startfinishIn addiction recovery, “almost” is never good enough.

No issue in addiction treatment is of greater importance than the prevention of relapse.  Sobriety is never an optional goal.  It is the “finish line” that justifies the time, expense, and constant effort.  Anything less may not represent failure — for there may be signs of significant progress, personal growth, and emotional healing – but only substantial clean time constitutes a “win.”

Unfortunately our system of healthcare and insurance reimbursement focuses primarily on inpatient and outpatient treatment.  Without question, treatment is critically important, but it represents the beginning of the journey we call “recovery,” not the middle, or the end.  I shake my head with frustration when I see rehab facilities publishing a “success rate” based on whether an individual finishes their program.  It’s easy to declare victory if you move the goal posts, but only those who believe that addiction can be cured are fooled by this statistic.  Success in addiction treatment is found in aftercare, the activities that support the addict or alcoholic as they change their lives — and learn to “be in recovery” and “live in recovery.”

All too often the addicted person is the loudest voice behind the misconception that all is well.  They have been clean and sober for 30 days.  Heads are clearer and life seems so much better.  It is only natural that they want to move on and get back into living.  However, lost in their enthusiasm is a willingness to embrace the reality that addiction is a chronic disease, for which treatment never ends.  There must be an ongoing effort to stay sober. Changes must be made, new “tools” learned in treatment must be practiced — over and over – until recovery becomes the way of life.  Aftercare can never be an afterthought!

When considering what a strong aftercare plan looks like, we should review the study published in the 2009 Journal of Substance Abuse Treatment.  Robert DuPont and his colleagues studied 906 patients, more than 90% of whom had no indication of substance abuse 5 to 7 years after reporting a problem and beginning treatment.  In an industry were “success rates” are sometimes cited as less than 20%, these findings are dramatic home runs.  The aftercare programs provided for these individuals (by various providers at dozens of different locations) were critical to their strong recovery, and should be seen as the foundation upon which others can build.

Because the patients in this study were doctors, it is easy to dismiss the results with explanations such as “they are so much smarter,” or, “they had so much to lose if they failed.”  While these comments are not without some merit, they do not justify dismissal of the findings.  The disease of addiction has no favorites. It is no less severe for one group of people, and it changes the brain of a doctor in the same way that it affects the brain of a factory worker.

So let’s review the aftercare lessons from this study that should be considered by everyone striving to break free from the destructive power of addiction.

  1. Abstinence.  The goal is to never again use drugs or alcohol.  There are no gray areas.  (It is interesting to note that only 1 doctor out of 906 used a medication such as Methadone or Suboxone to help their recovery.)
  2. Longer treatment.  The “treatment” phase of recovery should be 90 days.  If the inpatient program is 30 days long, it should be followed by counseling, an IOP, or other formal treatment options.
  3. Support Groups. Participation in regular support groups is not an option.  AA, NA, Celebrate Recovery, or other 12-Step groups should always be part of the aftercare plan.  The strong message is that recovery cannot be accomplished alone.
  4. Accountability.  There must be a process of accountability with regular drug and alcohol testing.  The lying, denial and manipulating behavior of addiction cannot be given a place to hide.
  5. Family engagement.  Families need to learn about addiction and how to support without enabling the addicted person.
  6. Health issues addressed.  Issues of mental and physical health need to be assessed and resolution sought. Continued counseling is encouraged.
  7. Relapse response.  If there is a relapse, the rapid spiral into addiction must be quickly addressed.  A plan to stop a relapse if it occurs is always ready.
  8. Extended care.  There is no allusion that recovery comes quickly or easily.  Professional support needs to monitor and assist the addicted person during the first 5 years of their recovery.

All of the action steps described are available to everyone in recovery, and they need to be part of every aftercare plan.  Fortunately, help is more accessible than just a few years ago.  The proliferation of “apps” to help people in recovery, the ability to attend meetings, counseling sessions and IOPs online, the new parity and healthcare legislation that expands benefits for substance abuse, all help make the tools of recovery available.

The bottom line is that we cannot ignore the importance of aftercare.  What happens when someone leaves rehab will determine the success of their recovery.  As treatment providers must do all that we can to prepare our residents for recovery, and be ready to support them as they strive to establish long-term sobriety.  Families also need to become invested for the long-haul.  But most importantly, the addicted person must realize that they are in a lifelong battle to keep addiction from destroying their lives – and keep fighting the good fight.  Winning comes by successfully reaching the only finish line that matters – the end of a life well lived!

Michael Campbell, Co-Founder & President of St. Joseph Institute