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Substance Abuse Treatment Modalities: Literature Review

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Provision of Aftercare

Aftercare refers to the continued provision of therapeutic activities to maintain the gains in functioning achieved through treatment as opposed to procedures which promote new treatment goals (Harmon, Latinga, & Gostello, 1982). The provision of aftercare is dependent on the type of substance abuse treatment that was initially offered to the offender. The majority of aftercare services are offered in the community although some maintenance sessions are provided to offenders at institution sites.

The goals and functions of aftercare will vary according to the conceptual approach and intervention techniques used during the original treatment. In some instances, offenders may be exposed to the 12 steps and 12 traditions of Alcoholics Anonymous as a method of maintaining sobriety in the community. Alternatively, aftercare following cognitive-behavioural treatment may focus on the continual development of problem solving, high risk identification, and related skills. The continuum of aftercare ranges from informal discussion groups examining issues surrounding sobriety to more formal interventions that concentrate on specific skill development exercises.

Aftercare is an extremely important intervention given that analyses of the relapse processes over time with various addictive behaviours show that about 66% of all relapses occur within the first 90 days following treatment (Marlatt and Gordon, 1985). This demonstrates that there is an essential requirement to provide offenders with ongoing support (aftercare) once they have completed their initial treatment. If we accept the fact that slips and relapses are a natural process that follows substance abuse treatment then we must seriously consider the role of aftercare in reducing substance abuse problems and recidivism.

CSC has made attempts to respond to the high risk period for substance abusing behaviour by offering core treatment in the community. The “Choices” program (Community Correctional, Brief Treatment, Relapse Prevention & Maintenance) divides treatment between a two week intensive phase and a three month maintenance phase. The length of the maintenance sessions for the “Choices” program coincides with the period of greatest danger for relapse in the community (90 days following treatment). The goal of the maintenance sessions is to increase the probability that the positive changes made in treatment in attitudes, knowledge, and cognitive and behavioural skills are maintained during parole. At the level of offender management, Choices facilitators are able to communicate the degree to which parolees are maintaining their recovery goals to the supervising case management officer.

There have been several controlled-outcome evaluation studies examining what impact aftercare has in changing substance abuse behaviour, especially for alcohol consumption. All of these studies examined the post-release adjustment of participants involved with hospital-based treatment followed by aftercare. A wide range of experimental outcome studies have reported significant post-treatment adjustment for participants enrolled in aftercare (Walker, et al., Ito, Donovan, & Hall, 1988; Rychtarik, et al., 1992; and, McKay, Maisto, & O”Farrell, 1993).

The behaviour changes for participants enrolled in aftercare are quite dramatic. In a large sample of participants (N=407) involved in hospital-based treatment, Walker, et al. (1983) found that the abstinence rates were significantly higher for aftercare completers when compared to aftercare dropouts (70% vs. 23% , respectively). Ito and Donovan (1986) observed improved outcome measures as a result of participation in aftercare that was linked to the learning process that took place during the maintenance sessions. Within this context, aftercare provides individuals with the skills to anticipate, avoid, and/or cope with high risk situations that threaten control and increase to probability for a lapse or relapse. Finally, recent research has established a relationship between aftercare, self-efficacy, and positive drinking outcomes (McKay, Maisto, & O'Farrell, 1993). Overall, aftercare should be viewed as an essential treatment modality that has demonstrated support in the research literature.

References for Provision of Aftercare:

Harmon, S., Latinga, L., & Costello, R. (1982), “Aftercare in chemical dependence treatment”, Bulletin of the Society of Psychologists in Substance Abuse, 1, 107-110.

Ito, J., Donovan, D., & Hall, J. (1988), “Relapse Prevention in Alcohol Aftercare: effects on drinking outcome, change process, and aftercare attendance”, British Journal of Addictions, 83, 171-181.

Ito, J., & Donovan, D. (1986), “Aftercare in alcoholism treatment: a review”, in: W.R. Miller & N. Heather (Eds), Treating Addictive Behaviours: Processes of Change, New York: Plenum Press, 435-452.

Marlatt, G.A., and Gordon, J.R. (1985), Relapse Prevention. New York: Guilford Press.

McKay, J., Maisto, S., & O'Farrell, T. (1993), “End of Treatment Self-Efficacy, Aftercare, and Drinking Outcomes of Alcoholic Men”, Alcoholism, Clinical, and Experimental Research, 17(3), 1078-1083.

Rychtarik, R., Prue, D., Rapp, S., & King, A. (1992), “Self Efficacy, Aftercare and Relapse in a Treatment Program for Alcoholics”, Journal of Studies in Alcohol, 53, 435-440.

Walker, D., Donovan, D., Kivlahan, R. et al. (1983), “Length of Stay, Neuropsychological Performance, and Aftercare: Influences on Alcohol Treatment Outcome” Journal of Consulting and Clinical Psychology, 51(6), 900-911.