Recovery policies don’t fail because people don’t want to change; they fail because they’re designed for an idealized version of patients that simply doesn’t exist. Policies are built in committee rooms, around rational decision-making, clear consequences, and personal responsibility. However, the people who need recovery are rarely calm, regulated, or capable of behaving like their best selves; they’re often overwhelmed and operating in survival mode. When policy ignores human behavior, good intentions at the top can unintentionally create harm at the front door.
I am a Performance Coach and Operations Consultant at Victory Recovery Partners in New York, with a focus on organizational systems and behavioral health. My work in this space is informed by my own experience in recovery.
The Hidden Assumption: Rational Actor Fallacy
Many recovery policies are built on the assumption that individuals’ behaviors follow from information; that if they state clear consequences and attach incentives for adherence, people will always act in their best interest. However, this operates on the assumption that patients are always rational and make decisions based on logical reasoning, self-interest, and cost-benefit analysis. The issue is that many individuals in recovery are not well-regulated and experience constant threat, preventing them from acting in their best interest despite being informed of consequences and incentives. This is particularly important given that trauma is extremely common among people seeking treatment; a study in The British Psychological Society suggests that around three-quarters of people with substance use difficulties have experienced trauma. It is paramount that policy-makers recognize that safety precedes change and that compliance has little to do with willpower. When one does not feel safe, the ability to learn, plan, trust, and commit narrows, making little else possible until the sense of threat eases.
Using this lens, we can see that a great deal of what gets labeled as ‘non-compliance’ is better understood as a natural response of the nervous system doing what it was designed to do under stress. Policies that fail to account for this are built exclusively to support a highly-regulated person who, in early recovery, rarely exists.
When Missed Appointments Trigger a Sanction Instead of Support
Most recovery programs have strict attendance requirements, with individuals being discharged for non-compliance after missing appointments. This may seem reasonable to policy-makers, but in practice leads to people being turned away from the services they desperately need. Taking into account human behavior, avoidance is one of the most predictable features in early recovery, but it is not a reliable measure of one’s desire to recover. Shame, fear and a dysregulated nervous system make the act of showing up far harder than policy assumes; what looks like indifference at a policy level is actually one of the symptoms programs exist to treat.
The predictable drop-off of participation that occurs as a result is used as proof that the individual wasn’t ready, when in reality, the policy created a closed loop in which it produced the very disengagement it is now punishing.
The Relapse-and-Discharge Rule
One of the clearest examples of recovery policies failing due to ignoring human behavior is the relapse-and-discharge rule, where an individual returns to using and ends their enrollment in the program. The logic behind this is that the program maintains standards, yet the consequence is removing someone from care at the exact moment their risk is highest. Especially considering that the National Institute on Drug Abuse states that relapse rates for substance use disorders are common, with 40-60% of people relapsing at some point during recovery.
This highlights the disconnect between policymakers and the individuals the policies are meant to serve, and underneath lies the assumption that abstinence should be a precondition for treatment rather than one of its goals. But for someone in recovery still learning to regulate, a slip-up should not be viewed as a failure of the program, but rather as a very predictable occurrence that we should expect to occur.
Compliance Milestones That Discriminate Against People Who Need Care Most
Many recovery policies set compliance milestones, including eligibility and continuation criteria that patients must satisfy to stay enrolled in the program. Policy makers often include these to filter out ‘unstable’ participants, without considering that the people these services were created for are often quite unstable, especially in early recovery. An unfortunate result is that those involved in the legal system, unhoused, or managing multiple conditions at once, are among the first to fall through the cracks.
It also shifts recovery programs into a self-serving, rather than patient-centered, approach; by filtering out ‘high-risk’ individuals, programs tend to consist more of individuals most likely to succeed. Then, programs can use strong outcomes as evidence that their model works, despite these policies measuring with their own selection bias and labeling it as success.
What Behavior-Led Policy Looks Like
The solution is to develop recovery policies built around human behavior; ones that meet people where they are and help move them forward without bias or prejudice. Rather than punish behaviors we’ve reasonably come to expect, policies should strive to keep those individuals in recovery programs despite predictable setbacks.
There are several changes policy makers can make to improve the chances of positive patient outcomes. First, nervous system regulation should be prioritized ahead of expectations; policies should recognize that safety must be established before expecting accountability. Programs that offer predictability, warmth, and low-stakes early wins instead of sanctions for non-compliance reduce the likelihood of program failure.
Second, policies can lower the friction individuals experience when participating. Every avoidable barrier between a person and their next appointment, like tedious paperwork, shame, or a confusing intake process, is a touch point at which someone can be lost. Policies that reduce these barriers, especially in early recovery, improve individuals’ likelihood of continuing in the program to the best of their ability, according to CSAT’s Office of Evaluation, Scientific Analysis, and Synthesis.
Third, accountability should be eased into rather than led with. Consequences have their place, but only work when enough safety and stability exist for them to be meaningful. When consequences are applied too early in recovery, they increase the threat response rather than help the individual.
Lastly, programs should measure engagement instead of just attendance; attendance only informs providers whether the individual was present, whereas engagement is a higher predictor of recovery.
For example, Victory Recovery Partners has designed care to be frictionless and fast, as early support leads to better outcomes. Individuals are typically seen within 24–48 hours of first contact, and a plan is immediately developed, with urgent cases receiving intervention in their first appointment.
When a patient misses an appointment, a system known internally as the “Leaky Bucket” prompts the team to keep reaching out to try and establish contact with the patient, and if a patient relapses, it does not trigger a discharge. Instead, a harm-reduction approach is used rather than demanding abstinence. As well, the gates to accessing services are deliberately kept open for individuals who would otherwise be rejected or discharged from other recovery programs. Access remains open to individuals who are often excluded elsewhere, including justice-involved populations and those using Medicaid or sliding-scale payment options. The result is a set of policies that increase a patient’s likelihood of recovery.
Recovery Is a Change of State, Not an Act of Will
A human behavior perspective helps make sense of why so many recovery policies fail to serve the very people they were intended to help. In the work I do, I describe four states people move through not only in recovery but in life: Drifter, Dreamer, Achiever, and Performer.
Many people enter treatment in Drifter Mode; their system has pulled the shutters down to conserve energy for survival, and they’re simply getting through each day without the ability to plan for the future. Others arrive in Dreamer Mode; they want to change and they dream of how much their life could change after recovery, but cannot yet sustain the behaviors to produce it. Then we have those in Achiever Mode who take action, but often through a white-knuckling effort that is unsustainable. Only those in the final mode, Performer Mode, can show up reliably, tolerate accountability, and self-correct without swinging too hard in one direction.
The mismatch at the heart of so many failed policies is that they’re created almost entirely for people in Performer Mode; they demand that someone who is completely dysregulated behave like their most regulated self, and when they cannot, it’s labeled as ‘non-compliance’. Recovery should be viewed by policies as the act of learning to move through these states, with setbacks and periods of instability. Individuals do not arrive in recovery as a Performer; they become one, and policies that don’t recognize that end up punishing people for not finishing their journey before they’ve had the opportunity to embark on it.
Where Good Policy Begins
Behavior-led policy means designing policies for the person actually standing at the front door, rather than an idealized version of them; when they account for how people behave under stress, rather than how we wish they would behave, compliance and compassion can work together rather than against one another.
The question that should anchor every recovery policy is the one we began with: “How can we build policies that create the highest chance of success for the people we are serving?” Until that question drives policy, good intentions at the top will continue to produce harm at the front door.
Hannah Power is a Consultant People and Operations Lead at Victory Recovery Partners. For more information, email [email protected] or visit victoryrp.com.
