Recovery coaches, counselors, and clinicians all want to be one of the first people a client turns to during a slip or relapse. When a client is struggling, it's ideal to be able to step in when the moment is fresh.
For those of you who are carrying a full caseload: Are you the first to know when a client slips?
Many providers are not able to find out until days or even weeks after a drinking event. A client mentions it in passing during session, or a spouse calls, or the signs were there and nobody put them together in time. It's a hard feeling to find out later, but remember that it has nothing to do with how much you care.
Here’s what helps you find out sooner, and what this article covers:
We talked with Kendall Maloof, LMFT, Clinical Director at Eagle Creek Recovery, about why slips stay hidden and what providers can do to hear about them sooner. Maloof leads therapeutic strategy for people recovering from substance use and co-occurring mental health disorders, and she starts every relapse conversation from the same place.
"My interest lies in knowing what happens when there is a relapse because it is important to understand what role the substance played in the process and what change took place in the environment of the individual to compel him or her to use the substance."
Maloof is a Licensed Marriage and Family Therapist, and in her experience the people at home usually notice before the treatment team does.
"It is significant to point out that some slips can be identified first in the patient's family setting and then in professional treatment because a partner or a family member who accompanies the patient might notice the revival of old habits, changes in communication, and sometimes even unexpected absence," she said. "Each case is unique in its specifics, although there are certain patterns."
By the time a slip comes up in treatment, she said, "family members are already experiencing its consequences."
Bringing family in helps. A meta-analysis summarized by the Recovery Research Institute found that treatment involving significant others led to better substance use outcomes than individual therapy alone, and the benefit lasted up to 18 months. Still, a 2026 survey of addiction care teams found that only 30% of providers regularly include family members in care.
In practice: At intake, ask the client who they would want involved if things get hard, and get that consent in writing. A partner or parent who knows they can call you is one more way a slip reaches you early.
Clients rarely hide a slip because they have given up. Usually they think they can handle it on their own.
"Patients might try to hide the information about their relapse because they believe they can cope with it on their own, taking the problem for an isolated incident," Maloof said. "To do this, patients avoid disclosing the information, saying that it will only make their relapse more tangible."
"The other crucial point that needs to be mentioned is the fact that when an individual chooses not to disclose their slip, this does not necessarily mean that the person is avoiding recovery. Most likely, the person is afraid of the repercussions of their actions."
Shame drives a lot of this. Randles and Tracy found that people newly in recovery who showed more shame while talking about their past drinking were more likely to relapse in the following months, and their relapses were more severe. A 2026 letter in The Primary Care Companion for CNS Disorders points out that shame often shows up sideways: missed appointments, downplaying how much someone drank, or pulling back after a hard conversation.
It also means self-report only gets you part of the way. In a 2020 study in Alcohol and Alcoholism, breathalyzer data contradicted 34% of 28-day self-reports that claimed complete abstinence. Kaplan and Koffarnus found that asking about the past day was much more accurate than asking clients to recall a longer stretch.
In practice: Watch for the indirect signs, like a canceled session or a client who suddenly has very little to say about the weekend. Ask about it gently and ask about the last day or two, since recent recall is the most reliable.
About 137 million Americans live in a federally designated mental health shortage area, and the country is projected to be short roughly 77,050 addiction counselors by 2038, according to Acuity. In a survey cited by HRSA, 93% of behavioral health professionals said they had experienced burnout.
If you see 30 or 40 clients, a week between sessions is a long time. A lot can happen in those days, and you can't be everywhere. Finding out sooner depends on building ways for information to reach you without adding more to your plate.
The fastest way to hear about a slip is for the client to tell you. That depends on trust, and Maloof works on it from day one.
"Trust is one of the first things that we work on. Trust develops when a patient realizes that being honest will not make him/her feel humiliated, but that professionals will treat the situation with curiosity and accountability," she said. "It is necessary to first comprehend the situation, rather than punish for it."
Your reaction to the first disclosure shapes everything after it. "A quick response does not have to be a dramatic response," Maloof said. "If every setback or relapse comes with some form of punishment, the result is that clients come to understand that it is very risky to disclose their substance use. I think a more proportional and collaborative response would suit our case better."
In practice: Have the slip conversation early, while things are going well. Tell the client what will happen if they use and tell you: you will talk it through, figure out what led to it, and adjust the plan together. The PCC authors recommend the same thing, along with treating a relapse as something to learn from.
A slip you hear about the next day is a very different conversation from one you hear about a month later.
"Earlier understanding allows us to consider the series of events while they are still fresh," Maloof said. "In behavioral therapy, for example, a functional analysis or chain analysis of what occurred previously, what the individual may have been feeling, what the person did, what relief/rewards followed the substance use, and what occurred afterward may be considered. We could gain insight into an area where we may need to intervene."
A 2025 review of 58 studies in Alcohol and Alcoholism notes that about 60% of patients aiming for abstinence have a drinking episode within six months of treatment, and that relapse usually starts with a vulnerable stretch followed by a high-risk situation. Catching it in that window gives you a real chance to help. The review also found that breathalyzers have been used successfully in clinical trials, while wearable sensors have barely been tested in treatment settings.
Soberlink is built for that window. Clients test on a set schedule with a professional-grade breathalyzer, facial recognition confirms who is testing, tamper detection flags attempts to get around it, and results reach your dashboard in real time. If a client slips on Tuesday, you can know on Tuesday.
Constantly trying to figure out if a client is telling the truth wears on both of you. Maloof sees objective data as a way out of that.
"First, there may be less of a tendency towards developing the detective relationship that sometimes surrounds the recovery process," she said. "These tools move the self-reporting to objective data with shared factual information."
"That will leave a common point to start with in terms of facts. The clinically valuable questions will remain the following: what happened prior to the use of alcohol? What need was met with alcohol use? What kind of support was absent?"
"Tools can give us the facts, but treatment will understand the person and context."
In a randomized trial that used Soberlink to deliver contingency management remotely, clients who earned incentives for negative tests were abstinent on 85% of days, compared with 38% in the control group. The researchers noted it put little burden on clients or staff.
Some clients hear "monitoring" and feel like they are being watched. Maloof doesn't argue with that.
"I would first acknowledge that reaction instead of convincing the client he was wrong about it. I would then frame monitoring as something that the client could get out of it. Instead of having to prove his stability constantly with words, objective results can show that he is indeed stable. For example, this will remove any doubt from family members, who can see the evidence of his success."
"In the end, it would aid the client in becoming independent. While the clinician remains aware of the situation and is able to intervene if necessary, the client can gain enough confidence from constant success."
Clients tend to feel this too. In a feasibility study of Soberlink in an in-home treatment program, participants found the device easy to use and said it helped their relationships and family life.
In practice: Try something like: "You don't have to keep proving yourself to me or your family with words. Your results will do that for you." It puts the client in charge of the evidence.
You won't catch every slip on your own, and you shouldn't have to. Bring family in early, make it safe to tell you, ask about the last day or two, and use objective data to fill in the days between sessions. When a slip does happen, you will hear about it while you can still do something with it.
If you want to see how Soberlink could work in your practice, book a short demo with the Soberlink team. We will show you how scheduled testing and real-time results can keep you connected to your clients between sessions.
