What is aftercare, and why do rehabs recommend an aftercare plan for substance abuse?
An aftercare program that patients attend after alcohol rehab or drug rehab is an outpatient treatment program dedicated to helping those patients to maintain sobriety. The goal of addiction aftercare is relapse prevention.
A stay at a rehab facility often lasts for about a month, or 30 days. During that time, the patient attends individual therapy as well as group recovery meetings.
Following graduation of recovering alumni from rehab, the addiction aftercare plan typically includes up to a year of involvement in an addiction aftercare program. The purpose of aftercare services is to support the recovery process for recovering alumni and help to ensure lifelong recovery.
The inpatient treatment program will likely also have patients attend real Alcoholics Anonymous or Narcotics Anonymous meetings in addition to daily group therapy. Learning to open up in group settings is a key part of the addiction recovery plan.
If you are subscribed to the best addiction recovery podcast, The Rehab, on the Mental Health News Radio Network, you may have heard our interview with Dr. Tamra Hall of American Addiction Centers, where she discusses the many programs available at AACs rehab facilities.
If rehab works, why do they need rehab aftercare?
You might think that residential treatment and drug or alcohol detox solves the problem of active addiction. Why should you be concerned about a relapse on drugs or alcohol after spending a month in rehab?
One issue is that many rehabs approach addiction treatment with various forms of talk therapy and initiation into the spiritual practices of the 12-steps. Unfortunately, talk therapy is not the ideal treatment for addictions that already have proven medical treatments available.
For example, it is certainly possible to detox a person off of alcohol in a medical detox facility. Medications are provided, along with around-the-clock nursing and observation.
After the patient is detoxed safely from what is essentially a forced cold-turkey quitting of alcohol, they are then transferred to a residential treatment center for a month or more of substance abuse treatment, consisting of group therapy and individual therapy.
Is long term recovery possible after a stay in rehab with an aftercare plan for substance abuse?
Relapse rates for alcoholics and people with drug addiction are alarmingly high after rehab. Rehab alumni who are overcoming alcohol dependence will likely face symptoms relating to the alcohol deprivation effect during the weeks or months after graduating from rehab.
The alcohol deprivation effect causes significant alcohol cravings to arise in a person who has quit alcohol cold-turkey. While these cravings do not always have to lead to a relapse and return to harmful drinking, they often do.
Cravings after rehab are also a serious problem for people addicted to various other drugs, besides alcohol. It is not unusual, for example, for a crack addict to start having vivid memories, or even dreams, about the act of smoking crack from a glass pipe.
They may even remember the smell of crack smoke and the physical feeling of anticipation of the high. During an intense craving, the crack addict in recovery might look down at the ground and think, for a moment, that they have seen a crack rock at their feet.
For people addicted to readily accessible drugs, whether it is alcohol from the local convenience store, or crack or heroin from the dealer who sits in front of that same store, seeing the location where they bought their drug of choice can bring about intense feelings and cravings. They might even find their car taking them on unfortunate detours to drive by places where they previously purchased drugs, which can eventually lead to a dangerous relapse.
Is aftercare treatment a bandage to cover up the inadequacies of rehab?
When people fail in recovery meetings or rehab, they are often blamed for their failure. They are told that they did not work the program well enough.
How often do we blame patients for their illnesses? No doctor would blame a cancer patient for a relapse, but blaming an alcoholic or drug addict for a relapse is common practice.
Is it possible that rehabs are simply not providing adequate treatment for addiction, which is a real medical problem? While in some cases, where medical treatment has not been developed, rehab may be the best we have.
For example, while there have been some advances in medication-assisted treatment of meth and cocaine addiction, these stimulants still do not have highly effective and established medical therapies available like we currently have for opioids and alcohol.
After a long stay in rehab, what does the rehab facility recommend? Why, more rehab, of course! Rehabs have come up with various addiction aftercare programs that provide ongoing substance abuse aftercare.
Aftercare planning typically involves the mainstay of rehab therapy, the group. Just like in residential rehab, people gather in a circle of chairs with a trained group facilitator. They share their feelings and how their lives are going after leaving rehab and rejoining society.
The group facilitator usually understands the secrets of facilitation due to long-term involvement in the world of addiction recovery. The team facilitator, an employee of the rehab, is typically a certified addictions counselor who is also in recovery.
Of course, there is a near endless supply of topics to be covered, as former rehab patients share with each other the challenges they face, back in the real world. While the facilitator will typically get involved at certain points, often, they will allow the “group dynamic” to manage itself.
Patients will feel better, getting inner feelings and concerns off their chest by sharing out loud, and they will get feedback from the sharing of other group members. The meetings in substance abuse aftercare programs often suspiciously resemble freely available 12-step recovery group meetings.
One of the main differences is that the aftercare members will be people who have been to the same fancy rehab program and there will be a paid, professional group facilitator with at least a certificate in addiction counseling.
Can an addiction aftercare program help with the cravings that arise after rehab?
One major difference between rehab aftercare and 12-step meetings may be the focus on spirituality in Alcoholics Anonymous and Narcotics Anonymous groups. If a person shares that they are having cravings, other members may recommend prayer and asking that their Higher Power remove the obsession to use drugs or alcohol.
While this same advice might also come up in aftercare services, the facilitator might be more likely to offer advice based on psychological principles, such as identifying and avoiding triggers. For example, if driving by the corner gas station causes an obsession with having a beer or buying some cocaine or heroin, then try finding other routes that do not involve driving by that particular gas station.
Of course, there is no harm in following these strategies. Prayer and a connection with spirituality definitely help many people through the recovery process. And, avoiding triggers is clearly a good idea for promoting lifelong recovery.
Yet, an addiction aftercare plan should also address continuity of care relating to medication-assisted treatment as part of the substance abuse treatment plan. This means that medications such as buprenorphine or naltrexone should be used as part of drug rehab treatment where appropriate and the addiction aftercare plan can serve as a way to ensure that medical treatment continues for an appropriate time period.
The best and scientifically proven, way to help a patient who is addicted to opioids to stay in recovery long-term is to provide medical treatment for at least a year. If rehab typically lasts for a month, an aftercare treatment plan may provide an ideal opportunity for ensuring the patient’s compliance with a medical treatment plan.
While aftercare treatment typically does not currently involve care by a medical treatment provider, there is an opportunity to design rehab and aftercare programs to work better for patients. As rehab administrators begin to accept the need for more medically sound programs, it would behoove them to overhaul the entire system to address long-term medical treatment with medical aftercare planning.
What is a sober living home and what part does it play in substance abuse aftercare?
Sober living is a way for a patient who has completed inpatient treatment to be reintegrated back into society. The patient goes from living in a residential rehab, where the controlled environment protects them from outside triggers and temptations, to living and working in the real world.
Often, the reason for going to sober living is that either the patient is not ready to live in their own home, or the patient’s family is not ready yet to have their recovering loved one back home. Active addiction can lead to family drama and emotional turmoil that can take time to resolve.
In addition to providing a home away from home, a sober living facility provides additional services to help prevent relapse and reinforce recovery. Many sober homes provide trained staff, enforce a daily recovery-focused program, including group meetings, routine drug testing, and other house rules that ensure residents will remain sober.
Additionally, residents of a sober home are often expected to obtain jobs and go to work on a regular basis. Living in a sober living house may help a person learn to live self-sufficiently and responsibly.
Unfortunately, very few sober homes are “Suboxone-friendly.” Administrators usually frown on medical treatment for addiction. They share the philosophy of most rehabs by embracing the abstinence-only, 12-step recovery process.
Again, sober homes being against what is considered to be the gold standard of opioid addiction treatment, are missing out on an opportunity to be part of a successful solution. By reinforcing the importance of patients continuing to take their treatment medication, rather than encouraging them to stop medical treatment early, sober homes could help their residents to have much higher success rates in remaining drug free.
Is addiction a mental health problem or a behavior problem?
The word “behavior” can be confusing when used to describe a medical condition. Why do mental health experts use the term “behavioral health” interchangeably with “mental health”?
While mental health issues, such as addiction, do have an effect on behavior, describing the condition as being behavioral in nature implies the person who is addicted is not truly ill, but simply has learned bad habits and requires some sort of retraining.
Addiction is not the same as having poor table manners. Being tormented with persistent drug cravings is different from not knowing which fork to eat with or resting your elbows on the table at dinner time.
In some ways, traditional rehab is not completely different from obedience school for dogs. No wonder, people often find the rehab experience to be demeaning.
In the twenty-first century, we now understand addiction to be a true medical condition that involves real changes in the brain. It is possible to overcome addiction, and by using modern medical therapies, the success rates are far higher than when only behavioral modification methods are used.
Addiction is not a moral failing due to poor upbringing. It is not a result of not being able to keep your room clean as a child. Being addicted to a substance does not make you a bad or a broken person.
In fact, addiction is a common trait that many people have in one form or another. It is far more common than people realize.
When a person’s addiction progresses to the point where treatment is needed, it does not mean that they are in any way inferior to anyone else. Just like some people have issues with controlling their blood pressure or blood sugar, some people have an issue with controlling obsessive thoughts about using substances.
Another issue is that many people who turn to drugs or alcohol have underlying mental health issues that have not been adequately addressed. They find themselves self-treating with street drugs or excessive alcohol use.
Rather than persistently focusing on a rehab patient’s shortcomings and character defects, it would be far more useful to focus on making a proper psychiatric diagnosis of the patient. That might require having the patient actually see medical professionals in rehab rather than just other patients and certified drug counselors.
While an aftercare program for substance abuse is important, the aftercare plan in question would best be one that works in conjunction with a true medical plan for treating addiction. Addiction aftercare must be more than simply hours of group sessions interspersed with smoking breaks for the clients.
It is possible for substance abuse aftercare programs to be highly effective if properly designed. Now is the time to rethink the rehab industry.
In order to provide the best possible care for patients with alcohol use disorder, opioid use disorder, or other substance use disorders, rehab and aftercare treatment should be focused more on evidence-based medical therapies, rather than rehashing the group circle methodology as a primary modality of treatment for addiction.