Changing Substance Abuse Relapse Policies

Dr. David Mee-Lee, a leading expert in co-occurring substance abuse and mental disorders, has recommended changing how substance abuse clinicians use the word “relapse.” He published the advice below in two issues of his newsletter, “Tips and Topics.”

“The general public still largely views addiction as a self-inflicted problem,” Mee-Lee said. “There is less tolerance for supporting treatment when compared with physical illness, and even for many mental disorders. What is even worse still is when addiction treatment also embraces policies which appear to view addiction relapse as wilful misconduct, needing consequences and possible discharge.”

Mee-Lee said people with substance abuse problems are often sent away from support groups or sent to crisis services if they have relapsed. In contrast, people with recurring depression, psychosis or diabetes are welcomed by health professionals.

There is no reason to refer people to a crisis service or turn them away from support groups and housing because they have used drugs once, Mee-Lee said. Professionals in the field are using the word “relapse” to reclassify their clients unnecessarily, based on moral judgment.

Mee-Lee quoted a 2012 interview with Bill Miller, the developer of motivational interviewing. ”When you’ve relapsed, it’s pretty clear you’ve done something bad and it’s your own fault,” Miller said. He said the word relapse “takes on very pejorative, shaming overtones.”

In 2009, Mee-Lee wrote in-depth guidelines for changing relapse policies. He recommended psychiatrists approach relapses as occasions to revisit clients’ treatment plans.

Excluding clients from services worsens their conditions. Clients can become homeless because of relapsing while living in treatment facilities. When they become homeless, their health generally becomes worse than it would have been otherwise. Giving them housing would improve their stability and reduce health care costs.

The fact that clients might trigger others in a group by being drunk or high is not a sufficient reason to leave them without services, Mee-Lee said. Clients with anxiety or trauma histories are not excluded from support groups because they might trigger others.

If a client is genuinely committed to getting help, but still brings drugs into the treatment setting occasionally, Mee-Lee believes clinicians should work with the client to improve treatment outcomes rather than putting him or her out on the street. However, if a client is just using a treatment center as a hotel and bringing drugs into the building, that is a different story.

For more information on changing relapse policies, please visit Mee-Lee’s website at http://changecompanies.net/tipsntopics/2009/06/june-2009/#more-807.

2 Comments

  1. This is so much informative and i agree with you

    Wednesday, December 12, 2012 at 11:17 am | Permalink
  2. Enceytec wrote:

    My initial unsardtending of recovery included the expectation that it is difficult to enter and to maintain. However, I did not fully realize the extent to which this is true. Dennis’ evaluation review findings, (that the average person requires 3-4 treatment admissions for 8-9 years to achieve a year of abstinence), struck me as daunting and have certainly shifted my approach to clients who are dealing with a relapse. Rather than seeing this hypothetical client’s relapse as a step backward, this article helped me consider it as a very normal struggle that is not separate from the process of recovery itself. Given this adjustment in my perspective, I imagine beginning with some work around the abstinence violation effect. To help this client, I would want to first explore the extent to which self-blame and perceived loss of control are impacting her own expectation about whether or not she can stop this downward spiral of relapse. My conviction that a return to recovery is possible for her is informed by so many of the readings we have completed this term. Sharing this conviction along with acknowledgement of the difficult road ahead would hopefully help us strengthen our alliance. From here we could begin to look at the circumstances contributing to her current use. We can re-identify risk situations and reiterate the benefits of utilizing other mental health and wraparound services. I would want to focus my interventions to emphasize areas that have been highly predictive of long-term abstinence rates such as: increasing her level of emotional support, teaching cognitive and behavioral coping strategies, and reviewing the psychological components of substance use such as her outcome expectancies. Perhaps most importantly, this week’s readings helped me think about this kind of session with less fear and apprehension and with an increased sense of the work that needs to be done.

    Monday, December 14, 2015 at 11:48 am | Permalink