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Developing Relapse Prevention Programs

An Article By Terence T. Gorski
GORSKI-CENAPS Web Publications
www.tgorski.com
Published On: June 23, 2001          Updated On: August 07, 2001
© Terence T. Gorski, 2001

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The 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 treatment.

Policies 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: 

1.         Relapse is common in two-thirds of all patients attempting sobriety for the first time; 

2.         Relapse is not a self-inflicted condition, it is caused by a wide variety of problems that can be treated;

3.         Relapse-prone patients deserve effective treatment with specialty methods designed to meet their needs, and

4.         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.

5.         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 completed.  

6.         The goal is to deal with relapse therapeutically rather than punitively whenever possible.  The consequence related to relapse are decided after answering five questions:  

Given the circumstances surrounding the relapse ...  

(1)       What are the legal or procedural requirements of referral sources? 

(2)       What is in the best interest of the client's ongoing recovery? 

(3)       What is in the best interest of the client's family?  

(4)       What is in the best interest of the community in which the client lives? 

(5)       What is in the best interest of maintaining the integrity of the treatment program.

Goals of Relapse Prevention

Relapse prevention programs have two primary goals. 

Goal #1:  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.

Goal #2:  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.

Goal #3:  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.

Options For Implementing 
Relapse Prevention Programs

Treatment centers interested in implementing relapse prevention programs have four options available to them:

1.         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. 

2.         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.

The Assessment 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.

3.        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:  

1.         Stabilization And Assessment Programs which screens and evaluates patients for appropriate placement in the proper track,

2.         Primary Recovery Programs for patients who are in treatment for the first time, and  

3.         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 drugs. 

4.         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.

The 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 prevention groups.

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.

References

Gorski, Terence T., Developing Relapse Prevention Programs, Addiction and Recovery Magazine, June 2001

Gorski, Terence T., Developing Relapse Prevention Programs, Addiction and Recovery Magazine, June, 1992

CENREF: ART010:  AAMAG12

Terry 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, www.cenaps.com, www.relapse.org

About the Author

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 Europe.  

For 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.

This 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.cenaps.com, www.relapse.org, 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.
 

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