Once substance abuse or addiction treatment is over, many people wonder what comes next – especially if they, or their treatment team, feel they are not quite ready to manage their substance use disorders without help. The answers to this concern are aftercare and alumni programs that can provide support and motivation for staying abstinent and maintaining recovery in the short- or long-term after treatment is over.
There are a lot of terms and concepts in aftercare that are helpful to know. Here’s some information to help in understanding how aftercare works.
What is relapse prevention?
Relapse prevention is the main goal of substance abuse treatment; as explained in an article from the National Institute on Alcohol Abuse and Alcoholism, it is quite literally what it sounds like: giving the individual who is being treated for substance abuse tools to prevent relapse to drug use during and after treatment. Aftercare is designed to help people keep up with relapse prevention after the relative structure and oversight provided in rehab are no longer available.
Relapse prevention includes tools that motivate an individual to stay sober, such as:
- Understanding the person’s triggers and how to avoid them or insert alternative behaviors
- Providing positive motivation for staying sober, such as rewards
- Expecting and maintaining accountability for sobriety, such as through regular drug tests
- Developing a supportive social structure that encourages and motivates continued recovery
What is an alumni program?
An alumni program is an aftercare program hosted by some treatment facilities that continues to provide connection with the people who have completed the program in the months and years after treatment. Alumni programs usually involve annual gatherings of program graduates and staff, as well as continued access to information and resources through the treatment center.
These programs can be invaluable in providing the individual with a sense of continued connection to and support for the recovery tools and lessons learned through rehab. It can also help an individual find the resources needed to get through difficult periods without relapsing.
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How can sober living homes, or halfway houses, help in the transition?
For people who have completed a treatment program but are not quite ready to manage living on their own without some form of abstinence support, a sober living home (formerly known as a halfway house) can offer structure, peer support and resources, and rules that promote continued sobriety while at the same time offering some level of freedom, such as working a job or going to school.
These homes provide a place to live for people whose home lives may not be conducive to recovery for one reason or another. Other residents of the house are also people who are in addiction treatment aftercare, so there is a sense of peer support. House rules usually require participation in 12-Step programs and ongoing education, participation in house chores, and adherence to a zero-tolerance requirement for any form of drug or alcohol use. As described in a study from the Journal of Substance Abuse Treatment, these homes have been shown to be effective in supporting the transition from rehab to self-sufficiency.
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What addiction support groups are recommended?
The support groups that are likely to help people continue in recovery after treatment is over are 12-Step programs and similar organizations that provide peer support, information, and access to resources that help people stay motivated to stay sober. While 12-Step groups are often the best known, there are other groups that have similar philosophies and work differently, as described in an article from Social Work Today. Some of these programs include:
- Well-known 12-Step groups, like Alcoholics Anonymous and Narcotics Anonymous
- Groups modeled on the 12-Step program but that use different steps, like SMART Recovery
- Groups with specific cultural affiliation, such as White Bison for Native Americans
- Groups involving specific religious connections, such as Jewish, Christian, or Buddhist programs
According to the Substance Abuse and Mental Health Services Administration, the benefits of working with peer support include meeting peers who are dealing with the same struggles. These peers can offer advice, support, and affirmation of the challenges each individual faces. It can be helpful to work with the treatment team in rehab to find a reputable group and give it a try.
What to do if you relapse?
As with all chronic illnesses, from asthma to high blood pressure to diabetes, substance use disorders and addiction have the potential for relapse. As explained by the National Institute on Drug Abuse, relapse does not mean that a person has failed in substance abuse treatment – but it does mean that treatment needs to be altered or adjusted to better support that individual’s ability to maintain abstinence from drug use.
If a relapse occurs, it is important to get in touch with treatment personnel to get back on track and look at how treatment may need to be adjusted to support a return to recovery. Relapse is a setback, but it can be managed, and the individual can continue in recovery by asking for help.
Do people continue to get drug tests in aftercare?
Depending on the aftercare program, drug tests will continue to be administered until the individual can demonstrate the ability to avoid relapse without this continued supervision. An article from Behavioral Healthcare describes the general reasons for continuing drug screening in aftercare; some of the types of programs that may require this continued drug testing include:
- Programs involving maintenance medications
- Contingency Management programs that provide rewards for remaining sober
- Sober living homes that have rules about drug use
- Programs for people who were referred to drug treatment through legal action
As long as motivation is needed to support relapse avoidance, drug testing may be continued.
How can a family member help a recovering loved one?
The best way to support a loved one who has completed rehab and is in aftercare is to provide support and understanding for the individual through the process that must be followed to maintain recovery. An article from LiveScience describes different elements of this support, which include:
- Learning about addiction: Knowledge is a powerful tool in supporting addiction recovery. Family members can help by educating themselves about what addiction is, how treatment is provided, and what their loved one is going through after treatment is over. Learning about the programs the individual is involved in can help too.
- Supporting oneself and other family members: Family members who are struggling with a loved one’s addiction issues can also get help through support groups like Al-Anon or Nar-Anon that provide education, resources, and the support of others who are dealing with the same problems. Taking care of one’s own emotional needs can make it easier to support another person.
- Understanding the big picture: The challenges of addiction provide more than just the struggle of stopping drug use. Financial support, medical care, transportation needs, and other elements of daily life become a struggle too. However, it’s not enough to simply provide those needs; enabling the individual to help with tasks is important to developing needed self-confidence.
- Setting boundaries: Setting rules, being honest, and stopping drug or alcohol use in the household can help the loved one understand that the family is willing to work through the issues that contributed to the substance abuse struggle to begin with. Family counseling can help, if needed, to set rules that remove uncertainty and help family members commit to the path forward.
Can addiction be cured?
Addiction is a chronic condition, much like asthma or diabetes are chronic, and as such, it cannot be cured. However, also like these other chronic illnesses, addiction can be treated, and recovery can be maintained throughout a person’s life. As described in a study from the journal Addiction, this calls for looking at addiction as the chronic illness it is and treating it accordingly.
Treatment is the means through which a person learns to maintain recovery, and aftercare enables the person to become more confident in using those tools so they can be accessed again and again throughout the person’s life as needed to avoid relapse and maintain long-term recovery.
What to do if someone stops taking needed medications?
Medications that are taken during aftercare are designed to help the person avoid relapse by decreasing cravings for drug use and helping the body continue to recover from the physical and mental damage that is done through addiction. Stopping use of these drugs can stall the recovery process and increase the potential for relapse. In this case, it is possible for relapse to lead to overdose because the person’s tolerance for the drug decreases after treatment. As a result, relapse can be dangerous.
Because of this, if an individual in aftercare stops taking needed medications, the first step is to contact the individual’s treatment leader to notify that person about the situation and get help in managing it.
How to find a sponsor?
As described on the Addictions and Recovery website, a sponsor can serve as a coach and cheerleader as a person moves through the 12-Step or other support group process. Finding the right sponsor to meet the individual’s needs is vital.
Before deciding on a sponsor, it can help to ask potential candidates how they work with sponsees. This can offer insight into the different methods different individuals use and give a sense of whether or not the relationship would be helpful for the person seeking a sponsor.
The sponsor should offer a combination of empathy and structure for working through the steps. It’s great to have a friend, but the sponsor relationship needs to offer a level of accountability that provides motivation to work the program and move forward in recovery. If a sponsor relationship isn’t working out, it is acceptable to end it and seek a sponsor who can provide help more suited to the individual’s needs.