Aftercare course References

References for the clinical and legal claims.

This page lists the primary sources behind specific quantitative or clinical claims in the aftercare course — MAT mortality data, hepatitis C cure rates, FMLA/ADA scope, relapse statistics, and the trauma modalities we name. We list them so you can check our work.

This course is educational, written by recovery coaches. It is not medical, legal, or therapeutic advice and does not replace care from a clinician. For medical questions, talk to your prescriber. In a mental health crisis, call or text 988 (the U.S. Suicide and Crisis Lifeline). For an overdose, call 911.

MAT cuts overdose death by roughly half

Session 6 · "The Body and the Meds."

  • Sordo, L., et al. (2017). Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies. BMJ, 357, j1550. doi:10.1136/bmj.j1550
  • Larochelle, M. R., et al. (2018). Medication for opioid use disorder after nonfatal opioid overdose and association with mortality. Annals of Internal Medicine, 169(3), 137–145. PMID 29913516
  • Santo, T. Jr., et al. (2021). Association of opioid agonist treatment with all-cause mortality and specific causes of death among people with opioid dependence. JAMA Psychiatry, 78(9), 979–993.

Overdose risk after MAT discontinuation

Session 6 · "The Body and the Meds."

  • Williams, A. R., Samples, H., Crystal, S., & Olfson, M. (2020). Acute care, prescription opioid use, and overdose following discontinuation of long-term buprenorphine treatment. American Journal of Psychiatry. PMC7002204
  • Sordo et al. 2017 (cited above) — strongest risk concentrates in the first four weeks after treatment cessation, with persistent elevated risk through subsequent months.

Hepatitis C cured by 8–12 weeks of medication

Session 6 · "The Body and the Meds."

  • AASLD-IDSA. HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C. hcvguidelines.org (rolling updates). Pangenotypic simplified regimens (glecaprevir/pibrentasvir 8 weeks; sofosbuvir/velpatasvir 12 weeks) achieve SVR in >95% of patients.
  • CDC. Universal Hepatitis C Screening Recommendations (2020) — all adults 18–79, and people with IV-drug-use history regardless of age.

Narcan — over-the-counter status and use

Session 9 · "Risk and the Slip."

  • U.S. Food and Drug Administration (March 29, 2023). FDA Approves First Over-the-Counter Naloxone Nasal Spray Product. fda.gov
  • Murphy, S. M., et al. (2024). Naloxone Availability and Cost After Transition to an Over-the-Counter Product. PMID 39058509 — mean out-of-pocket cost dropped from $90.93 to $62.67 after OTC transition; retail list around $45 per two-dose pack.
  • Free distribution programs are state- and program-specific (e.g., NEXT Distro, NaloxoneForAll, state health-department mail-order programs); universal free access is not the norm.

FMLA, ADA, and recovery

Session 7 · "The Life Waiting at Home."

  • U.S. Department of Labor. 29 CFR § 825.119 — Leave for treatment of substance abuse. law.cornell.edu
  • U.S. Department of Justice. The ADA and Opioid Use Disorder. ada.gov
  • EEOC enforcement guidance on the ADA Amendments Act of 2008. "Current illegal drug use" is not protected; recovery and supervised rehabilitation are. Medication for opioid use disorder under a prescriber's supervision (buprenorphine, methadone) is protected and does not count as illegal drug use.

Relapse statistics

Session 1 · "The Investment."

  • McLellan, A. T., Lewis, D. C., O'Brien, C. P., & Kleber, H. D. (2000). Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation. JAMA, 284(13), 1689–1695. — Canonical source for the 40–60% chronic-illness comparison. PMID 11015800
  • Sliedrecht, W., et al. (2019). Alcohol use disorder relapse factors: A systematic review. Psychiatry Research, 278, 97–115. — AUD first-year relapse rates concentrate in the 60–80% range depending on cohort and definition.
  • Smyth, B. P., et al. (2010). Lapse and relapse following inpatient treatment of opiate dependence. Irish Medical Journal — ~91% relapse within one year of detox-only opioid treatment.

Co-occurring disorders in SUD treatment

Session 6 · "The Body and the Meds."

  • SAMHSA. 2022 National Survey on Drug Use and Health (NSDUH). samhsa.gov/data
  • SAMHSA. TIP 42: Substance Use Disorder Treatment for People with Co-Occurring Disorders (2020 update).

Sleep and craving

Sessions 3 and 5.

  • Brower, K. J. (2015). Assessment and treatment of insomnia in adult patients with alcohol use disorders. Alcohol, 49(4), 417–427.
  • Hasler, B. P., Smith, L. J., Cousins, J. C., & Bootzin, R. R. (2012). Circadian rhythms, sleep, and substance abuse. Sleep Medicine Reviews, 16(1), 67–81.
  • Logan, R. W., et al. (2018). Impact of sleep and circadian rhythms on addiction vulnerability in adolescents. Biological Psychiatry.

EMDR, somatic, IFS, and trauma intensives

Session 10 · "Repair, Meaning, and the Long Arc."

  • U.S. Department of Veterans Affairs / Department of Defense (2023). VA/DoD Clinical Practice Guideline for the Management of PTSD and Acute Stress Disorder. EMDR is listed alongside CPT and PE as one of the trauma-focused psychotherapies with strongest evidence for PTSD.
  • World Health Organization (2013). Guidelines for the management of conditions specifically related to stress. Recommends EMDR for PTSD.
  • NICE (UK). PTSD guideline NG116 (2018). Recommends EMDR for adult PTSD outside the first month after non-combat trauma.

Exercise and BDNF

Session 3 · "The Brain in Early Recovery."

  • Cotman, C. W., & Berchtold, N. C. (2002). Exercise: a behavioral intervention to enhance brain health and plasticity. Trends in Neurosciences, 25(6), 295–301.
  • Szuhany, K. L., Bugatti, M., & Otto, M. W. (2015). A meta-analytic review of the effects of exercise on brain-derived neurotrophic factor. Journal of Psychiatric Research, 60, 56–64.

Habit formation timeline

Session 5 · "The Routine."

  • Lally, P., van Jaarsveld, C. H. M., Potts, H. W. W., & Wardle, J. (2010). How are habits formed: Modelling habit formation in the real world. European Journal of Social Psychology, 40(6), 998–1009. — Median time to automaticity 66 days, range 18–254. The "ninety days" figure used in recovery culture is a rule of thumb within this range.

PAWS — clinical description, not a formal diagnosis

Session 3 · "The Brain in Early Recovery."

  • SAMHSA (2010). Protracted Withdrawal. SAMHSA Advisory. — Treats the phenomenon as clinically real but does not give it formal diagnostic standing. PAWS is not in the DSM-5 or ICD-11.
  • Bahji, A., Crockford, D., & el-Guebaly, N. (2022). Management of Post-Acute Alcohol Withdrawal: A Mixed-Studies Scoping Review. PMC9798381 — Found "credible evidence to support the concept" while noting a heterogeneous literature without standardized diagnostic criteria.

If you need help right now

You don't have to wait for the next session.

These lines are free, confidential, and open 24/7 — for you, for your person, or for anyone you love. You don't have to be in the worst moment to call.

Overdose or medical emergency

911

Signs of overdose: slow or stopped breathing, blue or gray lips or fingertips, gurgling, unresponsive. Call 911, give naloxone (Narcan) if you have it, and roll them onto their side. Stay on the line.

Good Samaritan laws protect you when you call for help.

Suicide & Crisis Lifeline

988

Call or text 988 any time you — or someone you love — is in emotional crisis, thinking about suicide, or just can't carry it alone tonight.

Call or text 988 · Chat at 988lifeline.org

SAMHSA National Helpline

1-800-662-HELP

Free, confidential treatment referral and information for individuals and families dealing with substance use. In English and Spanish.

1-800-662-4357 · 24/7 · No insurance needed

Never Use Alone

1-800-484-3731

A person answers, stays on the line while someone uses, and calls for help if they stop responding. No judgment — harm reduction, not intervention.

Share this number with your person, even if it's hard.

Domestic Violence Hotline

1-800-799-7233

Substance use and abuse often overlap. If you're being hurt, threatened, or controlled — physically, emotionally, or financially — trained advocates can help you think through what's next.

Call · Text START to 88788 · Chat at thehotline.org

Naloxone (Narcan)

Get it free

Naloxone reverses opioid overdose. It's available over the counter, and many programs mail it for free. Keep it in your house, your car, your bag — even if you don't think you need it.

nextdistro.org/naloxone · Pharmacies carry it without a prescription.

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