Standards on Substance Abuse: Standard XIII. Relapse

Standard XIII

Every court should implement strategies to prevent relapse of a substance abuser who is in recovery and be prepared to address relapse. The strategies should include a plan for imposing graduated sanctions or consequences. The court should inform every party that relapse will have consequences.

Commentary

Relapse is a stalling or slowing of a person's recovery process, when a person's unmet needs lead to stress and recovery difficulties. Relapse is not an event, but a process, in which the stress keeps building and the person becomes increasingly isolated, confused, and overwhelmed. Without an intervention, the person will often return to substance abuse. Often a relapse means that a person has reached an impasse in his or her recovery, sometimes called a "stuck point." The processes of relapse and recovery are intimately related to one another. The process of relapse can be interrupted by making a needed intervention, such as the responses noted below, which may resolve the person's recovery problems.

Relapse prevention techniques can provide people with an understanding of their own relapse warning signs, so that they will know when their recovery is in trouble and that they need to address their problems immediately.

Recovery is a lengthy process, and substance abuse cannot be "cured" any more than other chronic disease, such as diabetes, hypertension, or asthma, can be cured. ⁽⁷⁾ People can, however, be taught to manage their substance abuse by remaining abstinent and following recovery principles. It is just as important to understand relapse and to support behavior change as it is to enforce treatment conditions vigilantly and supervise people closely. See Commentary to Standard XIV, sixth paragraph, for the suggestion that courts should refer parties only to treatment providers which offer comprehensive relapse prevention services.

It is of vital importance that courts understand relapse, anticipate relapse, be prepared to deal with it, and respond to it promptly. The appropriate response to a relapse must be fashioned based on each person's individual needs, history of substance abuse, and previously utilized treatment modalities. Graduated responses are generally appropriate, including ordering or increasing drug testing, increasing frequency of attendance at outpatient or day treatment services or recovery meetings, increased supervision, and ordering in-patient detoxification or residential placement. In some cases, an offender's behavior or uncooperative attitude will present such a clear or immediate threat to public safety that probation revocation and incarceration are the only appropriate responses.

7. See McClellan et al., Is Drug Dependence a Treatable Illness, op. cit., p.26 - 31.