Care-giver substance abuse (SA) represents one of the most common reasons for entering the child welfare system in the USA with families and children for whom substance abuse is an issue fairing worse at every stage of the child welfare process from investigation to removal to reunification. In this conceptual article, we assert that a paradigm clash between a framework for SA that understands treatment and recovery to be a linear process and a framework that views relapse as normative underlies many of the reasons that SA represents a seemingly intractable issue within child welfare. We identify this mismatch as a mechanism for more severe trajectories of SA cases and then suggest new models for child welfare policy and practice that anticipate relapse and which respond to the often chronic nature of substance use disorders.