Written by Elizabeth Cairns, Mobilize Recovery Special Projects and Michael Masiowski, MD, reviewed by Code Recover Clinician Advisors, August 2026

In the ED, it is easy to focus on the negative aspects of what presents in patients who are in the acute phase of active addiction, and to lose sight of the fact that many people do recover from addiction and go on to lead healthy, productive lives. No one wants to be addicted. It is painful for the person using substances as well as for the people around them, and every effort to help them reach recovery is worth making.

It is important to remember that addiction is a chronic, relapsing medical condition, and a patient in the ED for overdose or withdrawal is likely in one of the most difficult moments of their life and their experience with the illness. (source) They have the capacity to get well, and that trajectory may not be a straight line. Relapse or return to use does not necessarily indicate a treatment failure; it is rather a sign that the treatment plan needs adjustment. Just as a previous heart attack is treated as a risk factor when a patient presents with chest pain, a patient who has been seen for substance-related complications or a previous overdose is at high risk for overdose death, and deserves to be treated with corresponding urgency. (source) Relapse is a common and unfortunate symptom of substance use disorder. Rather than resetting the clock, it should be viewed as a clinical symptom, and met with greater effort to connect the patient to ongoing care.

Peer programs do more than bridge the patient from the ED to longer-term care. They also provide a living example of what long-term recovery and successful management of this chronic disease can look like. The clinician's job is to understand rather than judge, and to implement best-practice, standard-of-care treatment — starting a patient who may be at the lowest point in their life on a path toward the restoration of their full potential. Believing that a patient can recover shapes the way they are treated, and how they respond in turn.

And there is good reason to believe it. Recovery is not a rare outcome — national survey data indicate that the majority of adults who have ever had a substance use problem eventually resolve it, and tens of millions of Americans are living in recovery today. (source) Recovery also restores function across every domain of a person's life. In the Faces & Voices of Recovery "Life in Recovery" survey, respondents reported dramatic improvements once in recovery compared to their time in active addiction: steady employment rose by more than half, paying bills and debts on time roughly doubled, participation in family life increased by half, and — notably for the ED — frequent use of emergency departments dropped nearly ten-fold. These gains compounded the longer a person remained in recovery. (source)

The patient presenting at their lowest moment has that same capacity — and the care they receive in the ED can be where it begins.