Aftercare generally refers to contact with a clinician or service immediately following intensive treatment, and has the goal of maintaining treatment gains and ensuring timely re-engagement if there is the risk of relapse or in the earliest stages of any relapse. The first 3 months of recovery are critical to success and are characterised by a high risk of relapse. Natural history studies reveal the risk of relapse continues for five years and occasionally even longer. Aftercare acknowledges this risk of recurrence of alcohol use and that to maintain change, ongoing monitoring and assistance is required beyond the initial treatment.
Aftercare is an important part of a comprehensive intervention plan. It is particularly suited to people with severe dependence whose likelihood of relapse is greatest. It provides the individual with a network supportive of sobriety, reinforces skills consistent with maintaining abstinence/controlled drinking and improving psychosocial functioning, and helps the individual negotiate unforeseen challenges.
Aftercare can consist of planned telephone or face-to-face contact following a period of treatment to discuss progress and any problems that may have arisen since the end of active treatment. Often primary care workers (such as general practitioners) can provide this function through ongoing follow-up, often as part of review of other health issues. Clinicians may use referral to self-help programs, such as Alcoholics Anonymous and SMART Recovery®, as forms of continuing care or in addition to a structured aftercare program (see Chapter 11).
Long-term follow up is an important part of a comprehensive treatment plan. Long-term goals include optimising mental and physical health and improving social functioning. It is important to develop an individual management plan to identify particular risks for a patient, identifying a plan to avoid a lapse and a plan to quickly address a lapse so it doesn’t become a relapse. This is comparable to escalation planning for other disorders (for example asthma) where early recognition and management can prevent clinical relapse. If the patient continues drinking, a clinical ‘harm-reduction’ model is inappropriate.
|Grade of recommendation
|Long-term follow-up of patients following an intensive treatment program is recommended as part of a comprehensive treatment plan, reflecting the chronic relapse possibility of alcohol dependence.