What Happens After Stabilization?
I experienced two very different healthcare systems. What happened after treatment is one of the reasons I built Primary Purpose Pivot.
There was a point in my life when I had about as much access to healthcare as anyone could reasonably ask for. I had built a successful career working for companies like Microsoft and Amazon. I had excellent commercial health insurance and access to good doctors, specialists, and mental health providers.
Then my life fell apart.
Addiction took me places I never imagined I would go. Eventually, I went from being a successful technology executive with great health insurance to relying on Medicaid. I got to experience both worlds, and they were very different.
That experience has shaped a lot of how I think about recovery today.
Getting sober is only the beginning
There are treatment organizations across this country doing incredibly difficult work. Many serve Medicaid populations while dealing with reimbursement constraints, workforce shortages, and people coming through their doors with enormously complicated lives. I've met many people in this field who care deeply about the people they serve.
But I question whether the system we've built gives them the resources and infrastructure to address what happens next. Someone may enter detox, move into residential treatment, then perhaps PHP and IOP. During that period, there can be tremendous structure: clinicians, groups, case managers, schedules, accountability, and peer support. Then, relatively quickly, much of that structure disappears.
The person's life hasn't suddenly been rebuilt. Rent is due. Transportation and employment matter immediately. Relationships may be damaged. Legal and financial problems may still be waiting. And now there is enormous pressure to get a job and support yourself.
I know this part because I lived it.
I worked because I had to survive
During the first couple of years of my recovery, I was a line cook at a nice restaurant, worked the register at a pizza place, worked as a behavioral health technician at a detox, became a driver's helper at UPS, and worked overnight at a homeless shelter.
There is nothing wrong with any of those jobs. For someone else, one might be the beginning of a great career. For me, they weren't. I took them because I needed income, needed to pay my sober-living rent, and needed to keep moving forward.
And I was miserable.
Not because I thought the work was beneath me. It simply didn't align with who I was, what I was good at, or where I ultimately wanted my life to go. I wasn't lost. I knew who I was and what I was capable of. I understood that this represented a point in time, not the rest of my life. But knowing that didn't make living through it easy. There wasn't much mental or emotional support for what it felt like to rebuild a life from that position. And I had an advantage many people leaving treatment may not have: I could see another future because I had already lived one.
What if you can't see the other side yet?
Think about someone leaving treatment who has never experienced professional success or had someone help them understand what they're naturally good at. Maybe much of their adult life has been defined by addiction, unstable employment, incarceration, or simply trying to survive. They're facing the same immediate pressures - income, housing, transportation, recovery - without necessarily having a picture of what could exist on the other side.
Survival has a way of consuming the present. When you're trying to make it through another week while repairing your life and protecting your recovery, it can be difficult to imagine a different future. People can begin to feel isolated and trapped.
I could see my future. I was struggling to get back to it. Many people leaving treatment may still need help discovering theirs.
Lived experience needs infrastructure around it
Many recovery organizations appropriately employ people with lived experience, and I believe deeply in the value they bring. Someone who has experienced addiction can understand things about another person's experience that no textbook can teach. But lived experience alone cannot be the entire workforce-development strategy for recovery support.
I have lived experience. That doesn't automatically make me qualified to perform every job in behavioral healthcare.
People doing this work also need training, tools, supervision, professional development, and clear standards. The answer isn't replacing lived experience with clinical credentials. It's recognizing its value while building professional infrastructure around it.
What are we actually measuring?
One question keeps coming back to me: How many people leaving treatment are actually doing well a year later?
Not simply whether they completed a program. Are they still in recovery? Are they working? Are they building some degree of stability?
Those are very different measures.
We spend enormous energy getting people stabilized, and we should. It saves lives. But it can be surprisingly difficult to determine what happens six months or a year after someone leaves treatment. Stabilization isn't the same thing as stability.
The missing part of the continuum
I don't think treatment organizations should become career centers. Clinicians shouldn't have to become career counselors, and recovery coaches shouldn't be expected to solve every problem in someone's life. But I do think we're missing something between clinical stabilization and long-term stability.
People need support moving beyond simply finding the next available job and toward understanding what they're good at, what matters to them, where they could realistically go, and what it will take to get there. And that support needs to extend beyond the few weeks or months when someone is receiving intensive treatment.
We also need better ways to understand what happens afterward. If someone is stable six months later, we should know that. If they're struggling, we should know that too. That doesn't diminish the importance of treatment.
It completes the continuum.
This is why I built Primary Purpose Pivot
Primary Purpose Pivot didn't start because I was looking for a software company to build. It came, in large part, from living through this gap myself. I knew there was another future available to me. I also know how difficult it was to live through the distance between where I was and where I knew I could eventually be.
I stayed sober. I kept working. Eventually, my life began opening up again.
But I don't want someone else's first year or two of recovery to depend entirely on whether they can endure being miserable long enough for life to eventually get better. Sometimes the first available job is exactly what someone needs. Take the job. Pay the rent. Build some structure.
But let's not confuse a survival strategy with a long-term plan.
Recovery creates an extraordinary opportunity to rebuild a life. We should help people see what that life could become - and give them the support to start building it.
Getting someone stabilized is an incredible accomplishment.
Helping them build a life they want to protect may be what turns that stabilization into something lasting.
Strengthening Recovery. Building Purpose.