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Ignoring the most important part of aftercare:
I am amazed by the number of people who spend a month or more in either an inpatient or an intensive outpatient treatment setting but then, after all that time and money spent, fail to follow-up with recommended aftercare. Aftercare plans, usually several carefully prepared pages, are written, disseminated, and discussed with recovering addicts for a very good reason - they outline the path to continued sobriety and a healthy, happy life. Ignoring any element of an aftercare is never a good idea.
These highly individualized plans typically include personalized information about coping skills and support resources addicts can utilize when they are back in the “real world” and triggered toward relapse. Nearly always there are recommendations for group support, as it is well-known that addicts don’t heal well in a vacuum. Instead, addicts need ongoing advice, feedback, and support from their peers (fellow addicts) if they hope to maintain the sobriety established in formalized treatment. Unfortunately, this critical element of the healing process is the aftercare recommendation addicts are most likely to skip. Usually recovering addicts are perfectly willing to continue with individual therapy and take medications (if any have been prescribed), but outpatient group therapy, twelve step recovery groups, and other peer-to-peer support networks are often ignored, even though these milieus provide much needed empathy, support, and day-to-day advice and assistance.
The importance of a supportive peer-to-peer healing environment:
For long-term sobriety and emotional healing, recovering addicts must overcome shame about their early-life traumas and their adult addictive behaviors. This best occurs in peer support settings, where addicts learn that their early-life issues and their maladaptive adult coping responses (including but not limited to addiction) are not unique. Knowing they are not alone in their battle is incredibly helpful in terms of reducing the guilt, shame, and remorse they often feel (all of which can be triggers for relapse).
Peer support groups are also an ideal setting for confronting the rationalizations, minimizations, and justifications (the denial) that addicts use to make their addictive behaviors okay (in their own minds). Peer confrontations about denial are powerful not only for the individual being confronted, but for the addicts doing the confronting. These interactions let everyone present see how rationalizations and justifications sustain active addiction and potentially lead to relapse. Perhaps most importantly, these supportive settings are where addicts talk and learn about the interventions and coping skills that work best in specific situations.
Typically, aftercare plans recommend peer support settings with the following elements:
- Emotional safety and stability among the members
- Peer similarity with addictive issues and, if possible, life circumstances
- Consistent gatherings in a safe, stable environment
- A focused, goal-oriented agenda related to sobriety and finding ways to enjoy life
- High levels of behavioral accountability
- The option to find a specific person with whom the recovering addict can share intimately (but not romantically) about whatever is going on in his or her life
These support settings may include “smart recovery” programs at treatment facilities, outpatient addiction-focused therapy groups, twelve step support groups, online support groups, and various other support environments, including church-sponsored support groups. Many peer support settings are facilitated by therapists or clergy members; others are simply structured groups run by the members. The recovering addict is usually accountable to the group itself, and also to either the facilitator or a specific member of the group (such as a sponsor in a twelve step group). Ultimately, these groups help addicts to not only maintain their sobriety, but to live life on life’s terms. In other words, these settings are where addicts committed to healing develop emotional maturity and stability, which helps them to become more functional in life and to find both serenity and joy.
Among the choices for peer support in recovery, twelve step groups are among the most useful, readily available, and affordable. These groups have helped millions of willing people recover from alcoholism, drug addiction, gambling addiction, compulsive spending, eating disorders, sex and love addiction, and other addictive and/or compulsive disorders. Even chronic mental health clients can find twelve step assistance in Emotions Anonymous.
Why do addicts resist peer-to-peer healing?
Recovering addicts resist and avoid the healing potential of peer support groups, facilitated or otherwise, for an almost infinite number of reasons. A few of the most common include:
- Fear of getting pulled in with no control (like joining a cult)
- Fear of or negative feelings about religion (not wanting to be part of a group where “God” is part of the healing process
- Lack of religious direction (not wanting to be part of a group where religion is not a strong element, or where the word “God” can be interpreted by the individual)
- Social anxiety and/or social avoidance
- Fear of being seen and then talked about later, outside the group, as a person who has a particular problem
- It is a reminder of “being sick” and therefore it reinforces shame
- Fear of being “hit on” sexually at meetings
- Fear of being affiliated with or becoming like the “losers” and “criminals” and “degenerates” who attend such groups
- Fear of failing in a public/group setting
- Fear of switching one addiction for another (going to meetings all the time)
You may have noticed that the main reasons for not attending peer support groups boil down to religious distaste, fears about the lack of privacy, and various forms of social anxiety.
- Religious distaste: Many peer support groups do have a spiritual component. For instance, twelve step recovery groups use phrases like “higher power” and “a power greater than ourselves” to help addicts put their faith in something beyond their own best (i.e., worst) thinking. The word “God” is used as well, usually followed by the words “as we understand God,” creating a lot of leeway for those who struggle with organized religion and the “God of their childhood.” Importantly, these references to higher power and God are not in any way directed toward a specific religious or belief system. In twelve step groups, recovering addicts are free to believe (or not believe) whatever they want. This, of course, can be a turn-off for some recovering addicts, particularly those with strong religious beliefs. The good news here is that many churches have addiction support groups that incorporate their specific religion. There are even peer support groups for atheists and agnostics.
- Lack of privacy: It’s a bit ironic that the same people who stumble drunkenly through bars and parties, get arrested for drunk driving or possession of illicit drugs, post nude pictures of themselves on dating sites and smartphone hookup apps, and engage in other similarly public behaviors will balk at the idea of walking into an addiction support group, worried that someone might see them and therefore know they have a problem. While it is true that peer support meetings are typically not bound to the same level of confidentiality as individual therapy, the vast majority of participants are nonetheless committed to anonymity as a part of their own healing process. Sometimes it helps to remember that if someone sees you at a peer support group, he or she almost certainly has the exact same problem and doesn’t want to be gossiped about any more than you do.
- Social anxiety: This is an equally invalid excuse for avoiding peer support. Usually, other than introducing yourself by your first name only (and perhaps self-identifying as an addict who “qualifies” for the group), participation is entirely voluntary. No one will make you talk about anything you don’t wish to divulge. Usually, over time, as you develop trust and empathy with fellow group members, this fear of sharing and “being known” goes away.
Sadly, avoiding peer support, which is perhaps the most essential portion of aftercare planning, often leads to relapse. I can’t even begin to tell you how many times I’ve heard a client say, “I can’t believe I relapsed. I’ve been doing everything I’m supposed to be doing except I’m not going to those meetings.” I also can’t begin to tell you how many times the clients who don’t want to attend peer support groups but do so anyway end up saying, “What was I so afraid of? Going to my support group is the best part of my week. I actually look forward to it. And now that I’ve made friends with people who are dealing with the same issues, it’s much easier and a lot more fun to stay sober.”
Robert Weiss LCSW, CSAT-S is Senior Vice President of Clinical Development with Elements Behavioral Health. He has developed clinical programs for The Ranch outside Nashville, Tennessee, Promises Treatment Centers in Malibu, and The Sexual Recovery Institute in Los Angeles, among others.An author and subject expert on the relationship between digital technology and human sexuality, he has served as a media specialist for CNN, The Oprah Winfrey Network, the New York Times, the Los Angeles Times, and the Today Show, among others. For more information you can visit his website, www.robertweissmsw.com.
