Completing an addiction detox program is a great achievement, but getting through the initial treatment is just the beginning. Once you are back at work, school, or in the community, you will likely find yourself tempted by cravings and urges to use drugs or alcohol again since addiction is a chronic issue.1
Experts recommend aftercare—also known as continuing or follow-up care—during the first couple of months to years after treatment. This usually involves participation in individual or group counseling, regular involvement in a peer support group (such as AA), or other activities designed to help you stay sober.1
One of the main reasons aftercare is so important is that it helps reduce your chances of relapse. A major research study found that for patients entering detox treatment, the odds of relapse decreased the longer they attended a self-help group after their initial treatment.2 Another study found that continuing care participation in the first 3 months following discharge from a treatment program resulted in significantly better outcomes and lower levels of alcohol-related impairment at 3 and 6 months following treatment.3
After successful completion of a detox, inpatient, or residential treatment program (or, in some cases, even an initial formal outpatient substance abuse treatment period), the next step in substance abuse treatment is continued recovery with some form of outpatient treatment. This may consist of a wide variety of options to help you maintain sobriety, including the ability to treat co-occurring mental or physical health problems.
With this type of aftercare, you live at home while attending your treatment groups or therapy sessions at the outpatient facility, which usually allows you to continue with work or school.4 Within outpatient aftercare, there are varying levels of treatment intensity, depending on your personal needs at the time:1
- Partial Hospitalization and Intensive Outpatient Programs (IOP). These programs are usually the most intensive outpatient programs for substance abuse and typically follow completion of detox and inpatient treatment. Also, many people begin with an IOP as their primary rehab effort, then step down to a less-intensive schedule as part of their aftercare plan. You might start out attending 5 days a week and then step down to 2 or 3 days a week as you progress in the program. Some of the services you might receive include psychoeducational and therapeutic groups, family therapy, medication management, and skills training. Often, you have access to 24-hour crisis-management services as well.
- Standard Outpatient Programs. These relatively less-structured programs can take place at counselors’ offices, community mental health clinics, or even at local health department offices. Many of these programs meet on the weekends or evenings so that you can continue to go to work or school full-time. Regular outpatient programs may consist of group and individual therapy, medication management, education about substance abuse disorders, life skills training, and relapse prevention treatment. The length and number of sessions you attend depends on your individual treatment goals, but most people begin with frequent visits that slowly taper off as you progress in your program.
Individual therapy helps you focus personally on a deeper level so you can:1
- Evaluate your personal issues around substance abuse.
- Identify intrinsic motivations for change.
- Repair broken relationships with family, friends, and others.
- Learn coping skills to avoid relapse.
- Create a new lifestyle focused on wellness rather than on drugs or alcohol.
Common therapeutic modalities used in individual therapy include:1,5–8
- Cognitive Behavioral Therapy (CBT). This type of therapy is based on the idea that faulty thoughts play a role in triggering you to abuse substances. During CBT, you learn to identify and correct negative thinking patterns that may lead you to use. CBT also teaches you to learn to apply coping skills to manage cravings and high-risk situations.
- Motivational Interviewing (MI). Also used as part of what is known as motivational enhancement therapy (MET), MI can help you identify your personal motivation to stay clean and then build on that to strengthen your long-term commitment to recovery. It also helps you prepare for and prevent relapse by teaching you how to detect and guard against triggers that might tempt you to use again.
- Family Therapy. Research has found that family therapy improves social functioning, reduces drug and alcohol use, and discourages relapse. It may include nuclear, extended, or non-traditional family members, but the overarching goal of family therapy is to help improve family functioning and support to enhance your motivation to stay sober. Family therapy may also include an educational component to enhance your family members’ understanding of addiction and its causes, effects, and treatment so they can better support you.
- Couples Therapy. Partners play a major role in the addiction and recovery process, so it’s important to include them in your aftercare treatment. Couples therapy may be used to help cohabiting or married couples reduce dysfunctional interactions that often contribute to substance abuse. Studies have consistently found that patients who engage in couples therapy have greater long-term reductions in drug use than patients who participate only in individual counseling.
The length of your aftercare treatment depends on many factors, including your motivation for change, the type and severity of your drug abuse, and any co-occurring issues. Most aftercare treatment lasts anywhere from a few weeks to several years. Usually, the maintenance phase of therapy gets less intensive with time and eventually tapers off.
Although there is no predetermined length of treatment, various research studies have shown that good outcomes depend on an adequate duration of therapy. In fact, research has found that patients receiving 3 months or more of outpatient treatment demonstrated better outcomes around abstinence from drugs and alcohol than patients with less than that amount of time. And people who received 12 months or more of treatment had even better outcomes than those with just 3 months.3 In short, the longer the treatment, the better.
Sober Living and Peer Support Groups
Sober living arrangements, self-help groups, and other means of peer support bring people together who are going through similar issues to provide each other encouragement to stay clean. They complement initial treatment and are often a component of inpatient or formal outpatient rehab programs that are meant to continue long after formal treatment. Some of the most common forms of peer support as aftercare include:1,9
- Sober Living Houses. One of the most immersive types of peer support programs, sober living homes are drug- and alcohol-free living environments for a group of peers in recovery. They rely on peer support and resident participation to help you stay sober and act as an effective form of peer recovery treatment following formal substance abuse treatment. Residents typically attend multiple peer support groups daily and must abide by house rules to stay. Research has demonstrated a decrease in drug use among those in sober living homes compared with those in other follow-up treatment settings.
- 12-Step Groups. These types of groups include the well-known Alcoholics Anonymous (AA) and Narcotics Anonymous (NA). They are based on a 12-step, spiritual model of recovery that involves accepting that you have a chronic disease of addiction and that willpower alone is not enough to overcome it. In a 12-step program, you accept the fellowship of others who have similar issues and follow the recovery activities laid out by the program such as complete abstinence, regular attendance, and working through the 12 steps. Program participants frequently pair with a peer sponsor able to provide them with recovery wisdom, encouragement, and support. Some 12-step groups have a dual recovery component that helps those struggling with substance abuse and co-occurring mental health issues. One study found rates of abstinence were twice as high for people participating in AA than those who did not participate, which were directly correlated with levels of attendance. Another study found higher rates of healthy coping skills and self-efficacy among AA participants.
- Non-12-Step Groups. Some people with substance abuse disorders find the religious nature of 12-step programs to be a deterrent, despite other non-religious people thriving in programs like AA. However, for those who prefer a peer support group based more on evidence-based treatment, certain non-12-step groups provide a good alternative. Like 12-step programs, they offer peer support but do so without the heavy spiritual component implicit in groups like AA. These programs may include internet support groups and in-person peer-run groups.
Both 12-step and non-12-step support groups have proven to be very effective in maintaining long-term recovery. Studies have found that participants with social supports and treatment providers have improved relationships, improved life satisfaction, and decreased relapse rates. They have even been found to help reduce behaviors that increase your risk of acquiring HIV.9
Peer support groups do not replace the need for formal treatments because your peers do not have adequate training to manage complex medical and psychological issues, but these programs are a great supplement to other forms of aftercare treatment.9
- Substance Abuse and Mental Health Services Administration. (2014). What Is Substance Abuse? A Booklet for Families.
- Dennis, M. & Scott, C. (2007). Managing Addiction as a Chronic Condition. Addiction Science & Clinical Practice. 4(1), 45–55.
- Proctor, S. & Herschman, P. (2014). The Continuing Care Model of Substance Use Treatment: What Works, and When Is “Enough,” “Enough?” Psychiatry Journal, Article ID 692423.
- National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Types of Treatment Programs.
- National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Cognitive-Behavioral Therapy (Alcohol, Marijuana, Cocaine, Methamphetamine, Nicotine).
- Substance Abuse and Mental Health Services Administration. (2013). Enhancing Motivation For Change in Substance Abuse Treatment.
- Center for Substance Abuse Treatment. (2004). Treatment Improvement Protocol (TIP) Series, No. 39. Substance Abuse Treatment and Family Therapy: Chapter 1 Substance Abuse Treatment and Family Therapy.
- Fals-Stewart, W., O’Farrell, T., & Birchler, G. (2004). Behavioral Couples Therapy for Substance Abuse: Rationale, Methods, and Findings. Science & Practice Perspectives. 2(2), 30–41.
- Tracy K. & Wallace S. (2016). Benefits of peer support groups in the treatment of addiction. Substance Abuse and Rehabilitation, 7, 143–154.