What do you do when patients are relapsing?
We consider relapse a part of the recovery process; we know that most patients take at least 3 months after starting the program to start doing well. We remind patients that relapse is part of recovery and honesty is highly valued; they must be honest with themselves and with us to fully embrace recovery and for our team and other patients to support them. We cannot help them if we do not know what’s going on.
Relapse can be an important learning opportunity. It is valuable to engage in a brief discussion with the patient about the precise circumstances of the relapse. When did it occur? Where did it occur? What was the patient thinking and feeling just before the relapse? What positive and negative effects resulted from the use of the drug(s)? If the patient used opioids and felt them, strong consideration should be given to increase in buprenorphine dosage. If the patient is helped to understand the circumstances and experiences that led to the relapse, the patient can use this information to be prepared and prevent a similar relapse in the future.
If patients relapse and relapse over and over, then we are clearly not helping them and they might need more support. We will then work with them to enhance their support, through such strategies as:
- Referral to higher level of care (inpatient or intensive outpatient) and once they graduate and are doing better, they can come back to our group
- Encourage attendance at 12 step programs (AA, NA) a certain number of days/week
- Encourage getting regular therapist and seeing frequently
Do you worry about the “ruckus” that “these patients” might cause, for example in the waiting room? Do you have security around?
Despite the many misconceptions about “these patients” with addiction who enter into recovery, our patients are seeking help and are generally very motivated, engaged, appreciative, and grateful. They also know that if they don’t behave they will not be welcomed into group.
That being said, to minimize disruption to clinic during the time our group patient check-in at the front desk, we recommend having a separate line for group check-in or a separate space entirely (we use a computer-on-wheels to check in patients near the group room). It is helpful to have designated front desk staff who are part of your GBOT model so that they can respond to any GBOT patient needs/request appropriately without creating confusion at the front desk. It is also advisable to have security around and available, but our experience has been, again, that this group is generally VERY well behaved and creates minimal ruckus.
