Why Aftercare is Essential Following Alcoholism Treatment
What is Aftercare?
Recovery from alcoholism is a lifelong process that doesn’t end once professional treatment is complete. Aftercare is an essential component of recovery and a form of continuing care that takes place any time you switch from different levels of care (such as when you move from inpatient to outpatient treatment or after you’ve completed outpatient treatment).
The planning for aftercare starts at the very beginning of the treatment process, starting with the transition from detox to inpatient treatment (or another form of care if appropriate for you). A variety of aftercare options can help you avoid relapse and maintain your hard-earned sobriety by promoting awareness of triggers and providing you with ongoing support, such as through brief check-ups, individual and group therapy, telephone counseling, and support group meetings.1
Aftercare supports the positive effects of the initial forms of treatment, meaning that it helps cement the skills you learned during each phase of rehab. While more research is needed, most evidence supports the idea that aftercare interventions that have a “longer planned duration of therapeutic contact” are more effective than briefer interventions.1
Additionally, active approaches that engage the person in recovery (such as outreach services or telephone contact), and are more convenient for them, may be better and more feasible alternatives for some people than traditional types of aftercare, such as 12-step groups or group therapy, although this can vary from person to person.1
What is a Relapse?
Relapse is prevalent among people with alcohol use disorders and, for many, is a common feature of their recovery. A relapse can be said to have taken place when a person no longer maintains their goal of abstinence and resumes previous levels of drinking behavior.2
While there are many potential contributing factors, people often relapse because they have difficulty handling or responding to various triggers, such as ongoing stress, emotional or psychological problems, financial issues or housing concerns, social issues such as rejection by peers, or other types of personal problems.2
However, treatment may reduce your chance of relapse. Studies examining relapse rates have had varied results, so more research is needed; yet, the available studies tend to show that treatment can have a positive effect on a person’s ability to maintain abstinence. One meta-analysis showed that average short-term abstinence rates have been estimated at “21% for untreated individuals in waiting-list, no-treatment or placebo conditions, compared to 43% for treated individuals.”3 Among those treated individuals who have maintained short-term abstinence, estimated long-term relapse rates have ranged from 20% to 80%.3
Phases to Relapses
Relapse tends to happen over time and in phases. Different researchers have posited their ideas about the stages of relapse. For example, the addiction researcher Terence Gorski has outlined 11 phases of relapse, and while this can be helpful for addiction professionals who want to examine the relapse process in their clients, it can be overwhelming to fully understand.
One addiction expert, medical doctor, and researcher Dr. Steven Melemis, explains that relapse can more easily be understood in terms of 3 stages—the emotional, mental, and physical stages.4 Dr. Melemis explains the 3 stages as follows:4
- The emotional stage of relapse is characterized by denial. During this stage, you are not actively thinking about using, but you may start to experience emotional issues such as bottling up your emotions, isolating yourself from others, avoiding recovery meetings, going to meetings but not sharing, placing more attention on other people and their problems (instead of your own), and neglecting self-care (which includes poor sleep habits).
- The mental stage of relapse is characterized by an inner war between wanting to use and wanting to stay sober. You may experience increased cravings for alcohol, have increasing thoughts about people, things, or places that are related to your previous alcohol use, trivialize the consequences of your previous alcohol use (i.e. having thoughts such as, “It wasn’t really that bad, I wasn’t drunk every day”), start bargaining (meaning you make deals with yourself such as “I can just have 1 drink and then stop again”), lie to yourself or others, try to come up with ideas of how you can control your drinking if you start again, seek out opportunities to relapse, and actively start planning your relapse.
- The physical stage of relapse occurs when you start drinking again.
Relapse Warning Signs
Some common emotional and mental relapse warning signs are indicated in the above stages of relapse. However, everyone also has their own unique triggers for relapse that cause or exacerbate these feelings and thoughts. Learning to recognize what makes you want to start drinking again is crucial for preventing relapse.
What causes someone else to relapse may not affect you, and vice versa. For example, you may not be as affected if you’re at a dinner party with friends who are drinking, but another person may be unable to tolerate it. Or you may have no trouble walking by the beer aisle in the grocery store, but another person may be unable to resist the temptation to make a purchase.
With that being said, being aware of relapse warning signs may help you stay sober by alerting you to when it’s time to reach out for help. If you feel a temptation to drink, you can then take action, such as by reaching out to your sponsor or counselor or other sober supports.
Keep in mind that there might be more than one warning sign in relapse; often, people experience multiple warnings that build on top of each other until they are no longer able to resist the urge to drink.
Relapse warning signs can include:2,5
- Exposure to stressful events, people, or situations.
- Exposure to alcohol or alcohol-related stimuli.
- Anxiety, depression, or other mental health issues.
- Loss (i.e. death of a family member, divorce, loss of your home, etc.)
- Poor social support.
- Problems at work.
- Interpersonal conflict.
- Social stigma.
- Poor physical health.
- Guilt due to a one-time slip-up (i.e. you may continue drinking as a way to cope with your feelings of shame of having had “that one drink”).
- Increasing negative thoughts, usually in the form of self-criticism, catastrophizing, or all-or-nothing thinking.
- Fear of alcohol recovery (meaning that you don’t believe you are capable of recovering from your addiction or that you aren’t able to live an alcohol-free life).
- Feeling resentful that you can’t “have fun” in the ways that you are used to (i.e. by drinking).
What Happens If I Relapse?
If you relapse, it is important to practice self-compassion and avoid judging yourself harshly. Relapse does not mean that treatment didn’t work; it means that you’ve experienced a common setback that many people in recovery deal with at some point. And sometimes, at multiple points.
It also means that you need to adjust your current treatment plan; perhaps even a different approach or form of treatment. Learning from your setbacks during alcohol recovery is also important because they don’t need to always end in relapse. For example, if things don’t work out the way you want them to in your life or you experience frustrations, you don’t need to give up and start drinking again.
One goal of treatment is to help people understand that relapse is a gradual process that starts way before you have the first drink. It’s important to understand your relapse as much as possible. Take a look at the reasons that you relapsed and think about them in the context of the above-mentioned stages of relapse and triggers.
Try to pinpoint when you started experiencing the first cravings to drink and think about what was going on in your life at that time. Developing an awareness of the specific warning signs that preceded your relapse may allow you to prevent a relapse in the future. It’s crucial to be aware of the early warning signs because that is when it’s easiest to reduce the risk of relapse.4
Developing an Aftercare Plan
The risk of relapse is the main reason why it’s necessary to have a comprehensive aftercare plan in place even before you’ve completed treatment. Aftercare is designed to help you stay sober in the early alcohol recovery period and to help you achieve your other life goals long-term.
Aftercare programs include:
- 12-step groups like Alcoholics Anonymous (AA).
- SMART Recovery.
- 12-step facilitation efforts designed to help you better engage with 12-step groups, such as Making AA Easier and Systematic Encouragement and Community Access procedures.
- Individual therapy.
- Group counseling.
- Sober living homes.
- Regular telephone contact with a counselor or sponsor.
- Home visits from a nurse or other medical practitioner.
- Case management services (usually provided by a social worker).
- Social clubs.
- Family support, such as through family counseling, one-on-one counseling sessions for partners, children, or other family members, educational programs about addiction for family members, and 12-step groups for family members, such as Al-anon.
Continued therapy and outpatient services are important tools in the transition from or “step down” to less intensive forms of treatment. You may be able to continue these services at the facility where you first received treatment, or you may switch to a different facility if that works better for your needs.
Certain situations should be avoided in aftercare planning, such as households or places where you may experience triggers or be offered alcohol. For those whom may need extra residential support, sober living homes provide alcohol- and drug-free residences designed to support you as you transition back to your regular life.
Or you may consider bumping up your attendance of 12-step meetings during stressful times or engaging in individual therapy in addition to self-help groups. Your counselor or care provider must understand and take into account your unique triggers when formulating your aftercare plan so that you are well-equipped to recognize the signs of and avoid a relapse before it occurs.
Getting Treatment For a Relapse
If you’ve recently experienced a relapse and are ready to adjust your treatment plan, American Addiction Centers (AAC) can help. As operator of AlcoholRehab.com, AAC’s admissions navigators can discuss your treatment options with you today.
Remember, a relapse doesn’t mean you have failed, don’t let it keep you from getting the help you deserve. Call our hotline 24/7 to speak with one of our admissions navigators; all calls are 100% confidential. Or, fill out the form below to see if your insurance covers treatment within an AAC facility.
. McKay, J. R. (2009). Continuing care research: what we have learned and where we are going. Journal of Substance Abuse Treatment, 36(2), 131–145.
. Alcohol and Drug Foundation. (n.d.). Relapse.
. Moos, R. H., & Moos, B. S. (2006). Rates and predictors of relapse after natural and treated remission from alcohol use disorders. Addiction, 101(2), 212–222.
. Melemis, S. M. (2015). Relapse prevention and the five rules of recovery. The Yale Journal of Biology and Medicine, 88(3), 325–332.
. Sinha R. (2008). Chronic stress, drug use, and vulnerability to addiction. Annals of the New York Academy of Sciences, 1141, 105–130.