Overcoming crack cocaine: the importance of aftercare

Relapse management is a critical component of treatment for all forms of addiction. Crack cocaine, in particular, has a high risk of relapse, with a large proportion of people relapsing within 3-6 months of exiting rehab. This means that aftercare, or continuing care, is crucial for people overcoming crack addiction. People with a higher risk of relapse benefit to a greater degree from continuing care, making aftercare a key part of treatment for people struggling with crack cocaine addiction.

What is aftercare?

Aftercare can be seen as the third stage in addiction treatment, following on from detox and rehab. During detox, the focus is on assisting the individual to withdraw from the drug safely, clearing it from their body, physically stabilising them and managing their withdrawal symptoms. Detox is the shortest stage.

Following detox, the person will enter rehab, which is designed to impart coping skills and address the root causes of addiction. Rehab timelines vary but tend not to exceed 90 days, although exceptions exist.

Aftercare is the ongoing support offered after rehab and can continue for years. Aftercare happens in the community, outside of residential rehab, and aims to protect sobriety, prevent relapse, and help the individual integrate back into everyday life.

Why is aftercare so important for crack addiction?

Susceptibility to relapse has many factors. Family history of substance misuse, lack of support, low self-efficacy, cravings and outcome expectancies all play a role. When high-risk situations are encountered, such as witnessing other people using drugs or encountering stressful situations, the risk of relapse increases. Rehab is oriented towards arming the individual with self-efficacy, necessary coping mechanisms and an understanding of the nature of addiction so they can withstand stressful or risky situations without relapsing. Rehab is also protective, as the individual is supported by their surroundings and taken away from the risky, stressful situations they were in when they were using. However, rehab doesn’t last forever, meaning continuing care is a lifeline for many people who are trying to retain sobriety.

Crack is a powerful and destabilising drug, and a person struggling with crack addiction may have led a chaotic life before seeking help for their addiction. Aftercare recognises that entering high-risk situations increases the likelihood of relapse – and returning to ‘normal’ for many people will simply put them back into the set of stressful circumstances where crack use is destigmatised, common, and used as a coping mechanism.

A study by the charity Crisis focusing on homeless people in London found that about 50% of those surveyed were taking crack, and about half of them were taking it every day. Aftercare aims to assist the individual to integrate back into normal life – but if normal life before rehab was stressful, as is the case with homelessness, many of the conditions that contributed to that addiction will remain unchanged, and the person will require a great degree of help, empathy and structured support to help them live a normal life.

Aftercare builds on the skills and coping mechanisms learned in rehab and aims to prevent relapse. If relapse does happen, aftercare attempts to mitigate its impact and help the individual get back on track.

Aftercare is not a magic bullet, and there are challenges. The individual must be committed to engaging with the aftercare process, and as their needs change over time, the process must be able to adapt to these needs. However, if adhered to, aftercare can help to boost the rates of abstinence in people leaving rehab – and help them to transition into a more stable life.

The components of aftercare

There isn’t a one-size-fits-all model of aftercare – and the methods used may change throughout the process to adapt to the evolving needs of the individual. Aftercare can instead be seen as a series of tools that can be employed to help address individuals’ specific needs as they continue to maintain their sobriety.

Telephone-based continuing care

Telephone-based continuing care offers weekly check-ins to assess goals and progress towards them. Telephone-based care is more effective for people at lower risk of relapse, meaning that this form of intervention alone isn’t sufficient for people at risk of relapsing on crack. However, aftercare doesn’t just employ one component – it uses many together to offer the greatest amount of support. Telephone-based care is also useful for offering at least some care if the individual isn’t able to engage with other forms of care for a while.

Recovery management checkups

Recovery management checkups are in-person check-ins at specific intervals, often involving drug tests. The aim is to get the person back into treatment if needed. This is an effective way of preventing relapse, or catching it early if it’s already happened.

Incentives

One of the challenges of continuing care is adherence, and incentive-based aftercare offers vouchers or other incentives for attending things such as therapy. This method does increase attendance rates, but it is still being determined if this increases sobriety in the long term; however, it is a valuable tool for increasing the amount of time individuals engage with aftercare.

Support groups

Support groups such as Narcotics Anonymous are an invaluable component of aftercare. The barrier to entry is low – anyone can attend a local group, and some meetings are held remotely. They are donation-based, so no one can be turned away for lack of funds. Support groups can also be attended indefinitely, for as long as the person is getting value and support out of the meetings – there is no time limit.

Support groups offer many things that are key to maintaining sobriety. They reduce loneliness and isolation, offering a powerful sense of community with a group of people who understand and empathise with the same struggles. They are a valuable source of information, where peers can share advice and experience on what helped them to stay sober. They can also be motivational and inspiring. Meeting other people who have experienced the same things and overcome them shows what is possible. At support groups, goals can be set and milestones celebrated.

Some people have put off group recovery programmes due to some of them having a spiritual focus – but most groups emphasise that you don’t need to have a spiritual belief to participate, and secular recovery-based groups such as Secular Organisations for Sobriety also exist, although they aren’t as widespread.

Housing and employment

In the UK, support for people who are maintaining sobriety and need housing or re-entry into the job market is often run by charities. These organisations will offer temporary shelter, help people get and retain tenancies, and offer training to help people gain employment.

These organisations usually operate locally, and services differ between regions. This highlights the need for a cohesive, government-led programme that can help people get secure housing and access to jobs.

Take the first step with UKAT

We understand the need for ongoing support to give you the best possible chance of beating your addiction. At UKAT, we offer free aftercare support for one year following the completion of your treatment, so you can keep getting the support that you need.

Reach out today to find out how you can help.