Aftercare
Even effectively treated people with addictions will confront unexpected situations after they leave a treatment program and return to their home environment. These situations may produce intense periods of craving to re-use alcohol and other drugs. Lapse, defined as re-use of alcohol or drugs at least once following treatment, occurs in at least 50% of those who complete treatment. The most dangerous period for lapse is the first 3-6 months after completion of formal treatment. Relapse, defined as return to excessive or problematic use, is less common, occurring in approximately 20-30% of those who complete formal care in the prior year.
It is critical that patients, their families and friends prepare for the possibility of lapse and relapse. The preparation should include early detection of a lapse and establishment of steps to keep that problem from becoming a full-blown relapse. Two sets of activities can reduce the likelihood of relapse and reduce the severity if it does occur.
Treatment-Related Preparation
A good addiction treatment program prepares patients to:
- recognize they have a problem that will require continued management and monitoring
- learn and practice some of the fundamental skills needed to recognize and overcome the urge to use or drink when these situations emerge
- be engaged in a continuing care program such as AA and receive regular monitoring of substance use through urine screening or breathalyzer
- receive periodic phone calls or in-home visits following care to monitor their recovery
These generic elements of effective planning during treatment are among the best clinical practices available to forestall lapse. This planning should involve families so they can better understand the treatment issues, be prepared to support the recovery plan and be aware of signs of lapse.
Post-Treatment Preparation
To prevent and contain relapse the family should agree to fully participate in planned continuing care activities. Families and all concerned others can take five helpful steps:
- Have copies of the continuing care plan prominently displayed to reduce ambiguity and promote full communication and response.
- Early in formal treatment, ask the family member in treatment to describe in writing some of the very early signs and behaviors that may lead to his/her lapse and relapse. For example, he/she might write something like “I will begin hanging out with my friend Jimmy,” “I will not do my homework” or “I will stop attending AA meetings.” As the family member undergoes continuing care, regularly refer to these written descriptions to monitor the recovery process.
- During formal treatment, as the individual thinks about relapse scenarios, ask what s/he thinks should be done when early relapse signs emerge. Use these words to develop a contract that includes an action plan the family will follow when any of these signs surface. For example, s/he might write “take my cash and credit cards,” or “increase the urine screens.” Be prepared – before the relapse happens – to take the type of actions contracted.
- Receive and display the results of post-treatment urine screens. Discuss any positive results openly and honestly.
- Monitor and support changes that are consistent with a drug-free lifestyle. In other words “catch him doing something good” and then support it appropriately.
Avoiding Relapse
In some ways, the hardest part of establishing and maintaining long-term recovery comes when the initial, intensive part of treatment has been completed. To avoid relapse, most recovering people need to be in the warm embrace of loved ones – whether their close, biological family or the new “family” of other recovered people that they can turn to when they feel in danger of relapse.
The five factors that most often contribute to relapse:
- inability to manage stress or negative emotional states
- interpersonal conflicts with family or others
- failing to stick to the recommendations of doctors and counselors
- negative thinking
- low motivation to change
These factors are not so different from the variables that affect relapse when dealing with other chronic disorders, such as diabetes:
- failing to stick to diet, medications, or behavior change
- poverty
- poor support from family members
- a co-occurring mental health disorder
Among other things, addicted people must learn how to avoid contact with the triggers that may set in motion their brain’s demanding cry for drugs or alcohol. And when those triggers are unavoidable, people must develop the skills that will prevent the craving from taking over. Learning these skills must be a core element of any treatment program; maintaining them should be part of an aftercare program or long-term recovery plan.
After care is a continuation and application of the lessons and tools learned in rehab. It is something you really need to be involved in if you want survive this. If you just leave 30 days’ treatment and you do not go to meetings and you do not get involved with a sponsor and a group and a commitment, you will go back into old patterns and behaviors.
Sustaining Recovery
Professional treatment of alcohol and drug problems can start someone on the road to recovery, but a few weeks of treatment should not be mistaken for long-term recovery.
If you have severe alcohol and other drug problems, you should know that successful recovery from these problems involves significant changes over time in:
- personal identity and beliefs
- family and social relationships
- daily lifestyle
It is about where you live, how you work and play, who is included and excluded from your life, and how you cope with the stresses of daily life. Recovery is more than just not drinking or using drugs; it is about putting together a new and meaningful life in which alcohol and drugs no longer have a place. Recovery from addiction is not like getting over an infection for which we can rest and take medication for a week or two and then get back to our otherwise unchanged lives. Those who view treatment for addiction in this way make up the group for whom treatment does not work. Recovery from addiction is closer to how someone successfully manages diabetes or heart disease – conditions that require sustained decisions and actions for life.