Does Treatment Work?
If you’re considering treatment for a substance use disorder, you may have some reservations. You may wonder if treatment will work for you, or what will become of you once treatment is complete; will you be sent back out into the “real” world to fend for yourself? What if the treatment doesn’t stick?
The answer to the question of whether treatment will work for you is “probably.” The National Institute on Drug Abuse (NIDA) points out that the goal of treatment is to help people return to a productive life, which includes optimal family functioning and productivity at work and in the community.1 According to research, NIDA says, most people who enter treatment and complete the program stop using drugs, decrease criminal behavior, improve their relationships at work and home and improve their social functioning.
Whether treatment will work for you depends on the nature and extent of your problems, how well your treatment program addresses those problems, the quality of the interaction between you and your treatment providers and your level of engagement in treatment and aftercare.
The answer to the question of what happens to you after treatment ends is found in the aftercare plan, which is a crucial staple of high-quality addiction treatment programs and an important key to successful recovery. An aftercare treatment plan is a continuing recovery plan that’s developed once initial treatment is complete. It’s an individualized continuum of care that offers a high level of support and services in the community to dramatically improve your chances of successful long-term recovery.
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What Happens After Treatment Ends?
Believe it or not, treatment can be a peaceful time. You’re sober, you’re learning new and interesting things about yourself every day and you’re developing a kinship with other residents as well as with your treatment providers. Everyone around you is in more-or-less the same boat, and you have iron-clad support around the clock.
But when treatment comes to an end, how do you integrate back into your community? Everything looks the same, but so much has changed. How do you move forward in recovery when a large part of your history in the community is rooted in addiction?
A fundamental function of addiction treatment is promoting long-term recovery through relapse prevention programming, which helps you identify triggers and develop an arsenal of personalized skills and strategies to cope with them. These are the skills and strategies you’ll employ during treatment and beyond.
Still, the National Institute on Drug Abuse points out that between 40 and 60 percent of people in recovery from addiction will relapse at some point, and so ongoing support after treatment is critical to successful recovery.2 The aftercare treatment plan answers the need for continued support and will be developed as a collaboration between you and your care providers. It will include several components that will address a wide range of issues to help prevent a relapse.
According to a study published in Psychiatry Journal, over 71 percent of people who engaged in aftercare for nine months or longer were sober at one year, compared to just 48 percent who participated for six months and 37 percent who participated for three months.3
Typical Components of an Aftercare Treatment Plan
Because the aftercare plan is designed to address the specific needs of an individual, no two plans are exactly alike, although they may have similar components. Following are some common components of a typical aftercare treatment plan.
Cognitive behavioral therapy and other behavioral therapies are a mainstay in addiction treatment due to their effectiveness. During cognitive behavioral therapy, clients learn to evaluate their thoughts, attitudes and behaviors and replace those that are harmful with those that are healthy and productive. They also develop an array of coping skills and strategies for handling stress and other triggers that can quickly lead to relapse.
Once treatment is complete, continuing to attend group and individual therapy sessions promotes ongoing personal growth, and it continues to address the complex issues underlying addiction, which may include trauma or mental illness.
Sober Living Community
Sober living communities, sometimes known as halfway houses, offer a safe place to live for people transitioning from residential rehab back to regular life. These residences offer a little bit of structure and a lot of support.
Sober living facilities are particularly suited to those who lack a stable, drug-free living environment. These homes typically have strict rules regarding abstinence and often test for drugs or alcohol on a regular basis. Residents are expected to participate in house meetings and attend support group sessions as well as help with household chores. In many cases, sober living facilities promote the development of important life skills like shopping for groceries, cooking healthy food, and managing finances. They also help to foster healthy lifestyle changes by offering workout facilities or providing a gym membership and encouraging other aspects of self-care.
According to a study published in the Journal of Psychoactive Drugs, people who live in a sober living facility for an adequate amount of time—which depends on the individual—had high rates of abstinence both while living in the house and upon leaving.4 They also showed improvements concerning employment, arrests and psychiatric symptoms.
According to the Substance Abuse and Mental Health Services Administration, addiction is a family disease that leaves the family system in a state of chaos as it tries to compensate for the unhealthy behaviors of an addicted family member.5
Restoring function to the family system is an essential function of addiction treatment, and the aftercare treatment plan generally calls for ongoing family therapy to continue to rebuild familial relationships, repair trust and improve communication among family members.
The Substance Abuse and Mental Health Services Administration points out that family therapy increases a client’s engagement in the recovery process, reduces drug and alcohol use, improves family and social functioning and helps to prevent relapse.6
Participation in a 12-Step or Alternative Support Group
Peer support is an essential component of most aftercare treatment plans. Twelve-step programs like Alcoholics Anonymous and Narcotics Anonymous and 12-step alternative programs like Smart Recovery offer a high level of support, promote personal responsibility and accountability and foster the development of healthy relationships with non-using peers.
A number of studies show that participation in a 12-step or alternative program helps to prevent relapse. A study cited by the Psychiatry Journal found that participating in this type of program after treatment makes a big difference in terms of successful recovery.3 In the study, 73 percent of those who attended one or more 12-step meetings each week remained abstinent after six months, compared to less than a third of those who didn’t participate in such a program.
Having a job can reduce your risk of relapse, according to an article published in the journal Current Drug Abuse Reviews, which points out that unemployment is a significant risk factor for substance abuse and relapse.7 Conversely, successful employment serves to improve self-esteem, strengthen self-identity, and increase self-efficacy in recovery. Regular employment offers routine and structure and engages an individual in activities that are meaningful and productive.
Vocational services offered through the aftercare plan address issues surrounding employment. Vocational counseling and job placement assistance help individuals:
- Identify occupational strengths and determine what career paths they might find interesting.
- Identify appropriate employment opportunities through aptitude and skills tests, personality evaluations and career counseling sessions.
- Create a resume, find potential employment opportunities and prepare for an interview.
- Address barriers to employment, such as the need for transportation or childcare.
Finding meaningful work is a major priority in recovery, and for some, additional education may be needed to find a fulfilling vocation.
For those who might consider returning to school, educational assistance may be included in the aftercare treatment plan. Educational services help individuals determine what sort of education program is appropriate for reaching specific goals. Whether the education is from a university, community college or involves a professional development course to bolster an existing career, counselors are available to help individuals sort through various programs, find sources of tuition assistance and enroll in the program of their choice.
Many people who seek treatment arrive with legal problems, such as DUI or child custody issues, which increase stress and anxiety and may be a trigger for relapse. Addiction treatment must address a wide range of problems and issues, including legal issues. The aftercare treatment plan may include ongoing legal assistance to help individuals find free or affordable representation or determine their rights in a particular situation. If a legal issue comes up once you’re in recovery, legal assistance can help prevent a stress-related relapse.
Ongoing Mental Health Care
A dual diagnosis is made when a substance use disorder co-occurs with a mental illness like anxiety or depression. Treating both the addiction and the mental illness at the same time through integrated treatment is absolutely essential for the best possible outcome. For those with a dual diagnosis, ongoing mental health care is included in the aftercare treatment plan as a crucial factor for successful long-term recovery.
Relapse Prevention Programming
Relapse prevention programming is concerned with educating clients about relapse and providing specific skills and strategies to cope with triggers. In relapse prevention sessions, clients:
- Identify and learn to cope with high-risk situations
- Improve their sense of mastery for handling high-risk situations without relapse
- Learn to set realistic expectations
- Learn the stages of relapse and the signs associated with each stage
- Formulate a detailed plan for handling lapses
According to the National Institute on Drug Abuse’s Principles of Effective Treatment, a combination of counseling and medication may be the best path to recovery.8 This is particularly true for those with an opioid addiction. Maintenance medications like methadone and buprenorphine stave off devastating withdrawal symptoms and combat cravings to allow individuals to put their lives back together.
If medication is part of the recovery plan, prescribing and monitoring the medication will be an integral component of the aftercare treatment plan.
The aftercare treatment plan is managed by a case worker who monitors the success of the plan and assesses for an individual’s changing or emerging needs. Aftercare is a fluid, dynamic plan that addresses multiple needs, and as such, it may need to be revised a number of times throughout its duration.
How Long Does an Aftercare Treatment Plan Last?
The duration of an aftercare plan isn’t set in stone and depends on the depth of your needs, the complexity of your issues and the severity of your addiction. As such, an aftercare plan may be active for several months or even a year or longer.
As you progress in recovery, some components of the aftercare treatment plan may no longer be needed and will be discarded. Designed as a step-down model of continuing care, the aftercare plan is fluid and dynamic and will provide support for as long as it is needed.
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The Family in Recovery
Families affected by addiction generally need therapy to sort through the complex issues that affect the health of the family system. Although family therapy is typically included in the aftercare plan, family therapy addresses the family as a system, and the therapy is framed in that regard. Individual therapy for family members isn’t typically part of an aftercare treatment plan, but it’s advisable for family members to engage in one-on-one counseling to work on particular issues more thoroughly.
A healthy family system requires healthy members, and individual therapy helps family members identify and change the unhealthy behaviors they’ve developed as a result of the addiction. This leads to more personal happiness and harmony and can speed up the healing of the family system. Additionally, individual therapy for younger family members can dramatically reduce their risk of developing a substance use disorder themselves.
Relapse is Always Possible
Although the aftercare plan is highly effective for helping to prevent relapse, setbacks are always a possibility. Setbacks are behaviors that lead you closer to relapse, such as putting yourself in a high-risk situation. Setbacks can quickly lead to relapse, but the National Institute on Drug Abuse stresses that relapse is no longer considered to be a catastrophe.9 Rather, it’s an opportunity to evaluate your recovery plan, identify what went wrong, and develop the skills necessary to prevent another lapse.
According to an article published in the Yale Journal of Biology and Medicine, how you approach a setback plays a major role in recovery.10 If you view it as a personal failure or failure of treatment, you’re more likely to stop focusing on the progress you’ve made and focus more on the obstacles ahead. With this mindset, it’s easy to feel overwhelmed, and some may give up on recovery altogether. But those who view a setback as a normal part of their progress tend to quickly assess what went wrong and take steps to correct it, landing back on the road to recovery better equipped—and often more motivated—than before.
Life Beyond Aftercare
As you become more confident in your sobriety and more skilled at coping with high-risk situations, your aftercare treatment plan will begin to reflect these changes. Eventually, you will no longer need an aftercare plan, but this isn’t to say that your recovery is complete. Mindful living day-to-day will be the cornerstone of long-term recovery, and what you learn about yourself, addiction and relapse during aftercare will have a major impact on your self-efficacy, self-identity and, ultimately, your success in recovery.
The more engaged you are in your aftercare treatment plan during the early months of recovery, the better equipped you will be for the future. The Butler Center for Research points to a 2011 study finding that the likelihood of successful ongoing recovery increases by 20 percent for each consecutive month you engage in the aftercare plan in the first six months following treatment.11
Treatment works, and aftercare helps to ensure it keeps working long into the future. If you have an addiction and are ready to move forward and realize a healthy, productive life, the first step is to choose a high-quality treatment program that includes a comprehensive, individualized aftercare treatment plan to help you succeed in recovery.
- How Effective is Drug Addiction Treatment? (2012, December). Retrieved from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/how-effective-drug-addiction-treatment
- Drugs, Brains, and Behavior: The Science of Addiction. (2014, July). Retrieved from https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery
- Proctor, S. L., & Herschman, P. L. (2014). The Continuing Care Model of Substance Use Treatment: What Works, and When Is “Enough,” “Enough?” Psychiatry Journal. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4007701/
- Polcin, D. L., Korcha, R., Bond, J., & Galloway, G. (2010, December). What Did We Learn from Our Study on Sober Living Houses and Where Do We Go from Here? Journal of Psychoactive Drugs, 42(4), 425-433. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3057870/
- Family Disease. (2016, February 24). Retrieved from https://www.ncadd.org/family-friends/there-is-help/family-disease
- Substance Abuse Treatment and Family Therapy. (2004). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK64269/
- Henkel, D. (2011, March). Unemployment and Substance Use: A Review of the Literature (1990-2010). Current Drug Abuse Reviews, 4(1), 4-27. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/21466502
- DrugFacts—Treatment Approaches for Drug Addiction. (2016, July). Retrieved from https://www.drugabuse.gov/publications/drugfacts/treatment-approaches-drug-addiction
- DrugFacts—Understanding Drug Use and Addiction. (2016, August). Retrieved from https://www.drugabuse.gov/publications/drugfacts/understanding-drug-use-addiction
- Melemis, S. M. (2015, September). Relapse Prevention and the Five Rules of Recovery. Yale Journal of Biology and Medicine, 88(3), 325-332. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553654/
- Research Update: The Importance of Recovery Management. (2016, April). Retrieved from http://www.houghtonhouse.co.za/wp-content/uploads/2014/04/Hazelden_Continuing-Care.pdf