This is the final installment in the five-part series, “Finding Addiction Treatment That Works.” Read Part One, Part Two, Part Three and Part Four. What happens after completion of rehab is critical to successful, long-term recovery from a drug or alcohol addiction. As many as 40% to 60% of patients treated for alcohol or another chemical dependency go back to using their drug(s) of choice within a year after treatment, for example, according to the physician-authored, clinical information resource UpToDate. That’s why securing “evidence-based” aftercare — aftercare that, based on results from clinical trials, is most likely to help you stay clean — is imperative. But what does that look like and how do you get it? Two scientifically tested strategies that have proven effective in supporting long-term sobriety are:
- Chronic Disease Management Chronic disease management is a way of understanding addiction as a lifelong disease that, much like other chronic medical conditions such as diabetes or hypertension, requires ongoing management in the form of healthy lifestyle choices and proactive self-care measures.Effectively managing a substance use disorder can involve a number of elements:
- Medically supervised maintenance therapy for an addiction and/or co-occurring disorders (dual diagnoses like anxiety, depression or mood disorders that so often accompany the diagnosis of a substance use disorder) can keep the disease of addiction at bay.Continuing care after inpatient rehab may in certain cases entail an ongoing (still temporary) regimen of medication-assisted treatment, depending on the nature of the addiction. Clinical trials suggest that the medicine buprenorphine boosts abstinence rates in patients with opioid addictions, for instance. Buprenorphine is thus one of several medications that doctors at The Right Step will sometimes prescribe for patients at risk of relapse.In situations where a psychiatrist has determined the presence of a co-occurring disorder like generalized anxiety disorder or major depression, medication maintenance is critically important to prevent relapse and must be part of an integrated, long-term treatment approach. The treatment prognosis for people with a dual diagnosis (of addiction and another mental disorder) is on the whole poorer, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). But numerous studies have also found that many patients with co-occurring disorders “did well” in response to psychiatric treatment, the same report by SAMHSA concluded. The ensuing recommendation? That patients with dual diagnoses receive “more intensive and psychiatrically specific treatment.”
- Ongoing counseling or psychotherapy for coping with life stressors, building resilience to addiction triggers, navigating difficult family dynamics, and/or preventing relapse helps to sustain abstinence from drugs. Decades of research and thousands of studies have shown that long-term abstinence outcomes improve when therapy accompanies medication maintenance, and that at least three-quarters of patients in psychotherapy show benefit.
- Ongoing case management by a trained professional who can provide regular recovery checkups, offer trusted referrals, connect you to peer and family support services and serve as a first responder in incidents of relapse, has also proven successful at encouraging long-term sobriety. That’s why for the first two years following addiction treatment with The Right Step, our program provides free, weekly check-ins with one of our counselors for the sake of support, counseling and referrals.
- Support Group Services Self-help groups like Alcoholics Anonymous have proven “lifesaving and critical” in helping patients manage their disease beyond the safer confines of inpatient rehab, according to a five-year study by Columbia University’s Center on Addiction and Substance Abuse (CASA). The consensus of the research is that those who participate in a 12-step group following treatment are “significantly” more likely —some studies have said twice as likely — to stay abstinent.If 12-step groups are not your cup of tea, other support group options are out there. These include therapy communities, sober living houses, and programs that, in the vein of the highly effective physician health program, which monitors physicians in recovery for up to five years with regular drug testing and other incentives, provide various forms of long-term support.
How to Get Effective Aftercare
Aftercare is something you need to inquire about before you enter treatment in any program. The following questions can help you decide whether a prospective program will offer you the kind of sustainable underpinning you will need in the way of chronic disease management and support group services:
- What components of chronic disease management does your aftercare program include (medically supervised maintenance therapy, psychotherapy, and case management)?
- To what extent do you implement the 12-step model in your treatment program and connect your clients to such groups in aftercare?
- What alternative support group services, beyond 12-step groups, do you encourage your clients to make use of in treatment and aftercare?
- How long is your aftercare program? Is it free? What evidence-based elements does your aftercare program incorporate?
- “Addiction Medicine: Closing the Gap Between Science and Practice,” CASA
- “Alcoholics Anonymous Effectiveness: Faith Meets Science,” Journal of Addictive Diseases
- “Evidence-Based Therapy Relationships,” National Registry of Evidence-based Programs and Practices, SAMHSA
- “Treatment of Co-Occurring Disorders,” Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs, Treatment Improvement Protocol (TIP) Series, No. 43, SAMHSA
- “Continuing care for addiction: Indications, features, and efficacy,” UpToDate