By Terence T. Gorski, www.relapse.org
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.
I remember touring a large medical-surgical hospital as part of my consultation with the addiction treatment program that was located in the hospital. The administrator was obviously proud of the hospital he helped to build. He personally gave me the tour.
As he showed me each specialty unit I felt like he was showing off his children. He obviously cared about the patients, greeting some by name as we walked through each unit.
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 times they needed treatment, he wanted the services of the hospital to be there to help them. “That’s my commitment,” he said emphatically. “And I am a man who keeps my word!”
When we went to the chemical dependency unit, he told me, in no uncertain terms, that the unit did not “enable chemical addicts by admitting 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!” To provide multiple treatments to people who don’t really want to get well is just enabling their disease. They need to hit bottom!”
Unfortunately, this misguided attitude is still very common. We say that addiction is a disease with a tendency to toward relapse. Unfortunately many treatment centers, and even the counselors who for them 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 that often refuse 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 get the treatment they need because of three mistaken beliefs:
1. Relapse is self-inflicted;
2. Relapse is an indication
that the Patient Is a failure s who really doesn’t Want to get well. The treatment works, it’s the patient refusing to follow the treatment that causes
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, is not self-inflicted. Relapse-prone patients experience a gradual progression of symptoms in sobriety 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 early relapse warning signs, and 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 pay for it.
Mistaken Belief #2: Relapse Is An Indication That The Patient Is A Failure Who Doesn’t Really Want To Recover!
Relapse is not necessarily a sign thAt the patient or the treatment is inherent entry a failure. It’s more likely that patient is experiencing problems that don’t match the standard package of treatment being offered. Since the problem that is the root cause of the pain in recovery is never addressed, the patient’s risk of relapse goes way up. Look at the statistics.
Between one half and two-thirds of all patients treated for alcohol and drug dependence will relapse, but at least one half of all relapsers will find long-term recovery within five to seven years after their first treatment. The belief that relapse means that both the patent and treatment failed ignores the fact that, for many patients, recovery involves a series of relapse episodes. Each relapse, if properly dealt with in a subsequent 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 in the first group tend to be addicted to a single drug, have higher levels of social and economic stability, and do not have coexisting mental of physical health problems. They are what are often referred to as “garden variety addicts” who have uncomplicated chemical addictions.
Transitionally relapse-prone patients in group two 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 in group 3 tend to have many different issues they are struggling with. Here is a list of some of those problems. They may have the primary addiction they are being treated for plus some combination of the following:
– Severe late stage addictions to multiple drugs, especially opiates and methAmphetamine that are powerfully addictive;
– Personality disorders, mental health problems, or physical illness that is no diagnosed or
– Severe post acute withdrawal (PAW) caused by symptoms brain dysfunction caused chronic alcohol and drug poisoning to the brain. These seems become more severe when the person is under high levels of stress.
Many relapse-prone patients fail to recover because these coexisting are not properly diagnosed and treated and they interfere with the primary treatment being given.
Mistaken Belief #3: Once Relapse Occurs The Patient Will Never Recover
Recovery is a process of learning, mostly by trial and error. Almost every recovering alcoholic or drug addict with long-term recover has had one orca short series of relapse episodes. They learned from these experienced and figured out how to put together a meaningful and comfortable long-term recovery.
“Judge not, that ye be not judged.” Matthew 7:1-3
About the Author
Terence T. Gorski is internationally author, trainer, and consultant who is best recognized for his contributions to Relapse Prevention Therapy. The scope of his work, however, extends far beyond this. He is 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.
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.