Learn / Life After Rehab: How to Plan for Aftercare
While rehab is a place to begin recovery, it’s only the first step in a long journey. During your program, you’ll start learning how to build a better life. This carefully curated environment may include individual and group therapy, recreational activities, and medical treatment. Most rehab programs are designed to temporarily protect you from external stressors, including work and family obligations. Without those concerns, you can dig deep into healing, developing sustainable tools to use in the future.
Think of your time in rehab as an intensive retreat. This is a crash course. It isn’t meant to be temporary. The goal is not to stay in rehab forever, but instead to learn new skills that you can put to use after leaving the program. And, best of all, you don’t have to do it alone. There are many resources available to people transitioning out of residential rehab.
It’s natural to be concerned about your transition out of rehab and back into the wider world. Without the structure of the program, you can expect to encounter both new and established triggers on a more frequent basis. You may also be returning to difficult circumstances. For example, you and your therapist might discover that work stress prior to rehab was interfering with your mental health. If that’s true, you may be planning to change jobs soon after you return home. Situations like this one can be stressful even in the best of times.
Every person’s experience of rehab is different, but recent graduates tend to have a few common concerns. Before you finish the program, it can be helpful to plan around how you’ll navigate the following:
Many people go to rehab when they realize they need more care than they’re getting from their loved ones. Because of this, it’s common for alumni to return home to difficult dynamics. You have to let go of unhealthy relationships in order to prioritize your own healing process. Without the structure of your program and the in-person support of your recovery peers, it can be hard to maintain those boundaries.
Healing takes time. That’s true for the body, the mind, and also for relationships. Many programs offer family therapy, so your loved ones can begin healing even before you return home. This work not only affects your familial dynamic; it can also have a positive impact on your and your loved ones’ other relationships. Ryan Soave, the Director of Program Development at All Points North Lodge, says “…often when we do family work, the families get better. We also find that they get better in their lives outside of the family.
However, family therapy is just one part of rehab. They may have attended weekly sessions, but you’ll have gone through a much more intensive program. You may find that you have more tools for emotion regulation than the people around you. Be patient with them, and with yourself, as you learn how to relate to each other during this new stage of your process.
From the moment you arrive at rehab, you’ll begin preparing for the possibility of relapse. Healing isn’t always a linear process, and this is an area of concern for many people in recovery. As such, your team of providers can help you plan ahead. Jan Gerber, CEO of Paracelsus Recovery, offers a clear description of this issue. “There’s a term called ‘post-treatment crash,’” Gerber says, “which is a quite familiar term to everybody working in addiction treatment. No matter how successful and intensive the treatment has been, without the proper care and company after leaving treatment, there are risks for relapse.”
Leaving rehab is stressful. And if substance use has been your primary way of coping with stress up to this point, you may have the urge to fall back into old patterns during this transition. Instead of engaging in unhealthy behavior, it’s important to stay focused on yourself and your goals. Having a clear and specific plan for aftercare can make that much easier. Even before you return home, you can start researching aftercare options to support you in life after rehab.
Individual therapy is an essential component of recovery. In most rehab facilities, this is a major focus of the program; clients often have daily one-on-one sessions, in addition to group sessions and other activities. Individual therapy is one of the most effective ways to heal from any mental health issue, including substance use. It’s highly recommended for people in recovery to continue individual therapy even after transitioning out of inpatient care.
Therapy offers a private, confidential space where you can explore your emotional experience. Because your emotional life changes over time, this isn’t a quick process. It takes time to process your past, learn to navigate the present, and plan for the future. Many people attend therapy for years, or throughout their lives. Like rehab, therapy is a tool to kickstart the healing process. However, therapy is also important for the maintenance of your mental health regardless of where you are in your recovery journey.
You may or may not be able to continue seeing the same therapist you saw during rehab after you leave the program. Most therapists are only licensed to practice in certain locations. Because of this, people who travel to attend rehab will almost certainly need to find a new therapist once they leave. Some therapists are able to offer telehealth services, or sessions on a remote basis. If you’d like to continue seeing the same provider after you return home, make sure to check with them before you leave to find out if that’s possible.
Finding the right therapist for you can be a long and even arduous process. The therapist-client dynamic works best when your provider has an intuitive sense of your needs, goals, and values. What’s more, not every therapist has experience in treating addiction. If you have additional concerns, you may need a provider who has other competencies as well. For example, a therapist who specializes in working with teenagers might not be a good fit for someone in their 40’s. Remember that you’re allowed to shop around. You can research a provider’s credentials before reaching out, and you can ask to have an initial trial session before committing to a longer process. It’s ideal to begin looking for a therapist before you leave rehab.
Intensive outpatient programs (IOPs) and partial hospitalization programs (PHPs) are one step down from residential treatment. These programs allow you to live off-site—usually either at home or in a sober living environment—while undergoing intensive therapy at a hospital or rehab center. An IOP or PHP might be right for you if you need significant support during the transition out of rehab.
If you participate in an IOP, you will live at home, on your own, or in a sober living environment, but you will attend the clinical program several days a week. Each of these programs is unique, but most of them include 10 or more hours of group and individual therapy per week. The Substance Abuse and Mental Health Services Administration (SAMHSA) lays out specific guidelines for IOPs,1 stating that “IOP services may incorporate other in-house treatment and peer services, encourage clients’ attendance at mutual-support groups, and collaborate with local community providers to secure needed services (e.g., medication-assisted treatment, psychological assessments, vocational rehabilitation services, and trauma-specific treatment).”
IOPs offer a gentle transition out of rehab. AspenRidge Recovery, a facility in Colorado, describes this type of program as “a safe and accountable way [for clients] to test their skills in real-world situations while still having a supportive team to rely upon.” You’ll continue to have a team of healthcare providers at your fingertips, as well as access to a cohort of people who are also in recovery. Your time on-site is intended to help you process the experiences you have outside of rehab and in between therapy sessions.
PHPs are similar to IOPs, but clients spend more time in the program. If you attend a PHP, you’ll spend the majority of each day in treatment, and only go home at night. This is a good option for people who need to be closely monitored by healthcare providers, but have some responsibilities they can’t simply put on pause, like family or schoolwork. You can attend a PHP after rehab, or choose this type of program instead of 24/7 treatment.
Pillars Recovery, a rehab in California, recommends PHPs to clients who can’t afford inpatient rehab. They also offer clients the option of staying in a sober living environment during the program. Depending on your insurance, one of these options may be more accessible than a more traditional stay at a rehab facility.
A sober living environment hosts residents who are adjusting to the rhythm of life without substance use. They are safe environments with clear rules and regulations, but far less structured than inpatient rehab programs. While you may choose to attend therapy during your time there, those sessions would likely take place off-site and through a different program. The goal of your stay in a sober living environment is to transition out of intensive treatment into a more flexible schedule.
Many sober living environments will only admit clients who have already completed a residential treatment program. Some, however, are available to people recovering from a number of concerns, and not only from substance use.
Unlike inpatient rehab, sober living offers you the opportunity to socialize and set your own schedule. You may have access to planned outings, a library of relevant materials, and other activities, such as yoga and meditation. You’ll likely be required to attend regular meetings, such as 12-step meetings, that support your new lifestyle.
Some kinds of healing can only be accomplished alone or in therapy. Other kinds of healing can only be achieved in a community. As you transition out of inpatient treatment, it’s important to take the skills you developed in rehab and put them into practice in your daily life.
Support groups are a valuable resource for people in recovery, both during and after therapy. These settings allow you to learn from other people with similar life experiences, and gain insights you might not have access to in individual therapy. Catherine Ulrich Milliken, Program Director of McLean Borden Cottage, explains that attending groups is “an important part of recovery, and the evidence shows that it’s a good, helpful component. It’s another way to be connected to a community. It’s another place of accountability. It’s another place for support. It’s the roof on the house of sobriety – making sure people engage in a spiritual component.”
Various support groups are available in most areas. Most aftercare programs—such as IOPs and PHPs—will provide facilitated sessions on-site. However, most of these groups are easily accessible to anyone.
If you’re living independently, don’t be afraid to try out a few groups before you decide which one(s) you’d like to attend regularly. The specific people in your group have a huge impact on the experience. You may find that you really connect with the people who attend a certain meeting on Wednesday nights, but you don’t have much in common with the people who go to the same group on Fridays. Rehab alumni often find it helpful to attend more than one group; some people even go to at least one session every day after leaving inpatient treatment. These groups are offered in a wide variety of styles, giving you the freedom to choose which philosophy works best for you.
In 12-Step support groups, participants follow 12 clearly defined steps toward recovery. These steps were originally defined by Alcoholics Anonymous, and over time, numerous similar groups have branched off. All over the world, it’s now possible to find local chapters of Alcoholics Anonymous, Narcotics Anonymous, Cocaine Anonymous, Pills Anonymous, Codependents Anonymous, Sex Addicts Anonymous, Workaholics Anonymous, and more. While these different groups use slight variations on the original 12 Steps, they all share a similar philosophy.
Most 12-Step meetings open with a reading or a prayer. After that, members may be invited to share their stories, or to engage in a group conversation. Every group’s format is a little different, based on the specific needs and goals of the participants and facilitators.
Sponsorship is an important component of the 12-Step program. A sponsor is someone who has been attending the group for some time, who feels ready to volunteer to work closely with newer members. When you form a relationship with a sponsor, you’ll connect with them outside of group meetings, possibly through regular conversations or other activities. This allows you to learn from their experience, strategize ways to achieve your own goals, and stay on track as you continue to heal. Depending on your specific sponsor, you may even be able to call them at a moment’s notice when you’re having a hard time.
12-Step groups have a strong focus on faith. While all are welcome, much of the literature references a higher power, and sometimes even a Christian God. These groups are a good fit for people who want to develop a spiritual practice, and they may be less effective for those who don’t. Alcoholics Anonymous, Narcotics Anonymous, and other 12-Step groups are some of the best-known support groups for people in recovery, but they’re far from the only options.
If the 12 Steps aren’t right for you, there are many other established support groups you can join. For example, SMART Recovery groups focus on self-empowerment and behavioral health. Their 4-Point Program2 encourages members to prioritize the following goals:
Groups are led by trained facilitators, who may or may not have personal histories of substance use. This abstinence-oriented program is founded in science rather than faith.
LifeRing Secular Recovery is another secular group, with a similar focus on personal growth. They espouse the 3S philosophy, “Sobriety, Secularity, and Self-Help.” Members give and receive support from each other in each meeting, but unlike 12-Step programs, do not engage in sponsorship. Instead, this organization teaches that “you know what’s needed in your life3 and what has to be abandoned. You know what triggers cravings and what provides healthy and strengthening pleasure. You know the path you want to be on and you are the only person who can figure out how best to get there.” Participants are encouraged to make their own choices, and to creatively build a life that makes them happy.
As important as it is to see a therapist and connect with your peers, there’s more to healing than processing complex emotions. Recovery is also an opportunity for joy. As you begin to live a more sustainable life, you’ll naturally find healthier ways of relating to the world.
After completing inpatient treatment, many people find joy in taking up new hobbies and learning new skills. Joining a special interest group can support that process. You may even want to continue working on something you started during rehab. For example, if you loved your time in art therapy, you might enroll in a painting class. Pursuing these activities can keep you grounded as you go forward, and may even remind you of positive experiences you had during treatment.
There are meet-up and affinity groups for almost any interest you might have. You can join a knitting circle, take a philosophy class, or start playing softball. It can be especially helpful to connect with people in person, instead of only engaging through social media. Forming relationships with people who share your interests but not necessarily your struggles can also be a helpful reminder that you are a complex, multi-faceted person. There’s far more to you than just your challenges.
Just as there are lessons you can learn in group therapy that would never come up in a one-on-one session, there are also valuable experiences you can only have outside of therapy. In an affinity group, you can learn about social dynamics and problem solving in entirely new contexts. You can also create new memories, develop a sense of accomplishment, and find ways to have fun without substances! These are the experiences that make life in recovery meaningful.
Recovery is the process of creating a life you don’t need to escape. Rehab can give you the tools to begin that process, but it’s up to you to follow through after you leave treatment. Maintaining your health isn’t just about giving up destructive habits; it’s about replacing them with positive ones.
The map is not the territory. During rehab, you’ll start to define what kind of life you want. After primary treatment, you can begin actively moving toward that life. This process can sometimes be messy and surprising, but it can also be highly rewarding.
No matter what, you don’t have to do it alone. All of these strategies—individual and group therapy, support groups, and social groups—invite you to connect with people who want to see you succeed. Making those connections is the first step toward a better life after rehab.
It’s not too early to start planning what you’ll do after rehab. Learn more about your aftercare options here.
After leaving rehab, you can expect to face new and existing triggers in the wider world. It’s important to plan around navigating relationships, maintaining boundaries, and addressing post-treatment challenges. This is especially true if you’re returning to difficult circumstances. Remember to get sufficient support in place before leaving treatment, and be patient with yourself and others as you adapt to this new stage of your recovery journey.
Yes, individual therapy is highly recommended even after transitioning out of inpatient care. It provides a private space to explore your emotional experience and continue your healing journey. Therapy helps with emotional processing, navigating the present, and planning for the future. Finding the right therapist may take time, so it’s ideal to start looking for one before you leave rehab.
After completing residential rehab, most patients use some combination of stepped-down care options. These include intensive outpatient treatment programs (IOPs), sober living, support groups, and virtual therapy. These provide ongoing support, structure, and community as you transition from residential rehab to daily life.
“CLINICAL ISSUES IN INTENSIVE OUTPATIENT TREATMENT FOR SUBSTANCE USE DISORDERS.” SAMHSA Advisory. https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/pep20-02-01-021.pdf
Smart-recovery-4-point-program. (n.d.). SMART Recovery. Retrieved July 26, 2021, from https://www.smartrecovery.org/leading-the-future-of-smart-recovery/smart-recovery-4-point-program/
LifeRing Basics Menu - LifeRing Secular Recovery. https://lifering.org/lifering-recovery-menu/. Accessed 29 July 2021.
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