An Aftercare Planning Checklist

You are about to leave, and you are afraid the plan is a speech you will not remember at 9 p.m. The overview of aftercare is a different page. That guide explains SAMHSA's continuum: people enter at a level that fits and move to more or less intensive care as needs change. What you want tonight is the paper. TIP 47, the intensive outpatient protocol, says continuing-care planning is a central task for staff, including when the next program is in another building. It also says the later community-support stage rests on a detailed and individualized discharge plan that uses resources that are actually available. Federal sources still do not publish one national form. The questions below are the set those sources give you. Write the answers.

If the night you leave brings an overdose, very slow or stopped breathing, a seizure, or someone who will not wake, call 911. For a mental health crisis, call or text 988.

Indications in a protocol, not a law you fail at home

TIP 47 describes stages inside intensive outpatient care. One exhibit lists clinical indications that can support a move from the early-recovery stage to the next level. The items include sustained abstinence for 30 days or longer, completed goals from the treatment plan, a relapse-prevention and continuing-care plan that has been created and put into use, regular participation in a support group, a sober social support network, stable drug-free housing, and medical, psychiatric, housing, or peer situations that could trigger relapse having been addressed.

Read that list as the protocol's indications for a transition inside intensive outpatient care. A clinician can discharge someone on a different clock because withdrawal risk, a court date, insurance, or a bed somewhere else changed the plan. You cannot grade yourself against the 30-day line at the kitchen table. If you are in danger tonight, the count is irrelevant. Use emergency help.

A later exhibit, for the maintenance stage, repeats some of the same themes before a move into continuing community care: abstinence of 30 days or longer as an indication, improved relationships, better coping and problem-solving, drug-free stable housing, continued support-group participation, and ongoing help with other problems if they are still there. Again, these are indications for a clinical transition. They are not a scoreboard.

What the community-support plan is supposed to name

Stage 4 in TIP 47 is community support. The duration the exhibit prints is years, ongoing. The completion line is blunt: clients may need community support for the rest of their lives to remain abstinent or to recover from relapses. There is no graduation box.

The goals named for that stage are to maintain abstinence, maintain a healthy lifestyle, develop independence from the treatment program, keep social connections, connect with support groups, pursue healthy community activities, and establish recreation and new interests. Independence from the program is one goal. It is not independence from all care. The exhibit still has the person obtaining medical or psychotherapeutic help as needed and continuing pharmacotherapy as needed.

Counselor activities in the same exhibit are the closest thing to a checklist the protocol prints. Confirm each one as a name, a date, or a written "not needed," rather than as a slogan.

The plan itself should be realistic, comprehensive, and individual. You should have helped build the transition early, not on the driveway. TIP 47 says an individual transition plan links the current provider to the next one. Written consent comes before clinical papers move. Responsibility for your care should transfer clearly before the first provider steps back. If nobody can say who is responsible on Tuesday, the transfer has not happened.

Local resources, named specifically, should cover how you will sustain abstinence, whether you will keep participating in a 12-step or other mutual-help group, who provides medical or therapy care, whether a medicine continues and who prescribes it, whether school or job training is part of the plan, how you will look for work if work is a goal, who is in the support network, how you will manage stress, and what you will do if use returns. "Enjoy abstinence" is also on the exhibit. It is not a promise that enjoyment arrives on day one.

NIDA's principles guide says the same handoff in fewer words for residential care. After a residential stay, people should remain in outpatient treatment, an aftercare program, or both, because that follow-up helps reduce the risk of relapse once the 24-hour setting is gone. "Help reduce the risk" is not a guarantee. The next setting is often the IOP and PHP guide. Extra contact some programs offer is the alumni guide. An alumni picnic does not replace the appointment on the list.

Needs that are easy to leave off the paper

NIDA's fourth principle says effective treatment attends to multiple needs, not only drug use. The list is medical, psychological, social, vocational, and legal problems. Principle 8 adds that the plan has to be reassessed, and that a person may need medication, medical services, family therapy, parenting instruction, vocational rehabilitation, or social and legal services. A continuing-care approach, with intensity that changes, is what the principle says gives the best results for many patients. If depression, a court date, or no place to sleep is still open, the checklist is unfinished even if a group schedule looks full. The housing comparison is the sober-living guide. It is not a lease.

Medicine gets its own line because a weekend with no prescriber is how a careful plan fails. Write the drug names you already take, the condition each one is for, the next prescriber, and how the first gap is covered. Doses stay with the prescriber. The longer explanation is the medication guide. Do not stop a medicine to make the discharge packet look simpler.

Overdose risk belongs on the same page as the follow-up appointment. NIDA says that using as much of a drug as before a period without it can cause overdose, because the body is no longer adapted to that exposure. Ask whether naloxone was discussed before you left, and read the overdose guide for what to do in the moment. Do not wait out slow breathing.

Five lines to fill in before the last day

1. Next level of care, with the date and time of the first appointment, and the name of the clinician who expects you.
2. Medicines that continue, the prescriber, and what you do if the pharmacy is closed.
3. Where you sleep, and whether that place is part of the plan or only a hope.
4. Who you call if use returns or the appointment is missed, besides emergency help and the crisis line.
5. Which supports are arranged, such as mutual help, family sessions, work help, or medical care, and which were only mentioned.

If the current program does not offer the next setting, search FindTreatment.gov. What those days feel like once the checklist leaves the building with you is the first weeks guide. If use has already started, open the relapse guide next.

SAMHSA's National Helpline, 1-800-662-HELP (4357), is the federal referral line. SmarterRecovery is a referral helpline. SMART Recovery is a separate mutual-help program. Call or text (800) 653-9376 if you want help sorting the next level of care. A clinician writes the clinical plan.

Additional Resources

Sources cited on this page:

• SAMHSA TIP 47, Chapter 3: Intensive outpatient treatment and the continuum of care (NCBI Bookshelf)
• NIDA: Principles of Drug Addiction Treatment, third edition
• NIDA: Treatment and Recovery
• SAMHSA FindTreatment.gov
• SAMHSA National Helpline
• 988 Suicide & Crisis Lifeline

Common Questions