Mapping recovery: A qualitative node map approach to understanding factors proximal to relapse among adolescents in a recovery high school.

Introduction: Despite data suggesting that recovery high schools are largely effective in reducing substance use, relapse in these settings is common. The goal of the current study was to characterize factors proximal to relapse among adolescents in a local recovery high school.

Method: Data for this study were 200 de-identified node maps (i.e., graphical break downs of a relapse event; randomly chosen from 600 available node maps) from the charts of students at a local recovery high school in a large Midwest city (Mean Age = 16.8 ± 1.9 years, 64.1% male, 89.1% White). A four-phase process of qualitative data sorting examined features most frequently described in relapse episodes.

Results: The most common elements reported were using with others (n = 153, 76.5%), away from home (n = 156, 78.0%), and in response to negative affect (n = 93, 48.4%). Six relapse pathways emerged: coping (n = 30), acting out (n = 15), unexpected temptation (n = 30), planned lapse (n = 19), resistant to recovery (n = 27), and passive agency (n = 30). The pathways identified represent three critical failures in the recovery system: failure to cope, failure to guard against temptation, and failure of belief. Identifying these system failures can contribute to increased rapport and engagement, as well as planning for detailed and specific factors proximal for relapse for any given individual, both on the individual and system levels.

Conclusion: The use of node maps aligned with previous work, showed good face and content validity, can be used to reduce blame and increase engagement in substance use treatment among adolescents, and produced novel micro-frames with new vocabulary to accurately understand common factors associated with relapse among adolescents.