Relapse Prevention Programs
An Article By Terence T. Gorski
GORSKI-CENAPS Web Publications
Published On: June 23,
2001 Updated On: August 07, 2001
© Terence T. Gorski, 2001
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Need For Relapse Prevention Programs
Relapse-prone chemically dependent patients
represent forty percent of all private sector patients and eighty to
ninety percent of all public sector patients.
These statistics drive home an important point.
Every treatment center in the nation currently treats
relapse-prone patients. The
question is whether they are going to do it well or poorly.
The problem is that many treatment programs deal poorly with
relapse-prone patients because they are not using specialized relapse
prevention therapy methods and, as a result, many relapse- prone
patients fail to recover.
This is unfortunate because it is no more expensive
to treat patients using relapse prevention therapy than it is to use
traditional recovery methods. And,
the difference in improved outcomes with relapse-prone patients can
radically increase recovery rates while lowering the long-term costs of
Governing The Management of Relapse
Every treatment program concerned about effectively
treating relapse-prone patients needs to develop a policy for dealing
with relapse. An
enlightened relapse policy recognizes that:
Relapse is common in two-thirds of all patients attempting
sobriety for the first time;
Relapse is not a self-inflicted condition, it is caused by a wide
variety of problems that can be treated;
Relapse-prone patients deserve effective treatment with specialty
methods designed to meet their needs, and
Relapse-prone patient are not hopeless.
Over 50 % of all relapsers will achieve permanent abstinence with
effective treatment and many of the remaining 50% will significantly
improve the quality of their lives and lower their health care costs in
spite of periodic relapses.
When a relapse occurs during treatment the current treatment plan is
suspended and efforts are made to help the relapsed client to stop using
alcohol and drugs and stabilize. Then a formal assessment and
inquiry into the circumstances surrounding relapse is
The goal is to deal with relapse therapeutically rather than punitively
whenever possible. The consequence related to relapse are decided
after answering five questions:
circumstances surrounding the relapse ...
What are the legal or procedural requirements of referral sources?
What is in the best interest of the client's ongoing recovery?
What is in the best interest of the client's family?
What is in the best interest of the community in which the client
What is in the best interest of maintaining the integrity of the
of Relapse Prevention
Relapse prevention programs have two primary goals.
To Prevent A Return To Alcohol And Drug Use:
This is done by helping recovering people to recognize and manage
the high risk situations and patterns of self-defeating thinking and
behavior that sets them up to start using alcohol or drugs again.
To Stop Relapse Quickly Should It Occur.
Prompt intervention assures that a patient who relapses gets back
into recovery as rapidly as possible.
This usually results in a short-term, low consequence, and low
cost relapse. The patient
also has a greater chance at future recovery because the damage from the
relapse is less than it would be without the intervention.
The third goal is to establish an early intervention plan that
involves all significant others, so if the patient does return to
alcohol and drug use, an intervention is promptly initiated which will
remove support for the drinking and drug use behavior and motivate the
patient to get back into treatment.
Relapse Prevention Programs
Treatment centers interested in implementing
relapse prevention programs have four options available to them:
Relapse Prevention Special Interest Groups:
Many treatment centers begin experimenting with relapse
prevention therapy by setting up a Relapse
Prevention Special Interest Group.
These include special lectures on relapse prevention and special
groups designed to help the patient identify and manage relapse warning
signs. Although this
approach is better than nothing, it is usually minimally effective
Audits done by The CENAPS Corporation with treatment centers
using this approach typically show that relapse-prone patients are
frustrated because they would like to devote more time and energy into
identifying and managing relapse warning signs and these programs simply
do not allow them to do so.
Standardized Relapse Prevention Treatment Plans: The second
approach is to design a Standard Relapse Prevention Treatment Plan for relapse-prone
patients. A standard
relapse prevention treatment plan guides a patient through the four-step
process of Assessment, Warning Sign Identification, Warning Sign
Management, and Recovery Planning.
carefully analyzes the past relapse history and looks for recurrent
patterns that set the patient up to relapse.
Warning Sign Identification
results in a final
warning sign list which describes the specific steps that a patient
takes as he/she moves from recovery towards relapse.
Warning Sign Management develops specific strategies for coping with
each warning sign and the irrational thoughts, unmanageable feelings,
and self-defeating behaviors that drive it.
Recovery Planning modifies
the recovery program to assure the patient has scheduled specific
activities to help identify and manage warning signs as they occur.
Specialty Relapse Prevention Programs:
Experience is indicating that it is more effective to treat
chronic relapsers in separate groups from patients who are in treatment
for the first time. Chronic relapsers often are angry and have serious doubts
about the effectiveness of the treatment they have received.
They are reluctant to be honest about these issues when they are
in groups with primary patients because they don't want to hamper the
new person's ability to recover.
By putting these patients in a separate group and letting
everyone know that they are all chronic relapsers, the level of honesty
increases and the willingness to talk about and resolve issues related
to relapse becomes important.
In order to integrate a
relapse prevention track into a primary recovery program, it is helpful
to conceptualize three components:
Stabilization And Assessment Programs which screens and
evaluates patients for appropriate placement in the proper track,
Primary Recovery Programs for patients who are in
treatment for the first time, and
Specialty Relapse Prevention Programs for clients
who have attempted abstinence in the past, but have been unable to
recover. Relapse Prevention Programs have a specialized
educational programs, group therapy programs, and individual therapy
programs that focus upon the goal of preventing relapse .
The primary thrust of therapy in a relapse prevention program is
to identify the specific warning signs that lead the patient back to
alcohol and drug use and to develop management strategies so the patient
can intervene upon these warning signs before he/she uses alcohol and
Integrated Relapse Prevention Practices: Relapse
prevention methods are proving to be helpful when used at all levels
care and stages of treatment. Whenever clients report or
begin acting out relapse warning signs, the regular treatment plan is
suspending and emergency relapse prevention or early intervention
methods are used.
Need For Long-term Outpatient Programs
Effective programs recognize that relapse
prevention therapy must be implemented in long-term outpatient programs. Treatment centers serious about relapse prevention become
serious about providing structured, long-term outpatient relapse
Relapse prevention programs cost no more to
administer than primary recovery programs.
A separate relapse prevention track can be installed in most
treatment centers. The only
additional cost is training the staff in the methodology and designing a
relapse prevention program.
The best way to reduce the cost of treatment for
chemical dependency patients is not only to get patients into recovery,
but to keep them there through the implementation of relapse prevention
programs. A viable national
objective should be to establish a formal relapse prevention program in
every treatment center in the nation, both public and private, within
the year 2000. This would
radically reduce the relapse rate and, hence, significantly reduce the
cost of chemical dependency treatment.
Terence T., Developing Relapse Prevention Programs, Addiction and
Recovery Magazine, June 2001
Terence T., Developing Relapse Prevention Programs, Addiction and
Recovery Magazine, June, 1992
CENREF: ART010: AAMAG12
Gorski and Other Members of the GORSKI-CENAPS Team Are Available To
Train & Consult On Areas Related To Relapse Prevention
Gorski - CENAPS, 17900 Dixie Hwy, Homewood, IL
60430, 708-799-5000 www.tgorski.com,
Terence T. Gorski is internationally
recognized for his contributions to Relapse
Prevention Therapy. The scope of his work, however, extends far
beyond this. A skilled cognitive behavioral therapist with extensive
training in experiential therapies, Gorski has broad-based experience
and expertise in the chemical dependency, behavioral health, and
criminal justice fields.
To make his ideas and methods more
available, Gorski opened The CENAPS Corporation, a private training and
consultation firm of founded in 1982. CENAPS is committed to
providing the most advanced training and consultation in the chemical
dependency and behavioral health fields.
Gorski has also developed skills
training workshops and a series of low-cost
book, workbooks, pamphlets, audio and videotapes. He also works with
a team of trainers and
consultants who can assist individuals and programs to utilize his
ideas and methods.
Terry Gorski is available for personal
and program consultation, lecturing,
and clinical skills training workshops. He also routinely schedules
workshops, executive briefings, and personal growth experiences for
clinicians, program managers, and policymakers.
Mr. Gorski holds a B.A.
degree in psychology and sociology from Northeastern Illinois University
and an M.A. degree from Webster's College in St. Louis, Missouri.
He is a Senior Certified Addiction Counselor In Illinois.
He is a prolific author who has published numerous books, pamphlets and
articles. Mr. Gorski routinely makes himself available for
interviews, public presentations, and consultant. He has presented
lectures and conducted workshops in the U.S., Canada, and
books, audio, and video tapes written and recommended by Terry Gorski
contact: Herald House - Independence Press, P.O. Box 390 Independence,
MO 64055. Telephone: 816-521-3015 0r 1-800-767-8181. His
publication website is www.relapse.org.
article is copyrighted by Terence To Gorski. Permission is given
to reproduce this article if the following conditions are met: (1)
The authorship of the article is properly referenced and the internet
address is given; (2) All references to the following three
websites are retained when the article is reproduced - www.tgorski.com,
www.relapse.net; (3) If the article
is published on a website a reciprocal link to the four websites listed
under point two is provided on the website publishing the article.