The Top Twelve Reasons Drug Treatment Fails & The Top 12 Ways to Improve Treatment Outcomes

A woman holding an umbrella floating on a yellow background; that represents breaking free from old limits and rising toward new possibilities because recovery is about more than healing, it’s about thriving.

By Alex Shohet & Bernadine Fried, LMFT, Co-Founders of Red Door Life

REASON 1: DISCONNECTION, ABANDONMENT, PUNISHMENT

Most treatment centers kick out clients who relapse, putting the client at high risk of an overdose, injury, or death. Disconnection is one of the critical causes of overdose and suicide. At their most vulnerable time, clients often are expelled and punished instead of supported with whatever care is possible, keeping inspiration in the picture as well as an easy path to return to treatment open.  

REASON 2: DEALING ONLY WITH THE SURFACE ISSUES

Most treatment centers focus on the client’s substance use instead of underlying trauma and other conditions that drive the addiction. Often, the underlying trauma can be complex and needs multi-dimensional modalities such as cognitive, emotional, positive psychology, developmental/ skills building, somatic, and nervous system-based modalities to heal.  

REASON 3: DISEMPOWERING THE CLIENT 

Most treatment centers focus on compliance rather than providing clients with agency over their recovery. Clinicians exclude the client, meeting behind closed doors, and clients are expected to conform to a one-size-fits-all pre-developed program.

REASON 4: GENERIC CARE PRACTICES 

Most treatment centers treat all clients with the same rules and treatment modalities without differentiating for age, diversity, gender, social determinants, underlying conditions, individualized trauma, family or career obligations, lifestyle preferences, health, and finances.

REASON 5: LACK OF TEAM EFFICIENCY & EFFICACY

Evidence states that the most effective treatment requires a multidisciplinary team of professionals working together. Yet the majority of professionals never have any formal training on working in teams. This leads to poor team communication, overlooked details, finger-pointing, and staff-splitting, all at the expense of the client. 

REASON 6: PREMATURELY ENDING TREATMENT 

Duration in treatment correlates positively with outcomes. Most treatment centers offer programs lasting 30, 60, or 90 days. Yet often this is not enough time for the brain to heal its executive function damaged from substance abuse so that one can regain control of their impulses, mood & behavior. It can often take the brain a year or longer for executive function to heal from substance abuse and/or trauma.  Executive function is the brain's management system— a set of mental skills that include working memory, flexible thinking, impulse control, decision-making, and the ability to self-regulate emotions. We use these skills every day to manage our daily lives, learning, working, focusing on our goals, and making constructive decisions that take into account consequences and our desired future. Most treatment centers are also unable to provide an environment that is engaging enough to encourage clients to stay, where they can continue to be supported in working on their individualized personal development, participate in sober world rediscovery, and develop a sense of purpose.  

REASON 7:  CRISIS RESPONSE INSTEAD OF PREVENTATIVE CARE

The treatment industry in general is geared towards crisis response, rather than a methodology that anticipates and mitigates predictable worsening conditions, creating the best outcomes at the least cost. This approach capitalizes on a client’s crisis instead of pricing services based on efficacy. Stigma and isolation often prevent one from admitting they have a problem and seeking help, and in this state of disconnection, their condition worsens until they are in a state of crisis. The nuclear family is not typically equipped to support a person with a moderate to severe acuity level and only does so in times of crisis, where they have no choice but to pay premium rates.  

REASON 8: TREATMENT LACKS CRITICAL DIMENSION 

Treatment centers rarely provide the necessary resources to help their clients become productive, self-supporting, or find a sense of purpose. Programs tend to focus on sobriety and tools to maintain sobriety while neglecting holistic personal development.

REASON 9: BURNOUT AND BREAKDOWN OF SUPPORT FROM FAMILY, FRIENDS, AND COWORKERS

Recovery rarely happens in isolation; it depends on networks of care. Yet many families and friends arrive at treatment centers already exhausted. They’ve tried for years, pleading, tough love, ultimatums, or waiting for their loved one to “hit bottom.” Over time, these repeated efforts often backfire: relationships fracture, family members blame one another for enabling, or fall into denial, convincing themselves that the problem “isn’t that bad.” Friends and coworkers may give up, step away, or become harsh critics instead of allies. Without a reliable circle of encouragement, accountability, and empathy, clients lose essential sources of motivation and belonging. The absence of authentic, effective support leaves people isolated, and isolation is a breeding ground for relapse.

REASON 10: ONE-SIZE-FITS-ALL APPROACH

Many treatment centers do not provide medication-assisted treatment and believe that abstinence is the only path to positive outcomes. While abstinence is always the goal, the journey may not be linear. Often, clients use multiple substances, and detoxing off certain substances and stabilizing, then getting off others, may improve the overall outcome.

REASON 11:  LACK OF INTEGRATION SUPPORT

Every transition raises a person’s chances of relapse. This includes going from a licensed treatment center to a sober living, or from a sober living to living to your own apartment or home. Often, clients are left on their own to navigate logistics and the complicated feelings that can arise. 

REASON 12: TREATMENT SUDDENLY ENDS 

Most treatment centers do not allow their clinicians to continue treating a client who leaves, discharges, or completes the program. Important bonds form while in treatment when a client shares their most vulnerable aspects with those helping them. Suddenly losing that connection and support can be traumatic and activate attachment wounds. 

The Top Twelve Ways to Improve Treatment Outcomes

 #1 RELAPSE IS PROBABLE, PREPARE FOR IT

When a client goes into treatment, there is a high probability of relapse anytime within the first 18 months. We cannot prevent relaps, bute what we can do is respond quickly when a relapse happens to reduce the chances of injury or death and shorten its duration. Much like a fire drill, the treatment center team and the client need to have a plan on what to do in case of relapse.

#2 RECOVERY IS A TEAM SPORT

Help the person assemble a great support team. Depending on the individual, this can include an advocate (also known as a counselor or case manager), psychiatrist, medical doctor, trauma-informed psychotherapist(s) (perhaps incorporating different modalities), holistic practitioners, life coach, peer support specialist (also known as a sober companion), and other team members as needed. We recommend that the person and the whole team meet regularly to discuss progress, goals, and obstacles and adjust as needed. 

#3 FIND A RECOVERY COMMUNITY

Living in a recovery community or attending meetings and group activities is important for a multitude of reasons including having shared experiences, being inspired by others who overcame similar struggles and are further down the path, being connected to mentors, being of service to others, being surrounded by support soothes the nervous system and aids mental wellbeing, and helps people naturally stay engaged with their recovery lifestyle and on a positive path.

#4 JOIN A FELLOWSHIP

Secular, Religious, 12 Step- it makes little difference as long as the fellowship is made up of people who are sharing the path toward recovery from addiction and/or mental health disorders and working on personal development. The fellowship should be loving, non-judgmental, not financially driven, inclusive, and supportive.

#5 HOW TO EQUIP FAMILIES, FRIENDS, AND COWORKERS WITH TOOLS FOR BETTER OUTCOMES

Family members may have been carrying a heavy load for many years. By the time their loved one gets to treatment, they usually need a break. For some loved ones with milder substance use and mental health conditions one time and treatment and their results are spectacular. For loved ones with moderate to severe conditions, their path to recovery is longer, harder, and more expensive. For the families, friends, and coworkers who care about people with moderate to severe conditions having expereinced guides to help them through is essential. Family education groups, coaching, and structured involvement teach loved ones how to set boundaries without abandoning, how to offer support without enabling, and how to recognize their own burnout. Coworkers and employers can be partners, too, when stigma is reduced and workplace support systems are in place. Healing the relational ecosystem means that clients don’t walk their path alone. When families, friends, and coworkers are equipped with evidence-based tools, they can become stabilizing forces that improves outcomes, reduces the cost, and helps their loverd ones live happier and healthier lives.

#6 BE CAREFUL OF TRANSITIONS

Any change of medication increases the likelihood of relapse. Any change of lodging increases the likelihood of relapse. Any change in relationships increases the likelihood of relapse. Any change in financial condition increases the likelihood of relapse. Any change of schedule increases the likelihood of relapse. Life is full of transitions; they cannot be avoided. When we acknowledge this, we can prepare in advance and provide extra support and connection during any life transition or change. 

#7 ENGAGE THE PERSON RATHER THAN RESTRICT: AUTONOMY & PURPOSE

“Human beings have an innate inner drive to be autonomous, self-determined, and connected. And when that drive is liberated, people achieve more and live richer lives.” (-Daniel H Pink) With an individualized, client-centered approach, clients feel they are part of a collaborative process and invest in their own recovery and personal development, ultimately improving treatment outcomes. 

#8 FOSTER MASTERY

Every human being has gifts. Helping a person align their giftedness to activities will help motivate them to be productive and successful. Asking a person to attempt things too far beyond their skills reduces motivation and affects one’s worth. Setting up skills-related goals and tasks that are slightly challenging but achievable increases esteem and dopamine.  Individuals in early recovery are handicapped- their brain and ability to function cognitively and emotionally regulate can be greatly diminished, and it is critical to reduce expectations and give them time to heal.

#9 FAITH OR HIGHER PURPOSE

In 12 Step Programs, you are encouraged to find a Higher Power, which could be a religious figure or a spiritual belief in the universe or something greater. For people who struggle with the concept of a Higher Power, finding a Higher Purpose is just as effective. People improve their recovery when they develop faith and a sense of purpose.

#10 BE OF SERVICE: HELP OTHERS

By helping others in their recovery, we derive a deeper understanding and commitment to our

own recovery. When we are feeling our worst, we can find simple pleasure in helping someone else who is also struggling. This helps us escape our own dark ruminations and fears. In addition, remember the acronym “P.E.A.,” which stands for People, the Environment, and Animals. By remembering PEA, we see many opportunities to help in a variety of ways. 

#11 GROWTH MINDSET

Mindset is critical on a recovery journey. The journey is not always linear, and there may be many setbacks and unexpected bumps in the road. It is essential to use each of these experiences to learn a valuable lesson and further develop resilience, rather than losing hope and succumbing to self-judgment.  

#12 PASSION & LIFE PURPOSE

People who have had a difficult time in life have powerful stories that they can use to inspire and help others in ways not possible had they not suffered. Connecting to a purpose and beginning to build a life from it inspires a higher level of living- building a gratifying life that fuels passion. These are beneficial and sustainable highs in life that help one stay on the path of recovery.