Aftercare Treatment Plans

The National Institute on Drug Abuse (NIDA) recommends that people working to overcome addiction and substance abuse stay in treatment for at least 90 days, or three months. This amount of time in treatment helps the person safely end their body’s dependence on drugs or alcohol while also working with therapists in individual and group sessions to change their self-awareness and behaviors that manage stress.

Once the person graduates from the program, however, they must still focus on maintaining sobriety. Around half of people who go through a rehabilitation program will relapse back into substance abuse at some point. Continuing to work on abstinence from drugs and alcohol, and changing behaviors around triggers or stress, will help a person avoid relapse.

Why Aftercare Is Vital to Avoiding Relapse

Most treatment programs incorporate aftercare plans while their clients are in rehabilitation. Creating this plan will help the person understand steps they can take after they leave rehabilitation to keep working on drug or alcohol recovery and find social support to maintain abstinence. For most people, an aftercare plan includes attending support groups, working with a therapist, or both; however, these meetings are not the only aspects of an aftercare plan, which should be tailored to the individual’s lifestyle and what best supports them.

Creating an aftercare plan helps a person stay actively involved in their ongoing recovery from addiction. Detox and rehabilitation are the two most important steps to overcome substance abuse patterns, but learning how abstinence pairs with daily life requires ongoing support.

According to NIDA, 40-60 percent of people who have gone through a rehabilitation program will relapse. The most vulnerable time, for many, is the first three months after they are discharged from a rehabilitation program. Roughly 25-35 percent of those who complete a rehabilitation program will be readmitted for further treatment due to relapse within one year after they finish their first rehabilitation program. The risk of relapse does not reduce for 4-5 years after a person completes rehabilitation, after which the risk of relapse drops to about 15 percent. Because addiction is a chronic disease, meaning it can be managed but does not go away, the risk of relapse back into substance abuse patterns also never fully disappears.

The good news is that millions of people have gone through rehabilitation programs successfully, and thanks to well-developed aftercare plans, they have stayed sober and healthy for years. Working with a therapist to develop a full aftercare plan, including social support and relapse prevention, helps a person focus on their long-term goals.

Some Components of an Aftercare Plan

The state of Massachusetts offers an online version of a form that is completed after a person is discharged from rehabilitation. This form essentially functions as a bulleted outline of important topics discussed during a meeting with a counselor or case manager. Included in the list are:2

• Times, locations, and frequency of support group meetings, including Alcoholics Anonymous (AA), Narcotics Anonymous (NA), or similar group meetings
• Names and phone numbers of sponsors or individuals for support who are involved in the program, so they can be contacted in crisis or relapse situations
• Individual goals for self-help, including journaling, maintaining a regular yoga practice, or attending religious services
• Individual therapy for ongoing substance abuse treatment, as necessary
• Meeting with case manager to keep up with the aftercare plan
• Managing daily time, including working on employment or educational goals, finding hobbies to destress, exercising, and more
• Making a list of supportive family members who will be able to offer assistance in a crisis
• Getting help with housing and transportation
• Maintaining insurance or other health insurance needs
• Completing vocational training or other educational goals
• Financial planning, if needed
• Childcare, nutritional help, parental assistance, and other programs that may be offered through local or state programs

While this is only one state’s form, these are a collection of discussion points and programs that will help relieve stress for a person who is leaving the protection of a rehabilitation program. By talking about their potential needs up front, the person has a way to approach their new, sober life with help.

The Substance Abuse and Mental Health Services Administration (SAMHSA) has a lengthy Action Plan document for prevention and recovery. The document points out that many people have ways they want to improve themselves, but have a tough time finding ways to do these things regularly. The stress of trying to manage resources without help can lead to lapses or even a full-blown relapse.

Steps to Developing an Aftercare Plan

SAMHSA recommends, while working with a counselor, therapist, or case manager, to create a binder containing much more detailed information to guide the individual on their recovery path. This notebook or binder will contain the relapse prevention plan, along with other aspects of aftercare that involve daily routines, appointments, relaxation techniques, and more. The five primary steps for a good aftercare plan include:3

1. The wellness toolbox: This is a cluster of daily activities that can help the individual feel better, relieve stress, and stay healthy, all at the same time. Some of these suggestions include:
   • Eating three healthy, balanced meals per day
   • Drinking enough water
   • Getting regular sleep, going to bed by 10 p.m.
   • Spending time on a fun hobby, like walking, playing a musical instrument, or knitting
   • Getting enough exercise
   • Spending time on mindfulness meditation or another relaxation exercise
   • Writing about the experience of stress and what might have caused it
   • Talking to a loved one
   • Taking prescribed medications as directed – not skipping a dose and not taking too much
   • Adding vitamins or safe herbal supplements with meals
2. Daily maintenance plan: The subsections of this plan include steps to take toward feeling better, achieving goals, and keeping track of eating and exercise.
   • Feeling well: Write a description of how it feels to feel good, positive, or content. If full sentences do not come to mind, making a list of descriptive words, such as bright, outgoing, energetic, or humorous, can help.
   • Dreams and goals: Aspirations, short-term and long-term goals, and even the wildest future fantasies can be listed here. This helps to keep a positive ending in sight when the daily routine may feel stressful or sluggish.
   • Daily list: This is the full list of daily steps to check off to support wellness. The wellness toolbox can be a reference for this list of activities, which can also include morning and evening personal check-ins, spending time outside for sunlight for at least 10 minutes, and spending time working on creative projects.
   • Reminder list: Many of these will occur regularly, but not daily, like therapy visits, doctors’ appointments, housework, writing letters, and attending support groups. This can be put in a calendar or list format.
3. List of triggers: This section of the aftercare plan should be worked on with a therapist or counselor who can give feedback and prompting questions. Triggers may include tense family relationships, specific locations, anniversaries of birthdays or deaths, physical or mental illness symptoms, and more. Understanding ahead of time many of the factors that may trigger cravings for drugs or alcohol will help the person avoid these, if possible, and manage the stress of the trigger if it cannot be avoided.
4. Action plan for triggers: Based on the list, create a plan to address stress and triggers as they arise. Finding ways to release tension and become comfortable, such as listening to music, performing a breathing exercise, or calling a loved one for comfort are all potential ways to reduce the risk of relapse due to triggers.
5. Early warning signs: Understanding the signs of a potential relapse early can reduce the seriousness of the event or prevent the relapse from occurring. Mental and emotional signs like anxiety, forgetfulness, loss of pleasure, feeling slowed down or sped up, and changes in appetite, can all indicate a potential relapse. Forgetting about self-care and daily steps in the aftercare plan itself, failing to attend support group meetings or therapy sessions, and becoming more solitary can also indicate a potential relapse.

The aftercare plan should follow the triggers and warning signs of relapse, and include information about doctors, rehabilitation programs, and involved loved ones who are available to help in the event that the individual relapses back into substance abuse. Preparing for a crisis is also an important part of aftercare planning.

Aftercare Programs and Institutionalized Support

States, nonprofits, and therapists can all offer aftercare support through various means.4 Support group meetings are the focus of this kind of care, and many institutions, from charities to hospitals to churches, host support groups of all kinds.

Some aftercare plans may include transitional housing, like a sober living home, to help the person focus on putting their rehabilitation program’s teachings into practice while staying away from drugs and alcohol.5 Case management is an important part of aftercare to manage resources, and a state organization or hospital may provide a case manager. Adolescents and teenagers going through recovery may benefit from attending a sober high school or joining a sober fraternity while in college.

Regardless of where aftercare help is offered, it is important to create a long-term plan to stay sober. Structured treatment is a vital step in the process of overcoming addiction, but thinking about life after a rehabilitation program has been completed will help to maintain sustained recovery.