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The concept of aftercare is explained in the word itself: caring for and supporting those who used to abuse substances after they complete a treatment program. Too often, the assumption is made that a few therapy sessions will “solve” an addiction problem, only for the reality to become starkly clear a few months after treatment: The effort to maintain sobriety doesn’t end when one walks out of a rehab center. Getting a loved one into aftercare makes the difference between reintegration into everyday life and relapsing into a drug habit.
Aftercare exists as an answer to the question of what happens after treatment. Family members will naturally wonder if their loved one will be ready to step back into the family unit after being mentally and physically treated for a drug or alcohol problem. At the outset, this might seem easy. Maybe the violent mood swings are gone, maybe money doesn’t mysteriously go missing, and maybe professional and academic obligations aren’t left by the wayside. In some ways, having a loved one back home after treatment is finished might be like having a brand new person in the house, especially after the trauma and misery of living with someone who was dependent on controlled substances.
But every honeymoon period comes to an end, and when life resumes its usual grind – the stress, boredom, and frustrations of bills, family, work, and school – the cracks that once let an addiction slip through are at risk of becoming wider.
To that effect, the risk of people relapsing to substance use is highest within the first three months of completing treatment. Around 25-35 percent of people have to return to treatment within the first year of their discharge, says HBO’s Addiction Project, which goes on to report that around 50 percent of people re-enter treatment within five years.
Recovery is not a quick process. According to the Harvard Gazette, it could take a person up to five years for the chance of relapse to drop below 15 percent, the threshold for recovery to be considered secure.
With that in mind, it is unlikely that there will ever be a true “cure” for addiction, writes Psychology Today. One of the reasons for that is that drug use isn’t just about the drugs. There are many layers and levels of susceptibility for a substance abuse problem to develop in a person. Treatment and rehabilitation seal off many of those layers and show people how they can guard against their weaknesses being exploited. But it is important for everyone involved to understand that this will be an ongoing process, and one that requires a degree of help and assistance that may (and maybe even should) last a lifetime.
One example of this is the importance of structure and discipline in the individual’s post-treatment life. In the days of the addiction, the person’s life would revolve around drugs (or alcohol): getting drugs, using drugs, getting money to use drugs, or simply thinking about using drugs so much that everything else in life fell by the wayside. An inpatient treatment program might try to gradually reintroduce a sense of routine and coherence to a person’s life: daily (or weekly) yoga classes, group therapy sessions, reading time, playing music, exercise, etc.
The idea of this is to metaphorically give the addiction no time or room to take hold in the person’s life. To that effect, family participation is important in this structure, either becoming a part of a family member’s activities (hitting the gym together, going to yoga together, or cooking together) or being supporting and helping the individual maintain a schedule.
This is also where the people in aftercare support groups and networks come in. They know the struggles of trying to engage with life again, while having to look over their own shoulders for the triggers that might bring about stress, anxiety, or depression that leads to (or work in conjunction with) substance abuse.
Such a group provides a foundation for a newly abstinent person to take the first steps in sobriety. These groups also teach the person how to learn from the inevitable mistakes that will be made, to work the concepts of the program, and to share their own stories with others who need to hear the message.
In talking about the importance of having such support systems in recovery, Psych Central refers to “healthy peer pressure.” It is the opposite of the kind of peer pressure that might have played a role in the development of the original substance abuse problem. In aftercare, peer pressure impresses a sense of accountability on individuals, holding them up to a standard that is their responsibility to maintain. When people stumble, the support group is there to catch them and help them back on their feet.
Today, enough is understood about recovery and aftercare that a variety of programs exist to provide a person with a relatable, fun, and reliable group of people to bond with. For example, sober exercise programs create an environment free from the temptation and pressure to drink. Some gyms even host “sober week” events, where recovering alcoholics and drug users can get together to work out and spend time with each other, safe in the knowledge that their very presence and participation in the event is a step forward for their sobriety.
Of course, exercise provides a number of health benefits, but working out also plays a role in keeping addiction under control. According to a professor of neuroscience speaking to Newsweekmagazine, an exercise session releases dopamine, the neurotransmitter that triggers feelings of satisfaction for doing something good. Drugs and alcohol work by hijacking the brain and causing excessive and harmful amounts of dopamine to be produced. Exercise, on the other hand, causes the release of a moderate amount of dopamine, enough for individuals to feel good about themselves and what they’re doing, but not so much that the activity of exercise itself becomes addictive (in the way that the mechanism of dopamine production causes drug and alcohol abuse to become habit-forming).
Additionally, group exercise as part of an aftercare program is useful in ensuring that the individual doesn’t become bored or jaded with the activity. This is important, because withdrawing from participation in an aftercare activity with sober friends could be a sign of the onset of depression, which may trigger relapse. Working out with a group ensures that the individual always has others watching their back; missing a number of sessions may prompt a concerned phone call.
In the same way that exercise programs provide a physical outlet (and inlet) for post-treatment recovery, other aftercare programs allow people to indulge their creative sides. Such approaches offer a way for individuals to invest in themselves, to derive a sense of self-worth and pride in what they create. Doing so helps stave off the harmful thought patterns of depression and shame that go hand in hand with an addiction or relapse.
Cooking is one such example. While often not thought of as “creative” in nature, the opportunity to come up with concoctions that are unique and enterprising simultaneously provides a sense of discipline and order (similar to how exercise, with its focus on repetition and metronomic activity, imbues structure in the very practice). The Wall Street Journal explains how some treatment centers include cooking classes as a way of helping people understand how they can reduce their stress, channel their thoughts and feelings into positive, healthy outlet, and live a little healthier in the process.
Cooking also tends to be a social activity, done for sharing food with friends and family, which feeds into the sense of social engagement that is key to guarding against relapse.
Another form of therapy through creation is art. National Geographic writes of how veterans who suffered brain injuries on the battlefield are guided to use art as a way of coping with the stress, sleep disorders, and substance abuse that arise out of their traumatic experiences. Such programs have evolved from being complementary components of treatment to forms of treatment in and of themselves.
Much like cooking programs for therapy, art therapy is not an art class, and individual submissions are not critiqued and graded. The focus is more on the process of creation and the exploration involved, not the results. In this way, the participants in an art therapy class are encouraged to support and encourage one another, as each member of the group finds and shares a unique voice.
There are a plethora of aftercare options available. Programs range from yoga classes to job training classes, from using music as therapy, to hiking groups and faith-based programs. To find an aftercare program that would best suit your loved one’s needs, ask your chosen treatment center for recommendations. Many rehab programs include aftercare planning as part of their standard program offerings.
One of the best ways to get a loved one into aftercare is to make yourself a member of the group. Doing so helps you step into the shoes of someone who has to relearn how to live and function without the crutch of substance abuse, and it also signals a solid investment in your family member’s recovery. As loved ones see you sweating it out with them, taking the time and energy out of your schedule to do something that is an important part of their journey, they will know that even though the road to recovery can be tough and long, they are not alone in the process.
Aftercare programs fully embrace the importance and participation of family members, so you will not be the odd one out at meetings or sober get-togethers. In fact, since other people might be taking part in these events with their own family members, new friendships and connections often form. Exchanging stories and perspectives is therapeutic in its own way.
The key idea is to support your loved one. Aftercare is not just something that is done to maintain abstinence and reduce the risks of relapse. It is as much a part of treatment and therapy as detox and counseling sessions.
As a family, it’s important to support your loved one during the aftercare process. This may involve cleaning things up around the home to create an environment that is positive and beneficial to mental and emotional healing. It could entail no wine during dinner or beer during sports games, or it could mean learning how to communicate without shouting or fighting. For some families, such measures might be a drastic change from the norm. If your loved one is deprived of this safety and security – if the home environment is one of stress, unhappiness, or temptation – then recovery may be at risk.
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