Inpatient settings offer comprehensive treatment for the physical and psychological aspects of addiction, while also providing a safe, structured environment for people in early recovery. Inpatient rehab programs offer life-saving treatment to people who are in the early stages of sobriety, helping to ensure they are physically and emotionally stable during the detox and withdrawal phase. While inpatient programs play a vital role in early treatment of addictive disorders, they are short-term programs that only work to meet the immediate needs of people in recovery.

Some inpatient rehab programs offer 30 day programs, but 1-2 weeks is a typical stay, which is not enough time to develop a strong foundation for recovery. Most people discharge from inpatient rehab in the very early stages of their sobriety, when their risk of relapse is highest. Most will return to the same environments they were in before, making it highly likely that they will encounter triggers and temptations, making them even more vulnerable to relapse.

Because of these risks, inpatient rehab is mostly successful only when it is followed by additional treatment, often called aftercare (1, 2, 3). 

What is an Aftercare Plan?

An aftercare plan is normally developed while a person is still in rehab. Normally, social workers, counselors, or other dedicated professionals at the rehab center help patients develop an aftercare plan before they discharge. An aftercare plan details the treatment, resources and additional services that a person will receive after leaving inpatient care.

Also called a discharge or transition plan, these plans are the key to maintaining the progress a person made while they were in rehab. In this way, aftercare plans help to protect the time, money and effort a person has invested into their treatment so far, ensuring that a person has all of the support they need to maintain their sobriety outside of the facility.

Determining Aftercare Needs

One of the most important components of an aftercare plan for a person discharging from inpatient care is a plan for continued treatment. The type of treatment a person needs when stepping down from inpatient treatment will vary, depending on a number of factors, including:

  • Prior substance use: what they used, how long they used, and how much they used
  • Co-occurring disorders: whether a person also has a mental health or medical condition 
  • Severity: the severity of their addiction, the level of risk their substance use poses to them
  • Prior treatment: whether they have had treatment before and if so, how it worked
  • Finances: a person’s insurance, covered services, or ability to self-pay
  • Availability: the amount of time a person can commit to aftercare treatment 
  • Accessibility: the types of treatment offered and whether they can access these
  • Personal preferences: what treatment a person wants or is open to trying

Depending on these factors, aftercare treatment may include one or more of the following:

  • Residential treatment
  • Intensive outpatient treatment
  • Partial hospitalization
  • Individual outpatient counseling
  • Outpatient family or couples counseling
  • Outpatient group counseling
  • Medication management

Determining which service is best for each patient is the result of a collaborative effort between the patient and their providers. Providers will often make recommendations based on their clinical knowledge and prior experience, but it is important for patients to be vocal about their needs and preferences. Typically, people who have more serious addictions or who are at high risk of overdose benefit from more intensive aftercare programs that allow them to “step down” gradually. Examples of more intensive aftercare programs include residential programs, partial hospitalizations, and intensive outpatient programs.

Residential Programs

Residential programs are often recommended for people who need housing or for those who would otherwise return to a home where others were actively using. Residential programs often offer some financial assistance to people, especially early on, but usually require people to pay rent, submit clean drug screens, and participate in substance abuse treatment. For some people, having a structured sober living environment offers them the long-term support they need to maintain their sobriety, as it is typical for these programs to last a year or longer.

Partial Hospitalization Programs and Intensive Outpatient Programs ( PHP’s and IOP’s)

Intensive outpatient programs are not residential, but they do provide more treatment than typical outpatient programs. Depending on the facility and specific program, IOP’s and PHP’s offer therapeutic programs 3-7 days a week, and include a combination of individual and group therapy, therapeutic activities and case management. Drug testing and medication management are often included in these programs. These more intensive aftercare treatments may be helpful for people who have not been successful in lower levels of treatment or those mandated to treatment for legal, custody, or employment-related reasons.

Outpatient Treatment

Outpatient treatment is a lower level of aftercare for people in recovery from a drug or alcohol addiction, and involves individual, family, and/or group counseling sessions. Usually, these therapy sessions are led by a licensed addiction counselor and are held once or twice a week for about an hour, sometimes longer for group therapy. Outpatient treatment for addiction is often a good option for those who are stable in their recovery who do not have severe addictions or other factors that place them at high risk of relapse. Some people also see a psychiatrist, doctor, or other professional that can prescribe them medications. Typically, medication is only recommended in conjunction with therapy, and not as a stand-alone treatment.

Self-help Groups for People in Recovery

Self-help groups for those in recovery are offered in most communities in the US, and are often free to attend. In these communities, people in recovery are often able to develop a new support system, while also learning valuable skills that they can use to help them stay sober. Some of the more popular groups are 12 step groups like Alcoholics Anonymous or Narcotics Anonymous or Smart recovery meetings. These groups are usually peer-lead, offering people in recovery a forum to discuss their challenges, successes, and to give and receive support and encouragement from others who have had similar experiences. While these are not technically considered “treatment”, they do have a strong track record of helping people maintain their sobriety, and can be combined with any other formal treatment.

Other Keys to Success in Aftercare

In addition to seeking aftercare treatment, people who are discharging from inpatient rehab facilities can also take additional steps to reduce their risk of relapse. These include:

  • Reducing exposure to triggers: Making sure there are no drugs or alcohol in the home, that phone numbers for drug dealers or friends who are actively using are deleted, and taking other steps to reduce the amount of exposure to other people, places and things that trigger urges to use.
  • Reconnecting with supports: While relationships often have become strained by things that were said or done in active addiction, they can often be repaired. Research shows that people are most successful at maintaining their sobriety when they have a strong support system.
  • Structured activities and routines: When leaving rehab, people often find that having a lot of free or idle time on their hands makes it harder to not think about alcohol or drugs. This can be prevented by working to identify a new routine that includes tasks, activities, and other positive uses of time that promote a healthy and sober lifestyle.
  • Accountability: Accountability measures are those that encourage people to follow through with their intended plans. One of the first accountability measures people preparing to leave rehab can take is to schedule their first aftercare appointment before they leave. Other accountability measures could include asking a friend or family member to help hold them accountable or tracking their progress on a calendar, app or journal.
  • Manage stress and cope with emotions: A final key to maintaining sobriety after inpatient rehab is to learn more effective methods of coping with difficult emotions and stress, which are almost always a culprit in people who have relapsed (3). This means addressing underlying mental health conditions like depression or anxiety, as well as reducing sources of toxic stress and attending meetings and therapy sessions to learn new coping methods.

Final Thoughts on Aftercare Plans

Many people who seek treatment for an addiction experience one or more relapses before achieving remission, but there are certain strategies that can reduce these odds. Research has proven that aftercare is one of the most significant factors influencing remission and relapse rates after inpatient treatment (2). People who develop comprehensive aftercare plans before discharging from inpatient treatment are more likely to engage in aftercare, and are less likely to relapse (2, 3).

Aftercare is most effective in preventing relapse when the programs are matched to the individual’s needs and preferences, rather than selected randomly or based on a clinician’s recommendation (1). Taking an active role in selecting aftercare treatments helps people commit to their recovery and begin to build the foundation of lasting change.

Sources:

  1. Brown, T. G., Seraganian, P., Tremblay, J., & Annis, H. (2002). Matching substance abuse aftercare treatments to client characteristics. Addictive Behaviors, 27(4), 585-604.
  1. Hawkins JD, Catalano RF Jr. Aftercare in drug abuse treatment. Int J Addict. 1985 Jun-Jul;20(6-7):917-45. doi: 10.3109/10826088509047759. PMID: 3000958.
  1. Raven, M. C., Carrier, E. R., Lee, J., Billings, J. C., Marr, M., & Gourevitch, M. N. (2010). Substance use treatment barriers for patients with frequent hospital admissions. Journal of substance abuse treatment, 38(1), 22-30.

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