Blending Perspectives and Building Common Ground. Dealing with Setbacks


As has been noted previously, most substance abuse treatment clients will suffer relapses, no matter how great their resolve to stop using alcohol and other drugs.  Unfortunately, however, there are not reliable ways of predicting which clients will be successful.  Relapse does not necessarily indicate treatment failure.  It may instead be an indication that the treatment plan has not adequately addressed important issues, and in addition may present a therapeutic opportunity to teach the client that controlled use of substances is not possible.  Given that most clients will relapse, the questions for service providers become (a) how to prevent relapses to the maximum extent; and (b) how to respond to relapses in order to minimize their duration and consequences for the individual, his or her family, and the community.

While the substance abuse treatment community views relapse as a part of the recovery process, relapse makes it extremely difficult for child welfare professionals to determine whether the client is making appropriate progress in treatment.  Even if progress is recognized, it remains hard to determine accurately whether that progress is sufficient to assure children's safety.  To a child welfare professional, relapse indicates that the client's behavior is likely to be unpredictable and that neglect of children's needs is a significant possibility.

Responses to setbacks may cause tension between service agencies.  A brief relapse may be taken by child welfare officials as evidence of treatment failure, even if the parent makes efforts to assure adequate supervision of children during relapse, for instance by taking children to a relative.  On the other hand, a substance abuse professional is likely to view a brief relapse during which child safety precautions are taken as a significant step forward for a severely addicted client who has not before achieved significant sobriety.  Further, if the relapse is more than brief, child welfare staff are likely to conclude alternative permanency options for the child should be pursued.  Yet foreclosing the possibility of regaining custody may further undermine the client's motivation for treatment.

It is important that steps be taken to keep clients engaged in the treatment process following a relapse.  Child welfare time lines, as discussed above, do not allow for a "hands off" attitude in which treatment providers wait for clients to become "treatment ready."  If clients cannot be made treatment ready quickly, child welfare agencies and courts must expeditiously make alternative permanency decisions for children.  Child welfare and substance abuse treatment staff must become better at utilizing parental concern for children to engage and re-engage families in treatment.

While tensions on these issues are inevitable, there are a number of steps which might be taken by child welfare and substance abuse agencies to build common ground regarding appropriate relapse planning and response.  These include articulating more clearly the demonstrable signs of treatment progress that child welfare agencies and courts can use to inform child welfare decisions; assuring that substance abuse treatment programs and child welfare agencies discuss with clients safety planning for children in the event of relapse; and establishing policies regarding under what circumstances the substance abuse treatment agency should notify the child welfare caseworker of a relapse (assuming a QSOA is in place, the client has provided consent for information exchange, or the situation warrants a formal child protective services report).  Similarly, substance abuse treatment agencies are likely to be more willing to discuss clients' relapses if there is a consistent pattern of child welfare system response they can anticipate.