Forging a Path After Residential Treatment: The Critical Role of Continuing Care

By now, most people are aware that addiction is a disease. What exactly that means, however, remains vague and undefined for many. According to the National Institute on Drug Abuse (NIDA):

Addiction is defined as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. It is considered a brain disease because drugs change the brain; they change its structure and how it works. These brain changes can be long lasting and can lead to many harmful, often self-destructive, behaviors.

The key words here are “chronic” and “relapsing.” As opposed to curable and temporary illnesses, such as the flu or chicken pox, addiction doesn’t simply go away once its symptoms are under control. Rather, addiction stays with you throughout your life and, like other chronic diseases, may result in relapse. In fact, hthe relapse rate for addiction is 40-60%, comparable to that of type I diabetes (30-50%) and asthma (50-70%). The chronic nature of addiction means that it must be continuously managed to prevent relapse from occurring; while residential addiction treatment is the ideal way to set the stage for initial relapse prevention, the insight and skills gained in residential care must be applied on an ongoing basis to maintain sobriety.

While you may acutely recognize the need for addiction treatment during active addiction and early recovery, it is common to experience a drop in motivation for continuing recovery work once symptoms like withdrawal, cravings, and constant thoughts about using subside. Ending active recovery at this point, however, leaves you vulnerable to a re-emergence of your symptoms, either spontaneously or due to an internal or external trigger such as a stressful situation or emotional pain. Relapse is particularly likely in your first year following residential treatment, as the neurological structures damaged by your substance use are still undergoing intense reconfiguration, you are only beginning to practice the skills you need to live in an emotionally and behaviorally healthy way, and you are still negotiating how your sobriety fits into your life.

However, relapse is possible at any time, even after periods of sobriety lasting years, and often results from the belief that the work of recovery is behind you. Ed Wigg, the Executive Director of the Curran-Seeley Foundation in Wyoming, has witnessed this phenomenon far too often. “Oftentimes we see people who have achieved sobriety fall away from continuing to do those things that they did to help them get clean and sober in the early stages,” he says. “They think that they’ve been sober for years so they don’t need to go to [meetings] or see a therapist anymore—all the things they did diligently in their early days. They slip back into a pattern of trying to do it on their own, without support.”

Part of the problem is that traditional addiction treatment programs have limited their services to acute care and have historically not included continuing care options. As Drs. Michael Dennis and Christy K. Scott write:

The conceptual model has been that an addicted person seeks treatment, completes an assessment, receives treatment, and is discharged, all in a period of weeks or months. This orientation stands at variance with clinical experience and studies conducted over several decades.

Not only does this model simply not work for the majority of people living with addiction, it also sets up unrealistic expectations of both themselves and addiction treatment; clients erroneously assume that they will “be cured and able to maintain lifelong abstinence following a single episode of specialized treatment.” This idea of being cured is sharply at odds with what we know to be true about the nature of addiction as a chronic and relapsing disease. In fact, research clearly demonstrates that stepping down from residential care into less intensive but ongoing treatment provides significantly improved outcomes and offers the best protection against relapse.

The American Psychiatric Association, the American Society of Addiction Medicine, and the Department of Veterans Affairs Office of Quality and Performance have issued clinical practice guidelines recommending that patients being discharged from intensive levels of addiction treatment be transferred to outpatient treatment for a period of time before leaving the addiction treatment system. A number of studies demonstrate that this practice promotes continuation of abstinence.

As such, programs that are designed with the best interests of clients in mind must focus on more than acute treatment; they must offer a path to continuing care following residential treatment.