RELAPSE IS DIFFERENT IN RECOVERY | Behavioral Healthcare Executive Skip to content Skip to navigation


October 1, 2006
| Reprints
Care systems need to avoid the temptation to step in and “make things right”

Relapse, viewed through the lenses of recovery, is framed very differently than it has been in the traditional behavioral health context. In a recovery context, relapse is not seen as a failure that reflects poorly on the person. The person is held accountable, but we also look at system issues that might have contributed to the relapse. This offers an opportunity for the person and the system to partner in reflection, honestly assessing what could have been done to prevent the slippage.

In the recovery context, we all make corrections and commitments to move ahead after a relapse, learning from each other's mistakes. A relapse becomes a learning opportunity for both the person (no longer referred to as a “patient” or “client” in a recovery context) and the system. We ask ourselves, What can we do differently? What can we learn from this relapse that will help us strengthen and improve what we have to offer? How can we improve our results next time?

Focus on the Person

Generally speaking, in a recovery context most problems are best addressed by looking at them from the

person's perspective instead of the system's point of view. Whether the problem is related to a single individual or to an entire system, we look to the people we are serving for guidance. We ask them to describe the solutions they are looking for, and we ask them what we can do to assist them.

This is different from having the people at the top come up with systems and programs, even those based on best-practice guidelines, and put them in place without ever including the voices and concerns of those receiving services. Looking for solutions at the “bottom” takes a great deal of integrity, courage, self-confidence, and maturity because we like to think that we know what's best, and we are used to planning and controlling services for others. In fact, when we aren't operating this way, we even may feel like we are abdicating our responsibilities. But we finally are carrying them out in a way that works best for those we are serving, which in turn gives us better outcomes—a win-win situation!

So when relapse happens, whether it be with someone experiencing mental health issues, substance use issues, or both, the first place to look for guidance is from the person involved. This keeps the ownership of the problem and the solution with the person, and gives him the support he needs to figure out a resolution. We can help by asking, What happened? What can we all learn from the relapse experience? What were the systemic issues that helped or hindered the recovery process? Are we missing something? Do we have big gaps in our approach that are letting people fall out at vulnerable moments? Are we getting in the way of the recovery process by holding onto choices and decisions that really belong to the person?

Don't Lose Momentum

The next most important step in recovering from relapse is to all get back up as soon as we can. Try not to lose the momentum of the successes the person and the system had before the relapse. We all need to hold onto the identity of recovery. The person is a recovering person who had a slip. The system is a recovering system that has an opportunity to learn better approaches.

The last thing any of us needs to do, especially the person trying to recover, is to allow the clutches of shame and guilt to snatch power away. We need all of the power we can muster to restart the recovery process. The person, program, and system need to stay in touch with their strengths and not get caught up in long, disempowering stories about disappointments and failures from the past.

Difficult Changes

If you aren't used to operating from this perspective, you may find it challenging and humbling at first. But trust us. If you are serious about transformation, this is a necessary part of the process. Operating on this level requires constant vigilance to keep from slipping back into a mode of managing that robs others of their rightful place in the planning and decision-making process. It is a challenging and sometimes difficult commitment to keep.

We were reminded of this recently while meeting with some great folks operating drop-in centers. During our conversation they realized that even they have slipped into operating in a fashion that keeps people from moving along the recovery path, because they are making too many of the decisions and calling the shots for the program, instead of encouraging and insisting that people take the lead. So even those who have received services themselves are tempted to step to the helm and make decisions without involving those who use the services.

John's Story

Someone we know recently went headlong into relapse. Our first inclination was to step in and fix things—take his rights away so we could make decisions for him without him having the power to resist or interfere with what we thought was the best plan for him. Thank God we caught ourselves before we completely disempowered him and then blamed him for not cooperating.

We stopped meeting without him being present. We started listening to him, and as we went around the table we began to introduce ourselves as John's friends instead of case manager, doctor, advocate, and so on. It changed the way we did our work. John continued to resist our ideas and had a few of his own.

We followed his lead even though we didn't really appreciate the process. It didn't seem efficient. If we could just make him do what we wanted, he'd get better faster, and we wouldn't have to put as much effort into it. We wouldn't have to sit around and listen to him search for words, thoughts, and a direction that felt right to him. We wouldn't have to share in the agony he was experiencing over the things he had to give up to move forward.