Five things I’d do differently if I could start again

New Year has a particular kind of energy when it comes to recovery.

Not the glossy “new me” version. More the quieter, grittier one. The version that knows how many people are walking into January with a head full of promises and a body full of fear. The version that knows how many practitioners are returning to work carrying the same question they carried last year:

How do we make this easier to sustain… for them, and for us?

I’ve helped design and run addiction services long enough to know this: most of what makes a service effective isn’t the programme. It’s the architecture of recovery that we build around the person. The scaffolding that holds when motivation dips, when shame spikes, when life gets loud again.

So, if I could start again, if I could build a service from scratch today, with everything I’ve learned the hard way, these are the five design choices I’d make:

1) I’d design for the day after discharge, not the day of admission

We still build too many services like the main event is the treatment episode.

But the real test is the Tuesday morning after discharge, when the structure is gone, the phone stops ringing, and the person is back in the same environment with the same triggers… only now they’re expected to “use what they learned”.

So, I’d build backwards from that moment.

Every care plan would answer: Who are you connected to? Where do you go when it wobbles? What routines are you rebuilding? What is your early-warning system? Who notices first? A living map of support that gets stronger over time.

If the service can’t hold the person beyond the programme, we haven’t built recovery… we’ve built a pause.

2) I’d make belonging a core intervention, not a “nice extra”

We say “community support” like it’s optional. Like it sits somewhere after the clinical work. But belonging is one of the most powerful relapse prevention tools we have. And it’s one of the most neglected.

So, I’d build a service where connection isn’t accidental but engineered. Peer roles that are properly supported and valued. Group spaces that don’t just educate, but bond. Partnerships with recovery communities that don’t feel like referrals into the void. A culture where people are known, missed, and welcomed back.

Because when someone feels they matter, they fight harder for their life.

3) I’d stop making people prove they’re “ready” before we help them

This one is uncomfortable, because it challenges some of our most normalised systems. We still gatekeep support behind stability: attend consistently, engage, be motivated, reduce use, comply with appointments, don’t be “too chaotic”.

But chaotic is often the entry point. Ambivalence is normal. Avoidance is part of trauma. Relapse is part of the story for many people, not a reason to withdraw care.

If I could start again, I’d build a service that meets people where they are without making them perform wellness first. Low-threshold access. Flexible touchpoints. Outreach that actually outreaches. And a culture that treats “returning” as a sign of strength, not failure.

The door stays open. And the service gets better at holding complexity, instead of punishing it.

4) I’d build the workforce like a bridge: expecting pressure, planning for stress points, and strengthening the structure before the strain shows.

Hope doesn’t live in policies. It lives in people.

And our workforce is carrying an extraordinary load: vicarious trauma, moral distress, caseload pressure, constant system churn, and the emotional labour of caring inside broken pathways.

So, I’d design the service around workforce sustainability from day one. Protected reflective practice. Trauma-informed supervision that’s more than case management. Real team cohesion. Clear decision-making. Training that’s linked to role and progression, not just compliance. And leadership that doesn’t disappear into strategy while teams drown.

You can’t ask staff to hold hope for others if nobody is holding them.

5) I’d measure what matters and use it to learn, improve and change

Most services collect data the way people collect receipts: because someone might ask for it later.

But if you’re building something new, measurement should feel like responsibility, not bureaucracy.

So, I’d measure the things that reflect real recovery: connectedness, safety, relationships, stability, meaning, agency. I’d build feedback loops that teams can actually use in real time. I’d treat outcomes as a learning tool, not a weapon. And I’d make evaluation something that strengthens practice, rather than something that sits in a report no one reads.

Because when we measure only crisis, we build systems that are brilliant at crisis and mediocre at helping people stay well.

You don’t need another “new initiative”.

You need a few good design choices that make recovery more likely and work more sustainable.

And maybe this year, instead of asking people to try harder…

…we build better containers for change.

What’s the one thing you’d build differently if you could start again?