The difficult and sad truth I’ve learned from 25 years in this profession is that most people who leave addiction and mental health treatment fail to sustain their recovery.
Sometimes it feels easy to blame the client. They didn’t put the work in, they weren’t motivated, they were just buying time. I’ve even seen the family blamed. I believe that, in many cases, the fault lies with the system itself. It’s too easy to blame the client, and it leads to no growth and development of services.
Many treatment centres have high aspirations and hopes for their clients. However too many are secretly undermined by easily addressed issues that turn a successful discharge into a return to symptoms. These are the structural flaws you won’t find in the glossy marketing materials.
If you are a client, a family member, or a professional, understanding these flaws can be a great support when it comes to choosing, or for delivering, effective care.
The unseen killer of treatment is staff burnout. I have many drafts I am working on about burnout in treatment centres. It’s real, it exists. Nobody is immune to it and it has a corrosive impact on treatment outcomes.
Most of the people to enter into careers of helping others do so because of a genuine desire to help and support others. Nobody on the front line does it for money believe me. However often these people are given impossible caseloads, poor working conditions. They have to fight for training, supervision and support. They are expected to give everything.
On top of difficult environment, they have to become of sponge for all the pain and trauma that comes their way. They have to be there for the clients, guide them, listen to them, hold the space. When staff are exhausted, under pressure, and constantly on the clock, they simply cannot be present for clients.
I’ve seen some truly outstanding therapists become cynical and distant, sometimes even stepping away from the profession entirely. This constant revolving door of talent is a catastrophic failure of management and owners of treatment centres. And ultimately clients and their families also pay the price..
The Serious Reality: Burnout quickly becomes clinical failure. Empathy fades. Clients are seen as case files, not as people in crisis. The pressure is all about occupancy and not outcomes. If the management doesn’t properly look after their staff, the staff cannot fully look after the client. It’s as simple, and as damning, as that. If you are an owner of CEO of a treatment centre, then FFS take this seriously. I’ve told so many people over the years, look after your staff, focus on outcomes, then the business will flourish.
The Fix: When choosing a program, ask about staff retention rates and clinical supervision. Check online for reviews from staff, it will give you a flavour of what’s going on in the treatment centre. I understand that platforms like Glassdoor and similar sites have reviews from disgruntled staff but you will still get a sense of how life is for the staff. If there’s a revolving door of therapists or staff, take your loved one elsewhere. A commitment to staff wellbeing is the number one clearest measure of commitment to client wellbeing.
The second mistake is the rigid, one-size-fits-all treatment centre.
I’ll be honest with you, my best work is done with drug users, alcohol users and gamblers. Over the years I have also been asked to work with hard-core anorexics, schizophrenics, people with OCD, bulimics, adolescent mental health, anxiety disorders, bipolar, personality disorders. Pretty much every type of client. I can still connect with people, regardless, but I know where my expertise lies. No matter how diverse the treatment centre, they can’t treatment everything.
The Serious Reality: Recovery is very complex; trauma is not universal. A client with complex trauma, a crippling co-occurring anxiety disorder, and decades of entrenched substance use needs a radically different approach than a young person who is smoking too much weed and not doing their homework on time. When the system tries to shoehorn a unique, complex person into a standardised box then the risk is the underlying issues go unaddressed.
The Fix: Demand individualisation. Look for centres that specialise in co-occurring disorders and trauma-informed care. The ideal question for a family to ask is: “How will my loved one’s daily plan and therapeutic focus differ from the person in the room next door?” If the answer is vague or suggests everyone gets the same six lectures, they’re using The Box.
Here’s a little tip for you. If you are asking to see then schedule, ask for more than one. If they treat anorexia and alcohol use disorder, then ask for a schedule for a typical client with these disorders. If the two schedules are basically the same, then all that is being treated is the symptoms. There is no plan for long-term recovery.
And here’s a tip for treatment centres: know your limits, know where your expertise lies, and don’t become some kind of pop-up for complex different conditions. People are relying on your support. That might mean helping them to find the experts.
Statistically, the biggest killer of long-term sobriety: the transition from the supportive environment of treatment to the chaos of real life.
When we spend weeks building up a client’s toolkit, it is vital we don’t push them out into a raging storm with no map, no support, and no one checking in. The Black Hole is the gap where supervision and accountability instantly vanish. Remember the end of treatment is when the recovery starts. It isn’t a finish line, it’s the starting pistol
The Serious Reality: The risk of relapse is critically high in the first 90 days after discharge. Even the most motivated of clients risk relapse because they walked out of the centre and back into a triggering situation. The stabilisers have been taken off and it becomes too much.
The Fix: Aftercare must be mandatory and robust—a required part of the package. This means documented, concrete plans for the transition back home. The costs should at best be integrated into the overall treatment costs and not a high priced, additional extra - don’t price a client out of aftercare. Educate the family and the client about the importance. Talk about it every week, not just the last days. Integrate regular family meetings into aftercare, and start these meeting before the end of the residential treatment phase.
These are the three quiet killers of treatment outcomes: the Burnout of undervalued staff, the OSFA of generic programming, and the Black Hole of aftercare.
The good news is that things can be done to fix all these challenges. We now have the insight to demand better. If you’re seeking help, use this knowledge to ask the hard questions. If you’re a professional, recognise these as structural failures, not client failures, and commit to fixing them in your own practice.
What is the biggest structural problem you’ve seen sabotage a well-intentioned recovery? Share your thoughts and let’s bring some light to the industry’s darker corners.