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Does Relapse Mean Treatment Failure
An Article By Terence T. Gorski

This article challenges three mistaken beliefs that often prevent treatment professionals from dealing effectively with relapse prone clients.  These beliefs are:  (1) Relapse is self-inflicted;  (2) Relapse is an indication of treatment failure; and (3) Once relapse occurs the patient will never recover.   (Get a low-cost pamphlet that teaches recovering people to challenge the common Mistaken Beliefs About Relapse)

Does Relapse 
Mean Treatment Failure?

By Terence T. Gorski

May 24, 2001

GORSKI-CENAPS Web Publications 
(www.tgorski.com; www.relapse.org)

Terry Gorski and other members of the GORSKI-CENAPS Team are Available To Train & Consult On Areas Related Relapse & Relapse Prevention
Gorski - CENAPS, 17900 Dixie Hwy, Homewood, IL 60430, 708-799-5000
www.tgorski.com, www.cenaps.com, www.relapse.org

Get a low-cost pamphlet that teaches recovering people 
how to challenge the common Mistaken Beliefs About Relapse

The administrator of a large hospital recently gave me a tour.  As he showed me the cancer, cardiac, and renal dialysis units, he emphatically told me that the hospital was committed to these chronically ill patients.  He stated with pride that no matter how sick, how difficult their recovery, or how many treatments they needed the hospital was committed to be there to help. 

When we went to the chemical dependency unit, he told me in no uncertain terms that the unit did not "enable chemical addicts by readmitting them for treatment after relapse."  His position was that if chemical addicts wanted to stay sober they would. Relapse, he emphasized, is a "self-inflicted condition" and to provide multiple treatments is enabling their disease.

Unfortunately, this misguided attitude is still very common.  We say that chemical dependence is a disease with a tendency to toward relapse, but many treatment centers don't act like it is.  Even more tragically, these misguided policies of refusing multiple treatments to relapse-prone addicts are being mirrored in insurance company and managed care reimbursement policies which are now refusing to pay for multiple treatments. There is even talk of refusing alcoholics the opportunity for liver transplants because their liver disease was self-inflicted.

Currently, most relapse prone patients are unable to access treatment because of three mistaken beliefs:

1.         Relapse is self-inflicted;

2.         Relapse is an indication of treatment failure; and

3.         Once relapse occurs the patient will never recover. 

Let's challenge this triad of mistaken beliefs.

Mistaken Belief #1: 
Relapse Is Self-Inflicted

Relapse, in most cases relapse, is not self-inflicted. Relapse-prone patients experience a gradual progression of symptoms that create so much pain that they become unable to function in sobriety.  They turn to addictive use to self-medicate the pain.  These patients can learn to stay sober by recognizing these symptoms as relapse warning signs, identifying the self-defeating thoughts, feelings, and actions they use to cope with them, and learning more effective coping responses.  Unfortunately, most relapse-prone patients never receive relapse prevention therapy, either because treatment centers don't provide it or their insurance or managed care provider won't fund it.

Mistaken Belief #2: 
Relapse Is An Indication Of Treatment Failure

Relapse is not necessarily a sign of treatment failure. Between one half and two-thirds of all patients treated will relapse, but at least one half of all relapsers will find long term recovery.  The belief that relapse means that treatment failed ignores the fact that, for many patients, recovery involves a series of relapse episodes.  Each relapse, if properly dealt with in treatment, can become the a learning experience which makes the patient less likely to relapse in the future.

Chemically dependent people can be divided into three groups based upon their recovery and relapse history.  One third of all patients are recovery prone and maintain total abstinence from their first serious attempt.  Another third are transitionally relapse prone and have a series of short-term and low consequence relapse episodes prior to finding long-term abstinence.  The final third, the most difficult patients to treat, are chronically relapse-prone patients can't find long-term sobriety no matter what they do.

Recovery-prone patients tend to be addicted to a single drug, have higher levels of social and economic stability, and not have dual diagnosis or serious coexisting problems.  They are what are often referred to as "garden variety addicts" who have uncomplicated chemical addictions.

Transitionally relapse-prone patients tend to have more severe addictions that are complicated by other problems.  They have the capacity, however, to learn from each relapse episode and take steps to alter or modify their recovery programs to avoid future relapses.

Chronically relapse-prone patients tend to have severe addictions complicated by serious dual diagnosis.  Most chronic relapsers have either severe post acute withdrawal caused by the effects of chronic alcohol and drug poisoning to the brain, a coexisting personality or mental disorder, or a serious coexisting physical illness.  Many fail to recover because these coexisting conditions are not properly diagnosed and treated.

Mistaken Belief #1: 
Once Relapse Occurs The Patient Will Never Recover

Even chronically relapse-prone patients are not hopeless. In 1988 I had dinner with over sixty skid row alcoholics who had completed a relapse prevention program at Alexandria Regional Detox Center.  These people were previously labeled as hopeless and given short-term revolving door non-medical detox.  All were sober for over six months after participating in weekly outpatient relapse prevention groups coupled with twelve step programs.  All of these people wanted to stay sober.  Prior to relapse prevention therapy, they did not know how.  Once they learned effective strategies for identifying and managing relapse warning signs, they were able to stay sober in spite of the other serious problems they experienced.

CENREF: ART008

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.

Terry Gorski and other members of the GORSKI-CENAPS Team are Available To Train & Consult On Areas Related Relapse & Relapse Prevention
Gorski - CENAPS, 17900 Dixie Hwy, Homewood, IL 60430, 708-799-5000 www.tgorski.com, www.cenaps.com, www.relapse.org
 

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Terry Gorski and Other Members of the GORSKI-CENAPS Team are Available To Train & Consult On Areas Related To Recovery, Relapse Prevention, & Relapse Early Intervention

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info@enaps.com; www.tgorski.com, www.cenaps.com, www.relapse.org