3 pillars that could make the difference between chaos and coherence in recovery systems

The side of person-centred care we don’t like to see

Leah had been doing well. She trusted her recovery worker, turned up every week, and was beginning to rebuild her routines. Their sessions felt alive, full of energy, humour and small breakthroughs that mattered. It looked like everything recovery was supposed to be - personal, supportive, deeply human.

And then one day, it stopped working. Not because her motivation had gone or her life suddenly fell apart. But because her recovery worker left, and what they had built together went with her. The next person did their best, but the rhythm was gone. The conversations felt thinner, the silences heavier. Leah began to miss appointments. First one, then another. No one else in the team knew about this. By the end of the month, she was gone.

Watching Leah’s recovery unravelling so quickly made me question if we've been asking the wrong question. Instead of "How do we personalise recovery?" should we be asking "How do we build structures that make personalisation possible?"

Because recovery is always personal. But the structure around it doesn't have to be.

The myth that's breaking our field

There's a story we tell ourselves in addiction recovery that goes something like this: standardisation kills a person-centred approach. Structure stifle the personal touch. If we build systems and frameworks and protocols, we'll turn recovery into a factory line where people become cases and workers become robots.

It's a seductive narrative because it feels human. It celebrates the dedication of frontline workers, the uniqueness of each person's journey, the art of therapeutic relationships. And there's truth in it - recovery work is deeply personal and the people doing it often go far beyond what anyone could reasonably expect.

But here's what this narrative misses: when we don't have solid structures, we force people to be heroes. We ask individual workers to bridge gaps that should never exist. We expect personal relationships to compensate for system failures.

We celebrate people working fourteen-hour days to keep services running, as if burning out our workforce is somehow a mark of quality care.

And the cost isn't just to the people we serve. It’s to the people we work with as well.

I think about Leah, but I also think about James, a brilliant service manager who told me a few weeks back that he cannot sleep because he kept seeing the 19-year-old who’d walked into his clinic three times in one week, desperately looking for help, only to disappear with no records, no follow up, no clue as to what might have happened to her.

If you’ve ever carried someone’s name and face home at night and felt that hollow in your chest, wondering if they made it through the weekend when no one called to check, you’ll know exactly what he means.

That weight should never sit only on one pair of shoulders.

You’re not supposed to be the continuity plan.You’re not supposed to be the entire safety net.You’re not supposed to catch everything.

I also think about a service in Birmingham that delivered exceptional outcomes and changed lives for over 30 years. Former clients and colleagues in the sector alike spoke about the place with a kind of reverence. But when commissioners asked them to replicate the model in Manchester, they really struggled to do so.

What had looked like a well-designed system was really a handful of extraordinary people holding it together. They drove up and down the motorway, splitting their time between the two clinics, trying to give their best to both. The Birmingham service started to fray. The Manchester one never found its rhythm. What everyone thought was a great structure turned out to be a few exhausted staff members carrying more than they could hold.

Isn’t creating recovery systems of care too important to let it be this fragile?

What structure actually enables

A while back I’ve consulted for a few months for Sarah, a senior manager who runs addiction services across three boroughs in London. When I first met her team, they were exhausted. Caseloads were crushing, staff turnover was high and too much depended on individuals stretching themselves thin just to keep up. They were serving over 2,000 people a year and it always felt like a fight to hold things together. 18 months later, they were still serving the same number, but it felt completely different. Staff were staying. Clients weren’t disappearing between appointments. More people were completing their plans and reporting they felt safer, more people were answering the follow-up calls than ever before. What mattered the most at the end of our collaboration wasn't the numbers though - it was how she described the impact of the approach we developed.

"Every person who comes through our doors still gets a different journey," she said. "But they all get the same foundation. They know what to expect from us. And because those things are clear, we can focus on what makes each person's recovery unique."

Her service uses now what she calls "reliable pathways, unique steps." Every client receives an evidence-based assessment using the same validated tools. Every worker follows the same care planning framework. Every discharge includes the same safety net of follow-up contacts. We know what we're accountable for delivering, and who’s accountable for each step of their journey.

But within that structure, there's enormous space for individual creativity, therapeutic relationships and personalised approaches. The structure doesn't constrain personalisation - it enables it. Because when workers don’t have to reinvent basic processes, when they're not compensating for inconsistent quality across the service, they can focus on what they do best: building relationships and facilitating recovery.

The difference showed up in their data. Lower staff turnover. Higher client satisfaction. Better long-term outcomes. But it also showed up in something harder to measure: the confidence clients had in the service, regardless of which worker they saw or when they engaged.

The three pillars of an effective recovery structure

What struck me in Sarah’s case was how much stronger her service became once those foundations were in place. But as inspiring as that was, it also left me wondering: why should this be the exception? Why should only a few services have the scaffolding that makes recovery both safe and personal? What would it look like if we built those same foundations into the whole system?

When I think about what a minimum viable structure turn recovery from fragile and fragmented into something strong enough to hold every journey should look like, I keep coming back to three essential elements that create the foundation everything else builds on.

First, we need a shared understanding of what recovery actually means. Not a slogan or a mission statement, but a clear, evidence-based framework that guides how we think about change, what we measure, and how we support people through different stages of their journey. Right now, we have hundreds of definitions of recovery, dozens of competing models and no consensus about what success looks like or how to achieve it.

This isn't just an academic problem. When services define recovery differently, people get confused messages about what they're working toward. When workers operate from different theoretical frameworks, team collaboration suffers. When commissioners fund based on different outcome measures, services optimize for different goals. We need a paradigm, what Thomas Kuhn defined as a shared set of assumptions and practices that allow a field to build knowledge systematically rather than starting from scratch every time.

Second, we need consistent national standards that define what good practice looks like across all addiction services. This means clear treatment guidelines based on current evidence. It means a competency framework that specifies what skills workers need and how to develop them. It means accessible training that doesn't depend on service budgets. And it means ongoing professional development that keeps pace with emerging research and changing needs of our service users.

The absence of these standards creates chaos. A person receiving treatment in Birmingham might get an evidence-based intervention delivered by a qualified professional with ongoing supervision. The same person in Exeter might get well-meaning support from someone with no formal training and no clinical oversight. We wouldn't accept this variation in medical care and we shouldn't accept it in addiction recovery.

Third, we need robust governance frameworks that ensure quality and safety across all providers. This means regulatory standards that apply whether you're a large NHS trust or a small voluntary sector organisation. It means inspection processes that focus on outcomes and impact rather than paperwork. It means accountability mechanisms that identify and address poor practice before people are harmed. And it means transparency that allows people to make informed choices about their care.

Without governance, structure becomes suggestion. Good providers maintain high standards because they choose to, while poor providers cut corners because they can. People receiving support have no reliable way to know what quality looks like or how to advocate for better care when they're not getting it.

Building on solid ground

Here's what happens when these three pillars are in place: services stop competing on ideology or funding and start collaborating on delivering outcomes. Workers stop reinventing wheels and start refining techniques. People seeking recovery stop navigating a maze of conflicting approaches and start choosing from consistently good options.

But most importantly, personalisation becomes possible at scale.

I saw this being possible in developing a partnership between services across Wales and England supporting people affected by gambling harms, that implemented shared assessment tools, common care planning frameworks and coordinated training programs. Individual services maintained their unique approaches - some focused on family therapy, some on acute mental health support, others on outreach support, others on residential rehabilitation. But they all operated from the same foundation of quality and safety.

The result was extraordinary. People could move between services without losing continuity of care. Workers could transfer skills and knowledge across organizations. Commissioners could compare outcomes meaningfully and make evidence-based funding decisions. And clients reported feeling more confident in the system as a whole, even when their individual journeys were very different.

This is what structure enables: not conformity, but coherence; not standardisation, but reliability.

The infrastructure we're missing

When I talk to leaders in our field, the conversation always comes back to resources. "We'd love to implement better structures, but we don't have the funding. We're already stretched too thin. We can barely deliver basic services, let alone invest in system improvements."

I understand this completely. But here's what I've learned from two decades in this work: we can't build our way out of resource constraints by working harder. We can only build our way out by working better. And working better requires the kind of infrastructure that makes excellence achievable for ordinary human beings, not just extraordinary ones.

Think about other fields that have made this transition. Aviation didn't become safe because pilots became more heroic - it became safe because the industry built systematic approaches to training, maintenance and error prevention. Emergency healthcare didn't improve outcomes by relying on the brilliance of a few doctors. It improved them by embedding evidence-based protocols, quality improvement processes and team-based care models.

Our sector needs the same kind of infrastructure revolution. We need shared platforms for training and development. We need common data systems that allow services to learn from each other. We need research and development capacity that turns local innovations into field-wide improvements. We need professional networks that share knowledge and maintain standards.

This infrastructure doesn't currently exist, which means every service tries to build it from scratch. The waste is enormous - hundreds of organizations developing their own training programs, assessment tools, and quality assurance processes, most of which never get tested or refined beyond their original context.

Making the transition

The shift from heroic individualism to structured professionalism doesn't happen overnight. It requires leadership at every level - from frontline workers who insist on proper tools and training, to managers who invest in systems rather than quick fixes, to commissioners who fund long-term capacity building rather than just short-term service delivery.

But it starts with recognizing that the current approach isn't working. When we celebrate workers who burn themselves out covering for system failures, we're not celebrating dedication - we're celebrating the absence of proper infrastructure.

When we praise services that achieve good outcomes despite chaotic environments, we're not praising excellence - we're praising resilience in the face of preventable problems.

The people in our field deserve better. They deserve clear expectations, proper training, adequate supervision, and systems that support rather than hinder their work. The people we serve deserve better too. They deserve consistency, quality, and care that doesn't depend on which worker they happen to encounter or which service they happen to access.

Most importantly, recovery itself deserves better. It deserves to be supported by structures worthy of its importance, frameworks robust enough to handle its complexity, and systems sophisticated enough to honour both its universal principles and its intensely personal nature.

The choice we face

We're at a crossroads in addiction recovery. We can continue building on the heroic model, celebrating individual brilliance while accepting system chaos. We can keep asking people to bridge gaps that shouldn't exist, to compensate for structures that should already be in place, to hold everything together through sheer force of will.

Or we can choose to build something better. Something that enables rather than exhausts our workforce. Something that supports rather than abandons the people we serve. Something that makes personalised recovery possible not because we got lucky with amazing workers, but because we built systems that make amazing work achievable.

The question isn't whether we can afford to build proper infrastructure for addiction recovery.

The question is whether we can afford not to.