Relapse occurs among 40-60 percent of those who have completed drug treatment, according to the National Institute on Drug Abuse (NIDA). This is on par with relapse rates for people with asthma and high blood pressure (50-70 percent relapse). There is a general understanding that relapse for those with high blood pressure and asthma means that treatment needs to be modified and adjusted to better treat the diseases. However, when it comes to drug abuse or addiction, relapse is often considered to indicate a general failure of any type of treatment to work. But this is simply not true.
Instead, as with asthma and hypertension, drug abuse and addiction relapse is an indication that treatment needs to be adjusted to better prevent future relapse. This is the idea behind aftercare. Offering thorough treatment for those who are at risk of relapse, including aftercare for those who need it, can provide better control of the drug abuse or addiction condition.
Once an addiction treatment program is complete, ideally, an individual struggling with drug addiction or alcoholism is ready to return to daily life with the tools and skills to avoid temptation and relapse and move into long-term recovery. In this ideal world, the treated individual is fully prepared and able to resist the triggers encountered at home, at work, and with friends.
However, this isn’t always the case. Sometimes it is necessary to help the person transition from the relatively trigger-free, managed care setting of rehab to the new life that awaits after treatment. The person transitioning may feel nervous and unsure how to manage the daily stresses, relationships, triggers, and temptations that led to drug or alcohol abuse to begin with. For these individuals, the gap between the treatment program and recovery may seem too wide to cross.
To bridge that gap, there are a variety of types of aftercare that can provide the continued support some people may need after their treatment programs are done. These types of care can help people get through the period of time after treatment in which relapse is more likely to happen, enabling them to resist returning to drug or alcohol use and reach the milestones that improve their chances for long-term recovery.
Aftercare’s Effect on Relapse Rates
A report in Psychology Today notes that the longer people dealing with addiction can stay abstinent from drugs or alcohol, the less likely they are to relapse. More than two-thirds are likely to relapse within the first year, while less than half will after a year of sobriety. After five years of sobriety, only 15 percent relapse.
Aftercare aims to increase the chances of beating the relapse odds by extending the amount of time people are abstinent after treatment, helping to build the skills and confidence that can help them get past the important one-year marker.
People Who Benefit from Aftercare
Those who are more likely to encounter situations that might lead to relapse benefit most from aftercare. According to research, including a study of drug addiction treatment in Colombia, the likelihood of relapse is based on multiple factors, some of which include:
- Higher degrees of prior drug abuse
- Previous relapses
- Genetic predisposition to addiction
- Co-occurring mental health disorders such as depression
- Negative family environment
- Unsupportive or lack of social networks
- High levels of stress
- Unemployment or minimal involvement in activities
- Motivation to complete treatment and achieve recovery
People who are dealing with one or more of these factors, or who may be otherwise returning to the environment that enabled their drug abuse to begin with, are at higher risk of relapse and can benefit from aftercare programs to help them manage these issues.
Aftercare can be provided in a number of ways. Depending on the degree of assistance needed, the issues that are being managed, and the particular personality and motivation of the individual being treated, a wide variety of aftercare program elements and options is available. These elements can be used alone or in combination, depending on individual needs and challenges.
Mutual Self-Help Groups
Most people are familiar with the concept of 12-Step groups like Alcoholics Anonymous. These organizations or others like them can provide peer support and motivation to maintain abstinence in the long-term after treatment is completed. In fact, research from the Journal of Psychoactive Drugs indicates that participation in 12-Step programs after treatment has a positive effect on short-term abstinence, which can contribute to long-term recovery.
These groups sometimes provide another element that can be essential to preventing relapse, which is spirituality. Another study from Alcohol Clinical and Experimental Research demonstrates that one of the contributing factors to the positive outcomes from 12-Step aftercare programs is the increased level of spirituality that the participants experience. Follow-up with such participants at the critical one-year mark after treatment shows higher abstinence rates.
Individual Therapy and Counseling
An element from rehab that is helpful to incorporate into aftercare is continued behavioral therapy and counseling. This is important because it continues to reinforce the person’s ability to recognize triggers and cues that may lead to a relapse episode, enabling the person to interrupt the response and replace it with a non-drug-seeking behavior.
In aftercare, this type of therapy can be offered in a group setting that allows individuals to work together to practice avoiding or confronting situations that may lead to relapse, such as being at a party and offered a drink. Practice and repetition of these techniques help to build strong response pathways and increase the person’s confidence in the ability to resist temptation and triggers and remain substance-free.
Cognitive Behavioral Therapy, in particular, helps to build and strengthen these pathways. A study in the Archives of General Psychiatry showed that people who received Cognitive Behavioral Therapy continued to improve in their ability to avoid relapse in the important year after treatment.
Also effective is interpersonal therapy, which helps people build their social networks and connections, as well as participation in activities, all of which has been shown to help people manage the challenges of drug abuse and addiction. A study from Substance Abuse showed that women with alcohol addiction and major depression who received interpersonal therapy were able to not only reduce their alcohol addiction behaviors and depression symptoms, but were also able to maintain their improvement over 32 weeks.
When a person is struggling with drug or alcohol abuse or addiction, sometimes family relationships can play into the problem – either directly through conflict, neglect, or abuse, or indirectly through stress, enabling, or codependence. Other aspects of family relationships can also serve as triggers for drug or alcohol use and lead to relapse once the person has returned home. Family counseling is often a part of rehab for this reason, and it is also an important part of aftercare to help the person transition back to living with the family.
Family counseling strives to not only help the individual learn to manage the relationships that will be part of everyday life, but to also help the family members to understand how best to support the individual in recovery. As the person is learning new behaviors to avoid relapse, the family members can learn new behaviors as well, creating a system that avoids creating triggers to begin with, and that recognizes potential triggers and helps the loved one to navigate them. This helps the person to avoid relapse.
A person who is not motivated to maintain recovery and avoid relapse is less likely to do so than a person who is motivated. Because of this, one type of aftercare involves motivational practices to help people remain abstinent long enough to build confidence in their behavioral and coping practices so they can then manage cravings and triggers. There are several types of motivational practices, such as:
- Motivational Interviewing: This practice provides regular follow-up with the individual, checking in to verify sobriety and provide feedback and support. Research in the American Journal of Psychiatry shows that this, along with other therapy elements, can be particularly helpful in supporting people with co-occurring mental health disorders within the critical first year after treatment. MI is often used in the beginning of a treatment program to enhance initial motivation to change.
- Contingency Management: This type of program regularly provides drug tests and rewards people for staying abstinent or sober through vouchers for services or prizes. In research from the Archives of General Psychiatry, this practice has been shown to increase both the amount of time people have remained in treatment and the number of people who remained abstinent.
- Self-monitoring programs: This call-in telephone service enables people to self-report progress, mood, confidence, and other factors. It includes feedback and support from a therapist if the person feels that there is a relapse risk. According to the American Psychological Association, this program has been demonstrated to increase abstinence, as well as reinforce coping mechanisms and confidence.
As demonstrated by these studies, enhancing motivation to complete treatment is an important factor in rehab aftercare. Even more, these methods work best in combination with other aftercare elements through a comprehensive treatment program.
Intensive Outpatient Programs
Intensive outpatient treatment is a type of in-depth program to help people in their transitions back to home and daily life. These programs offer regular counseling and group sessions, along with motivational elements designed to provide psychological and practical support for abstinence. These can include a combination of:
- A 12-Step program or similar support group
- Educational sessions
- Practical therapy to practice coping techniques
- Behavioral, family, and other therapies
- Motivational practices, such as drug testing and interviewing
The social support, coping tools and practices, and motivational interventions that are provided through an intensive outpatient program can be customized and fine-tuned to an individual’s specific needs and challenges. According to Principles of Drug Addiction Treatment: A Research Based Guide, customization is one of the most critical elements of a treatment program that results in long-term, positive outcomes.
Other crucial elements are optimism and motivation to complete treatment and achieve recovery. Just as with the regular treatment program, the aftercare treatment program is more likely to result in long-term positive outcomes if the person is optimistic about the future and about abstinence or sobriety. The Journal of Personality and Social Psychologydemonstrated that people in an inpatient aftercare program after treatment were more likely to complete treatment with a positive outcome if they had optimistic dispositions.
Finding a Program
It is possible to find 12-Step groups and other well-known programs through a search online, or by contacting the state or local Behavioral Health Department for assistance. However, because everyone is different, and each person’s treatment needs are based on specific personal issues and challenges, the most effective aftercare program is one that is developed with those needs in mind. This is most easily managed through working with a professional addiction treatment program to plan the most appropriate rehab and aftercare programs for the individual in need.
Once detox and rehab are complete, asking for references to aftercare groups and programs can get an individual started on the right path. Even better, look for a rehab program that features a robust aftercare program as part of the provided services. High-quality, research-based treatment centers and programs often include aftercare programs as part of their offerings.
Getting the Most out of Aftercare
As with a rehab treatment program, the longer a person is able to participate in aftercare, the more likely it will be to help extend long-term abstinence. NIDA’s Principles of Effective Treatmentinclude the research-backed fact that treatment outcomes are better when a person spends a longer amount of time in treatment.
The way to get the most out of aftercare, therefore, is to stay involved and stick with aftercare methods as long as possible. Depending on the program elements and the individual’s specific needs, aftercare can last from a few weeks to several months. Working with the rehab treatment center or other care manager to plan a thorough aftercare program that is customized to meet the individual’s specific needs, and sticking with it to the end with optimism and motivation to achieve recovery, will help the person get the most out of treatment. This person can then look forward to a future of long-term recovery with a lower risk of relapse.