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 relapseprone patients. The question is whether they are going to do it well or poorly. The problem is, many treatment programs deal poorly with relapse-prone patients because they are not using specialized relapse prevention therapy methods and, as a result, many relapseprone 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.
Every treatment program needs to be concerned about effectively treating the needs of relapse-prone patients, and developing a policy for dealing with relapse.
An enlightened 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.
Relapse prevention programs have two primary goals. The first is to prevent a patient from returning to alcohol and drug use after treatment. The second is to promptly intervene should a relapse occur. Prompt intervention assures that a patient who relapses gets back into recovery as quickly as possible. Prompt intervention 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.
Goals of Relapse Prevention Therapy:
• To prevent a return to alcohol and drug use.
• To stop relapse quickly should it occur.
The best practice 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:
1- Assessment- carefully analyzes the past relapse history and looks for recurrent patterns that set the patient up to relapse.
2- Warning Sign Identification- a list of warning signs which describes the specific steps that a patient takes as he/she moves from recovery towards relapse.
3- 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.
4- Recovery Planning- modifies the recovery program to assure the patient has scheduled specific activities to help identify and manage warning signs as they occur.
Experience indicates that it is far more effective to treat chronic relapsers in separate groups apart from patients who are in treatment for the first time. Chronic relapsers are often 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:
• A stabilization and assessment program which screens and evaluates patients for appropriate placement in the proper track.
• A primary recovery program for patients who are in treatment for the first time.
• A relapse prevention program for patients who have attempted
abstinence in the past, but have been unable to recover.
The relapse prevention track should be structured to have a separate educational component, a separate group therapy component, and a separate individual therapy component. 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. 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.
Effective relapse prevention therapy must be implemented in all programs. Relapse prevention programs cost no more to administer than primary recovery programs. The best way to reduce the cost of treatment for substance abusing 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 2020. This would radically reduce the relapse rate, significantly reduce the cost of treatment, and reduce the overall risk of relapse.
To learn effective relapse prevention strategies and techniques- Attend the Relapse Prevention Therapy Certification School April 16-20, 2018. Please call 352-596-8000 for more information or to register.