Author: Brittany Tackett

According to the New England Journal of Medicine, approximately 3 million people in the U.S. and 16 million individuals around the world have a current or past clinical diagnosis of opioid use disorder, or opioid addiction.¹ Because opioid use disorder is a chronic condition with similar relapse rates to hypertension and diabetes, aftercare and maintenance treatments are crucial for lifelong recovery. Aftercare for opioid addiction refers to any type of ongoing care and support and may include counseling, peer support, and medication-assisted treatment, as well as residential stays in sober living homes.^1,2

What is Aftercare for Opioid Addiction Treatment?

Recovery from an opioid addiction is a lifelong process. To prevent relapse, aftercare is an essential next step when you complete the initial opioid detox as well as when you complete an inpatient or outpatient rehab program.

Opioid addiction is a chronic and complex disease that affects all aspects of a person’s life. When you complete treatment and go back into daily living, you will be faced with many triggers that could lead to a relapse. For this reason, people in recovery should continue to be supported by peers and treatment professionals long after initial treatment has been completed.

Aftercare substance abuse programs build upon problem-solving and coping skills learned in rehab, connect people to community support, and offer additional resources, such as transition housing, career counseling, case management, and substance use monitoring.^1,2,3

Types of Aftercare for Opioid Addiction Treatment

Different types of aftercare for opioid addiction may be beneficial to you if you are in recovery. These include:^1,2,3,4

• Sober living homes: Sober living communities (also called recovery houses or halfway houses) are residential group homes for people in recovery. These homes provide a safe, drug-free environment to transition to after completing inpatient addiction treatment.
• Outpatient treatment as step-down care: Outpatient treatment is often the next step for those completing more intensive inpatient rehab programs. Outpatient addiction aftercare programs typically consist of a combination of individual counseling, group therapy, peer support programs, and medication-assisted treatment.
• Individual therapy: Individual counseling helps people struggling with opioid use disorder to identify triggers for drug use, develop healthy coping skills, and address underlying trauma that may be contributing to substance misuse. Because recovery is an ongoing process, keeping up with regular therapy appointments is an important means of preventing relapse and sustaining long-term recovery.
• Family therapy: Family therapy can help prevent relapse by promoting healthy family communication and dynamics and providing a family with tools to support the person in recovery.
• Group counseling: Group therapy can help people in recovery realize they are not alone in their struggles. During group counseling sessions, people can hear stories from peers and learn from their unique situations and share their own experiences in return.
• 12-step groups: While 12-step programs like Narcotics Anonymous (NA) are not medical treatments, they offer additional peer support and encouragement during recovery. Their themes of acceptance, surrender, and staying involved in the recovery process can be motivational and even life-changing for many people recovering from substance use disorders.
• Non-12-step peer support groups: A variety of other non-12-step peer support groups and programs are available across the nation that help people maintain long-term sobriety through peer support. Each group is unique and may be formed based on religious affiliation, culture, gender, or shared interest.

Continuing Methadone or Buprenorphine After Rehab

Research has shown that recovery plans that include medication-assisted treatment have higher rates of success.⁵ Many people start taking methadone or buprenorphine during active treatment and may wish to continue to take these medications as part of their aftercare plan. These opioid addiction medications not only help to prevent relapse but can also reduce the risk of opioid overdose, which often occurs as a result of lowered drug tolerance following a period of abstinence.⁶

Those who wish to continue with medication-assisted treatment will need to find a clinic or treatment provider who can prescribe the medication. Methadone can only be administered in a certified opioid addiction treatment program setting, while buprenorphine can be prescribed by a doctor for use outside of a clinic.⁵

People in aftercare for opioid addiction may choose to take methadone or buprenorphine on a short-term or long-term basis. These medications are generally safe to take for months, years, or even a lifetime.⁶ For some people, remaining on the medication permanently may be the best means of preventing relapse and living a stable, substance-free life. Talk to your treatment team to determine which medication regimen is right for you and how long you need to adhere to it.

Methadone Maintenance

Methadone is given as a daily liquid.5 Patients will start on a low initial dose, which is typically no more than 20 mg. Prescribers will monitor the person closely and gradually increase the daily dose until they determine what is most appropriate and effective for them. The average daily dose is 60–120 mg. Most people will only take one daily dose, but in some cases, it may be better for you to split that dose in half and receive it twice daily if you can make it to the clinic that often for administration.⁷

Buprenorphine Treatment

Buprenorphine is available in many forms: dissolving tablets, extended-release injections, cheek films, and a six-month implant under the skin.5 The recommended starting dose for buprenorphine is 4 mg. Dosing is increased gradually and should generally not exceed 32 mg. Dissolving tablets and cheek films are typically administered daily but may be decreased to three times a week once stabilization is achieved. Unlike methadone, buprenorphine can be prescribed for take-home use, and the patient is trusted to take it responsibly as prescribed.⁷

Creating an Aftercare Plan: Addiction Recovery

As you near the end of your opioid addiction treatment program, you will meet with your treatment team to collaborate on an individualized aftercare plan that meets your unique needs. Your treatment provider will give you information on a variety of addiction aftercare programs and help you decide what aftercare services are best for you.
You may choose to transition to a sober living home, or you may step down to an outpatient treatment program. Your addiction recovery team can also help link you to methadone centers or buprenorphine doctors if you choose to continue with medication-assisted treatment as a form of maintenance and relapse prevention.³

How Does Drug Rehab Aftercare Prevent Relapse?

Relapse rates for substance use disorders are similar to those of other chronic medical conditions.³ Research has shown that the majority of people in recovery from opiate addiction will relapse within the first year, though that doesn’t necessarily mean that you will.⁸ For this reason, drug rehab aftercare is essential to help prevent relapse and support your recovery long after you are released from treatment.
Some of the many benefits aftercare substance abuse programs can provide you are:^1,2,3,4,5

• Continued access to addiction treatment professionals who want to help you maintain your recovery and achieve your goals
• Ongoing therapy to help you process emotions, build stress resilience and distress tolerance, identify triggers for substance misuse, develop healthy coping and problem-solving skills, etc.
• Belonging to a community of peers who know your struggle and can relate to your experience
• Additional community resources that can support you in sustaining recovery and building a new life of sobriety. These include career counseling, transitional assistance, education, substance misuse monitoring, and case management services.
• Drug rehab aftercare programs help those in recovery to achieve a sense of purpose and remember the reasons they chose to stop using and create a new life. This helps people build confidence, stamina, and belief in their ability to maintain sobriety and live the life they truly want.

What Happens if I Relapse During Opioid Addiction Recovery?

Relapse is common and is considered a normal part of the recovery process.³ You don’t need to feel guilt and shame if you experience a relapse. Relapse doesn’t mean that you’ve failed. It just means that you need additional support.

If you relapse and you are not currently in an opioid addiction treatment program, consider enrolling in one as soon as possible. If you are currently in a drug rehab aftercare program and you relapsed, it may be best to enroll in a higher level of care than you are currently receiving.

For example, if you are only attending 12-step meetings or group therapy, you may wish to consider adding individual or family therapy and returning to a formal outpatient treatment program. If you continue opioid use in an outpatient program, you may consider enrolling in an inpatient treatment program to help eliminate some of the stressors of the outside world that may be contributing to your drug use.

If you need assistance in finding an opioid addiction treatment program that’s right for you, call 800-934-1582(Who Answers?) to speak with an addiction support specialist.

Resources

1. Schuckit, M. (2016). Treatment of Opioid Use Disorders. The New England Journal of Medicine.
2. U.S. National Library of Medicine. (August 2020). Opioid Misuse and Addiction Treatment.
3. National Institute on Drug Abuse. (July 2020). Drugs, Brains, and Behavior: The Science of Addiction. Treatment and Recovery.
4. Substance Abuse and Mental Health Services Administration. (April 2016). Recovery Homes Help People in Early Recovery.
5. Centers for Disease Control and Prevention. (September 2021). Recovery is Possible: Treatment for Opioid Addiction.
6. Substance Abuse and Mental Health Services Administration. (December 2021). Medication-Assisted Treatment (MAT).
7. Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence. (2009). World Health Organization. Annex 12 Prescribing Guidelines.
8. Kadam, M., Sinha, A, et. al. (2017). A Comparative Study of Factors Associated with Relapse in Alcohol Dependence and Opioid Dependence. Indian Journal of Psychological Medicine, 39(5): 627-633.