Maintenance – Preventing Relapse and Rebuilding Quickly When It Happens
Helping Prescribers Reinforce Progress, Normalize Setbacks, and Sustain Long-Term Change
Clinical Vignette
Ms. R is a 35-year-old woman with bipolar disorder and a history of medication non-adherence. She’s been stable for 6 months and has kept all appointments.
She says:
“I’m finally feeling like myself again.”
But recently, she skipped two doses. Her explanation?
“I just forgot. I thought maybe I didn’t need it anymore.”
She’s in the maintenance stage—a place of progress but also risk. The goal now is continuity, not complacency.
What is the Maintenance Stage?
Maintenance is the fifth stage of the Stages of Change model. The person is:
Maintaining new behavior for 6+ months
Developing identity around the change
Facing temptations, fatigue, and triggers
Still vulnerable to relapse or drift
Maintenance is not coasting; rather, it’s rebuilding, reinforcing, and recommitting—day after day.
Goal for the Prescriber: Strengthen Systems, Normalize Lapses, Celebrate Milestones
In maintenance, your job is to:
Reinforce motivation and identity (“This is who I am now”)
Solidify environmental and social supports
Normalize lapses and prevent spirals
Celebrate success with intention
Tool: Lapse Recovery Plan + Monthly Maintenance Check-In
Lapse Recovery Plan
Ask:
“If things get tough or you slip a little, tell me what’s your plan is to get back on track quickly.”
Build:
A non-judgmental action plan (e.g., who to call, what to say, how to restart)
A reflection tool: “What helped me bounce back before?”
Monthly Maintenance Check-In
Every 4–6 weeks, ask:
“Tell me what’s working.”
“Tell me what’s wearing you down.”
“Tell me what needs reinforcement.”
“Tell me what we can celebrate today.”
Common Pitfalls to Avoid
🚫 Don’t assume maintenance = no support needed
🚫 Don’t treat lapses as failure
🚫 Don’t ignore identity work (from “I’m doing this” to “This is who I am now”)
Instead, show up as a consistent partner, helping the patient build trust in their ability to stay the course.
Scientific Citations
Hser, Y. I., Longshore, D., & Anglin, M. D. (2007). The life course perspective on drug use: A conceptual framework for understanding drug use trajectories. Evaluation Review, 31(6), 515–547.
Prochaska, J. O., & Velicer, W. F. (1997). The transtheoretical model of health behavior change. American Journal of Health Promotion, 12(1), 38–48.
Marlatt, G. A., & Donovan, D. M. (2005). Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behaviors (2nd ed.). Guilford Press.
Baumeister, R. F., & Tierney, J. (2011). Willpower: Rediscovering the Greatest Human Strength. Penguin Press.
Reflection Prompt
“Do I treat maintenance as passive—or as a stage that needs active support?”
“How do I help patients recover quickly from a lapse without shame?”
“What rituals of celebration and reinforcement do I offer in this stage?”