Treatment aftercare

Relapse Prevention as Part of Treatment, Aftercare, and Psychotherapy... 

When treatment, aftercare, or halfway house time are over, will the chemically dependent young person remain sub stance-free on his or her own ... 

Provides prevention, treatment, rehabilitation and aftercare programmes (in partnership with other... 

Aftercare. A treatment modality that comes after and is less intensive than outpatient or inpatient therapy. The focus is usually on relapse prevention. Behavior chain analysis. Assessing how one behavior leads to another, which leads to another, and so on. 

Aftercare goals are almost always the same as treatment goals. True or False ... 

Counselors and therapists have to determine when the client has made sufficient progress to move into this next phase of therapy. The decision whether the client is ready to be moved from formal treatment into aftercare is determined by client progress on the treatment plan. The counselor or therapist uses clinical judgment to ascertain whether the client has made sufficient progress on the plan to warrant movement from formal treatment into aftercare and whether the client is sufficiendy stable in his or her recovery to take this next step toward autonomous recovery. The next section covers factors that counselors and therapists should consider when making the decision to graduate clients from treatment into aftercare. In addition, this chapter provides an overview of what can be expected during this final phase of treatment and therapy for professionals, and for clients and their families. 

Suggested Criteria for Discharging From Treatment Into Aftercare... 

For both counselors and therapists, the treatment plan provides an excellent way to determine when a client is ready for aftercare. As you may remember, the treatment plan includes various types of problems that are prioritized by the relative threat to the recovery and well-being of the client (see Chapter 4, especially Research Frontiers on page 166. Counselors and therapists can also use the tier system to guide their determination of when a client is ready for a taper in treatment or therapy. For example, counselors and therapists will most certainly want clients to be stable before referral to aftercare, which suggests that all Tier 1 and... 

Tier 2 problems should be resolved before such referrals are made. The resolution of Tier 3 problems becomes more a matter of clinical judgment, but certainly a counselor or therapist will want to determine whether enough progress on Tier 3 problems has been made that the client can begin to direct his or her own treatment out in the real world. I would recommend that significant progress has been made on most, if not all, Tier 3 problem items on the treatment plan prior to discharge into aftercare. 

Aftercare represents the ideal forum for addressing Tier 4 problem items, so it is expected that many of these will not have been addressed in treatment. Therefore, it is not necessary to have made progress on Tier 4 problems before a referral to aftercare. Many of these problems, as mentioned in Chapter 4, will require clients to develop their own plans for how to address them in everyday life. The aftercare counselor or therapist can serve as a guide in this effort to find new life pathways, but clients must do the actual walking when the trails are chosen. 

The continuing care plan, developed prior to discharge from treatment into aftercare, is constructed with the different spheres and zones of recovery in mind. The ultimate goal of the continuing care plan is to help the client move into this new phase of recovery as seamlessly as possible. So, like the treatment plan (remember Chapter 4), the continuing care plan should be comprehensive but not overly intrusive, should be simple enough to follow, and should be developed collaboratively with the client prior to discharge. 

Just as with treatment, the appearance of aftercare may vary according to the therapeutic model. For example, Minnesota-model aftercare usually operates in groups that meet weekly. The format of these weekly sessions usually involves psychoeducation around relapse prevention, often related to an issue germane to specific members of the group. Sometimes the psychoeducation topic is predetermined by the outline of a relapse prevention manual (see Chapter 7). 

Before aftercare begins, a client will likely meet with the aftercare counselor. This counselor may be different than the one he or she works with in treatment. However, the client likely will know the aftercare counselor from treatment groups even if that person was not her or his primary individual counselor. This first... 

Darien is a 24-year-old finishing treatment and preparing for aftercare. 

Many treatment centers offer family programs, such as weekly family or couple support groups, that may coincide with the aftercare program that the client attends. In addition, the aftercare counselor may decide that meeting jointly with client and partner can be helpful during aftercare to address relationship... 

Many new challenges can arise after treatment for partners. A family therapist can prepare the partner for these challenges as part of a family orientation to aftercare. Such a meeting will occur around the same time as the client develops his or her continuing care plan just prior to discharge from treatment. The family therapist may address adjustment concerns that many partners experience when a client is discharged from treatment. The family therapist can prepare the partner for what to reasonably expect from the loved one after treatment ends. 

Family therapy programs continue in many treatment programs throughout aftercare, and as mentioned, a family therapist may be available to family members. Children who are having adjustment problems may find therapy beneficial, for example. Including all family members can be helpful for the client and allows other members of the family to work on their own personal growth, too. 

The client likely will benefit from continued involvement of family in the therapeutic process during aftercare. Many commonly reported relapse triggers are related to relationship stress (see Chapter 7), and family therapy may help reduce relationship stress. As the client is learning how to adjust to living drug free after treatment, the family learns how to live with a drug-free loved one. 

Aftercare can help you consolidate all that you have learned so far in treatment or therapy. This period presents an opportunity for you to practice what you have learned in real-world settings, as well as to enjoy your new freedom from drug use. Use this time to practice the new skills you have learned and experiment with new directions for your life. Also, enjoy yourself as you rediscover who you are without being under the influence of drugs ... 

Many clients have told me that they found aftercare a liberating time of great self-exploration. Not many people get a chance to redefine themselves later in life, but this is exactly the opportunity that lies before you now. Treatment and therapy have provided you with many skills for overcoming a drug problem, but nowhere is there a manual written on how you must use them to reach your dreams. That manual must be written by you, since you are the expert on yourself. How you use those tools will redefine who you are in effect, you have the opportunity to become whoever you want. 

Finally, other crises can occur that have been mentioned before, such as aggressiveness, suicidality, and perhaps even a psychotic break. Since dealing with these crises was covered in great detail in Chapter 3,1 will not cover them again here. Basically, you will want to treat them the same way in aftercare that you would in therapy or treatment. Counselors and therapists should be aware that depression may increase after treatment for some clients, so if you notice the telltale symptoms, you may want to assess your client for suicidality just to be on the safe side, and respond accordingly. 

---