How To Develop A Relapse Prevention Program

May 26, 2018

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.


How I Dealt With Bullying

April 3, 2018

I Was Bullied and Refused to be Defined by the Bullies. It was difficult at the time but I managed to work around it by avoiding bullies and the sports teams where they ruled. I joined the debate team and was elected to student government.

Most importantly, I DID NOT SULK, COMPLAIN, OR EXPECT SOMEONE ELSE TO RESCUE ME.

I refused to lower myself to dealing with the bullies on the violent level they tried to deal with me.

The bullies got bored with me quickly and I was elected to the student senate and invested my energies there.

The bullies grunted their way into the obscurity well earned by Neanderthal idiots.

ILIGITMI NON CARBORUNDUM

Don’t Let The Bastards Wear You Down


Anger

March 15, 2018

Anger is just a human feeling. It is how we manage our anger that determines its consequences. We tend to become angry when faced with a threat to ourselves or those we love. This anger directs our attention and motivates action. Whether that action makes us more or less safe depends upon our training in managing our anger with words and behaviors appropriate to the threat or situation triggering the anger.

Truth

The truth is hard to find. The human brain is the ultimate instrument of self deception. http://www.relapse.org click on denial.

The Samurai, the Japanese warriors who many believe are the best in the world refuse to fight when angry because they believe it inhibits their combat skills. The seek to fight from a state of peaceful centeredness. This requires years if not lifetimes of training.

“Anger management is a critical skill for all addiction professionals. These online courses from SAMHSA are important resources.” ~ Terence T. Gorski (The Publications of Terence T. Gorski)

Anger is only a human emotion that is neither right or wrong, it just IS! If we let it go it will pass without harming us, if we act on it we are trying to take control. CONTROL, the most devastating symptom of codependency and the root of all of our addictions!

Anger is just a human feeling. It is how we manage our anger that determines its consequences. We tend to become angry when faced with a threat to ourselves or those we love. This anger directs our attention and motivates action. Whether that action makes us more or less safe depends upon our training in managing our anger with words and behaviors appropriate to the threat or situation triggering the anger.

Truth

The truth is hard to find. The human brain is the ultimate instrument of self deception. http://www.relapse.org click on denial.

The Samurai, the Japanese warriors who many believe are the best in the world refuse to fight when angry because they believe it inhibits their combat skills. The seek to fight from a state of peaceful centeredness. This requires years if not lifetimes of training.


Consciousness

March 15, 2018

Perception and memory allow us to become aware of and store sensory information.

Knowing that the Information we store in our brain/mind is important requires us to be consciousness of ourselves, others, and the world around us.

Striving for higher levels of consciousness drives the brain/mind to develop language.

Language allows us to reach out and communicate with other human beings. Language and hence information is always shaped by culture, which is the containing frame of language.

Information, like truth itself, wants to be free to move from mind to mind.

It is as if the truth has a life of its own struggling to expand human consciousness until it can be fully grasped by the human brain/mind.

The search for truth seems to be the most basic drive of human consciousness.


Fear and It’s Variations 

September 10, 2017

Look at all the worry you could have wasted getting to this point in dealing with the hurricane. 
Worry is fear of being afraid. Anxiety is fear of being afraid. 

Fear is a signal that there might be a threat and we should check out. 

If there is a threat, the fear converts into either anger (to fight), fear (to run), or ambivalence ( to hunker down and shelter in place). Anxiety and fear are friends because they alert us to potential danger. Worry is a impotent waste because it focus us upon a fog of immobility. 


Old vs. Young 

September 10, 2017

Checking out at the store, the young cashier suggested to the much older lady that she should bring her own grocery bags, because plastic bags are not good for the environment.The woman apologized to the young girl and explained, “We didn’t have this ‘green thing’ back in my earlier days.”

The young clerk responded, “That’s our problem today. Your generation did not care enough to save our environment for future generations.”

The older lady said that she was right — our generation didn’t have the “green thing” in its day. The older lady went on to explain:

Back then, we returned milk bottles, soda bottles and beer bottles to the store. The store sent them back to the plant to be washed and sterilized and refilled, so it could use the same bottles over and over. So they really were recycled. But we didn’t have the “green thing” back in our day.

Grocery stores bagged our groceries in brown paper bags that we reused for numerous things. Most memorable besides household garbage bags was the use of brown paper bags as book covers for our school books. This was to ensure that public property (the books provided for our use by the school) was not defaced by our scribblings. Then we were able to personalize our books on the brown paper bags. But, too bad we didn’t do the “green thing” back then.

We walked up stairs because we didn’t have an escalator in every store and office building. We walked to the grocery store and didn’t climb into a 300-horsepower machine every time we had to go two blocks.

But she was right. We didn’t have the “green thing” in our day.

Back then we washed the baby’s diapers because we didn’t have the throw away kind. We dried clothes on a line, not in an energy-gobbling machine burning up 220 volts. Wind and solar power really did dry our clothes back in our early days. Kids got hand-me-down clothes from their brothers or sisters, not always brand-new clothing.

But that young lady is right; we didn’t have the “green thing” back in our day. 

Back then we had one TV, or radio, in the house — not a TV in every room. And the TV had a small screen the size of a handkerchief (remember them?), not a screen the size of the state of Montana. In the kitchen we blended and stirred by hand because we didn’t have electric machines to do everything for us. When we packaged a fragile item to send in the mail, we used wadded up old newspapers to cushion it, not Styrofoam or plastic bubble wrap. Back then, we didn’t fire up an engine and burn gasoline just to cut the lawn. We used a push mower that ran on human power. We exercised by working so we didn’t need to go to a health club to run on treadmills that operate on electricity.

But she’s right; we didn’t have the “green thing” back then.

We drank from a fountain when we were thirsty instead of using a cup or a plastic bottle every time we had a drink of water. We refilled writing pens with ink instead of buying a new pen, and we replaced the razor blade in a r azor instead of throwing away the whole razor just because the blade got dull.

But we didn’t have the “green thing” back then.

Back then, people took the streetcar or a bus and kids rode their bikes to school or walked instead of turning their moms into a 24-hour taxi service in the family’s $45,000 SUV or van, which cost what a whole house did before the”green thing.” We had one electrical outlet in a room, not an entire bank of sockets to power a dozen appliances. And we didn’t need a computerized gadget to receive a signal beamed from satellites 23,000 miles out in space in order to find the nearest burger joint.

But isn’t it sad the current generation laments how wasteful we old folks were just because we didn’t have the “green thing” back then?

Please forward this on to another selfish old person who needs a lesson in conservation from a smart ass young person.

We don’t like being old in the first place, so it doesn’t take much to piss us off… Especially from a tattooed, multiple pierced smartass who can’t make change without the cash register telling them how much.


MY FINAL POFESSIONAL GOALS

May 21, 2017

By Terence T. Gorski, May 21, 2017

Life goes on! As my life moves into its final chapter, I realize that two great challenges face me:
1. Organizing and archiving in an easily understandable and useable way, the great archive of organized knowledge and useable skills about recovery technology and relapse prevention that I have spent over 45 years of my career developing so it can be readily available for future generations. (I have begun this project at http://www.terrygorski.com); and

2. To set up an ongoing international movement to transmit this RECOVERY AND RELAPSE PREVENTION TECHNOLOGY to the next generations of clinicians. 

3. To motivate them to deeply understand and build upon these principles and practices by integrating it with their personal clinical skills and program styles, so they My continue to improve it based upon based upon their personal experiences and continued completion and application of research. 

As your life goes on, please consider joining me in moving these final challenges of my career forward. If you wish to join me please forward your email to tresa@cenaps.com


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