now in early recovery are placed near the same triggers that caused the addiction in the first place. A sober living home gives people a fresh start and makes them feel like a contributing member of a community.

A unique journey

Everybody’s addiction is different, so their recovery journey has to be unique too. Good aftercare will help address the causes of addiction, and most importantly provide the techniques and support for the addict to avoid relapse, helping them manage triggers and strengthen their coping strategies for when — inevitably — they are faced with temptation.

References: Aftercare

  1. Anglin MD, Hser YI. Drug abuse treatment. In: Watson RR, editor. Drug and Alcohol Abuse Reviews. Treatment of drug and Alcohol Abuse. Vol. 3. Human Press; Totowa, NJ: 1992. pp. 1–36. []
  2. Alcoholics Anonymous . Alcoholics Anonymous: The Story of How Many Thousands of Men and Women have Recovered from Alcoholism. 3rd Ed. Alcoholics Anonymous World Services Inc.; NY: 19391976. []
  3. Gerstein DR, Johnson RA, Harwood HJ, Fountain D, Sutter N, Malloy K. Evaluating recovery services: The California drug and alcohol treatment assessment (Contract No. 92–001100) Sacramento: California Department of Alcohol and Drug Programs; 2020. []
  4. Caldwell PE. Fostering aftercare client connections with Alcoholics Anonymous: A framework for social workers in various practice settings. Social Work in Health Care. 1999;28(4):45–61. []
  5. Etheridge RM, Craddock SG, Hubbard RL, Rounds-Bryant JL. The relationship of counseling and self-help participation to patient outcomes in aftercare. Drug and Alcohol Dependence. 1999;57:99–112. []
  6. Humphreys K, Moos RJ, Cohen C. Social and community resources and long-term recovery from treated and untreated alcoholism. J. Stud. Alcohol. 1997;58:231–238. []
  7. Montgomery HA, Miller WR, Tonigan JS. Does Alcoholics Anonymous involvement predict treatment outcome? Journal of Substance Abuse Treatment. 1995;12(4):241–246. [PubMed] []
  8. Watson CG. A comparative outcome study of frequent, moderate, occasional and non-attenders of Alcoholics Anonymous. Journal of Clinical Psychology. 1997;53(3):209–214. []
  9. McCarty D. Keynote Address. Reengineering Our System of Services: Developing and Implementing a Comprehensive and Integrated Continuum of Aftercare Services. California State Department of Alcohol and Drug Problems; Sacramento, CA. September 6–8.2006. []
  10. Polcin DL. Bridging psychosocial research and treatment in community substance abuse programs. Addiction Research and Theory. 2004;12(3):275–284. []
  11. Polcin DL. Sober Living Houses after, during, and as an alternative to treatment; Research Conference; Little Rock, AK. October 23–25.2006 October, []
  12. Polcin DL. How health services research can help clinical trials become more community relevant. International Journal of Drug Policy. 2006a;17(3):230–237. []
  13. Wittman FD. Affordable housing for people with alcohol and other drug problems. Contemporary Drug Problems. 1993;20(3):541–609. []
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Why Aftercare is Important
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Why Aftercare is Important
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Aftercare will sometimes include a sober living facility. These vary in their nature, sometimes having addiction professionals living there, and sometimes just being a group of addicts who support each other. These will retain some rules and structure from rehab, but, like other aftercare, it is a taper, so the addict can start moving towards a normal life.
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