Addiction Recovery and the Importance of Aftercare
The general steps in addiction treatment are a period of initial withdrawal as an inpatient followed immediately by some time in rehab where behavioral therapy is introduced and, lastly, an extended aftercare program.
Unfortunately, many addicts do not follow through, increasing their chances of relapse. All too often this leads to a repeating cycle of inpatient admissions for detox and rehab, release, and then readmission for the same condition months later.
Types of Aftercare
There are a variety of programs that fall under the umbrella term of aftercare:
- Transitional programs, also called halfway houses, provide a structured environment with ongoing, daily treatment that also introduces some aspects of living with the outside stresses and temptations of employment. Substance abuse monitoring (drug/alcohol testing) is usually part of the arrangement.
- Sober living is a type of transitional environment that may provide housing and minimal treatment (weekly meetings) without direct supervision. These conditions rely on clients meeting set objectives for employment, life skills and benchmarks, and keeping up any terms of parole/probation.
- Stepped down care typically has one or two outpatient sessions per week for several months after release from a more intensive, inpatient program.
- Community immersion programs use brief check-ups along with attendance at 12-step meetings (or other informal groups). These are used when strong family support is available.
Breaking the Cycle
Aftercare is an essential ingredient shown to improve long-term outcomes in both alcohol and drug abuse patients. As recently as 2011, studies showing effectiveness have demonstrated a positive effect. For each month of participation, abstinence rates increased by 20 percent (compared to non-participants).
A model that finds broad application in many environments is the Recovery Management Checkup (RMC). Primarily, this methodology arose to address the unwillingness of recovering addicts to stay in existing programs. Data from 2004 shows that the median length of stay in outpatient programs maxed out at 52 days. Half of the participants are gone from care within eight weeks, with less than 25 percent staying in an aftercare program the minimum 90 days as recommended by the National Institute on Drug Abuse.
RMC offers a low-cost way to maintain engagement with recovering addicts and alcoholics. It is meant to identify problems and risk of relapse early as well as help improve participation in aftercare programs.
An addict’s “drug career,” without effective intervention, will average about 30 years. Active intervention can reduce this figure to about 10 years. This doesn’t necessarily mean treatment has to extend for an entire decade, since much of the “career” will come before treatment is even sought. However, it does show the dramatic difference between expectations and actual substance abuse patterns.
Patients and others who expect a short period of inpatient treatment leading to a “cure” are woefully uninformed. Realistically, it will take months to see significant change, and that change can be quite fragile.
RMC is meant to be a comprehensive program that addresses many areas of a client’s life and attempts an early intervention when a relapse occurs. It can be as simple as a 15-20 minute weekly phone call or as involved as visitation-based assessments coupled with once or twice weekly office visits. Less contact is cheaper and can be broadly instituted. An example of interview questions that may be asked can be found here.
Key to Long-Term Recovery
Whatever the particular format, the key ingredient is to have an addiction specialist contact and assess the recovering addict on a regular basis. This is usually coupled with following a plan of set goals and is blended with care received as an inpatient. It is not always reasonable to expect complete abstinence, and the study cited above followed patients for two years with an average of 480 abstinence days over that time. Although contact was only made once every three months, the RMC cohort showed more abstinence days and fewer symptoms of abuse, dependence and associated problems.
There are then two significant ideas in play. The first is that complete abstinence may not be achievable, but a patient’s life can still be greatly improved by long-term “check-ups.” The second is that aftercare must be considered a much longer process than is typically envisioned or funded. Years, not months, are the rule with addiction seen as a chronic condition.
The combination of harm mitigation and a commitment to persistence does pay off by shortening the overall period in which an addict has to suffer from active addiction. RMC is one way to help accomplish this, but attention to aftercare in general should be the rule and not the exception in addiction treatment.