Rethinking Aftercare

20140725-090319-32599221.jpgBy Terence T. Gorski

The term aftercare was introduced into the alcoholism treatment field in the early 1960’s to describe a loosely structured program filling 28-day Minnesota Model Treatment. It was designed to supplement, not replace the 12-Step Program. In a strict sense, aftercare was never intended as treAtment. The aftercare programs were generally offered as a free service to ease the transition from residential rehab and community-based recovery programs. Aftercare programs had a place but were quickly replaced by continuing or ongoing outpatient treatment program.

Recovery can be enhanced and relapse minimized by building a concrete and specific philosophy for ongoing care and a self-regulated recovery support system. The goal is to connect patients with as many “naturally occurring” community activities that support sobriety as possible.

Effective continuing care programs include a team of professionals who are addiction friendly — including doctors, dentists, lawyers, fitness centers, housing programs, employment counseling, life skills training, etc.

Here are some points to consider:

1. Aftercare is the traditional name for Continuing Care or Ongoing OP Treatment.

2. Aftercare is not the best name for the service because it gives the impression that the “treatment” is over and this is “post treatment support.”

3. Most addicted patients need a long-term period of ” ongoing treatment following residential care. This is because: (1) patients are very ill prior to admission to residential rehabilitation. Addiction is a biopsychosocial disease and the biological symptoms of acute and post acute withdrawal can require several months to go fully into remission. Addiction disrupts brain functioning, especially during periods of high stress. These symptoms of transient brain dysfunction are called Post Acute Withdrawal (PAW) which impairs attention, concentration, conceptual integration, and memory. These problem cause difficulty in learning. In a sense, many addicted people in early recovery have an addiction-related learning disability that corrects itself with long-term abstinence, addiction counseling, proper nutrition, and cognitive restructuring focusing upon the impaired areas of cognitive, emotional, and behavioral functioning.

4. PAW and related learning problems are stress sensitive. When in the structured sober environment, stress is low so clients experience less problems with learning information and skills. The stress of discharge and adjustment to a return to home, work, and establishing a community-based recovery program causes high stress. As a result PAW symptoms become more severe.

5. Discharge from residential care is so stressful because recovering people are leaving a group of fellow clients with whom they have developed close emotional bonds, often for the first time in their lives. The people they shared residential treatment with gave them an instant source of interpersonal support, loving confrontation, and healthy sobriety-based fellowship.

6. Residential rehabilitation is an artificial environment that separates the client from the real demands and stresses of life.

7. Discharge creates a rapid and stressful shift from the structured sober and responsible environment of rehab as they renter the addictive and stressful world that spawned and nurtured the development and progression of their addiction.

8. Upon discharge they experience high levels of stress as a result of powerful social pressures to go back to:
– Old patterns of addictive thinking and feeling;
– Painful relationships that are part of their old addictive social world they are returning to;
– Disconnection from important sobriety supportive people and systems;
– The need to change or end old destructive relationships.

9. People deal with the stress of this transition in different ways. Some people pretend it doesn’t exist and do nothing to prepare for or manage the stress. Some people minimize the stress if the transition by transferring to long-term residential program, which could be the start of life-long institutionalization. Others transfer into sober living or halfway houses. Many people entered a structured Intensive Outpatient Program (IOP) and begin a long-term therapy relationship with a therapist in the community. Other people engage with a case manager, a life coach for building life-skills, or a sober companion to provide support through difficult high risk situations.

Here are some basic principles for successfully managing the transition from residential rehabilitation to continuing community-based recovery.

1. Build sober and responsible life structure including professional addiction counseling and community-based support groups such as 12-Step Programs, SMART Recovery, Women for Recovery.

2. Involve the family in ongoing recovery.

3. Teach people to build a personal world of sobriety and responsibility around them. This can be done by building a strong relationship with a community-based support group (12-Step, SMART Recovery, etc.) which includes a home group, schedule of meetings, a sponsor, friendships with other members; and continuing professional treatment.

4. To build a successful transition between residential rehabilitation and a return to the community-based recovery often starts by building an ongoing recovery plan from day one of residential treatment; having the patient start participating in community-based support groups during residential rehabilitation.

5. Involve the family during residential rehabilitation.

6. Schedule regular Recovery Checkups to revise and update recovery and relapse prevention plans to meet emerging needs in recovery.

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One Response to Rethinking Aftercare

  1. Linda R says:


    You said “Build sober and responsible life structure including professional addiction counseling and community-based support groups such as 12-Step Programs or SMART Recovery.”

    There are other free sobriety meetings held in a some local communities:

    Women for Sobriety (WFS)
    Secular Organizations for Sobriety (SOS)
    LifeRing Secular Recovery

    I think professional counselors should explain to patients/clients that they can look for these free sobriety meetings in the local community.

    In addition, what telling patients/clients about non-12 Step AA/NA meetings?

    For example, Open, Discussion AA/NA meetings that do not study the 12 Step program of the Big Book (AA) or the 12 Step program of the Basic Text (NA).

    Or AA meetings that study the AA Conference-approved Living Sober textbook, instead of studying the 12 Step program of the Big Book.

    If the patient/client doesn’t want to work the 12 Step program I think the counselor should explain to patients/clients that they can find AA/NA meetings in which the meeting facilitator doesn’t teach the 12 Step programs of the Big Book (AA) or Basic Text (NA).

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