Module 3: Treatment Strategies

5D. Differing Views of Relapse

Collaboration among mental health, substance abuse, and criminal justice staff is particularly strained when the juvenile offender with co-occurring disorders relapses back into substance use or mental illness. This is partly due to the differing views of relapse held by each of the three systems (Griffin, Hills, & Peters, 1996).

The following are common views of relapse among professionals in the substance abuse, mental health, and juvenile justice systems:

• Juvenile justice: Relapse is a violation of the law or conditions of supervision
• Substance abuse: Relapse is a predictable step in recovery
• Mental health: Relapse is a gateway to worsening of mental health disorder

Perception of Relapse in the Juvenile Justice System

Many juvenile justice supervision systems and some mental health or substance abuse systems are set up to reinforce the idea of relapse as "recidivism." For example, one positive urine drug test may be considered a violation of probation, in which case, relapse equals recidivism. This zero tolerance for substance use is not a realistic expectation of treatment for adolescent offenders with co-occurring disorders. It is important to recognize that reduction of substance use and increasingly longer periods of sobriety are also legitimate treatment outcomes.

Relapse in the Mental Health and Substance Abuse Treatment Systems

Relapse is a characteristic feature of mental illness and substance abuse that is anticipated; thus, relapse prevention must be addressed in treatment and in supervision plans. It is critical that the treatment/supervision plan for youth in the juvenile justice system includes clear consequences when relapse occurs. For instance, the treatment provider can address relapse and its consequences with prompt, increased program opportunities. Requiring an extra hour of counseling or support group participation may not seem like much of a consequence, but for an adolescent offender, it means extra control and less freedom. A longer stay in mental health or substance abuse treatment may also be an option if this is driven by treatment needs and not punishment.

Relapse Seen as Time for Continued Collaboration and Reevaluation for Youth with Co-occurring Disorders

If youth with co-occurring disorders relapse and engage in inappropriate or illegal behavior, it is a good time to reevaluate the following conditions in a collaborative manner:

• Mental status and medication needs
• Strengths and weaknesses of the relapse and treatment management plans
• The youth’s current exposure to high-risk situations
• Any positive steps the youth took in response to the relapse, such as promptly seeking help, avoiding criminal behavior, or decreasing the severity of the relapse

Substance abuse, mental health, and juvenile justice staff should support consequences along the treatment continuum so that relapse is not punished as if it were an additional criminal offense. Defining and explaining the steps in the recovery process are important parts of educating everyone involved with youth who have co-occurring disorders. This helps staff from all systems understand the types of problems faced by youth on the road to recovery and about realistic expectations at various stages of treatment. See Responding to Problems in Complying with Treatment for suggested ways to respond to youth.

It is important to note the distinction between the terms management and cure. In both severe mental illness and substance abuse, treatment providers work toward effective management of disorders rather than unrealistic expectations of a cure. Management strategies are intended to keep youth with co-occurring disorders in contact with the treatment systems over a long period of time. For more information on management strategies, see Management Strategies/Treatment Engagement.