The Next Step after Detox

Individuals should enroll in extended treatment programs for their alcohol use disorder once they complete withdrawal management.

In the acute stages of recovery for an alcohol use disorder, many individuals undergo a physician-assisted withdrawal management protocol (medical detox) to help them get through the withdrawal period.

Withdrawal management for alcohol abuse is often best accomplished on an inpatient basis in a hospital or clinic. Sometimes, individuals will transition from the inpatient environment to a residential treatment center where they may continue to get intensive treatment even though they no longer require 24-hour medical supervision or medical treatment. Typically, patients spend a few weeks to 90 days or more in residential care, depending on the situation. In these acute treatment programs, residents are required to maintain abstinence from alcohol. After the acute phase, they are expected to transition to outpatient treatment or aftercare. Following the acute phase of treatment (detox and/or residential treatment), no individual should consider themselves to be “cured” or “recovered” from their alcohol use disorder.

According to the National Institute on Drug Abuse (NIDA), even in individuals who are in active treatment programs for substance use disorders, such as alcohol use disorder, relapse rates are relatively substantial, often ranging from 40 percent to 60 percent, depending on the type of drug abuse one is recovering from. The American Society of Addiction Medicine (ASAM), the American Psychiatric Association (APA), and numerous other professional organizations formally state that individuals who do not become involved in aftercare programs following acute treatment, such as withdrawal management and residential treatment, relapse at rates that approach nearly 100 percent. In fact, completing a medical detox program or even a residential treatment program is only the beginning stage of long-term recovery. The real work begins when an individual becomes involved in a comprehensive treatment program.

Ongoing Treatment

Individuals should enroll in extended treatment programs for their alcohol use disorder once they complete withdrawal management. These programs are the backbone of recovery. When the person is in the acute phases of treatment, such as a detox or a residential program, they are strictly supervised around the clock. Once they are released from these programs, they are thrust back into the world where they have to deal with all of the issues that drove their substance abuse.

NIDA reports that nearly 50 percent of people with substance use disorders who have completed the acute phase of treatment do not get involved in aftercare treatment programs, and other research indicates that nearly all of these individuals will relapse. While relapses occur for people who choose to participate in ongoing treatment programs, these individuals are far better prepared to handle issues associated with relapse, learn from relapse, and strengthen their recovery program.

Ongoing treatment and aftercare programs include a variety of components. According to the book Substance Abuse and Aftercare, these include:

  • Substance use disorder therapy: The main component of recovery from an alcohol use disorder or any substance use disorder is involvement in a formal program of substance use disorder psychotherapy. The preferred approach for treating individuals with substance use disorders is to use therapy that utilizes a cognitive-behavioral (CBT) approach to treatment.CBT works by identifying dysfunctional beliefs in the person, having a person test these dysfunctional beliefs in the real world, and then, once the person realizes that these dysfunctional beliefs are irrational, they work on restructuring their beliefs in order to produce more functional behaviors. Although CBT is the preferred approach, other forms of therapy can also be useful depending on the person. Therapy performed in an aftercare program consists of outpatient therapy sessions.
  • Family therapy: Family therapy can be an important component of an extended treatment program if there are family issues, or if an individual’s alcohol use disorder has seriously affected their relationships with family members. Family therapy includes group therapy with members of one’s family, or marital or partner therapy where the clients are a married couple or romantic partners.
  • Participation in peer support groups: Peer support groups are typically not run by a licensed therapist or mental health professional, but by individuals who have the same or similar issue. The most popular and recognizable type of these interventions are 12-Step groups, such as Alcoholics Anonymous, but there are numerous peer support groups that are not 12-Step groups, such as Rational Recovery, Moderation Management, SMART Recovery, Women for Sobriety, etc. These groups are sources of long-term aftercare interventions because they are ongoing, and individuals can participate in them after their psychotherapy sessions have run their course.
  • Medically assisted treatments: Medications and other medically assisted treatments, such as medical management techniques, are ongoing interventions that often work as part of aftercare treatment for individuals with alcohol use disorders.
  • Complementary and alternative treatments or therapies: These interventions are designed to be used in conjunction with substance use disorder therapy and/or peer support groups. They use creativity, introspection, animals, and other alternative means to help individuals be successful in their recovery. Music therapy, psychodrama, wilderness therapy, art therapy, the use of exercise or martial arts, yoga, animal-assisted therapy, etc., can all be part of an aftercare program.
  • Other interventions: Other interventions can conceivably be part of an aftercare program, such as vocational rehabilitation, tutoring, case management services, financial assistance, etc.
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Effective Rehab Aftercare Programs

According to NIDA, the effective components of an aftercare program include:

  • The use of empirically validated treatments: This refers to using treatment protocols that have sufficient research evidence to justify their validity in the treatment of an alcohol use disorder.
  • Personalized interventions: Even though there are standard protocols, such as the use of substance use disorder therapy, peer support groups, etc., the interventions should be adjusted to fit the needs of the individual. For example, some people may respond better to group therapy sessions than individual therapy sessions, and vice versa. The aftercare program should be designed to follow the principles of effective treatment and to fit the needs of the person.
  • Holistic or comprehensive treatment: Utilizing an aftercare treatment program that addresses all areas of need, as opposed to simply addressing one’s alcohol use disorder is a more effective approach. For instance, many individuals with alcohol use disorders also meet the diagnostic criteria for another mental health disorder, such as major depressive disorder, some type of anxiety disorder, a trauma- and stressor-related disorder, etc. The aftercare program should include treatment for all co-occurring conditions in addition to treatment for alcohol abuse.
  • Continued reassessment: When a person is first involved in a formal treatment program for their alcohol use disorder, they are most often given a comprehensive assessment that includes an evaluation of their physical functioning, psychological status, and social status. The results of the evaluation help to create the treatment plan for that person. A competent aftercare program continues to reassess the person’s situation and progress in order to make needed adjustments to the treatment plan to benefit the individual and ensure successful recovery.
  • Accountability: Individuals in aftercare need to be accountable for their behaviors. Most often, this means the use of random drug or alcohol screenings to ensure sobriety. In addition, individuals should own their behaviors, particularly if they experience a relapse. Individuals should take responsibility for themselves, understand that their successes or failures are largely dependent on their own efforts, and be responsible for adhering to their treatment program.
  • Long-term treatment: Recovery from an alcohol use disorder is not a short-term endeavor. In fact, organizations like ASAM and NIDA suggest that an individual in recovery should maintain abstinence and remain in some treatment-related activity for a minimum of 5-7 years. This is because individuals with substance use disorders are always prone to relapse, and relapses typically occur within the first 5-7 years after the person begins their recovery program. Even after this time period has come and gone, it is recommended that most individuals remain involved in some form of treatment-related activity, such as peer support groups, for decades. People who have experienced multiple relapses in the past should remain in some form of treatment-related activity indefinitely.