Rethinking Return to Use: New SUD Resources


Like most things in life, recovery is never a simple, straightforward process.

While science suggests that addiction is a chronic illness, much of our thinking — and even the system designed to provide treatment and recovery support — is geared to provide episodic acute care. On March 19, the National Council for Mental Wellbeing published two important new papers: Demystifying Relapse: A Recurrence of Symptoms and Demystifying Relapse: Rethinking Return to Treatment are intended to help people throughout the field of substance use treatment and care reexamine what we do and how we do it.

It’s important to consider the context in which we’ve written and released these new papers. More than 1 in 6 Americans had a substance use disorder in 2022, according to the National Survey on Drug Use and Health released last November. In real numbers: About 27 million people had a drug use disorder. About 6 million of those had an opioid use disorder. Another 30 million had an alcohol use disorder.

In addition, new data released by the Centers for Disease Control and Prevention in March found that nearly 108,000 people died of an overdose in 2022, highlighting the need for improved intervention strategies.

The Demystifying Relapse papers seek to shift the conversation around substance use recurrence and treatment, urging a reevaluation of our views of people who use alcohol and other drugs, the nature of substance use and the barriers to recovery. By embracing these perspectives, we can refine approaches and develop effective strategies to support those on their journey to recovery.

People can and do recover, and we must remember addiction is a disease. It’s a chronic condition. Like other chronic conditions — asthma or diabetes, for instance — the goal for treatment and recovery supports should be progress, not perfection. This is especially true when we remember that a return of symptoms is common among chronic conditions.

While it’s commonly accepted that an individual who has been diagnosed with a substance use disorder (SUD) is in “remission” when none of the criteria for the disorder have been met for at least 90 days, the term “relapse” is often misapplied to instances of return to use within this period. A return to use within the first 90 days doesn’t signify a failure of recovery; it indicates that the person is still experiencing the same episode of their disorder and has not yet achieved remission.

Broader acceptance of the perspective that substance use disorder treatment requires ongoing, long-term care is an important step. It’s an acknowledgement that individuals need sustained support for their recovery. This approach might include continuous patient monitoring, primary care involvement and a reevaluation of rigid payer-driven systems that often fail to quickly reengage individuals with services during or after recurrence.

Furthermore, we need to do more to expand the availability of medications for addiction treatment, such as buprenorphine, methadone and suboxone, and provide person-centered care to facilitate stable, long-term recovery. We now have the opportunity to integrate harm reduction approaches, such as use of the overdose reversal drug naloxone, into recurrence prevention strategies and use emerging technologies that enhance patient reengagement and monitoring strategies like never before.

Reevaluating our beliefs about and approaches to recurrence is essential to save lives. It’s crucial that we, as a field, continue to explore fresh perspectives and innovative strategies that acknowledge recovery not as a single event, but a journey with multiple steps and potential setbacks.

Please check out our new resources DEMYSTIFYING RELAPSE: A Recurrence of Symptoms and DEMYSTIFYING RELAPSE: Rethinking Return to Treatment and share your thoughts on treatment and recovery supports. Are there other opportunities to improve substance use treatment and care? What are we missing?

And join the authors for a panel discussion during NatCon24 in St. Louis. Demystifying Relapse: Rethinking Substance Use Recurrence and Treatment will take place Wednesday, April 17, 10:30-11:30 a.m. CT.


Charles Ingoglia, MSW
(he/him/his) President and CEO
National Council for Mental Wellbeing
See bio