The Continuum of Care: What Happens After Rehab?

Author: Samantha Bothwell

Recovery doesn’t end once you complete alcohol or drug rehab. Addiction recovery is a lifelong process that involves continued support and care after rehab. While the transition back to your everyday life can be overwhelming, it’s possible to maintain abstinence, even in the face of triggers and stressors.

How Can I Plan for Life After Rehab?

Aftercare planning is an important part of the treatment process.1 An aftercare plan is an individualized plan for what your continued care and relapse prevention strategies will be after inpatient or residential treatment.²

This plan aims to support you post-rehab to prevent relapse and help you reach your goals. This can help you feel more confident about navigating the transition between rehab and the next phase of recovery, whether that be step-down care in the form of outpatient treatment, sober living homes, or a support group. Research shows that aftercare planning helps prevent relapse, especially for high-risk individuals.³

A relapse prevention plan often asks you to consider what could motivate you to use substances again.⁴ This part of the aftercare plan involves identifying your unique triggers and figuring out coping skills.

These coping skills can help you tolerate any negative emotions or urges to use substances that come up from being triggered. For example, if you feel urges to consume alcohol when you are feeling stressed or lonely, then using coping skills to help you tolerate stress or loneliness can help replace the need to drink. You typically learn these skills in rehab, so it’s important to utilize them once you transition home.

Everyone’s relapse prevention plan will be different to some extent. Some common relapse triggers include:⁴

• Negative emotions, such as depression, anxiety, or boredom
• Situations involving other people that may result in negative emotions, especially conflict
• Social pressure to be around or use substances

Being around people who use substances or pressure others to use them is a common relapse trigger. This is why sober living environments can be especially helpful when someone is trying to balance sobriety with other life responsibilities such as relationships, work, or school.

What Can I Do to Protect My Sobriety After Treatment?

Recovering from addiction is more than not using a substance anymore. Achieving and maintaining recovery requires changing your lifestyle. Not every aspect of your life has to change, but certain factors that were contributing to misusing substances typically need to change.⁵

This is why relapse prevention strategies often involve avoiding people, places, and things that were associated with using substances.⁵ For example, if there were friends that you typically used substances with, it’s likely that continuing to hang out with these friends could be really triggering.

This is why sober living homes can be such a powerful tool in protecting your recovery.⁶

Sober Living Homes

Sober living homes are places where adults can live who are living a sober lifestyle and working toward recovery from addiction. A stable and substance-free living environment can make a huge difference in the early days of your recovery.⁶

Sober living environments are structured living situations that often have certain rules. These homes are temporary and meant to support someone in their transition to living independently. If you live in a sober living, you might be expected to follow rules like these:⁶

• Abstaining from drugs and alcohol
• Paying rent and other fees
• Participating in house chores and attending house meetings
• Attending treatment or 12-step meetings

Some people enter a sober living environment directly from inpatient treatment.6 However, if you’ve been out of treatment and could use the support of a drug and alcohol-free environment during your recovery process, then a sober living house may be a good fit for you.⁶

What are the Benefits of Sober Living?

Research shows that sober living makes a difference in the lives of people trying to recover from substance misuse.⁶ Aside from offering a substance-free environment, sober living provides certain benefits that are helpful for recovery. Connection, support, sobriety, and quality of life are important aspects of the recovery process. Sober living offers these benefits.⁷

Structure

Inpatient treatment is highly structured. If you are transitioning from inpatient treatment, the structure of a sober living house might be helpful. While not as structured as inpatient in that many people are able to work or go to school, many sober living environments have rules. Some of these rules may include attending a certain number of 12-step meetings per week, drug testing, or participation in therapy.

Accountability

The structure of a sober living environment also offers accountability. Expectations around attending 12-step meetings and drug testing offer accountability. This can be helpful in the early phases of recovery when it might be more difficult to abstain from substances.

Community

Having a supportive community is a powerful recovery tool.^3,7 Lack of social support is a common barrier to maintaining sobriety or recovery.³ Research shows that people in recovery who spend time with others who use substances are more likely to relapse.⁶

Sober living provides you with a community of people who are also living a sober lifestyle. Peer support is also an opportunity to receive feedback from other people who understand your unique situation. Some sober living homes offer peer support groups.

Maintaining Momentum

Rehab can give you the sense that you are making a lot of progress in therapy and in your recovery overall. It can feel like progress is interrupted or stopped when you leave rehab. A sober living house can help motivate you to continue making progress and maintain momentum toward your recovery.

How Do I Find Stable Sober Living?

Sober living environments are typically not paid for by insurance or included in an outpatient treatment program. Residents are expected to pay for their living expenses. If you are transitioning from rehab, haven’t had steady employment, or have experienced incarceration or homelessness, this can be an extra challenge.⁷

However, the need for safe, stable, and sober housing is important. Research shows that people in recovery who are able to find a sober living house are less likely to relapse than people who aren’t.⁷ Much like with substance abuse treatment, there are ways to finance sober living if you don’t have the means. Some sober living homes will work with you to create a payment plan. There are also grants and scholarships available.

Multiple national organizations focus on researching and identifying standards for recovery homes.7 One government-recognized organization is the National Association of Recovery Residences.^8,9 NARR suggests that it’s important to identify the type of residence you need first. There are four different levels.⁹ These include:¹⁰

• Level One, Peer-run: This type of sober living environment is run by the residents. These tend to be the most cost-effective as there are fewer supportive services offered. It is required to complete drug screenings and attend house meetings. Self-help meetings like 12-step are encouraged.
• Level Two, Monitored sober living homes: A house manager or senior resident runs the house. House rules provide structure. Level two homes also have drug screenings, house meetings, and require participation in 12-step meetings or treatment.
• Level Three, Supervised housing: People see treatment providers, like mental health clinicians, in the community. There is a strong focus on developing life skills to support residents to transition down to a lower level of supervision.
• Level Four: This type of sober living is a residential treatment facility. It is considered a sober living environment, but it is not a living environment that people would stay in once they have completed these phases of treatment.

You can ask a treatment provider to help you figure out which type of sober living home is right for you. Often addiction specialists will have sober living programs they are familiar with and can refer you to. This is likely going to be part of your aftercare plan.

If you have already left treatment or you are recognizing that you could benefit from sober living, call 800-963-1579 (Who Answers?) to speak with an addiction support specialist. We can help you find the right form of aftercare for you.

Resources

1. Duffy, P. & Baldwin, H. (2013). Recovery post treatment: Plans, barriers, and motivators.
2. Patton, D. and McDowell, T. Substance Abuse Aftercare Treatment. Arizona State University, Center for Applied Behavioral Health Policy.
3. Manuel, J., Yuan, Y., Herman, D., Svikis, D., Nicholas, O., Palmer, E., & Deren, S. (2017). Barriers and facilitators to successful transition from long-term residential substance abuse treatment. Journal of Substance Abuse Treatment, 74, 16-22.
4. Larimer, M.E., Palmer, R.S., & Marlatt, G.A. (1999). Relapse prevention. Alcohol Research and Health, 23(2), 151-160.
5. Melemis, S.M. (2015). Relapse prevention and the five rules of recovery. Yale Journal of Biology and Medicine, 88, 325-332.
6. Polcin, D.L., Korcha, R., Bond, J., Galloway, G. (2010). What did we learn from our study on sober living houses and where do we go from here? Journal of Psychoactive Drugs, 42(4), 425-433.
7. National Institute on Drug Abuse. New NIDA Research Reveals the Power of Social Reinforcers.
8. Substance Abuse and Mental Health Services Administration. (2021). Affording Housing Models and Recovery.
9. National Association of Recovery Residences. (2012). A Primer on Recovery Residences: FAQs
10. National Association of Recovery Residences. (2011). Standard for Recovery Residences.