There’s a misconception that treatment for substance use disorder ends when you are discharged from a treatment facility or “rehab.” That’s a fallacy. Substance use disorder is a chronic, life-long disease that needs to be managed, just as you would any other chronic disease like diabetes, asthma or multiple sclerosis. In reality, when you leave in-patient treatment, it’s just the beginning.
Coming out of a treatment facility is a critical period of transition, with the likelihood of long-term recovery going up exponentially if someone can remain sober for one year. Because of this, every patient requires a disease management plan that focuses on addressing the short-term and long-term needs of each individual patient.
The decision whether someone is ready to move on to aftercare – whether that means returning home or moving to a halfway house or sober home or an intensive outpatient program – depends on the clinical situation. Let me repeat, there is no one aftercare plan that fits everyone. During treatment, the support team evaluates the patient’s decision making, impulse control, and ability to negotiate rehab, peer involvement and conflict to determine the patient’s next level of care. Factors considered include the history of a person’s drug and alcohol usage, any co-occurring mental health, psychological and psychiatric needs, the family situation, and the patient’s own ability to negotiate autonomously. Also factored in are patient’s goals, all of which inform the disease management plan that the patient, family and clinicians work together to create – a plan that addresses the question “What’s Next?”
The Importance of a Recovery Action Plan
At discharge, a short-term Recovery Action Plan is necessary and should include:
- Establishing a circle of support. Isolation is a significant trigger for relapse. All patients must have a range of individual and group support in place after leaving treatment. Research shows that the combination of a 12-step program or other consistent support group, individual therapy and trusted loved ones all make a difference in the successful management of a chronic disease. Before a patient leaves, they should have their circle of support identified and first appointments set.
- A treatment plan that continues clinical and medical care. In advance of leaving treatment, patients should work with their provider to establish a health-care plan moving forward. This can include identifying a physician, psychologist and/or social worker and other specialists as appropriate. It’s important to find providers that align with the residential center’s use of evidence-based practices and treatment modalities, including the use of Medication Assisted Treatment (MAT) such as Vivitrol, Naltrexone and Suboxone. This way a patient can transition smoothly from one environment to another without any disruption in treatment
- A list of people, places and things they are not allowed to be around. This reduces the temptation to fall back into bad habits.
- Contingency planning. This strategy for relapse prevention and reengagement identifies specific actions the patient and their family can take in the event of an emotional or actual relapse. Everyone will undoubtedly encounter a person, place or thing that may make them vulnerable to a relapse. Triggers exist – whether it’s a destructive family member or the sight of a cocktail on television. But with the right strategy developed in advance of leaving treatment, a person can turn to healthy behaviors to address these issues. However, since addiction is a chronic disease, relapses may happen. Therefore, the plan can also prepare for immediate re-engagement without shame if a relapse occurs.
It also is critical for those newly in recovery to remain connected and engaged with the people and resources keeping them on their recovery path and helping them quickly when they relapse. Caron places a tremendous emphasis on maintaining contact with patients as they transition out of in-patient treatment into their local communities. Having numerous points of contact in the recovery network can be extremely helpful, especially in detecting a potential emotional relapse in time to prevent an actual relapse.
Finding the right setting
In selecting a treatment provider to support the transition out of in-patient treatment, it is important to find one that is in alignment with the in-patient center’s use of evidence-based practices and treatment modalities, including MAT.
Other factors to consider in choosing a post-treatment provider include:
- The safety and affordability of the facility.
- The quality of care at the facility.
- Licensing by the state and accreditation by either CARF or the Joint Commission.
- The educational achievements of the treatment staff are Masters level and above.
- The facility can treat co-occurring psychological and psychiatric issues.
- Family can be included in therapy.
- Urine screening as appropriate.
Getting started, and planning for the long-term
People are particularly vulnerable in the first few days and weeks after residential treatment. Suddenly, everything they’ve worked so hard to cultivate during treatment goes from theoretical to very real. Everything’s new, and everything is potentially dangerous. While they are in treatment, we coach people on what to expect and to help them navigate these situations.
We also work with people to think long-term. Milestones of three, six or nine months are all great, but they can also be times of great danger for those in recovery. When people cross those major milestones, they may become complacent, and, as with other chronic diseases, this complacency may lead to a return to unhealthy habits. It’s important for people to understand these warning signs before they go completely off course. For example, if a person knows in advance that starting to minimize the need to attend meetings or take medicine is a slippery slope, he or she can redouble their efforts. That could mean attending a brief residential program or going to therapy more frequently to thwart the mental gymnastics that lead to slacking and sliding.
This is when loved ones and circle support become so important. If your loved one is in recovery and they hit these milestones, and you notice they’re backsliding, it’s okay to point it out in a non-confrontational way. “I’m proud of you. You’re doing so well. But Caron taught us that this is chronic; it’s a disease and you need keep treating it. Don’t slide off.”
Substance use disorder is a chronic disease, but the good news is that a well-developed plan both in the short and long-term can support a lifetime of wellness and recovery. Establishing a solid disease management strategy opens the door to endless possibilities.