The Long Road Back

L I F E S T Y L E

‘After-care’ for drug and alcohol abusers

At the Betty Ford Center in Rancho Mirage, Calif., patients are prohibited from receiving phone calls for their first five days of treatment, cannot keep any medications they might have-not even vitamins or mouthwash-and are assigned chores: Elizabeth Taylor hauled garbage and hosed down the patio. At the Smithers Center for Alcoholism and Drug Treatment in New York City, where New York Mets pitching ace Dwight Gooden spent the last four weeks, residents trying to kick the habit go through a program that harkens back to grammar school: they meticulously copy out statements, such as a list of definitions of sobriety, and attend lectures. But when patients complete the standard one month of in-house treatment at a rehabilitation clinic, they are only beginning what may be the most critical part of their recovery: after-care.

Even doctors and psychologists who debate the merits of various treatment programs agree on one thing: a few days or weeks spent in an alcohol-or drug treatment center is not enough to wean patients from their dependency. Some 80 percent of addicts, be they drinkers or drug abusers, fall off the wagon at least once, says Dr. Thomas Kosten of the Substance Abuse Treatment Unit at Yale University. And short "detox programs" have, he says "a failure rate of 90 to 100 percent within a couple of months." For that reason, every reputable rehab center provides its patients with an aftercare program to follow after release. Though the requirements vary, they generally include weekly follow-up visits to the clinic for meetings to talk about learning to live sober.

But a primary goal of many after-care programs is to get patients into Alcoholics Anonymous or a similar support group that uses AA’s 12 steps. "Meetings are your lifeline," says Betty Ford. The clinics urge patients to attend 90 AA meetings in their first 90 days back home and, after that, to attend regularly or whenever they feel the need-for the rest of their lives. Sometimes, just going to a meeting to help others will keep an addict on the wagon. Mrs. Ford, for instance, regularly works with patients.

One relapse-prevention strategy recognizes that old environments can trigger old habits. Ex-patients encounter "cues" that can prompt them to reach for the bottle or the white powder once again. The cue might be a friend who uses cocaine or a party at which many people are drinking. Clinics therefore teach patients to identify such cues and deal with them-to quickly leave the party, for instance, or find new, non-coke-snorting friends.

Most centers have patients return for counseling after release. Graduates of Smithers usually return two or three times a week at first, then once a week for about two years, says associate director Dr. Allan Lans. Gooden, who tested positive for cocaine use late in spring training, is expected to receive psychiatric counseling up to three times a week. One reason for mandated follow-ups is that patients who’ve grown accustomed to leading disciplined lives at the treatment centers are more likely to suffer a relapse when they have all day to themselves. Sports stars whose youth and huge financial resources make it extra hard for them to recover might especially benefit from the continued scrutiny. Some clinics also offer after-care sessions for family members of patients, partly because domestic problems that may have triggered a coke habit will not necessarily have disappeared during the patient’s stay.

Minor Slips: Despite the best after-care, some relapses are bound to occur. The riskiest period is the first 90 days after discharge. But after-care can keep a minor slip from becoming a renewed addiction. The Veterans Hospital in Seattle found that 70 percent of patients who completed its nine-month after-care program maintained complete abstinence or had only an isolated relapse during that period; 80 percent of those who dropped out of after-care had serious relapses. Certainly there is no sure-fire cure for the estimated 17.9 million alcohol abusers and 5.8 million cocaine users in the United States. But after-care seems to be the best way to keep them on the road to recovery.

Sharon Begley with Mark Miller in Washington, Michael Reese in Los Angeles and Karen Springen in New York

Source: Newsweek©, May 11, 1987


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