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.

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