This question is top of mind for many addicts coming out of treatment for substance abuse. After spending one to three months in an environment of structured care and support, their release from rehab can be terrifying.
The prospect of re-entering society, facing addiction triggers and tackling the stressors of daily life without clinical support — and without alcohol or the other substances they previously relied on to help them cope — can be daunting.
Addiction specialists and counselors at The Right Step, an alcohol and rehab center just outside Austin, Texas, emphasize the importance of creating a customized aftercare plan for every client who completes one of their treatment programs. In fact, each client is expected to collaborate with their addiction counselor in building a recovery plan that is unique to their personality and tailored to their specific needs.
“People in recovery have to be part of the solution,” says addiction counselor Justin Steen, LCDC, regional director of outpatient services for The Right Step (TRS) and Promises Austin in Texas. “It is critical that we involve clients in the sculpting of their aftercare plan so they will be more motivated to follow it and complete it.”
Steen, discussed the various components that might be included in an aftercare plan co-created by staff and their clients.
An Effective Aftercare Plan
“Each client’s aftercare plan is different, so the ideal components will vary from individual to individual,” Steen says. Depending on a client’s specific needs and medical history, their aftercare plan might include:
Prescribed medication that is safe for recovery — along with regular doctor visits, referrals to counselors for ongoing outpatient therapy, as well as external clinicians for continuing treatment of any co-occurring eating disorders, mental health issues or trauma they may have experienced
A recovery sponsor, usually obtained through a community 12-step program or other recovery peer group
Resources for legal assistance to help resolve any legal issues stemming from their addiction, and letters or other communications to help meet requirements for court dates, appointments with probation officers, or re-entry into the job market, anda health plan that includes exercise and a nutritious diet.
“An important aspect of recovery is taking pride in your life and your body, and good nutrition and exercise are part of that,” Steen explains.
Getting Support and Building Leadership Skills Is Empowering
“Everyone who completes addiction treatment at The Right Step works with us on their aftercare plan and is transitioned into our Aftercare Program,” Steen explains. “The Aftercare Program is open to all our alumni for two years post-treatment at no cost. It includes a support group meeting once a week that is attended by a clinician and facilitated by other alumni — often those who were in the same treatment program — so coming back to the same treatment facility for aftercare support meetings is kind of like coming home.”
Unlike some recovery support groups that require people to have six months or more of sobriety under their belts before they can take on leadership responsibilities, the TRS Aftercare Program allows alumni who are relatively new to recovery — perhaps just three months sober — to take leadership roles at support group sessions. “This can be very empowering for our program graduates and is also a great learning tool as they work through recovery,” Steen said.
Structured Aftercare Can Reinforce Treatment, Strengthen Recovery
Scientific research shows that addiction is a chronic, progressive disease that affects the brain’s reward centers, and addiction to alcohol and other substances changes a person’s brain chemistry over time. Those chemical changes and the destructive behaviors that stem from them take time to undo — often much longer than the 30 to 90 days a client spends in detox and rehab. It is important to provide structured aftercare and intensive support to clients as they begin using newfound strategies for avoiding relapse and maintaining recovery.
“While sober support groups are a necessary part of recovery, they are not the whole story,” Steen said. “We want to make sure each client is also getting good clinical support. A treatment program is a good foundation for recovery, but it is a very controlled environment. After treatment, our clients are going to go out in the world and encounter stressors. How are they going to handle those stressors now that they are sober? They are going to need continued clinical support to help them handle stress in healthy ways until they learn to make healthier choices on their own.”
More rigorous than TRS’s regular Aftercare Program, Javelin Continuing Care Services at The Right Step are based on a one-year customized aftercare plan that is supervised by a case manager and holds clients accountable to their recovery. Javelin has three components, including:
Weekly recovery coaching via phone to motivate clients to stay on course
Case management to provide clients with referrals to clinicians who can provide outpatient therapy or other continuing care
Staff assistance with finding resources in the community, from legal advice to resume writing, which helps reduce stress and eases their post-treatment reintegration, and
Regular urine testing for substances to hold them accountable to their sobriety.
“We see much lower rates of relapse among our clients who enroll in Javelin,” Steen said. “Plus, providing recovery coaching through the weekly phone calls is rewarding for addiction counselors because we get to touch base with clients as they put their new coping tools into practice. We can help them figure out which strategies are working, which ones aren’t, and make adjustments. Clients get a chance to talk about new issues or challenges that come up during their recovery process, and get one-on-one help with problem-solving.”
Sober Living: A Safe Place to Stay During Aftercare
A sober living option will sometimes be recommended to clients completing treatment if their sobriety might be challenged by their going home. In some cases, a spouse may abuse substances or may be abusive, or there may be other stressors in the home. In other cases, especially for younger clients who still live at home, the parents may have given them an ultimatum that they must be sober for six months before returning home — so going home and continuing aftercare from there is not an option. Alternately, if a client lives alone and is likely to go home and isolate, then that client’s home environment is not conducive to successful aftercare. Isolation is generally considered bad for sobriety.
As an addiction counselor, I must consider if clients will be successful if they go home and continue with their Intensive Outpatient (IOP) care or other aftercare from home, or if their home environment will not support their sobriety,” Steen explained. “If not, we will recommend sober living as their next step after treatment.”
Clients can be referred to a variety of different sober living environments, including halfway houses that offer recovery curriculum, and three-quarter houses that don’t offer a curriculum, but offer a safe place to live with other people in recovery. Sober living arrangements vary as well, where clients may stay for three to six months or, and in some cases, even longer. The important thing is that the sober living environment supports positive progress through a client’s aftercare.