How do I help someone who can’t seem to stop using? I’ve been working with a client with SMI and SUD for 3 years. When I met him, he had very severe substance use, but over the years I’ve helped him get into various types of SUD treatment and he has had some periods of sobriety. He keeps telling me he wants to be sober, and he does okay for a while and then he slips. He seems to be a chronic relapser, and I don’t know how to help him.

It would help you to understand and apply best practice principles and interventions for integrated treatment to your work with this client. First, it is important to be strength-based.  There is no such thing as a “chronic relapser,” there are only people (like all of us) who are “recurrently successful.” Your client is working hard to address not only one but two chronic relapsing “brain disorders.” When he is abstinent, his addicted brain is still on the other team, and he needs more help than either of you realize to develop the skills he needs to succeed. Further, his trajectory of progress is on target. He is slowly moving through stages of change and your job know is to identify what he does right when he stays sober for a period of time, and help him practice new self-management and asking for help skills to do better in the future, as well as considering if additional interventions like medications could be helpful. For more information, see Implementation Guide: Stage-matched Interventions for Individuals with Serious Mental Illness (SMI) and Co-occurring Substance Use.

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