Education & Skills Training in Alcoholism Aftercare

When a person receives medically sound and evidence-based treatment to overcome alcohol use disorder (AUD), they are given the tools to achieve sobriety and become healthy. Following structured treatment, access to recovery and aftercare support to aid abstinence from alcohol is important, especially for those who have struggled with AUD for several months or years.

As medical researchers develop a better understanding of addiction, and how it affects the brain and behavior on a long-term basis, more robust aftercare options are being developed and used. The National Institute on Drug Abuse (NIDA) lists 13 Principles of Drug Addiction Treatment, which are based on research and studies into the best treatment options. Among those principles, NIDA notes that no single specific course of treatment is appropriate for everyone, and that a person’s treatment plan must be continually assessed and modified when necessary. These principles apply to the entire course of addiction recovery, from detox to recovery support years down the road.

Importance of Skills Training & Education during Recovery

Generally, education and skills training for those just out of rehabilitation, or at the end of their rehabilitation program, can help individuals continue their focus on overcoming AUD. There are several approaches to education and skills training, and a person recovering from alcohol abuse may engage in multiple types of training, depending on their needs.

Education and skills training focuses on three foundational skillsets:

• Coping skills
• Social skills
• Communication skills

People recovering from alcohol abuse and dependence are especially vulnerable to social isolation, traumatic and abusive relationships, struggles with self-confidence, and low self-esteem. These patterns increase the risk of relapsing back into alcohol abuse because of the intense mental and emotional stress they cause. However, if a person receives training to manage cravings, stress, and triggers as part of their long-term recovery plan, they will be better equipped to avoid relapse into problem drinking.

Relapse Prevention Education (RP)

Specific approaches to skills training and education can help clinicians provide the best possible options for those recovering from alcohol use disorder.

The Relapse Prevention model was developed in 1985, based on socio-cognitive psychology approaches to mental and behavioral health. The goal is, as the name suggests, to prevent or limit episodes of relapse among those struggling with alcohol use disorder, dependence, or abuse. The approach involves uncovering and understanding the person’s immediate determinants versus covert antecedents.Immediate determinants include:

• Being in high-risk situations
• Low ability to cope with stress
• The abstinence violation effect

Covert antecedents include:

• Urges
• Cravings
• Lifestyle imbalances that add to stress

Using a cognitive-behavioral model of therapy, RP focuses on high-risk situations as the main cause of relapse. Being in a high-risk situation, without RP, leads to an ineffective coping response to the stress; decreased self-efficacy to control urges; a lapse with an initial use of alcohol; perception of positive effects of alcohol, along with guilt for drinking, leading to the abstinence violation effect; and increased probably of ongoing drinking, leading into a full relapse. However, with training through RP, the person will have an effective coping mechanism to manage the stress of the high-risk situation, leading to increased self-efficacy dealing with stress and cravings, and lowering the risk of relapse due to triggers.

Coping Skills Training (CST)

Similar to RP but with a more specific focus, Coping Skills Training approaches the high-risk situation – such as a party where alcohol is served – and trains the person in specific strategies to avoid alcohol. For example, if the person is offered a social drink, it’s important to learn how to politely decline without experiencing shame from saying “no.” People who apply the specific skills to high-risk situations after practicing these with a therapist or addiction specialist will become more self-effective; people who do not receive specific skills training during or after rehabilitation are more likely to relapse in the first six months after leaving their rehabilitation program because they have a much lower stress threshold. CST works well for those who have co-occurring mental health conditions that make stress levels harder for them to manage, especially those with psychotic disorders or abnormal neurological states.In addition to RP, CST can train one to better communicate needs or boundaries in family or social settings; coping skills to deal with urges or cravings (which overlaps with cue-exposure treatment); and cognitive-behavioral management techniques for specific, high-intensity emotions.

Cue-Exposure Treatment (CET)

This version of skills training and education focuses on potential cues in a person’s environment that may contribute to relapse. These cues may include the sight of an alcoholic beverage, specific moods that are associated with drinking, places where the person drank, or friends who were involved in drinking activities. Being around these cues can trigger cravings and compulsive behaviors to get alcohol and drink it. However, by exposing the person to these cues in a safe environment, discussing the reaction, and training the person in coping mechanisms for these cues, the individual will be better prepared to re-enter life and deal with these cues. Not all cues can be avoided, so it is important to understand which events or objects may be triggers, and practice dealing with them. CET methods have included consuming alcohol in very specific quantities: for example, in one scenario, those in CET sniffed a small serving of bourbon, then sipped it, while very slowly decreasing the amount of time between sips. Because this occurred in a controlled environment, reactions to the process could be safely monitored and discussed, and the therapist could work with their client to develop coping mechanisms while they were around alcohol. Abstinence-based approaches to this form of exposure therapy can also work, especially for those new to recovery. Thinking about or “acting out” drinking alcohol, by picking up a wine glass and drinking water out of it, for example, can trigger specific emotions and stresses in the brain, which can then be discussed in the therapy session.CET requires a thorough assessment of the client’s mental and emotional state, including how they react to specific cues. CET may not be appropriate at certain stages of recovery.

Training in specific coping, communication, and social skills is important when a person is recovering from substance abuse. Their former behavioral responses to alcohol put them in a physically risky situation, and led them to addiction and dependence. Learning specific approaches to managing stress will help the person gain self-confidence in their ability to maintain abstinence.