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Relapse Prevention 
In The Managed Care Environment

An Article By Terence T. Gorski
GORSKI-CENAPS Web Publications
www.tgorski.com
Published On: June 10, 2001          Updated On: August 07, 2001
© Terence T. Gorski, 2001

Terry Gorski and Other Members of the GORSKI-CENAPS Team Are Available To Train & Consult On Areas Related To Addiction & Mental Health
Gorski - CENAPS, 17900 Dixie Hwy, Homewood, IL 60430, 708-799-5000 www.tgorski.com, www.cenaps.com

Relapse prevention is a serious concern of managed care providers who are responsible for containing the cost of chemical dependency treatment.  When we look at the relapse rates following treatment, it is easy to understand why.  Forty seven percent of patients treated in private treatment programs will return to chemical use within the first year following treatment.  Of those who relapse, about 40% will have short-term, low consequence relapses and will rapidly return to recovery, while 60% of relapsers will have long-term, high consequence relapses that require costly treatment.  

In reviewing these statistics, it is important to keep the following points in mind.

1.    Fifty three percent of chemically dependent patients do recover after treatment

2.    Recovery rates can be as high as 90% in clients who are socially Stable (i.e. are employed, have a stable residence and have social support in the form of family or significant friendships), supported by Employee Assistance Programs, and do not have polydrug addictions, other psychiatric disorders, or serious medical complications.  

3.    When compared to other chronic life style related diseases, such as cancer and heart disease, the relapse rates to chemical dependence are relatively low. 

4.    The recovery and relapse rates for chemical addiction have significantly improved since the introduction of abstinence-based recovery methods in 1935. Prior to the development of Alcoholics Anonymous in 1935, the 98% relapse rate led to alcoholics being declared as hopeless by most leading psychiatrists and physicians.  The introduction of Alcoholics anonymous (AA) increased recovery rates to about 25% and the introduction of Minnesota Model Treatment that combines 12-Step recovery with detoxification, education, and counseling caused an increase in recovery rates to about 50%.

5.    Patients who relapse are not hopeless.  40% of relapsers find their way into long-term recovery after experiencing short-term and low consequence relapses.  Other relapsers significantly improve their overall health and functioning and decrease their health care utilization in spite of experiencing periodic short-term and low consequence relapses that are rapidly stabilized by appropriate intervention and treatment.

6.    Relapse prevention therapy is improving the chances of recovery for relapsers.  A study completed by Father Marten's Ashley found that chronic relapsers who completed a CENAPS Model Relapse Prevention Program had the same improvement rates (approximately 65%) as did patients completing primary treatment for the first time.

Relapse Cannot be Ignored

Treatment centers and managed care providers cannot afford to ignore relapse because it is so common.  Approximately 40% of all patients admitted for chemical dependency treatment in the United States are relapsers who have previously been treated for chemical dependence.  

Treating these relapsers is expensive.  The National Drug and Alcohol Treatment Utilization Study (NDATUS) estimated that the nation spent a total of $4.08 billion in treating chemically dependent people.  Since 40% of these patients were relapsers, the nations spent $1.63 billion treating relapsers.  Unfortunately, most of this money was spent on recycling patients through treatment that had already failed. Few treatment program have comprehensive relapse prevention tracts in spite of the large number of relapser that they treat.

Failed Strategies To Contain The Cost of Relapse

Managed care providers are concerned about relapse because it increases the cost of treatment.  In the eyes of most managed care providers, treating relapse-prone patients in treatment programs that failed to produce sobriety the first time around is not cost effective.  "If it didn't work the first time," they argue, "Why should it work the second?"

This has led to many managed care providers establishing cost control strategies that refuse to pay for repeat treatments with methods that have failed.  These strategies limit the number treatments per lifetime to between one and three.  

Unfortunately, this strategy doesn't work because without treatment relapsers keep using alcohol and drugs until they develop serious medical and psychiatric illness that requires expensive treatment.  In the long run, the policy of refusing to pay for repeat treatments increases rather than decreases treatment costs.

Since relapsers represent 30% to 40% of private treatment dollars and 50% to 70% of public treatment dollars, this policy of refusing to pay for repeat treatment places many treatment programs in serious financial trouble.  

A Cost Containment Strategy That Works

What is needed is a new strategy for treating relapsers in specialty relapse prevention programs that lower relapse rates and rapidly intervene upon patients who relapse so that the duration, severity, and consequences of relapse episodes will be reduced.  This significantly reduces the cost of treating relapse-prone patients.

Many managed care providers are aware that their old strategies for coping with relapse don't work.  They are beginning to institute a new strategy of paying for multiple treatments only in relapse prevention programs.  This new strategy works because relapse prevention programs directly address the causes of relapse, lower relapse rates, and reduce the consequences and costs of relapse.

What is needed is the wide spread implementation of specialty treatment programs for relapse-prone people. Fortunately, such programs can be quickly and efficiently introduced in most treatment programs and cost no more to operate than other addiction treatment approaches. 

CENREF: ART009:  AAMAG11:

References

Gorski, Terence T., Relapse Prevention In The Managed Care Environment, GORSKI-CENAPS Web Publications, June 10, 2001

Gorski, Terence T., Relapse Prevention In The Managed Care Environment, Addiction and Recovery Magazine, March, 1992

Terry Gorski and other member of the GORSKI-CENAPS Team are Available To Train & Consult On Areas Related To Addiction & Mental health
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.

Terry Gorski and Other Members of the GORSKI-CENAPS Team Are Available To Train & Consult On Areas Related To Addiction & Mental Health
Gorski - CENAPS, 17900 Dixie Hwy, Homewood, IL 60430, 708-799-5000 www.tgorski.com, www.cenaps.com, 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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