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Importance of Aftercare in Recovery

Sep 17, 2015 - 4 comments











Substance Abuse




Substance Use Disorder

Importance of Aftercare in Recovery

The Move from Addiction Treatment to Aftercare

It is tempting for those who have made it through an addiction treatment program to conclude that their problems are over. Getting help for an addiction is a great achievement but it is not the end of the story. It would be fairer to say that the real work begins after the initial treatment period. This is why it is generally agreed that some type of aftercare is required, particularly during the first couple of years of recovery.

Aftercare Defined

Aftercare refers to any subsequent interventions that follow the initial treatment. In the case of addiction treatment, it will often refer to the additional support that is given following release from the residential part of the program. This may occur in the form of support groups, booster sessions, counseling, or follow-up meetings. The aftercare can be in the form of debriefings, or it may involve teaching new skills and coping strategies.

The Risk of Relapse

Up to 50% of those who make it through an addiction treatment program will later relapse. Those who relapse may never get another opportunity to recover. This is a depressing fact, but the good news is that relapse is preventable. The highest risk of relapse is during the first 60 days following discharge from a rehab. This risk remains high for the first five years of recovery.

The Causes of Relapse

When the individual leaves a treatment facility they will usually be highly motivated and confident about the future. They have made it through physical withdrawals and a can now see how a life without substance abuse is possible. Their self-efficacy is high. They should rightly feel proud of their achievement. Once they return to normal living though, they can find that recovery is more of a challenge.

Staying off alcohol or drugs is harder in the outside world then it is in a residential treatment facility. There is a lot of support in rehab and the individual is protected from temptation. A return to normality can come as a shock. The individual is once again surrounded by temptation and they now lack the support found in rehab. It can be a real struggle not to be drawn back to familiar behavior.

There are a number of reasons why people relapse after a period of recovery. Motivation can wane if there is not a concerted effort to keep focused on living free of alcohol and drugs. The individual can begin to feel that their problems are behind them and that no special effort is required to stay sober. They then forget the reasons that drove them into recovery in the first place. The pain of their rock bottom is forgotten. If they fail to put enough effort into staying sober, they stop progressing and life in recovery becomes unsatisfying. They may react to this by once again returning to addiction.

Coping Strategies Needed in Recovery

Another reason why people relapse is that they fail to pick up the necessary coping strategies needed to live comfortably in recovery. Life will always have ups and downs and the individual needs to be able to handle both. Addicts will turn to substance abuse in the first place because they are unable to cope with life. If the individual just gets sober without developing new ways of coping, they will continue to struggle and may relapse.

The Importance of Aftercare

Those who receive some type of aftercare are less likely to relapse and more likely to live longer. This aftercare can keep the individual motivated and provide support when things get difficult. The individual who goes through a treatment facility will pick up a lot of knowledge and skills, but most of the learning needs to occur during normal everyday living. As the person in recovery is faced with new problems, they will be encouraged to find new solutions. This way they will build up effective coping strategies over time.

Those who return to substance abuse tend to follow a certain pattern called the relapse process. This begins with becoming stuck in recovery. This process leading to relapse can be stopped at any time and aftercare is the most effective way of doing this. Those who continue to receive support are far more aware of relapse triggers. They are also more likely to spot the warning signs that they are moving towards a relapse.

Types of Aftercare

There are a number of aftercare options. Some of these will be provided by a rehab for those who have passed through their residential program. Other types of aftercare can be arranged by the individual themselves.

* Twelve Step Groups are the most well known of all the aftercare options. The members are encouraged to attend regularly for the rest of their life. Those who are new to recovery may be advised to try to attend ninety meetings in ninety days. The 12 step program offers a way of life that works well for many people. There is also an important social element to these groups with events like conventions, conferences, and dances.
* As well as the 12 step programs, there are other Support Groups available. Not everyone is comfortable with the spiritual aspect of groups like AA, so these other groups offer a good alternative. Rational Recovery is probably one of the most well known of these other options.
* Booster sessions are offered following rehab. This is not something yet offered by many treatment facilities, but there is a lot of support for their effectiveness. These sessions occur a few months after the individual has left rehab. They will be debriefed about their experiences in early recovery, and new coping strategies and skills are taught. These sessions will have the effect of rejuvenating the individual’s motivation and reducing the risk of relapse.
* Counseling Sessions are another option for aftercare. Here the individual will be able to talk about any problems as they arise, and look at those issues that drove them to addiction in the first place.
* Dual diagnosis support is required when an individual has another mental health problem as well as their addiction. A lot of addicts can also suffer from depression or other types of mental problems that need addressing. These mental health issues can occur as a result of addiction, or they may have been there prior to addiction. Failure to treat a dual diagnosis will mean that life in recovery is unsatisfactory and can easily lead to relapse. The type of support required will depend on the nature of the dual diagnosis.

I was on the news

Aug 26, 2015 - 17 comments

My boss asked if I would be willing to do an interview for the local news about the increase in heroin I did it.

Non 12-Step Aftercare Options

Sep 29, 2014 - 6 comments





non 12 step




relapse prevention

Aftercare is important. If you find yourself not growing in your current recovery program or you have participated in the same recovery program for years and are a chronic relapser and dont know what your doing wrong so you do the same thing over yet relapse again, maybe its time to try something new. Are you being told that "you must not be working the program right", but you know in your heart you are....maybe its time to try something new. Its not about any program being better than the other...its about finding what program works best for you. There are a lot of programs out there but here are some that are non 12-step based:

• Women for Sobriety helps women overcome alcohol dependence through emotional and spiritual growth.

• Jewish Alcoholics, Chemically Dependent Persons and Significant Others (JACS) helps people explore recovery in a nurturing Jewish environment.

• Self-Management and Recovery Training (SMART) is a cognitive–behavioral group approach that focuses on self-reliance, problem solving, coping strategies, and a balanced lifestyle.

• LifeRing Secular Recovery is a secular, non-profit organization providing peer-run addiction recovery groups for anyone with a desire to recover from alcohol and drug addiction or who are in a relationship with an addict or alcoholic

• Secular Organizations for Sobriety maintains that sobriety is a separate issue from religion or spirituality and credits the individual for achieving and maintaining sobriety.

• Community-based spiritual fellowships, which take place in churches, synagogues, mosques, temples, and other spiritually focused meeting sites, often form the basis for support, lifestyle change, and clarification of values in peoples’ lives.

• Recovery International is a mental health self-help organization founded in 1937 by neuropsychiatrist Abraham Low in Chicago, Illinois. Recovery's program is based on self-control, self-confidence, and increasing one's determination to act

To find out more about any one of these meetings just google the names. I didn't list websites because its not allowed.

Coping With Urges

May 12, 2014 - 16 comments





















By: Robert Westermeyer, Ph.D.

Habits and urges go hand in hand. In fact, many people in the throes of an addictive behavior problem, whether it is overeating, drug use or alcohol abuse, claim that they derive no pleasure from their habit--that it is nothing but the relentless craving that fuels ongoing addictive behavior. What is usually most difficult for people when changing a bad habit is coping with the sometimes relentless urges. The initial days of a habit kicking plan can be exhausting as urges dominate thinking and interfere with daily routine. Many people give up change efforts because they feel that there is no way they can function without their habit as the urges interfere too much with quality of life.

It is important to remember that urges, in and of themselves, are normal. We experience craving in varying degrees every day. And because your habit has been important to you for a long time, it may be unreasonable to expect urges to vanish completely. What is hoped is that you will come to experience urges with less frequency and that when they are experienced you will be able to react in a way that avoids relapse.

The "three Ds" can be helpful in coping with urges and craving, 'whether these urges are related to alcohol or drug use, overeating, tobacco use or any habit you are attempting to change. The Ds stand for Decatastrophizing, Disputing expectancies and Distracting.


Especially early on in your change efforts, craving can seem excruciating. Your daily routine has been altered by the elimination of an important part of life and now you can't get your mind off it. Everything you see reminds you of your habit. If you smoke, every room you enter may bring to mind the image of> a cigarette and associated pleasure. The inability to satisfy the urge can lead to frustration and inner statements like, "I can't stand this!" or "There is no way I will be able to live without giving in. I'll just go crazy!" Statements like this can be overwhelming. So much so that people often give up efforts.

As is the case with anxiety, catastrophic thoughts can lead to a great deal of arousal which can, in turn, make things seem worse than they are. If you believe that you are completely out or control, your emotions will follow. What is important to remember is that urges are normal and typically decline in intensity as you continue implementing change. To combat catastrophic reactions to urges it is important to remind yourself of times in the past when you have successfully changed habits (think now, we all have done so at least once or twice!). Do you still experience urges? If so, are they as intense as during the initial phase of your change efforts? Probably not, right? Furthermore, think about other people you have known who have undergone significant change. Do they seem haunted by urges such that they cannot function? If not, who is to say that you cannot accomplish that also?

Try to take some of the power away from a black and white adjective like "horrible" or "unbearable." Belief in horrible extremes only makes you feel worse. Just how unbearable is your urge right now? To accurately answer this you may need to conjure images of what other types of suffering reported as unbearable are like. Is this as unbearable as getting stabbed in the stomach? Or better still, what have you endured which was worse than your current urge? Was that unbearable? lf so, does it folIow that your urge is less than unbearable and perhaps only "very uncomfortable."

Disputing Expectancies

Craving is, in essence, the activation of expectancies. Beck and his colleagues (Cognitive Therapy of Substance Abuse, 1993, Guilford Publications) believe that there are three beliefs associated with the acute decision to engage in substance abuse." They are Anticipatory, such as "I'm gonna be Mr. Wonderful after one line." Relief Oriented, such as "I won't have to think about work if I drink this bottle of wine." and Facilitative or Permissive, such as, " I've been good all week, I'm entitled to an evening high." Though Beck and his colleagues presented these fundamental beliefs in reference to substance abuse problems, it is this author's contention that these beliefs can function in any habit urge.

Since we rarely think about distant consequences when craving, bring them to mind deliberately. Bring to mind the negative emotions which may be
experienced at a later time due to engaging in your habit. Urges are "myopic" in that they can only see advantages. You must shed some light on your craving in order to effectively control it. Ask yourself questions like:
* How will I feel later if I give in to my urges?"

* What consequences might I suffer if I give in?"

* Will the negatives outweigh the positives in the long run if I give in?"

Another way to cope with urges is to imagine that someone very close to you is voicing the very urge you are experiencing. How would you go about convincing them not to give in. Sometimes distancing ourselves from our urges is imperative before you can subject them to any scrutiny.

Your ability to conjure vivid images can be used in your favor when you experience craving. In the presence of a strong urge, try to imagine a very negative outcome. The more negatively graphic the better. The more true to your life the better. For example, if you have a problem with alcohol and experience a strong urge to walk down to the convenience store and buy a bottle of Vodka, imagine the worst hangover possible. Imagine vomiting all morning. Better still, imagine someone very important dropping by, someone you really want to impress, and seeing you in that condition. It is amazing how powerful our own imagination can be in fueling and impeding behavior. Use it to your advantage in your habit change efforts!


Some urges are so relentless that talking back to them is insufficient. You still can't get your mind off your habit. Good old fashioned distraction is sometimes the only medicine that can pull your thoughts away. Distraction can be cognitive, in the form of some mental exercises, or behavioral, in the form of activity. Certainly the latter is going to be the most effective, in that urges tend to occur in environments which are the same or similar to those in which the habit occurred in the past. If you are trying to quit smoking, and you have previously smoked in your office all day, being in your office is going to elicit a strong drive to light up. Certainly if possible, taking your work into a conference room, or taking a break and walking outside will often be enough to decrease the urge to a manageable level. You must evaluate your schedule and determine which situations evoke the most intense craving and create as much flexibility as possible so that you can "escape" if necessary--especially in the initial days of your change efforts.

Cognitive distraction can be very powerful. Certainly imagery has been used as a means of helping stressed people learn to relax. You too can use imagery to take your mind off an urge which is dominating consciousness. Conjuring a pleasant place like a beach or on a raft in a lake can help you not only take your mind off the urge but relax as well.

However, "relaxing" images are not helpful for everyone. Some find that if they relax when craving they will only want it more. This makes sense as we have discussed that many habits are associated with relaxation and pleasure, and evoking these feelings in places previously associated with your habit can strengthen urges tremendously. I recommend that you find some mental task that will be very difficult to finish but which is interesting and consuming that you can activate in response to an urge. I like to refer to these as Mental Tapes. Some examples of tapes which have been helpful are:

* Writing the perfect epic novel or screenplay.

*Planning the perfect vacation.

*Creating the ideal money-making business.

*Interpreting a dream from the night before.

*Picking an acquaintance and trying to "figure them out."

Certainly what you choose will depend on your interests, but the key is to make it something that will be easy and perhaps interesting and fun to do. Choosing to think about all the mistakes you've made this year and how you could have done things differently is not going to prove a good distraction tape as it won't be enjoyable. In fact it may increase the power of your urge, especially if stress has precipitated your habit in the past.

It is sometimes best to try one urge control technique at a time so that you don't get overwhelmed. These techniques work, but they also require a great deal of mental energy and conscious effort. The aim here is not to make change excruciating or extraordinarily taxing, but to provide you with some tools which you can add to your armory at a your own pace.