A cycle of ups and downs exists in the treatment of every major disease. It’s important to understand the trendline in Mental Health and Substance Use Behavior (MH and SUD) treatment. What direction is it trending? Like any other disease, treatment takes time to develop visible changes in outcome. An obese person with Type II Diabetes may get their physiologic insulin levels under control, but still has a long way to go with behavioral changes in diet and lifestyle before visible changes are perceptible. The same philosophy applies to treatment of MH and SUD. Initial detox and medication management are a key starting point, but visible changes to behaviors may not occur for quite some time. Understanding this decreases stigmas and builds more realistic expectations. A setback is not necessarily a downward spiral. Neither should a visible downward spiral be discounted as merely a setback. What's the trendline?