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Addiction professionals understand that continuing care is an essential piece of the addiction treatment continuum. Continuing care plans with varying levels of accountability exist throughout the United States. For the addiction treatment professional, however, the difficulty often comes when it is time to put the next “right step” in place for a patient moving to the next level of care.
Traditional 30-day inpatient treatment and corresponding outpatient treatment have become highly refined over the years. Today there are hundreds of excellent treatment centers throughout the United States that offer variations on these basic models. Most do a great job of detoxing their clients and beginning the process of getting them grounded in an understanding of their addiction and their responsibility to manage the ongoing care of their addiction once they leave treatment. As is well known among treatment professionals, managing one’s addiction is easier while still in treatment with all of its available support. It is the transition out of treatment and either “back to life” or on to a lower level of care that presents the greatest challenges to the newly recovering individual.
Too often this crucial piece of continuing care planning does not get the attention it requires from addiction counseling providers. It is not enough to keep individuals addiction-free during the time they are under a professional’s care and then idly release them to the world with a basic plan for attendance at 12 Step meetings and words of encouragement. More care must be given to working with the patient on successful implementation of an in-depth, thoughtful and structured continuing care plan. If counselors and case managers gave each client’s continuing care plan more individualized attention, it would greatly increase the rate of recovery and provide a more seamless transition.
Often the focus of counselors and case managers is on keeping the client in the here and now, present and focused on the work at hand. This goal becomes a dilemma as an equal effort to engage the patient in his continuing care plan is begun. The unfortunate outcome is that aftercare planning often receives only passing attention as a final treatment planning item. Our challenge is to raise awareness of both the importance of continuing care and the responsibility of the treatment program to look outside its own borders and build a more seamless continuity of care.
Here are some solutions that address five of the issues facing continuing care planning and implementation today:
Concern:
Aftercare plans are often homogenized and lack specificity
Solution:
Individualize your client care plans. Every addiction professional says that they customize the plan, but the reality is that too often clients in recovery receive a standardized plan – and patients are made 100% responsible for its implementation. If your patient is simply leaving primary treatment to return home, rather than going on to another level of care such as a halfway house with a built-in treatment agenda, truly individualized follow-up is vital. Once out of treatment, many patients simply are handed a piece of paper suggesting they attend AA meetings three times a week. That’s not enough – a truly individualized care plan will give the address and phone number of a convenient AA group near their home or office, explaining the dates/times of the appropriate meetings, what to expect, and more. Information that is simple for an addiction professional to research can be impossible for a patient to handle – many patients don’t know what an AA meeting is or how to find one – and it’s the responsibility of the continuing care coordinator to remove every obstacle in their way.
Individualized continuing care plans recognize the factor of age -- if a patient is a teenager, the continuing care plan might involve high school guidance counselors and parents, whereas a plan for a senior in recovery might take into account medical issues, and expectations of wife/husband and children. Other factors that continuing care plans should take into account include chronicity (how sick someone is and how many times they’ve been through treatment before), whether there are trauma and abuse issues, existence of dual disorders including depression, mental illness and eating disorders; and any other secondary issues not addressed in primary care which need to be followed up when someone gets home from the clinic.
Concern:
No information on quality of continuing care resources outside the immediate locality. Too often addiction professionals have a special support or counseling need to fill for which they do not have a ready answer. Not everyone in the addiction field gets the opportunity to do site visits and research each aftercare programs and therapists personally. Ultimately we rely upon the research and references of others that we trust to determine quality of care, reputation, and outcomes.
Solution:
Build a referral database containing contact information for psychologists, psychiatrists, physicians, grief counselors, trauma and abuse counselors, other treatment centers, after-care groups, outpatient continuing care programs, addiction hotline numbers, regional AA numbers, emergency rooms and hospitals specializing in addiction services, and local detox facilities. Finally, ever referral database should contain phone numbers for individualized local leaders in the recovery community.
Telephone numbers change, people move, treatment programs open and close. It is essential to stay on top of the data; information on treatment facilities alone could include the number of beds, what addictions they treat, ratio of male to female patients, cost and average length of stay, name of primary contact, whether they admit seven days a week and whether they take health insurance. Nothing is more discouraging to a newly recovering individual than to get home from treatment and find that their recovery contact is no longer recovering and that the counseling center they were referred to closed last year. Take the time, if you have not already, to build a counseling and treatment database that is cross-indexed and searchable.
Concern:
Provider is unaware of specialty resources available that would benefit the patient in recovery.
Solution:
Do the research to keep your database of addiction-related services up-to-date. That means setting aside the time, money and staff required to ensure that your knowledge of specialty resources is accurate and valid – do on-site visits, get copies of their videos and brochures, eat the food, meet with the counselors and ensure that the treatment facility you’re sending patients to is qualified to go on your list. Federal government resources like Substance Abuse and Mental Health Services Administration and Web-based substance abuse sites can be helpful, too. The core of your research is making friends in the treatment industry – we trade information about treatment resources with our contacts at Hazelden on a weekly basis. If you have a client that needs ongoing therapeutic work for trauma after completing an inpatient program for chemical dependency, where can you send them? Find out who specializes in all areas particular to the clients that you serve and add them to your database. Be prepared for a variety of possibilities that fit all needs of multi-cultural populations.
Concern:
How to educate the client about the need to manage their ongoing recovery after treatment is finished. Handing a client a piece of paper with instructions on it for implementing a continuing care plan does not make it happen.
Solution:
Encourage your patient to become invested in their continuing care plan from the beginning of their treatment. Many patients are overwhelmed with the prospect of lifelong management of their addiction and remain focused on the task of completing the treatment underway. Making appointments, keeping appointments, and walking cold into a room full of strangers for a meeting can be overwhelming responsibilities. Ensure that your client has a safe next place to continue to develop their recovery. Help them to do the groundwork for their continuing care plan ahead of time to avoid the pitfalls after treatment of no plan, too much time, and old habits. Some basics:
If they are continuing on to another treatment facility or secondary level of care, make sure that bed space, financing and travel arrangements are all in place prior to discharge.
Provide lists of continuing care resources in their locality
- 12 step meetings
- facilitated continuing care groups
- names of therapists that specialize, for example, in addictions, grief and trauma, and familial issues.
If they are returning to their community, have the client call ahead and schedule appointments for a therapist or continuing care group.
If possible, have the patient schedule a meeting with a recovery contact prior to discharge.
Concern:
Unaware of the depth and breadth of the larger field of addiction treatment.
Solution:
Invest in continuing education and relationship building, which means networking through organizations like NAADAC/Association for Addiction Professionals, and even cold-calling treatment facilities that you are not yet familiar with. Take advantage of any and all opportunities to learn about different treatment resources. There’s a tendency for addiction professionals to become provincial – you are hired by a Chicago treatment facility and you know everything about resources in Chicago, but not beyond those borders.
Because of the nature of our field, it’s vital to educate ourselves about specialized resources not in our geographic areas – treatment and aftercare have a different flavor and nuance depending upon if the provider is in the Midwest or on the Coasts. There are developments in treatment modalities, new understandings of halfway houses and extended-care sober living in Southern California that aren’t visible or available to us here in Minnesota.
Recognize that to properly serve your patients, you must know about treatment centers specializing in gay and lesbian people in recovery, as well as those that offer inpatient gambling treatment, long-term treatment for women and adolescent girls, professional programs for physicians, dentists and veterinarians in recovery, and the very rare centers that provide chemical dependency care for people with psychiatric issues beyond depression such as schizophrenics who are addicted. There is no substitute for building relationships with other treatment programs, halfway houses, sober houses, counseling centers, 12 Step programs, and therapists – before your patients need your help in identifying them.
These solutions should enable continuing care counselors and clinical case managers to provide a more seamless transition for patients as they make their way from one of level of care to the next. Through education, experience, and attention to the individual, we can create creative workable continuing care plans. With effective counseling, encouragement, and support, patients can learn to take responsibility for instituting these plans and ultimately for their own recovery.
-- Andrew T. Wainwright is the Executive Director of Addiction Intervention Resources (A.I.R.), a St. Paul, Minnesota-based national addiction and intervention consulting organization. Andrew can be reached at Andrew@AddictionIntervention.com or through A.I.R.’s website at www.AddictionIntervention.com
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