Relapse Prevention – Consider a Continuing Care Plan

Developing a solid “Continuing Care Plan” to follow the acute detox/rehab treatment period can help reduce the stress that leads to relapse. There is the perception that after a 28-day residential and/or intensive care treatment program, for example, “all is well” and life can go back to “normal.” What is missing is the understanding that addiction, like other diseases, requires continuing care. According to the ASAM’s 2009 Principles of Addiction Medicine Fourth Edition, “…effective treatment attends to multiple needs of each individual, not just his or her alcohol or drug use. To be effective, treatment must address any associated medical, psychologic, social, vocational, legal problem, and environmental problems” (ASAM, Principles…, p. 389). Additionally, the Principles cites one of the key components of “the best treatment programs” is “continuing care” (ASAM, Principles…, p. 351).

Because addiction is a brain disease, there is no way all aspects of healing the brain can be completed in 10, 28 or even 60 days. Yes, a great start can be made, but a continuing care (a.k.a. an after care) plan that extends “treatment” for at least a full year is critical. In this manner, the addict/alcoholic identifies the tools they’ll need — their relapse prevention plan.

Why a written, detailed plan?

The addict/alcoholic’s embedded addiction-related neural networks will be triggered by any number of cues – sound, sight, memory, the smell of alcohol, an emotion, a stressful person or situation. Therefore, planning how to prevent and/or handle such cues is critical to relapse prevention. Let’s face it, treatment for a heart disease patient or diabetic doesn’t stop after the person is stabilized, nor is it assumed a patient’s diabetes or heart disease goes away after the rehabilitation effort. Instead, those patients are counseled, provided education and behavioral modification strategies, and then they are given a continuing care plan and follow-up with further modifications, if necessary. This same approach must be used with treating addiction. For as you can imagine by now, healing, developing and changing neural networks takes time.

To be effective a Continuing Care Plan needs include a specific strategy that outlines how the drug addict/alcoholic is going to maintain abstinence. They must go far beyond the “typical” drug testing and 12-step meeting attendance monitoring. They must include plans for how to integrate with the family; for how to deal with the fall-out of not dealing with “life” while in their addiction (e.g., credit destruction, parenting issues, relationships problems, foreclosure, lost jobs, lost friendships — the “life” situations than can trigger a person who is in early recovery (day 29, 30, 45 or 72, for example); for identifying strategies to handle relapse (stress) triggers; for what the family needs in order to help themselves and in that process, help their loved one. Just as a person with diabetes, heart disease or cancer has a continuing care program/plan to help them continue their recovery once the acute care treatment (e.g., surgery, radiation, chemo) is complete, so too must the alcoholic / addict AND the family member/friend. And if the addict/alcoholic plans to move back home, it’s best to involve the key family members as part of that plan.

For more information, please check out “Family Continuing Care Plans,” on BTC’s Help for Families page.