The National Institute on Drug Abuse (NIDA) lists 13 steps of effective substance abuse treatment; among them, noting that addiction is a disease of the brain, treatment must be readily available, and no one form of treatments works for everyone. Also, remaining in treatment for an adequate period – which NIDA states should be at least 90 days – is essential to recovery.
For many people, medically supervised detox and rehabilitation are the primary steps, but not the only steps, toward recovery. It is important to know that recovery should continue after the individual completes a rehabilitation program. For many, support groups are free sources of encouragement in recovery that offer new friends and emotional support.
The Importance of Support Groups in Long-Term Recovery
The concept of support groups, which are also sometimes called self-help groups and mutual support groups, involves peers discussing issues and offering emotional validation and self-care tips, with guidance from a leader who is not a professional doctor or therapist. While working with physicians and therapists is an essential part of recovery, spending time with those who understand the individual’s struggles is also deeply important. Support groups help those who are actively recovering from addiction, as well as friends and family of those overcoming substance abuse.
Many people may, at first, confuse support groups with group therapy. While both offer important discussion among people going through similar issues, like overcoming addiction to drugs and alcohol; group therapy is typically guided by a trained therapist or counselor; support groups, on the other hand, are led by peers who may or may not have some training in leading the group, but who are, more importantly, people who have also gone through the recovery process.
Support groups are typically small. They meet on a regular basis, usually once or twice per week, to discuss issues that have come up in that time and review new thoughts on the concerns brought up from the previous meeting. It is important to note, however, that support groups are not a replacement for therapy. Working with a therapist and attending a support group at the same time, especially for mental health issues associated with addiction, is the best combination for long-term recovery.
For many, the ultimate goal of recovery – as much as there can be a conclusion to the process, which is a lifelong goal for most – is to maintain abstinence while gaining stability and returning to active participation in one’s community. Support groups are an essential part of the transition from rehabilitation, which focuses on therapy, to being a productive part of society. Support groups are a place for people in recovery from addiction to discuss their ongoing experiences, fears, and successes.
Here are a few reasons that support groups are an important stepping stone between overcoming addiction and re-entering society:
- The individual is surrounded by likeminded, healthy peers; from before rehabilitation may still struggle with addiction or may trigger relapse.
- The individual can voice their concerns, struggles, and fears without judgment.
- The individual gets “healthy peer pressure” from the group to focus on sobriety and overall wellbeing.
- The individual has new friends and confidantes that can be reached in the event of a personal crisis.
Rates of Success among Support Group Attendees
As the benefits of peer support for long-term recovery become more apparent, researchers are examining exactly how effective these groups can be. A meta-analysis of peer support in the treatment of addiction, published in 2016, examined 10 studies from 1999 or later. There are several distinct types of peer support groups for abstinence in various locations, but many of them, according to the 2016 analysis, dramatically improve recovery. For example, the reviewed Recovery Association Project (RAP) found that, at a six-month post-rehabilitation follow-up point, 86 percent of those who attended support groups in some form had been abstinent from drugs and alcohol in the previous month, which is much higher than the general recovering population at that point in their process. These participants also reported a high rate of satisfaction with their support group. Other studies in the meta-analysis reported more general findings of greater success maintaining abstinence among support group attendees, but no specific percentages.
A slightly older analysis published by the Office of Veterans Affairs (VA) found that veterans who worked to overcome substance abuse, and who attended support groups as part of their recovery, reported greater success abstaining from drugs and alcohol – not just at the six-month mark, but at the first, second, and even third year after recovery. However, attending a support group regularly had much better results than sporadic attendance or dropping out after a few months; among veterans who left before one year, or who did not attend weekly or biweekly meetings, results for abstinence were the same as those who did not go to support groups at all.
An article from Scientific American, which examined the effectiveness of Alcoholics Anonymous (AA), reported that those who regularly attended support group meetings maintained abstinence for much longer than those who did not. A 16-year study following problem drinkers and AA attendance found that 67 percent of those who attended at least 27 weeks of AA meetings in the first year – or about one meeting every two weeks – maintained abstinence all the way through the 16-year study. In contrast, 34 percent of problem drinkers who did not attend AA meetings maintained abstinence in this 16-year period. Attending therapy sessions improved outcomes, too; 56 percent of problem drinkers who attended therapy maintained abstinence compared to 39 percent who did not. A combination of the two likely supports more complete sobriety and recovery, as peer support and therapy address issues from multiple angles.
How to Find a Support Group
As technology improves, support groups are adapting to reach more and more people. Phone support groups gained popularity in past decades, but online support groups and forums are taking off now and helping people in remote areas, with uncommon conditions, or who simply do not want to leave the house. People who otherwise might be isolated due to their or a loved one’s condition can find common ground with peers all over the world.
Peer support in person can also be deeply important. A quick search online, perhaps using the Substance Abuse and Mental Health Service Administration’s (SAMHSA) treatment locator tool, can offer immediate assistance for those curious about their options. Other ways to find support groups include:
- Ask a doctor, counselor, therapist, or social worker for help.
- Contact local community centers or religious organizations.
- Ask staff at a rehabilitation program.
- Talk to friends and family if they have gone through comparable searches.
- Contact national organizations.
When searching for a support group, it is important to find an organization that matches individual needs and preferences. This may include gender-exclusive groups, such as male-only or female-only meetings. People who are parents in recovery from addiction may prefer their own, separate meeting. Adolescents may form a support group at school to help each other through recovery. Groups about specific substances, like alcohol, cocaine, or opioids, are also useful, since people recovering from these substances may be exposed to drugs in similar ways or experience similar withdrawal symptoms that need management.
Most Popular Forms of Support Groups
AA is one of the first forms of substance abuse treatment, founded in 1935 in the United States. Since then, the medical understanding of addiction has changed drastically, but AA remains important as one of the largest support groups available. For those who are not struggling with alcohol addiction or who do not want a Christian focus during recovery, there are dozens of other structures of support groups available. These groups strive to be free and open to new members, so finding a nearby meeting is usually easy.
- 12-Step Support (AA, NA, etc.):
Groups based on the 12 Steps began with AA, but now include Narcotics Anonymous (NA), Nicotine Anonymous, Cocaine Anonymous (CA), Crystal Meth Anonymous, Marijuana Anonymous, Dual Recovery Anonymous, Al-Anon Family Groups, Ala-TEEN for adolescents and teenagers, Adult Children of Alcoholics (ACA), Nar-Anon Family Groups, Gamblers Anonymous, and Computer Gaming Addicts Anonymous, among others. These groups all use various forms of the 12 Steps, a list of steps to take during recovery to reduce stress and find balance in a new, sober life. These steps are:
- Admitting powerlessness over drugs or alcohol
- Believing a power greater than the individual restores sanity
- Dedicating one’s life to that higher power
- Making a moral inventory
- Admitting the nature of one’s wrongs to oneself and the higher power
- Becoming ready to have these wrongs removed
- Asking the higher power to remove character flaws
- Making a list of those harmed by addiction and become willing to make amends
- Making direct amends whenever possible, but not hurting people in an attempt to make amends
- Continuing the personal moral inventory process
- Praying for knowledge of the higher power’s will
- Carrying healing to others in need, such as by becoming a sponsor
- Jewish Recovery Center
: This is an organization dedicated specifically to people of the Jewish faith struggling to overcome addiction. It is inspired by the 12 Steps and essentially follows the same tenets. Other group offerings to support those in recovery include Shabbos and Jewish holiday meals, lecture series from Jewish leaders, spiritual retreats, related support groups for family members, and group outings.
- Millati Islami World Services
: This group is also based on 12-Step recovery, but with a focus on Islam rather than Christianity. Both men and women can join support group meetings through this worldwide organization. Millati Islami has a structured meeting format that is easy to follow and focuses on guidance from the Qur’an.
- Women for Sobriety:
This is the first female-only sober group, also inspired by the 12 Steps. WFS uses 13 Statements instead of 12 Steps, however, and these are designed to encourage spiritual and emotional growth in attendees. Although there is a leaning toward spirituality, this does not take a specific religious form. Abstinence is the only acceptable goal for each meeting.
- SMART Recovery:
Inspired by 12-Step programs, Self-Management and Recovery Training (SMART) aims to avoid Christian or religious language, but offer free meetings for peers working to recover from addiction. Instead of the 12 Steps, the program focuses on four points of recovery, worked on through face-to-face meetings as well as daily online meetings.
- Secular Organization for Sobriety/Save Our Selves:
SOS is yet another organization inspired by the 12-Step model, but with the intention to move away from Christianity and focus on peer support, recovery, and abstinence from drugs and alcohol. The 32nd anniversary of the group’s founding was in 2017. There are currently about 500 in-person support groups, as well as an extensive online support network. Each meeting is run slightly differently, based on who leads it, what the group’s needs are, and where they are located.
- LifeRing Secular Recovery:
Originally part of SOS, the group broke off to focus more on a specific set of self-help and recovery tools. Through meetings, LifeRing participants develop a personal recovery plan, and through discussions of occurrences in the past week, peers work together to reinforce good habits, recommend ways to destress or avoid triggers, and manage long-term sober goals.
- Recovery International
: Around for nearly 80 years, this international organization provides support group meetings for those in all stages of recovery who are seeking peer support and self-help training. The founding organization focuses on cognitive-behavioral techniques to manage stress and continue making positive changes, but the groups are not led by professionals trained specifically in CBT.
- Peer Support Groups through the VA:
Veterans’ benefits cover all kinds of medical care, organized through local VA hospitals. Support groups are an important offering, gathering fellow veterans to help each other through post-traumatic stress disorder (PTSD) and comorbid conditions, including substance abuse.
- Mental Health America’s Crisis Text Line:
A text conversation can do a lot to help those in the midst of an emotional or psychological struggle. Start by texting MHA to 741741 and get a rapid response any time of day.
- Sober living homes:
These homes are rapidly gaining popularity as a step between inpatient rehabilitation and living completely in the outside world. States are beginning to regulate these homes, which typically house 10 or fewer occupants in a large house. The point of sober living homes is to support recovery by eliminating the presence of intoxicating substances while each person in the home focuses on getting a job or following an educational track. Many homes also require those in recovery to attend support group meetings and/or therapy sessions to sustain their focus on long-term health. For the most part, residents must attend these meetings outside the sober living home, but some meetings occur within the home itself, so residents get to know each other and build a sense of camaraderie.
34 – July – Treatment Solutions – How to Create a Drug Recovery Aftercare Plan
The National Institute on Drug Abuse (NIDA) recommends that people working to overcome addiction and substance abuse stay in treatment for at least 90 days, or three months. This amount of time in treatment helps the person safely end their body’s dependence on drugs or alcohol while also working with therapists in individual and group sessions to change their self-awareness and behaviors that manage stress.
Once the person graduates from the program, however, they must still focus on maintaining sobriety. Around half of people who go through a rehabilitation program will relapse back into substance abuse at some point. Continuing to work on abstinence from drugs and alcohol, and changing behaviors around triggers or stress, will help a person avoid relapse.
Why Aftercare Is Vital to Avoiding Relapse
More rehabilitation programs and drug treatment counselors are incorporating aftercare plans while their clients are in rehabilitation. Creating this plan will help the person understand steps they can take after they leave rehabilitation to keep working on recovery and find social support to maintain abstinence. For most people, an aftercare plan includes attending support groups, working with a therapist, or both; however, these meetings are not the only aspects of an aftercare plan, which should be tailored to the individual’s lifestyle and what best supports them.
Creating an aftercare plan helps a person stay actively involved in their ongoing recovery from addiction. Detox and rehabilitation are the two most important steps to overcome substance abuse patterns, but learning how abstinence pairs with daily life requires ongoing support.
According to NIDA, 40-60 percent of people who have gone through a rehabilitation program will relapse. The most vulnerable time, for many, is the first three months after they are discharged from a rehabilitation program. Roughly 25-35 percent of those who complete a rehabilitation program will be readmitted for further treatment due to relapse within one year after they finish their first rehabilitation program. The risk of relapse does not reduce for 4-5 years after a person completes rehabilitation, after which the risk of relapse drops to about 15 percent. Because addiction is a chronic disease, meaning it can be managed but does not go away, the risk of relapse back into substance abuse patterns also never fully disappears.
The good news is that millions of people have gone through rehabilitation programs successfully, and thanks to well-developed aftercare plans, they have stayed sober and healthy for years. Working with a therapist to develop a full aftercare plan, including social support and relapse prevention, helps a person focus on their long-term goals.
Some Components of an Aftercare Plan
The state of Massachusetts offers an online version of a form that is completed after a person is discharged from rehabilitation. This form essentially functions as a bulleted outline of important topics discussed during a meeting with a counselor or case manager. Included in the list are:
- Times, locations, and frequency of support group meetings, including Alcoholics Anonymous (AA), Narcotics Anonymous (NA), or similar group meetings
- Names and phone numbers of sponsors or individuals for support who are involved in the program, so they can be contacted in crisis or relapse situations
- Individual goals for self-help, including journaling, maintaining a regular yoga practice, or attending religious services
- Individual therapy for ongoing substance abuse treatment, as necessary
- Meeting with case manager to keep up with the aftercare plan
- Managing daily time, including working on employment or educational goals, finding hobbies to destress, exercising, and more
- Making a list of supportive family members who will be able to offer assistance in a crisis
- Getting help with housing and transportation
- Maintaining insurance or other health insurance needs
- Completing vocational training or other educational goals
- Financial planning, if needed
- Childcare, nutritional help, parental assistance, and other programs that may be offered through local or state programs
While this is only one state’s form, these are a collection of discussion points and programs that will help relieve stress for a person who is leaving the protection of a rehabilitation program. By talking about their potential needs up front, the person has a way to approach their new, sober life with help.
The Substance Abuse and Mental Health Services Administration (SAMHSA) has a lengthy Action Plan document for prevention and recovery. The document points out that many people have ways they want to improve themselves, but have a tough time finding ways to do these things regularly. The stress of trying to manage resources without help can lead to lapses or even a full-blown relapse.
Steps to Developing an Aftercare Plan
SAMHSA recommends, while working with a counselor, therapist, or case manager, to create a binder containing much more detailed information to guide the individual on their recovery path. This notebook or binder will contain the relapse prevention plan, along with other aspects of aftercare that involve daily routines, appointments, relaxation techniques, and more. The five primary steps for a good aftercare plan include:
- The wellness toolbox: This is a cluster of daily activities that can help the individual feel better, relieve stress, and stay healthy, all at the same time. Some of these suggestions include:
- Eating three healthy, balanced meals per day
- Drinking enough water
- Getting regular sleep, going to bed by 10 p.m.
- Spending time on a fun hobby, like walking, playing a musical instrument, or knitting
- Getting enough exercise
- Spending time on mindfulness meditation or another relaxation exercise
- Writing about the experience of stress and what might have caused it
- Talking to a loved one
- Taking prescribed medications as directed – not skipping a dose and not taking too much
- Adding vitamins or safe herbal supplements with meals
- Daily maintenance plan: The subsections of this plan include steps to take toward feeling better, achieving goals, and keeping track of eating and exercise.
- Feeling well: Write a description of how it feels to feel good, positive, or content. If full sentences do not come to mind, making a list of descriptive words, such as bright, outgoing, energetic, or humorous, can help.
- Dreams and goals: Aspirations, short-term and long-term goals, and even the wildest future fantasies can be listed here. This helps to keep a positive ending in sight when the daily routine may feel stressful or sluggish.
- Daily list: This is the full list of daily steps to check off to support wellness. The wellness toolbox can be a reference for this list of activities, which can also include morning and evening personal check-ins, spending time outside for sunlight for at least 10 minutes, and spending time working on creative projects.
- Reminder list: Many of these will occur regularly, but not daily, like therapy visits, doctors’ appointments, housework, writing letters, and attending support groups. This can be put in a calendar or list format.
- List of triggers: This section of the aftercare plan should be worked on with a therapist or counselor who can give feedback and prompting questions. Triggers may include tense family relationships, specific locations, anniversaries of birthdays or deaths, physical or mental illness symptoms, and more. Understanding ahead of time many of the factors that may trigger cravings for drugs or alcohol will help the person avoid these, if possible, and manage the stress of the trigger if it cannot be avoided.
- Action plan for triggers: Based on the list, create a plan to address stress and triggers as they arise. Finding ways to release tension and become comfortable, such as listening to music, performing a breathing exercise, or calling a loved one for comfort are all potential ways to reduce the risk of relapse due to triggers.
- Early warning signs: Understanding the signs of a potential relapse early can reduce the seriousness of the event or prevent the relapse from occurring. Mental and emotional signs like anxiety, forgetfulness, loss of pleasure, feeling slowed down or sped up, and changes in appetite, can all indicate a potential relapse. Forgetting about self-care and daily steps in the aftercare plan itself, failing to attend support group meetings or therapy sessions, and becoming more solitary can also indicate a potential relapse.
The relapse plan should follow the triggers and warning signs, and include information about doctors, rehabilitation programs, and involved loved ones who are available to help in the event that the individual relapses back into substance abuse. Preparing for a crisis is also an important part of aftercare planning.
Aftercare Programs and Institutionalized Support
States, nonprofits, and therapists can all offer aftercare support through various means. Support group meetings are the focus of this kind of care, and many institutions, from charities to hospitals to churches, host support groups of all kinds.
Some aftercare plans may include transitional housing, like a sober living home, to help the person focus on putting their rehabilitation program’s teachings into practice while staying away from drugs and alcohol. Case management is an important part of aftercare to manage resources, and a state organization or hospital may provide a case manager. Adolescents and teenagers going through recovery may benefit from attending a sober high school or joining a sober fraternity while in college.
Regardless of where aftercare help is offered, it is important to create a long-term plan to stay sober. Structured treatment is a vital step in the process of overcoming addiction, but thinking about life after a rehabilitation program has been completed will help to maintain sustained recovery.
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