2025’s Top Posts – #7 – Relapse and burnout among recovering addiction professionals

Over the next several days, we’ll be sharing 2025’s posts with the most views. Today is #7.

Some of us intend to do occasional reviews of some of William White’s papers. Many of his most important papers are 25 years old, meaning a whole new generation of addiction professionals have entered the workforce since they were published. Further, the volume of his work makes it overwhelming to approach. We will curate and summarize some of his works that made a strong impression on us and contain important information for today’s addiction professionals.

Relapse as a Phenomenon of Staff Burn-Out Among Recovering Substance Abusers by William L. White (1978)

Summary

This paper explores the issue of relapse among recovering counselors in addiction treatment programs. He interviewed 20 people who relapsed while working in the field, identifying organizational factors that may have contributed to their relapse. The paper includes 3 case studies to help illustrate the organizational factors and role stressors.

Key themes include the following:

Staff Burnout as a Systemic Issue:
The paper positions burnout and the risk of relapse not as an individual failure but as an organizational issue that needs systemic intervention. It challenges the notion that relapse results from individual factors, like an “addictive personality,” instead attributing it partly to workplace stress.

Role Stressors Leading to Relapse:
The research identifies ten key role stressors that contribute to burnout and relapse:

Role/Person Mismatch – a discrepancy between an individual’s abilities, stress tolerance, and the demands of their job.
Role Conflict – conflicts between expectations related to different roles the counselor occupies, such as addiction professional vs. client/alumni or AA/NA member or family roles.
Role Integrity – misalignment between personal recovery beliefs and the treatment philosophy of their workplace.
Role Ambiguity – unclear job expectations, leading to anxiety and stress.
Role Feedback – lack of consistent feedback to feel competent and supported, or monitor for burnout.
Role Overload – expectations to handle more responsibilities than they can realistically manage, leading to exhaustion.
Role Boundary Position – placement in high-risk boundary positions, meaning they serve as a bridge between their agency and the community. Boundary management can lead to isolation and emotional strain.
Role Connectedness – social and professional isolation within the workplace, often related to tensions between professional knowledge and experiential knowledge. This can result in microaggressions toward recovering staff.
Role Deprivation – inadequate role meaning, autonomy, or professional growth.
Role Termination – these stressors relate to inadequate exit pathways from addiction professional roles to protect recovery and workplace/community relationships.

Organizational Implications and Recommendations:
The paper argues that if the field continues to employ large numbers of recovering professionals, it has a responsibility to shape policies and supervisory structures that support recovery rather than undermine it. The paper recommends that organizations should:

Improvement in recruitment, orientation, and training of recovering professionals.
Provide stronger supervisory and peer support.
Address systemic stressors that increase the risk of burnout.
Offer structured pathways for staff to seek help without fear of punitive measures.

Relevance for Today’s Addiction Professionals

This paper was published nearly 50 years ago. There’s a lot more awareness of issues like burnout, vicarious trauma, compassion fatigue, and the consequences of chronic stress. While awareness has grown, addressing these issues is still generally not treated as an organizational or systemic responsibility.

Counseling roles are significantly more professionalized today than they were in 1978. While this paper is still relevant to all recovering addiction professionals, it’s particularly salient for the peer recovery workforce that’s emerged over the last few decades.

These roles recruit people based on their recovery status, and their roles are less structured and less professionalized, leaving them highly vulnerable to role stressors like the ones described in the paper.

The emphasis on lived experience coupled with changes in conceptual boundaries of the problems addressed, the pathways used, and recovery raise a lot of potential role stressors:
What lived experience does the system want? My addiction, my trauma, my recovery?
What lived experience is relevant for what problem types? For what pathways?
What are we using my lived experience to achieve? Harm reduction? Recovery? Something else? (If recovery, what does recovery mean?)
Is the work I’m doing what I believed I was hired to do?
Is the work recovery safe? Does it routinely put workers in high-risk situations?

Another potential stressor related to peer training and the changing boundaries of recovery. A person in abstinent recovery will be trained to believe that continuing alcohol and drug use can be compatible with stable recovery. This can introduce misalignment with the peer’s beliefs or lead them toward questioning their own abstinence.

Further, in this context, if that peer does resume alcohol and drug use, who’s to say what constitutes a relapse? Particularly in settings that characterize harm reduction as recovery. This raises challenging questions for the peer, the organization, their colleagues, their clients, and local communities of recovery that interact with these agencies.

Finally, the overdose crisis makes vicarious trauma and complicated grief more relevant than ever before.

Conclusion

This paper, particularly with its case studies and focus on role stressors, would be extremely useful in any treatment or recovery support setting to evaluate potential stressors and consider options for preventing relapse or recovery strain within its workforce.