The reason why Extended Care matters
Co-Authors: Jake Summers and Joanna Lilley
When clients participate in residential treatment, often the countdown until they “complete the program” begins the moment they enroll. There is a level of grit and determination that a patient can hold onto when they know that after a certain number of days or weeks they’ll be living freely out in the world again. Variations between length of stay, clinical focus, and continued care recommendations ultimately determine a lifetime of chronic relapse, or starting a life of recovery. Extended care matters for a life of recovery.
The most common treatment approach for substance use disorder (SUD) is still the 28 day ‘rehab’, or inpatient facility model. This is an outdated approach, although still commonly used, and mainly insurance-driven. Patients enter a facility and go through a 5-7 day detox program to treat for symptoms of withdrawal, and then begin clinical and group work for SUD. In this model, patients often abruptly pause their career and home life, and enter a treatment facility with little or no resemblance to normal living.
The assumption inherent in this model is that a month without use and an introduction to some tools for recovery is an adequate foundation for lifelong sobriety. While experience has shown that this model undoubtedly works for some, a study published in the Journal of the American Medical Association found that relapse rates in the first year of sobriety are 40-60%. Another point to mention is that often those discharged from a 28-day program are often recommended to a sober living facility. Without the clinical foundation (read: extended care program) sandwiched in between residential and sober living, solely moving into a sober living program is not enough.
Treatment programs have started to realize that extending the length of treatment increases the overall chance of success. Many 28 day rehab programs have started to change their model towards 60-90 days of care. While this provides an even stronger foundation for sobriety, it still forces patients to re-enter life with little to no transition. Without a step-down the shock of the reintroduction with a lack of support could really force the hand of the newly sober individual to self-medicate to cope with the stress. Insert the need for recommending an extended care program.
Extended care, also referred to as continued care, recovery programs, or transitional living programs, are designed to give patients a safe and healthy environment to begin their transition back into everyday life. This includes rejoining the workforce, restarting academic studies, rebuilding romantic and familial relationships, and relearning basic life skills. These programs generally last for 6-12 months, and gradually step down the clinical care and structure over time.
In the first month, a patient may be singularly focused on not drinking or using. As time in recovery increases life becomes more complex, and recovery is, like all things in life, not a linear journey. The job you lost is replaced with a new career, the children you weren’t allowed to see are back in your life, the college that kicked you out has allowed you to start classes again. Recovery gives you a life again, and with that comes responsibilities. Each time life expands, you have to take a step back and extended care programs exist to provide you clinically grounded support during the first year of sobriety.
For example at Green Hill Recovery, when a patient enters extended care, they may not have a phone or car, or privileges to leave the recovery house without staff. By the end of their stay, they will have completed our academic and career counseling tracks, started working part time, completed visits home to family, and developed relationships in the community. Goals are set and pursued with the help of a robust clinical curriculum. Mistakes and setbacks are used as opportunities for growth and learning with the help of licensed therapists. Extended care is a vital step in helping an increasingly younger population in recovery build a strong and lasting foundation.
Another important factor to consider for extended care treatment comes with the increase in comorbidity in patients. A study from HHS showed that 36-40% of young adults with mental health disorders also meet the criteria for SUD. Essentially treatment providers acknowledged the need to simultaneously treat two conditions; both SUD and mental health. Common comorbid diagnosis might include addiction, anxiety, depression, and trauma. To be direct, these disorders must be managed alongside SUD to prevent relapses. By only focusing on one single issue (i.e. addiction), we are playing a game of whack-a-mole. Once you think you have one issue taken care of, another issue rears its ugly head. It’s an endless, and exhausting game if that’s the approach taken. By focusing on mental health, extended care programs can now provide a spectrum of clinical modalities that could include Dialectical Behavioral Therapy (DBT), Somatic Experiencing (SE), Eye Movement Desensitization and Reprocessing (EMDR), Brainspotting, Mindfulness, and Experiential therapies just to highlight a few. Additionally, extended care programming cannot be a cookie cutter for every participant. With individualized treatment plans and more clinically specialized programs, providers have the ability to treat these disorders in harmony.
For someone who finds themselves in a residential treatment program for SUD, if they are genuinely interested or curious about a life of sobriety they need to understand extended care.
Extended care programs vary by the population they serve, geography, and type of program. While Green Hill focuses on academics, there are other excellent programs that have different specialty approaches to treatment. If you are uncertain about which type of extended care program would be most appropriate for your loved one, you may want to consider working with a Therapeutic Consultant. These are professionals who have visited and vetted each program and will be able to best match your loved one to the most appropriate extended care program for them.
For questions or comments contact Joanna.
