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recovering addicts face in adjusting to regular work and library, public or social hall, place of worship, or any employment (such as socializing with fellow workers, suitable place, rather than the rehabilitation center. coping with routine and monotony, coping with authority, This helps foster a sense of well-being, as it helps not being able to speak up, etc.). Since vocational clients feel more like respectable members of the Aftercare Services rehabilitation is crucial for recovery, any risks on the job community than addicts. can be risks to recovery. The aftercare staff might have to maintain contact with the employer, make non- for Drug Dependence Persons ix. Networking and co-ordination intrusive visits to the workplace, intervene in crises on Close co-ordination must be maintained with similar the job, conduct group discussions on job-related issues, as well as other social, medical, law enforcing, and assist in job-or work-related decision making. religious or other services and groups, to ensure prompt intervention at times of crisis or urgent client What is Aftercare? vii. Fellowship and community activities needs (such as for detoxification), client follow-up, ‘Aftercare’ refers to services that help recovering drug-dependent persons to adapt Such activities wonderfully supplement group vocational rehabilitation, or for any aftercare activity. to everyday community life, after completing earlier phases of treatment and meetings by providing wholesome recreation and rehabilitation. It provides an opportunity to address important issues and problems socializing among members. Meetings should be associated with abstinence and recovery. Aftercare provides a safe environment for held regularly, preferably every week. To hasten Aftercare Outcome and Evaluation continued support till it is no longer needed. social reintegration, guests should be invited from the community and attempts should be made to hold Why Aftercare? In order to develop and refine an aftercare program, Developing Community Drug Rehabilitation and Workplace Prevention Programme as many activities in the community as possible. The journey of recovery continues even after treatment and rehabilitation, and close attention must be paid to the program’s outcome (AD/IND/94/808) is long and steep. Since clients may take a year or even more to complete this data. The outcome information will help assess the Ministry of Social Justice and Empowerment last part of the recovery journey, they need support and guidance during this viii. Community-based meeting sites effectiveness of the program and modify it suitably. Shastri Bhawan, New Delhi - 110 001 period. Group meetings should preferably be held in Such evaluation will also identify staff training needs Tel : 23388580 Fax : 23384918 and the direction the program must take. locations within the community such as a school, United Nations Office on Drugs and Crime, Regional Office for South Asia Aftercare should: EP 16/17, Chandragupta Marg, Chanakyapuri, New Delhi - 110 021 Setting up an Aftercare Program: Summary Steps Be an integral component programed into a treatment and rehabilitation Tel : 24104970, 71, 72, 73 Fax : 24104962, 63 service Before starting an aftercare program, decide (for smaller treatment programs) or a larger, whether to ‘own’ the aftercare program or formal and structured aftercare program, as International Labour Organization Include training to prevent relapse and other crises ‘outsource’ it. suitable. Core 4B, IIIrd Floor, India Habitat Centre, Lodi Road, New Delhi - 110 003 Focus on reviewing and consolidating the gains made during treatment and aim Set up an ‘Aftercare Team’ with one or more The Aftercare Team should: Tel : 24602101 Fax : 24602111 E-mail : [email protected] at Whole Person Recovery (with strategies for being drug-free, crime-free and counselors, a manager or member of the Plan program components gainfully employed) European Commission treatment center’s Board, and a recovering Identify areas of staff training and Impart new skills for maintaining recovery, including help in handling everyday 65 Golf Links, New Delhi - 110 003 addict counselor (if possible). The Aftercare capacity building responsibilities, managing family and other relationships, making new friends, Tel : 24629237, 38 Fax : 24629206 E-mail : [email protected] Team will carry out the planning, Estimate financial and other resources for developing alternative recreational activities, adjusting to work and employment implementation and development of the the program and mobilize such resources or acquiring/re-learning occupational skills, overcoming the stigma and shame of National Centre for Drug Abuse Prevention aftercare program. Carry out a periodic evaluation and the past, and developing new insights. review. Ground Floor, West Block 1, Wing 7, Rama Krishna Puram, New Delhi - 110 066 Plan client-by-client individualized aftercare Tel : 26173257, 26100058 Fax : 26173257 E-mail : [email protected]
The client who successfully graduates from an risks of relapse decrease with the passage of Acknowledgements aftercare service will have made substantial time, relapse can still occur. The aftercare Principal Author : Dr. Sunil Mittal Whole Person Recovery to lead a normal life. experience enhances the client’s capacity to Scientific Editor : Dr. Pratima Murthy, NIMHANS Aftercare Services Yet, the road to recovery does not end here, as cope with this risk and make progress on a Coordinated by : UNODC, Regional Office for South Asia recovery is a continuous journey. Though the drug-free life. Design : Lopez Design Reprint : 2005
The opinions expressed in this publication do not necessarily represent the official policy of the United Nations Office on Drugs and Crime, 5 Ministry of Social Justice and Empowerment, ILO and the European Commission. Differences between Aftercare and follow-up counselors should pay attention to each client’s purpose. Other counselors and volunteers may be relationships, work and employment, finances, start, change or stop these medicines are best left to Aftercare should not be an afterthought While an aftercare program does include follow-up aftercare needs. When the group of clients trained to assist in the program. health, social and spiritual activities the medical professional in charge. procedures, mere follow-up is not aftercare. grows, a more formal program of aftercare can Home visits by counselors or volunteers. be developed. ii. Recovering addict counselors iii. Psychiatric and medical treatment ‘Senior’ recovering addicts can form an effective Clear entry and completion criteria Certain clients in aftercare may continue to receive Aftercare Follow-up part of the aftercare team, as they not only provide Define clearly the criteria and standards for entry psychiatric or medical treatment for co-morbid Definition Planned services that help recovering drug Monitoring and collecting information about clients dependent persons to adapt to everyday after they leave a program Who Provides Aftercare? role models but can also be effective peer into and ‘graduating’ from the aftercare program. conditions. Such patients require: community life counselors and peer leaders. This maximizes benefit and reduces wastage of Monitoring of treatment and ensuring compliance Although desirable, not all drug treatment centers resources. Admit only those clients who are ready Focus Support and guidance in relapse prevention, Learning about clients after they leave a program Appropriate referral and contact with the Whole Person Recovery, and developing need to provide for aftercare themselves. The iii. Volunteers to use the service. new skills treating doctors. aftercare component can be provided by a different Volunteers from the community who are familiar agency in the community. For example, hospital- with the process of drug dependence and recovery, iv. Family counseling Issues in Aftercare Goals in Aftercare based detoxification-only programs may refer their who have the sensitivity and ability to listen and Components of Aftercare Family counseling should be continued on a single- ‘graduates’ to other rehabilitation programs that empathize, and the capacity to understand, may be family basis in the treatment center setting or through Aftercare includes working on: Based on the aftercare issues outlined, the staff of facilitate the rest of recovery. trained to assist in aftercare services. i. Individual counseling a family support group outside the center, in the a. Recognition, review and consolidation of the program should formulate a set of client goals. community. Counseling includes helping family General Principles of Individual Counseling treatment gains These should be in tune with the recovery model Smaller rehabilitation programs may opt for members learn new strategies to cope and relate to b. Addressing the issue of drug-craving in terms of: being used in the treatment and rehabilitation a more flexible client-to-client approach for Aftercare Activities and Procedures Respect for the Client A thorough understanding each other, resolve conflicts and prevent relapse. They Rapport of the basic nature of the services. Well-defined goals provide a focus for community reintegration (individualized aftercare). must also learn to overcome social stigma, shame, and Identification of drug-craving Authenticity problem and client’s ability Non-judgmental pain and their own ‘co-dependence’. In such Identification of psychological and other both the client and the staff and also set criteria Alternatively, several rehabilitation services may The Aftercare plan to improve Ability to identify Ability to identify resources and situations, aftercare may involve family counseling, cues that trigger craving and standards for client entry into and completion share resources and set up a common central Ensure that the aftercare plan: attitude utilize them for client’s benefit family groups, group fellowships and other activities. Tracking of craving urges of aftercare. aftercare service, where they continue to provide Specifies the person(s) responsible for Warmth providing aftercare Even occasional home visits may be required to assess Anticipating situations that may lead to individualized counseling but rely on the common drug use A good aftercare program also needs to be program for group or larger activities. Works out time, frequency, place and nature of ii. Continuation of medications the living situation and to intervene. Depending on the recovery model used by the Handling craving individualized. All clients differ as regards their contact treatment and rehabilitation service where the v. Aftercare group c. Establishing a new social network by: individual problems, needs, and psychological as Is systematically planned. Every session or Those clients who show a certain level of readiness Developing social and intimate relationships well as social capacities and resources. A flexibility The Aftercare Setting activity must conclude with a mutually agreed aftercare program is based, suitable clients may with non-drug using persons and peers that allows more individual choices, makes a plan for the next have been prescribed and maintained on certain could be associated to form an aftercare group that medication to facilitate aftercare and recovery. Carrying out non-drug using ‘fun’ activities program more attractive and effective. Aftercare services may be offered on an outpatient Is reviewed periodically and modified as focuses on common issues of aftercare. Such a Such medicines include: Establishing healthy social activities basis by the designated staff of the treatment unit. required. group should be formally led by a trained aftercare d. Beginning or resuming new roles and Alternatively, aftercare may be offered in the staff member and could be co-led by a ‘senior’ Antagonists (e.g. Naltrexone in cases of opiate responsibilities as: The Place of Aftercare in the Treatment community by trained community volunteers, or by The Aftercare contact recovering addict. Regular meetings should be held dependence) An employee, worker or student Process an aftercare self-help group. You can plan various types of aftercare contact at least once weekly. Group therapy in such Agonists that work as maintenance substitutes including: settings is a powerful technique of aftercare. A family member (e.g. Methadone, Buprenorphine in opiate Personal meeting and interview (most preferable) A parent, son, daughter or homemaker Plan aftercare arrangements before discharging the dependence) client from the treatment and rehabilitation facility. Aftercare Staff Personalized letters to the client Self-help groups such as Narcotics Anonymous and A friend, colleague or co-worker Aftercare Services Anti-craving medicines (e.g. Naltrexone or Such a plan should specify the person(s) Personalized messages of care and concern Alcoholics Anonymous can also form a part of the e. Lifestyle changes required for Whole Person Telephonic contact. Information may be Acamprosate in alcoholism) responsible for providing aftercare, the time, i. Specially trained staff network for aftercare support. Recover. This includes helping the client handle gathered and advice, support and A staff member or a committee should be Aversive drugs that cause an adverse reaction work/employment, family and relationships, frequency, place and type of contact. encouragement offered (e.g. Disulfiram in alcoholism). finance, as well as social and recreational designated to oversee the aftercare program. One Structured or semi-structured questionnaires for vi. Vocational rehabilitation activities, without resorting to drug use If your treatment program is new, with only a few or more experienced counselors can be trained to the client to fill. Questions include frequency and The aftercare staff may need to supervise medication This ‘employee assistance’ component of the f. Relapse prevention. clients having reached the aftercare stage, acquire the special competence required for the evel of drug use, family and other interpersonal to ensure compliance. Decisions regarding when to aftercare plan aims to reduce the difficulties that
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