The CENAPS® Model and Mindfulness In Relapse Prevention

December 8, 2013

imagesMindfulness meditation is currently a major interest in the field of addiction treatment and relapse prevention. It is also becoming a popular modality integrated into pan management by in the work of Dr. Grinstead in Addiction-free Pain Management (APM) and in the form of acceptance and commitment therapy (ACT). This is because mindfulness-type meditation is a useful technique for interrupting stressful patterns of automatic self-talk or rumination that elevates stress to the point of activating craving in addictive disorders, symptoms of a mental disorder, such as depression, and activating acute episodes of pain in chronic pain patients.

The Gorski-CENAPS® Model has used forms of mindfulness meditation since the early 1980’s. In the Gorski-CENAPS Model the form of meditation used was based upon techniques used with biofeedback based upon the early research in meditation especially the work in stress and illness (Pelletier 1977) and The Peniston Protocol (Peniston 1989) used in the treatment of alcoholism The Menninger Clinic. Mindfulness Meditation has a strong basis in the Marlatt’s Model of Relapse Prevention.

The goal of using mindfulness mediation and related meditation methods in Relapse Prevention Therapy (RPT) is to help patients to achieve a state of consciousness often described as detached awareness. This is the same state of mind produced by mindfulness mediation. Detached Awareness is a state of consciousness that allows people to stay aware of their flow of thoughts and feelings without become attached to them.  Detached awareness of thoughts and feelings, in this context, means to allow them to come into awareness without activating the the sympathetic nervous system. In other words to be able to be aware of what we are thinking and feeling without having a stress reaction or activating a fight or flight response.

1533785_10151948786018172_1927814949_nIn the CENAPS® Model, this involved developing the psychological system identified as the Higher Self  (The Observing Self, The Silent Witness) as reported in the book Keeping The Balance by Terence T. Gorski. It involves become physically relaxed while being able to observe and then release or detach from the flow of thinking and the rise and fall of feelings and emotions. This technique was later described as Immediate Relapse Prevention Training and rapidly became a primary goal in Relapse Prevention Therapy (RPT) and is listed as the first skill in the Workbook entitled Starting Recovery With Relapse Prevention. The methodology was first presented in a Professional Paper authored by Terence T. Gorski and Joseph E. Troiani entitled: Application of Biofeedback To Alcoholism Treatment, Ingalls Memorial Hospital, 1976. (Currently not in print).


Pelletier, K. R. (1977). Mind as healer, mind as slayer . NY: Delta.

Peniston, E. G., & Kukolski, P. J. (1989). Alpha-theta brain wave training and beta-endorphin levels in alcoholics. Alcoholism: Clinical and Experimental Research , 13 , 271-279.

Ma, S. Helen and Teasdale, John D., Mindfulness-Based Cognitive Therapy for Depression: Replication and Exploration of Differential Relapse Prevention Effects, Journal of Consulting and Clinical Psychology, 2004, Vol. 72, No. 1, 31–40

Addiction Treatment and the Affordable Care Act (ACA)

November 22, 2013

By Celia Vimont
February 26, 2013

An Introduction
By Terence T. Gorski

The following article by By Celia Vimont summarizes the predictions made by Thomas McLellan, PhD, who reported at the 2013 annual meeting of the New York Society of Addiction Medicine that he believes that the Affordable Care Act (ACA) will revolutionize the field of substance abuse treatment.

I am not as optimistic as as Dr. McLellan about the positive impacts of the ACA on overall recovery rates for addiction clients. Here’s why;

1. When addiction services are merged into medical services the addiction tends not be diagnosed and initial referrals are made to individual doctors most who use medication management.

2. Residential Rehabilitation will not be considered an essential services.

3. Brief screening and early intervention will be attempted but relapse rates tend to be high.

4. Stigma and poly-drug abuse that mixes legal and illegal drugs will both deter early voluntary intervention.

Here is the article reporting on Dr. McLellan’s projections, which are far more optimistic than mine.
The ACA Could Provide Substance Abuse Treatment to Millions of New Patients”

“It will have more far-reaching positive consequences for substance abuse treatment than anything in my lifetime, including the discovery of methadone,” he said at the recent annual meeting of the New York Society of Addiction Medicine.

“It will integrate substance abuse treatment into the rest of health care.”

Currently, just 2.3 million Americans receive any type of substance abuse treatment, which is less than one percent of the total population of people who are affected by the most serious of the substance use disorders—addiction, said Dr. McLellan, who is a former Deputy Director of the White House Office of National Drug Control Policy.

Most who receive treatment are severely affected, he said.
“If diabetes were treated like substance abuse, only people in the most advanced stages of illness would be covered, such as those who had already lost their vision or had severe kidney damage,” he said.

A. Thomas McLellan, PhD
Dr. McLellan reported that 23 million American adults suffer from substance abuse or dependence—about the same number of adults who have diabetes.

An additional 60 million people engage in “medically harmful” substance use, such as a woman whose two daily glasses of wine fuels growth of her breast cancer. The new law will allow millions more people to receive treatment, including those whose substance abuse is just emerging.

Under the ACA, substance abuse treatment will also become part of primary care, and will be focused more on prevention.

Substance abuse treatment will also be considered an “essential service,” meaning health plans are required to provide it. They must treat the full spectrum of the disorder, including people who are in the early stages of substance abuse. “There will be more prevention, early intervention and treatment options,” he said. “The result will be better, and less expensive, outcomes.”

By the end of 2014, under the ACA, coverage of substance use disorders is likely to be comparable to that of other chronic illnesses, such as hypertension, asthma and diabetes. Government insurers (Medicare and Medicaid) will cover physician visits (including screening, brief intervention, assessment, evaluation and medication), clinic visits, home health visits, family counseling, alcohol and drug testing, four maintenance and anti-craving medications, monitoring tests and smoking cessation.

Currently, federal benefits, such as Medicaid and Medicare, focus on inpatient services, like detox programs, but do not cover office visits for substance abuse treatments. In contrast, Medicaid covers 100 percent of diabetes-related physician visits, clinic visits and home health visits, as well as glucose tests, monitors and supplies, insulin and four other diabetes medications, foot and eye exams, and smoking cessation for diabetics.

“These are all primary care prevention and management services, which are the most effective and cheapest way of managing illness,” he said.

The impact of these new rules will be quite substantial, since an estimated 65 percent of insured Americans are covered by Medicaid or Medicare, and the rest are covered by insurance companies that base their benefits structure on federal benefits, said Dr. McLellan.

As addiction becomes treated as a chronic illness, pharmaceutical companies will be much more interested in developing new medications, he added.

“Immense markets are being created,” he said. “Until now, there have been about 13,000 treatment providers for substance use disorders, and less than half of those are doctors. Now, 550,000 primary care doctors, in addition to nurses who can prescribe medications, will be caring for these patients.”



Terminal Illness and Relapse: Why Stay Sober If You’re Dying?

November 22, 2013

Untitled1By Terence T. Gorski — —

I had just completed a workshop on relapse prevention. As I was leaving the conference room, a thin and frail-looking man from the audience approached me.  In a voice tinged with quiet desperation, he asked if he could talk with me privately. We moved to the side of the conference room, pulled up a couple of chairs, and sat down to talk.

“Mr. Gorski,” he said, “My name is Malcolm. I am recovering from chemical dependence and have been sober for nearly eleven years. I’ve had AIDS now for over two years and I’m beginning to get very sick and I know I will die. A big part of me wants to start drinking to deal with it and, to be quite frank, considering my condition, I can’t think of any good reasons to stay sober. What should I do?”

Many counselors are asked this question. Their clients struggled to get sober, only to become a statistic in the growing in the growing AIDS epidemic. Other sober people also ask this question when, in sobriety, they are diagnosed with cancer or other chronic and fatal diseases. Many of these people find the courage to face their death in sobriety.  Others return to alcohol or drug use. Of those who relapse, some get back into recovery and die sober, but many others die a horrible death from the combination of AIDS and out of control chemical addiction.

What can we say to these people?  How can we convince them that it is in their best interest to stay in recovery in spite of the horrors of their disease. How can we give them the courage to face their death sober? Should we even try? If an addict is dying, why should he or she stay sober? I can think of many good reasons for staying sober in the face of death.

Alcohol and Drugs Won’t Help!

It is tempting for terminally ill patients to believe the mistaken notion that alcohol and drug use will somehow make their disease easier to cope with. It does not.  I ask patients to think back to the times when they were using alcohol and drugs and to remember the quality of their lives.

No matter how painful or debilitating your terminal illness may be, alcohol and drugs will only make it worse.  The mental anguish and pain you may be experiencing will increase and your ability to cope with your disease will progressively disappear.  At best, alcohol and drugs will provide brief moments of temporary anesthesia, followed by periods of shame, guilt, and dysfunction.  As the chemical dependency progresses, and it always progresses, the resultant loss of control will prevent you from responsibly treating your illness, destroy any hope of having quality moments of life, and escalate your movement toward a painful death.

For people who are addicted, alcohol and drugs are never a solution to any of life’s problems, including terminal illnesses.  The temptation to believe that alcohol and drugs are a solution is part of the delusional system that accompanies chemical addiction.

The Choices In Facing A Terminal Illness

When facing a terminal illness, we only have three choices.  We can deny it by pretending everything is fine.  We can fight it by learning all that we can about our disease, fortifying our sobriety, steeping ourselves in courage and hope, and doing everything we know how to do to increase the duration and quality of our survival time.  Or we can accept it.  We can face the inevitability of our death and surrender to it.  By surrendering we can reinvest our energy in finding a sense of dignity, and meaning in the experience of our illness and death.  We can finish our business here on earth and turn to strengthen ourselves spiritually to face the transition from this life to the next.

Which is the best or correct way?  There is none.  We each will have to choose which of these alternatives we will embrace at each stage of our movement toward death.  At times, it is best to deny our illness and live as if we will live forever.  At other times, it is best to steep ourselves for the battle and fight for our lives with everything we have.  At still other times, it is best to surrender to the inevitable and face our death for what it is, the final transition of our physical lives.

The bottom line, however, is this — none of these alternatives will be available to us if we choose to use alcohol and drugs to cope.  Our disease of chemical dependency will rob us of all choice and self control. It will make our pain worse and rip us away from ourselves, our God, and those who love us.  Alcohol and drugs can never be a solution to anything for a chemically dependent person.

Reasons To Stay Sober

When Malcolm asked me the question, “Why should I stay sober?” my response was very direct, “Because you owe it to yourself and those around you.  Because you are in recovery and you are able to face anything sober and this includes your own eventual death.”

For a moment I became philosophical. “We can all create precious moments in time,” I said as I leaned forward and looked him in the eyes. “We can, at times, transcend our fear and carve out moments of joy and wonder.” I looked away for a moment a realized how often I had failed to follow my own advice. Then I continued: “We can choose to laugh when we feel like crying. We can live fully, even in the face of death. This is just true for us all.”

My mind flashed words of Earnest Hemingway: ‘All true stories end in death.’ In other words, we are all dying in every moment that we level. We are all living in every moment we are dying. We can choose to embrace life and revel in it, or we can choose to embrace death and quake in horror, fear and despair. Many people have told me the most painful thing they faced when confronted with their own impending death was how many moments in their lives they had wasted.

Then my rational brain took charge and I began explaining to Malcolm that there are seven good reasons to stay sober even if you have a terminal illness.

1. There Is Always Hope:

Only God decides when we die.  In recovery, we learn that we are not God.  Although we will all eventually die, the timing of our death is never certain.  Many people with HIV will never develop AIDS.  Of those who have AIDS, some will have spontaneous remissions and others will live a long and meaningful life before eventually dying.  On top of that, there is always the hope of a major medical break through in treatment.  Perhaps a cure will be found!  Even if such a break through never comes, people are happier and healthier when they live with hope than when they live in despair.

2. Staying Sober Increases The Length And Quality Of Survival Time:

Staying sober, eating right, exercising moderately and managed stress (all of the components of good recovery program for chemical dependence) will increase the length and quality of survival time.

3. Staying Sober Allows Us Connection With A Higher Power:

It is only in sobriety that we can experience a deep connection with our Higher Power and contemplate with hope what lies beyond the limits of our physical existence.  This is the only true source of comfort when facing our own death.

4. Alcohol And Drug Use Escalates Disease Progression:

Alcohol and drug use inhibits the immune system and accelerates the development of AIDS.  Alcohol and drug use will also interfere with the effectiveness of many of the new medications and other treatments that slow down the progression of AIDS.

5. Staying Sober Gives Us The Possibility Of Death With Dignity:

By staying sober, we can approach our death with dignity and self-respect.  We can reflect upon the meaning of our lives, the loves we’ve shared, the experiences we have had, the things we have accomplished and contributed.  We can bring closure to our lives and our relationships.  We can search for and find a deeper meaning to our lives and to our death.

6. Relapse Adds Pain And Problems To An Already Bad Situation:

When a chemically dependent person returns to alcohol and drug use, there is a big price to pay.  Physically, the booze and drugs rip our bodies apart and make us more vulnerable to the progression of other illnesses and less responsive to treatment.  Psychologically our self-esteem suffers and we develop shame, guilt and anguish.  This emotional response accelerates our plunge into depression and eventual despair.  Socially we become isolated and unable to give or receive love.  We inadvertently hurt the people we love most and cut ourselves off from one of the few sources of true comfort, the loving embrace of other human beings.  Spiritually we become bankrupt and disconnected from the God of our understanding.  We lose conscious contact with our source of courage, strength, and hope.

7. It Is Better To Die Sober Than To Die Drunk:

I strongly believe that it is better to die sober than it is to die drunk.  Using alcohol and drugs is never a solution for anything.  Alcohol and drugs cut us off from our inner source of courage, strength, and hope.  Addiction destroys our self-esteem and self-respect.  And, on top of that, it will make whatever other disease we have worse.  In the long run, it will create more pain and misery.

The Difference Sobriety Can Make

Staying sober in the face of terminal illness can and does make a difference.  I had two friends in recovery who died of cancer. One of them gave up hope and used his terminal illness as an excuse to relapse. He spent several months bingeing on booze and drugs and wallowing in self-pity. His behavior deeply hurt all of us who loved and cared about him. Most importantly, he ultimately hurt himself.  He cut himself off from those he loved and alienated himself from his higher power and his inner source of courage, strength, and hope. He ultimately decided to take his own life. He left devastation and scars on all those who touched him and died in personal misery.

My other friend faced his death sober. As a result, all who were involved with him benefited from his courage, his willingness to work through the steps and stages of accepting his own death, making his own personal peace, and being prepared to surrender himself spiritually. This friend died in a hospital surrounded by family, friends, and AA associates. His death was not pleasant, but he was able to face it using the wisdom and courage he learned in his twelve step program and through his years of recovery. As a result, he died in peace with himself and with others.  He finished the unfinished business of his life and he left behind him a legacy of the power of recovery, courage and compassion.  He showed us all the true strength of sobriety when supported by an effective recovery program.  He gave courage and hope to all who were involved with him in his final days.

Any recovery program that is strong enough to help people to face their own death in a sober and dignified way is a powerful program indeed. I wish that everyone suffering any chronic disease can learn to tap into that power.  As counselors and therapists, we need to believe in the power of the recovery tools that we teach and realize that they can assist a person in living a high quality life for as long as possible. They can help people to face the reality of their eventual death while finding the courage to live – even when they know we are dying.

Counseling The Terminally Ill

Counselors who are working with chemically dependent patients who are terminally ill need to develop a firm belief that alcohol and drug use will only make the condition worse.  Most importantly, they need to clearly and forcefully communicate that conviction to their patients.  They need to recognize that it is never in the best interest of the chronically ill patient to relapse into alcohol and drug use.

They also need to know that the use of pain medication, as prescribed, to improve the quality of the life in the face of severe pain is no a relapse. Without proper management, which usually includes a properly supervised pain medication regimen, the pain can become so severe that it destroys any ability to have quality survive time.

Therapist also need to be able to redirect their counseling and therapy towards three primary goals. The first is to maximize the use of treatment interventions that can produce a cure of the fatal condition. This means encouraging the patient to fight back against the disease by using the most effective treatment methods available. The second is to maximize the quality of survival time so that the person can live to the fullest in the remaining years, months, days, or hours of life. This means helping people to consciously bring closure to unfinished business, explore his or her values, and spend time engaging in valued activities.  The third is to develop a sense of spiritual fulfillment, which can allow patients to face their death with dignity and self-respect.  This means working through the stages of denial, anger, bargaining, and depression. This can bring people to a deep spiritual acceptance of death.

It is difficult for counselors in a death-denying society to realize that there are vital counseling interventions that can be used with terminally ill patients.  It is important to help people work through the stages of accepting their illness while still maintaining a sense of hope and a proactive vision of the future.

Counseling the terminally ill patient who is in recovery is the most challenging and, at the same time, the most meaningful experience that I have ever had.  Working with these patients in learning how to realistically face their own death has helped me come to terms with my own mortality.

Redefining Relapse

When working with terminally ill patients who often experience chronic and incapacitating pain, we have to think carefully and realistically about how we define relapse.  One of the most difficult challenges in counseling terminally ill, chemically dependent patients is to help them make wise and prudent choices about the use of medically prescribed painkillers.

I am a strong believer in abstinence as a primary treatment goal. I also recognize, however, the need that many patients have to find relief from intractable pain.  I have been approached by many people and asked if I consider it a relapse when terminally ill patients use painkillers such as Demerol or morphine.  My answer is a strong and resounding “No!  It is not a relapse!”  These pain medications are necessary to allow some quality of life.

It is important to remember that the pain associated with many chronic diseases can be more incapacitating than the use of legally prescribed painkillers.  There is a big difference, however, between using prescribed drugs under careful medical supervision and self-medicating addictively.

Counselors and therapists can learn how to help their patients come to terms with their needs for medically prescribed pain medications.  Counselors can help patients in the severe intractable pain to accept that this is not a break in sobriety. They can work with responsible pain-management physicians to develop an effective pain management plan that allows the longest and highest quality of survival time.

Relapse Warning Signs For Terminally Ill Patients

There are a number of relapse warning signs that can help terminally ill, chemically dependent patients recognize that they are moving toward a chemical relapse and take corrective action.  These are:

1. The belief that returning to the addictive use of alcohol and other drugs will make the illness more manageable or provide relief from pain.  As we discussed, the use of alcohol and other drugs will only make the disease worse.

2. The belief that the use of previous drugs of abuse will be more effective in pain management than the use of prescription drugs.  Most people quit using their drug of choice because they no longer get the desired effect.  This is the result of tolerance.  Your drugs of choice didn’t work well before and they won’t work well now.  Find a physician who will work with you in finding an effective medical regimen for the management of pain and supplement the medication with other forms of pain control.  This will be more effective in the long run.

3. The belief that returning to alcohol and drug use will bring about a quick and painless death.  Many terminal ill patients want to end the pain and mistakenly believe that alcohol and drug use will be an efficient way to commit suicide.  This is not true.  Death from chemical addiction is a slow and painful process both physically and psychologically.  If a person has decided to end his or her own life, there are other more effective and painless ways to commit suicide.

4. The belief that having a terminal illness means that there is nothing left to live for and, therefore, alcohol and drug use is justified.

When I finished, Malcolm stood up, put on his hat and said: “Thank you, I have a lot to think about.” As I shook his hand and turned to walk away, I realized that, like Malcolm, I also had a lot to link about.

Relapse Prevention In The Criminal Justice System: Applications of the CENAPS Model

November 6, 2013

By Terence T. Gorski

BARS_Defeated_HandThis article based on material presented at the Mental Health and Correction Symposium 1993 conducted on June 9, 1993 in Kansas City, Mo  sponsored by The Federal Bureau Of Prisons Of The United States Penitentiary at Leavenworth, Kansas The United States Disciplinary Barracks, Fort Leavenworth, Kansas  and The American Association for Correctional Psychologists.  The material in this article is copyrighted by Terence T. Gorski (Copyright, Terence T. Gorski, 1993)

The purpose of this article is to explore recovery and relapse prevention for chemically dependent criminal offenders and to explain how the CENAPS Model of Treatment is being applied to the treatment of chemically dependent criminal offenders. This article will provide methods for treating the chemically dependent criminal offender, as well as specific strategies for recovery and relapse prevention in the criminal justice system.  Effective treatment strategies and relapse prevention therapy for chemical dependency will be applied to the population of chemically dependent criminal offenders.

Alcohol And Drug Use Among The General Population

Alcohol use is common in the United States.  Approximately 33% of adults are abstainers.  Light drinkers who drink less than three times per month and consuming one or two drinks per drinking occasion represent about 34% of the population and consume 7.9% of all alcohol sold.  Moderate drinkers, who represent 24% of the population, consume 26.3% of all alcohol sold.  Moderate drinkers drink two to three times per week and consume an average of two to three drinks per drinking occasion.  Heavy drinkers represent 9% of the population.  They tend to be daily drinkers, consume three drinks or more per day, and consume 65.8% of the alcoholic beverages sold.

Type Of Drinker % Of Population % Alcohol Consumed
Abstainers  33% 0%
Light Drinkers 34% 7.9%
Moderate Drinkers 24% 26.3%
Heavy Drinkers 9% 65.8%

Incidence Of Chemical Dependence

Conservative estimates indicate that approximately 10% of the adult population in the United States is suffering from alcohol dependence and 5% of the United States population is drug dependent.  Therefore, a total of 15% of the general population of the United States is chemically dependent at any given time.  Alcohol and drug use and dependence among criminal offenders is more common.  Nearly 100% use both alcohol and drugs on a regular basis.  The vast majority of criminal offenders fall into the moderate or heavy drinking categories.  Approximately 70% of all inmate populations across the United States are incarcerated for alcohol and drug related crimes ranging from intoxication at the time of the crime to illegal drug trade.

Chemical Dependency In The United States
Use Pattern General Offenders
1.  A/D Use



2.  A/D Dependence



Alcohol Use And Crime

Statistics show that 54% of violent criminals are under the influence of alcohol at the time of the crime and 40% are under the influence of alcohol when committing property crimes.  With drug crimes, meaning illegal drug trade, 29% are drunk or high on drugs while engaging in those transactions and 64% are under the influence of alcohol when committing public order offenses.  This is a total average of 48% of the criminal population being under the influence of alcohol at the time they commit a crime.

The statistics are striking when looking at violent crimes and the violent criminal.  Fifty-four percent of all violent criminals are under the influence of alcohol and drugs at the time of the crime.  Many report using alcohol and drugs to gain the courage to facilitate the violent acts.  Others say that alcohol or drugs break down impulse control which causes them to react spontaneously with violent behavior in high stress situations.

A breakdown of violent crime reveals that 49% of murderers are intoxicated at the time of the murder.  Statistics show that 68% of manslaughter convictions, 52% of rapes and sexual assaults, and 62% of non-sexual assaults occur while the offender is intoxicated.

Types Of Alcohol And Drug Problems Among Inmates

When focusing on the types of alcohol and drug problems among criminal offenders, it is essential to use DSM-IIIR categories and the two subcategories of substance use disorders.  The first subcategory is chemical abuse disorders.  People with chemical abuse disorders get into trouble as a result of their alcohol and drug use, but they are not physiologically addicted.  They have not achieved high levels of tolerance and dependence, and do not go through withdrawal when they attempt to stop.  It is estimated that about 28% of all inmates in the United States or 40% of all inmates committing alcohol and drug related crimes are diagnosed as having chemical abuse disorders.

The next DSM-IIIR subcategory is chemical dependency disorders or substance dependency disorders.  Forty-two percent of all inmates in the United States have chemical dependency disorders and approximately 60% of those committing alcohol and drug related crimes are diagnosed as having chemical dependency disorders..

Alcohol And Drug Abuse And Antisocial Personality

Offenders with alcohol and drug related crimes can be divided into three categories.  In the first category, the crime is a symptom of the non-addictive use of illegal drugs in persons who do not have chemical use disorders or criminal personalities.  A good example of this is the man who does not have a drug problem getting arrested for using and selling marijuana.  Only 5% of criminal offenders fall into this category of people who are arrested on drug charges who are not chemically dependent.

In the second category, crime is a symptom of chemical dependency.  For example, a heroin addict begins to commit burglaries to support his habit.  Another example is an alcoholic who is down on his luck and, at moments of poor impulse control, steals money to purchase alcohol or shoplifts in a liquor store in order to get alcohol.  Approximately 15% of the inmate population falls into this category.  Once the chemical dependency goes into remission and the person gets sober, the criminal behavior will spontaneously disappear.

In the third category, alcohol and drug use is a symptom of a criminal personality.  These people basically have DSM-IIIR Cluster B personality disorders in conjunction with their chemical use, but are not chemically dependent.  They have the personality disorder that predisposes them to act out against authority, break rules, and commit crimes primarily for thrill seeking behavior.  They are abusers, but are not addicted.  They comprise approximately 15% of the population where alcohol and drugs are involved.

By far, the largest category is where crime is both a symptom of chemical dependency and criminal personality traits which is approximately 65% of the chemically dependent criminal offenders.  This is important information to consider in determining treatment strategy because many criminals who are chemically dependent seek sobriety so they can become more efficient criminals.  They realize that because of the loss of control they are getting caught and their goal is to get sober so they will not get caught again.

The conclusion here is a very simple one.  Most criminal offenders who commit alcohol and drug related crimes have serious chemical use disorders.  Few criminal offenders are social drinkers or recreational drug users.  There will always be the exception, but they are few and far between.

Alcohol And Drug Problems and Criminal Recidivism

Alcohol and drug problems are related to criminal recidivism.  Fifty-one percent of repeat offenders have chemical use disorders, the majority of them untreated.  In inmate populations among the United States, less than 15% of the chemically dependent criminal offenders today get any type of treatment for their chemical dependency.  Of the 15% that do receive chemical dependency treatment, for 70% of them the only intervention available is voluntary attendance at Alcoholics Anonymous and other twelve step meetings with only about 30% of the current inmate population being exposed to structured chemical dependency programs across the entire inmate population of the United States.

Alcohol and drug use among parolees is associated with three things – breaking parole and probation, renewed criminal behavior, and re-arrest for criminal activity.  If a parolee starts to drink and use drugs, the likelihood of engaging in criminal activity that leads to re-arrest is very high and results in new arrests and convictions.  The basic sequence is breaking parole and probation requirements, going back into criminal behavior, getting caught, and returning to the legal system to start the entire cycle all over again.

Antisocial Behavior Is Common Among Criminal Offenders

Commit Antisocial Acts – 100%

Habitual Criminals – 75%

Antisocial Personality Disorders

How many criminal offenders commit antisocial acts?  One hundred percent of the inmate population commits antisocial acts.  Stanton Samenow and Dr. Samuel Yochelson studied hard-core criminal offenders and found that for every one time a criminal is caught, most have committed at least 100 previous crimes for which they have not been caught.

Habitual criminals represent 75% of the offender population.  Seventy-five percent of habitual criminals have a criminal personality disorder, criminal personality style, or a collection of criminal personality traits that need to be dealt with and addressed if they are going to be successfully rehabilitated.

Let’s look at the incidence of antisocial personality disorder in various populations.  In the general population, approximately 4% of males and approximately 1% of females are diagnosed at any given time as having antisocial personality disorder.  Fifteen percent of alcoholic males, a little over three times the incidence of the general population males, have diagnosable antisocial personality disorder and 10% of the alcoholic females have diagnosable antisocial personality disorder, which is  nine times that of the general population females.

Of all male narcotics addicts, 32% have diagnosable antisocial personality disorder.  Statistics of female narcotics addicts are not readily available as there are so many more male narcotics addicts than female narcotics addicts.

In prison inmate populations, 50 to 80% of the inmates have diagnosable antisocial personality disorder.

Criminal Personality Disorders

Criminal personality disorder consists of deeply entrenched, highly destructive tendencies.  There are basically four DSM-IIIR Cluster B personality disorders that tend to coexist to some degree as a mixed personality disorder.

 DSM-IIIR Cluster B Personality Disorders

1. Antisocial (Rule Breakers)

2. Narcissistic (Egotistical and Self-Centered)

3. Histrionic (Disruptive Attention Seekers)

4. Borderline (Chaotic and Volatile)

The antisocial personality disorder features compulsive, rule-breaking behavior.  People with antisocial personality disorder have difficulty with authority; they have poor impulse control; they have no respect for established authority; they tend to find it thrilling and exciting to break the rules and laws; and they enjoy this behavior.

The second personality disorder is the narcissistic personality disorder.  People with narcissistic personality disorder are egotistical and self-centered;  they tend to believe that other people exist merely as instruments to their well-being; and they have a tremendous tendency to personalize everybody else, turn them into objects, and simply use them to enhance their own ego.  People with antisocial personality disorder usually possess significant narcissistic traits.  The stronger the narcissistic tendencies in the antisocial person, the more difficult the rehabilitation challenge.

These are the personality styles and disorders that coexist to some degree or another in chronic, habitual criminals.

Punishment Alone Does Not Work

It is proven that punishment alone will not stop criminals with chemical use disorders from using alcohol and drugs.  Threatening consequences will not stop chemical use either.  Monitoring for alcohol and drug use through urinalysis is not enough to interrupt the obsession, compulsion, craving, and the maladaptive life patterns that lead these people back to chemical use.

Similarly, punishment alone will not stop criminals with criminal personality disorders from committing crimes because of the fact that the higher the risk, the greater the attraction to the crime.  People who have severely antisocial personalities are attracted to criminal thrill-seeking behavior.  The higher the risk of a criminal act, the greater the high produced when the act is committed.  Many people with antisocial personalities are excitement junkies who are addicted to criminal and sexual thrill seeking.  Criminal grandiosity also programs criminals to “put themselves to the test” by proving that they can commit high risk crimes and get away with it.

Criminal behavior is expanding and reaching epidemic proportions.  The simple humane warehousing of criminal offenders will not meet the needs of this nation.  Jails are overcrowded and are getting more so every day.  The solution is not to build more jails as the criminal population will expand to fill the jails that are available.

There is significant evidence that treatment alternatives to incarceration are reducing recidivism and increasing positive adjustment back into society following episodes of incarceration.

For Treatment Alternatives To Work …
Criminal Offenders Must Be Screened
And Concurrently Treated For …
1.         Chemical Use Disorders
2.         Criminal Personality Disorders
3.         Mental Disorders

In order for treatment alternatives to work, every criminal offender must be screened and concurrently treated for three distinct categories of disorders.  The first category is chemical use disorders; the second category is criminal personality traits and disorders, i.e. DSM-IIIR Cluster B personality disorders; and the third category is mental disorders as many people with severe substance use disorders and personality disorders also have another Axis I diagnosis of schizophrenia, panic disorders, or phobias.

Policies must be established universally at county and local levels were diagnostic and treatment procedures are integrated into the criminal justice system as   a standard operating procedure.  Until this level of integration exists, the chemical dependency and behavioral health programs will be viewed as add-on programs.  The goal must be integration.  How do we integrate these programs into the criminal justice system, into the prison systems, into the probation and parole systems so they become the normal way of doing business in an enforcement and incarceration environment?

First, screening needs to be done prior to sentencing.  Technology must be enhanced and proper evaluation tools must be used to screen for chemical use disorders, criminal personality disorders, and mental disorders.

Secondly, treatment must be concurrent with punishment.  There must be treatment during incarceration.  The ideal, of course, is to turn all of our criminal institutions into rehabilitation environments, set up varieties of therapy to address different needs, and provide concurrent treatment to every criminal offender.

Limited resources must be applied to their best advantage.  Intensive rehabilitation should occur towards the end of the inpatient incarceration period.  In this way, the offender learns sober and responsible coping strategies while they are in the criminal justice system population which prepares them for the transition period out of the criminal justice system population.

Ongoing treatment must be a mandatory condition of parole and probation.  This is becoming a widespread practice.  Criminal offenders are being sentenced to ongoing treatment as a mandatory condition of probation and parole and there are very strict consequences if this condition is not adhered to.  Any person breaking the treatment protocol must receive rapid disciplinary action where the offender is returned to incarceration.  Contingencies should be devised where the first break in treatment structure results in a return to jail for three days; the second break results in a two week incarceration; the third break results in a return to jail for 30 to 60 days, and the fourth break results in returning to jail to finish off the entire sentence.

Inmates need to know that there are consequences to breaking their rehabilitation structure after they are out of the institution.  These people must be kept on a long-term continuum of care.  This must be linked into the probation, parole, and the court procedures so that if a person breaks the treatment regimen, strict consequences follow.

Criminal Personality Disorders and Chemical Use Disorders
Are Coexisting Disorders That Are Best Treated Together

There should be treatment alternatives to incarceration for criminals who have two coexisting disorders —  criminal personality disorders and chemical use disorders.  People having these two disorders should be screened and evaluated for placement in  specialty programs when they enter the criminal justice system.  Some offenders will go

into incarceration environments; some will go into primary treatment; some will go into relapse prevention programs.  A profile of specialty programs should be made available to them.

Criminal personality disorders and chemical use disorders are coexisting disorders that must be treated together.  If you attempt to treat the chemical dependency while not treating the criminal personality traits of a chemically dependent criminal offender, the offender is at high risk of relapse to alcohol and drug use.  Similarly, if a person has severe antisocial traits and the antisocial traits are treated but the chemical use disorder is not focused upon, the person will relapse into drinking and drug use and all of the antisocial traits will return.

Why is this?  The reason is because there is a very definite relationship between chemical dependency and criminal personality disorders.  There are three links in the chain that bind these disorders together.  The first link in the chain is mutual predisposition.  Predisposition is a term used to describe the factors that set the person up to get the disorder.  Criminal personality disorder increases the risk of chemical dependency.  Substance use and abuse is a feature of criminal personality disorder.  People with Cluster B personality disorders, especially antisocial personality disorder, drink and drug heavily.  If they have the genetics that make them sensitive for physiological dependence and addiction to alcohol and drugs, they are very likely to become addicted.

Chemical dependency increases the risk of criminal personality traits and disorders.  If a person moves into a progressive history of alcoholism or drug addiction, he turns to illicit antisocial behaviors and to an illegal drug culture in order to survive and maintain his active addiction.  For example, a drug addict enters a criminal underground of illicit behaviors to acquire and use a drug.  The addict enters a dangerous criminal underworld which conditions his behavior and creates criminal personality traits as        an adjustment reaction to moving into the criminal underground life.

People in this type of underground existence have antisocial tendencies.  They are entranced or excited about the prospect of this underground existence, but once they get into it, there is a progressive involvement in more violence and more criminality.  This mutual predisposition forms the first link in the chain between chemical dependency and criminal personality disorder.  Alcohol abuse brings a person right back into their contact with the illicit drug culture.

The second link between chemical dependency and criminal personality disorder is symptom reinforcement.  Once chemical dependency and criminal personality traits develop, there is symptom reinforcement.  Criminal personality disorder promotes alcohol abuse as a condition and a necessary prerequisite for its existence.  Large numbers of criminal offenders who use alcohol and drugs will tell you that the reason they use is to give them courage to get ready for the act, it allows them to recover from the act, or it enhances the thrill of the criminal behavior.  Alcohol and drugs are being used purposefully as an extension and exaggeration of the benefits that the criminal gets from criminal behavior.

Alcohol and drug abuse promotes antisocial behavior by lowering habitual and impulse control making criminals susceptible to poor judgment that results in renewed criminal behavior.  The third link in the chain between chemical dependency and criminal personality disorder is reciprocal relapse where alcohol and drug use triggers criminal behaviors and criminal behaviors trigger alcohol and drug abuse.

Because chemical dependency and criminal personality disorder are closely linked, there needs to be concurrent diagnosis and treatment.  Abstinence from alcohol and drug use must be the primary goal in our rehabilitation setting in the criminal justice system.  Controlled drinking and controlled use of illicit drugs should not be on the criminal justice agenda for this nation.

Another goal should be abstinence from criminal behaviors.  Of course, this is very clear within the criminal justice system.  There is an intrinsic link between alcohol and drug use and abuse and criminal recidivism and the goals for both must be tied together.

Alcohol, drug, and criminal life style patterns must be changed through internal changes in thinking patterns, emotional management patterns, behavioral patterns, and making external structural changes in the person’s life style.

All programs need to have a very strong foundation in holistic health.  Physical rehabilitation, proper diet and exercise, proper stress management, psychological rehabilitation focusing on changing thinking and emotional management strategies, behavioral control strategies, behavior enhancement techniques, and social rehabilitation are necessary.

The CENAPS Model of Treatment

The CENAPS Model of Treatment is different from other models in that it is integrative and it is evolutionary.  The CENAPS Model is not a revolutionary, new model.  Revolutionary models tear down the past and propose a bold, new approach to the future.  They believe what came before is basically irrelevant.  The CENAPS Model takes various approaches and tries to come up with a unified field theory and united systematic approaches.  The goal is to integrate what is already known, consolidate it, and overcome the language problems that are so divisive among different therapeutic specialties.  A uniform set of terms and uniform nomenclatures must be established to continue this movement.

The CENAPS Model Combines …

A Biopsychosocial Disease Mode
Of Chemical Dependence
With Criminal Personality Theory
To Create A Practical System For Treating
Chemically Dependent Criminal Offenders

The CENAPS Model is a biopsychosocial disease model for chemical dependency.  Rehabilitation must consist of broad-based biopsychosocial intervention.

The CENAPS Model of Treatment is being integrated with criminal personality theory.  The model is taking the chemical dependency treatment field and is integrating it with the psychotherapy community and the criminal justice rehabilitation program to create a unified, evolutionary understanding of how to treat chemically dependent criminal offenders.

The goal is to create a practical system for treating chemically dependent criminal offenders.  The CENAPS Corporation has developed this tool.  With the assistance of the Office of Treatment Improvement, The CENAPS Corporation has developed three manuals.  One of these manuals is a relapse prevention workbook for criminal offenders.  Another manual is an instruction guide for counselors, probation and parole officers, and prison guards.  Anyone who is working with criminal offenders can access an instruction guide to use this practical technology.  The third manual is a briefing document containing figures and statistics which will be available to administrative judges and high level decision makers to help them in supporting this thrust in rehabilitation.

 The CENAPS Model Integrates …
1.         Cognitive Therapy
2.         Affective Therapy
3.         Behavioral Therapy
4.         Social Systems Therapy

The CENAPS Model integrates cognitive therapy techniques.  The CENAPS Model is primarily an applied cognitive therapy interested in changing addictive and criminal thinking patterns.  Stanton Samenow’s book Understanding the Criminal Mind and the three-volume series on the criminal personality by Samuel Yochelson and Stanton Samenow contain excellent illustrations of the criminal personality.

The CENAPS Model of Treatment is also based upon a broad spectrum of cognitive therapy principles.  Affective therapy is used to cope with unmanageable feelings that drive addictive and criminal behaviors.  There is an emotional charge, an emotional drive, and a thrill seeking or sensation seeking component.  Emotional integration is necessary for a person to recover.  A specific emotional management strategy must be developed for coping with addictive and criminal behaviors.

Crime is the end product of a sequence of maladaptive, self-defeating behaviors.  Chemical use is the end result of a long sequence of maladaptive, self-defeating, coping behaviors that have become deeply entrenched and associated with cues and triggers in a person’s life style.  This type of behavioral reconditioning or behavioral programming strategies must be integrated into every comprehensive treatment program.

Social system therapy is designed to change addiction-centered and crime-centered social networks with particular focus upon employment, social, and intimate networks.

Almost all criminal offenders with criminal personality traits have significant problems achieving and maintaining intimate relationships.  Almost always, their intimate and family relationships are exploited and abusive where their mate or family members are relegated to objects and are used and abused for criminal, violent, and sexual thrill seeking behaviors.  When addressing rehabilitation in these populations, intimate relationships must also be addressed.  Dysfunctional intimate relationships are a major relapse trigger.  My book Getting Love Right is a simple guide for relapse-prone alcoholics on how to have healthy relationships.

An instrument called the Biopsychosocial Assessment Grid (BAG) is a biopsychosocial disease model for diagnosis and assessment.  The Biopsychosocial Assessment Grid is a way of looking at relevant physical, psychological, and social valuables for the purpose of differential diagnosis of chemical dependency and criminal personality traits.  The BAG system can be extended simply by adding columns for any other dual diagnosis you wish to add.  You can create the BAG categories by simple analysis of symptomatology and breaking it down physically, psychologically, and socially in a similar format.

The Developmental Model of Recovery emphasizes that recovery unfolds over a long period of time in stages.  Each stage requires a different primary treatment focus. There are different goals and tasks in each stage of recovery, and the treatment plan must shift with each stage of recovery.  A chemically dependent criminal offender must be locked into a long-term, accountable rehabilitation program for a minimum period of three to five years if he is going to see any significant changes occur.

The CENAPS relapse prevention therapy model deals with the problem of recidivism.  Relapse prevention strategies are very powerful in preventing relapse, but unless they are coupled with biopsychosocial models of diagnosis to treat coexisting illnesses that surface and treat the physical, psychological, and social symptoms of the disorders, relapse prevention is going to be very limited.

Relapse prevention therapy is a vitally needed link in the rehabilitation chain, but of and by itself it is insufficient to handle the massive problem of chemical dependency and criminal relapse.

The CENAPS Model has been expanded to meet the needs of the criminal justice system by integrating the diagnosis and treatment of chemical use disorders, both abuse and dependency with criminal personality disorders.

The CENAPS Model is compatible with twelve step principles.  This model follows the twelve step tradition.  It is practical and easy to use.  It is easily adaptable to inpatient, residential, and outpatient programs and is adaptable to working in residential and camp-like environments in the criminal justice system.  The CENAPS Model of Treatment is oriented to the real world of the criminal justice system and is adaptable and flexible.

The CENAPS Model Provides Diagnostic And Treatment Methods For :

1.         Transitional Patients
2.         Primary Patients
3.         Relapse-Prone Patients
4.         Family Members

The CENAPS Model provides diagnostic methods for basically four categories of clients or patients.  The first is what we call transitional patients.  These are involuntary patients who are in strong denial and definitely have alcohol and drug problems.  Everyone knows this except them.  They may be willing to abstain from alcohol and drug use for a little while to avoid the consequences, but still want to be social drinkers.  They are actively antisocial in everyone’s mind except their own.  They believe they are simply innocent victims of the system.  If they weren’t victimized by that rape victim who screamed too loud or the police officer that came to arrest them, they would not be in this trouble.

The CENAPS Model provides diagnostic and treatment methods for primary patients.  Primary patients know they have a problem and realize that if they do not change their alcohol and drug use patterns and their personality, they are going to be incarcerated again.  When you mix transitional patients and primary patients together, the transitional patients destroy the efficacy of treatment for the primary patients.  Differential screening and differential placement of transitional patients and primary patients is strongly recommended.

The CENAPS Model also provides diagnostic and treatment methods for relapse-prone patients.  Relapse-prone patients know they are chemically dependent and have antisocial tendencies.  They have learned recovery strategies and have attempted to use them, but have failed.  They have encountered some obstacle that they could not manage.  Relapse prevention therapy is a special treatment designed for people who are unable to stay in recovery in spite of their desire to do so.

The CENAPS Model also provides treatment for family members.  Family members may relapse into codependent behaviors of enabling, controlling, and care taking.  When the chemically dependent person is surrounded by these types of people, their reality testing and sanity checking disappears, they lapse back into inappropriate, irresponsible behaviors, and relapse rates go up.

What is diagnosis?  Diagnosis in the CENAPS Model is an organized system for identifying the symptoms of the disease or disorder.  The patient must recognize and take ownership of his disease or disorder.  CENAPS diagnostic methods are designed to provide professional diagnosis, but most importantly to guide patients through self-diagnostic procedures so that they use themselves and other clients in their groups as an active laboratory to learn about what is wrong with them that is causing them to get into trouble.

 Components Of The CENAPS Model

                      1.         Biopsychosocial Addiction Model

2.         Developmental Model of Recovery (DMR)

3.         Relapse Prevention Therapy

Treatment in the CENAPS Model is defined as an organized system for bringing the symptoms of a disease or disorder into remission.  Effective treatment produces changes in the way a person thinks, feels, and acts and, as a result, produces changes in their life style.  This is a goal-oriented, change-oriented strategy which looks at internal changes in thinking, feeling, and action urges.

Chemical use disorders are the regular, heavy use of alcohol and drugs resulting in psychosocial dependence.  “I need alcohol and drugs to psychologically feel good about myself and to socially function.”

This results in personal, social, and occupational impairment.  “I cannot function personally.  Things are happening personally that upset me and I cannot function socially.  When I get into social situations, I upset people and create problems.”

It also creates occupational impairment.  “I cannot maintain a productive job.       I cannot work in a problem-free manner.

Chemical use disorders basically involve the pathological use of alcohol and other mood-altering drugs.  This results in the development of physical problems, withdrawal-related complications, illnesses, organ system problems, psychological problems, the development of irrational thinking, the development of maladaptive, self-defeating emotional management strategies, and the development of self-defeating and destructive social relationship patterns.  Marty Mann has an excellent rule of thumb, “If a person has a problem with alcohol and they continue to drink in spite of the problem, they are probably alcoholic.”

If a person has problems with chemical use and they continue to use alcohol and drugs in spite of the problem, he or she probably has a chemical use disorder.  This is a very simple, practical, diagnostic standard.

Chemical use results from chemical use in psychosocial predisposed persons.  Abuse does not require a genetic predisposition which is where many hard-line chemical dependency disease concept people get into trouble.  They do not recognize that there are non-addictive abusers who get into trouble with alcohol and drugs.  They are psychosocially predisposed.  Their chemical use causes personality disorganization and life style problems, but does not cause major physiological changes or high levels of tolerance, dependence, and withdrawal.  Chemical abuse is often a symptom of antisocial personality disorder.  Many people with antisocial personality disorders, about 15% of the criminal population, will show up as non-addicted abusers.

Substance dependence disorders can be defined as chemical use in genetically predisposed persons that causes brain dysfunction resulting in tolerance and withdrawal, personality disorganization resulting from a toxic brain, life style problems, and progressive biopsychosocial deterioration.  The chemical use problems take on a life of their own, independent of life style circumstances.  For genetic research distinguishing between the progression of abuse disorders and the progression of dependency disorders, refer to George Valiant’s book The Natural History of  Alcoholism, which reports on a forty-year study of young men diagnosed in their teens who became alcohol and drug dependent.

The Relapse Progression

                 1.         Stable Recovery

2.         Relapse Warning Signs

3.         Renewed Alcohol/Drug Us And Criminal Behavior

There is progression from abuse to dependence.  Genetically predisposed people who use and abuse chemicals become addicted.  Chemical abuse can, but does not always, progress to chemical dependency.  The majority of chemically dependent people go through a progression of stages.  Approximately one-third of patients will be instant alcoholics and instant addicts, whereas the other two-thirds will follow through a progression of stages.

The CENAPS Model of Treatment focuses upon the concept of a continuum of alcohol and drug problems and mirrors the President’s commission which explained in their report entitled Broadening the Base of Alcoholism Treatment that it is helpful to think of degrees of severity of alcohol problems from mild, to moderate, to severe.  The CENAPS Model does differ with that report in that it recognizes that people with severe alcohol and drug problems have dependence disorders.  These dependence disorders constitute an objective and verifiable disease state.  Once people have severe problems with alcohol and drugs, less than 2% of those people are able to return to controlled drinking.  Therefore, chemically dependent people with severe alcohol and drug problems should not have the goal of controlled drinking.

On the other end, we have people with abuse disorders who have mild problems with alcohol and drugs, but are not addicted.  These people will benefit from self-control training if they do not have a coexisting mental or emotional disorder that is aggravated by alcohol and drug use.

Borderline cases, the most difficult cases, either are severe abusers or early stage addicts, but it is difficult to determine which.  Treatment principles are essentially the same for both disorders.  How people deal with borderline cases depends upon their theoretical bias.

What are these treatment principles?  Basically, recovery from chemical dependency requires three things.  First, recovery requires abstinence from alcohol and drugs.  A definite abstinence goal must be set and measurement techniques, such as blood alcohol and urinalysis surveillance, must be used to make sure this is being maintained.

Secondly, recovery requires identifying and changing thoughts, feelings, and behaviors and isolating the specific thoughts, feelings, and behaviors that lead a person back to chemical use.  We must identify and change irrational thinking, unmanageable feelings, and self-defeating behaviors and identify and change addiction-centered life style patterns.

Thirdly, recovery requires deep personality and value change which is often called advanced recovery work or Stage II recovery work.  If this deep personality change and value change does not occur, the person will relapse.

Criminal personality is defined as an habitual way of perceiving, thinking, feeling, acting, and relating to others that results in constant opposition to established authority, acting out against others, and chronic and compulsive rule breaking and criminal behaviors.

Criminal personality disorders fall under Cluster B personality disorders which are:  antisocial (compulsive rule breakers), narcissistic (egotistical, self-centered people), histrionic (disruptive attention-seekers), and chaotic (volatile).

As there is a continuum of alcohol and drug problems, there is also a continuum of criminality.  The assessment of the continuum of criminality is not black or white.  Problem arise with people who fall into the mid range of the continuum of criminality.  There are mild, moderate, and severe problems with criminal behavior and antisocial tendencies.  A majority of people have at least low level antisocial potential.  This may grow into actual, observable traits that may cause people to act out in criminal ways until this escalates into criminal personality disorder where the person is out of control.

Recovery is a long-term process of biopsychosocial rehabilitation.  Brief therapies will not work with chemically dependent criminal offenders who have antisocial personality traits.  The CENAPS Model is the tool necessary for integrating chemical dependency and the treatment of criminal personality disorders.

Remember, there is hope!  Chemically dependent criminal offenders are difficult to treat; they are not impossible to treat.  Recovery is possible if both disorders are concurrently addressed and long-term treatment is provided systematically in an integrated context in the criminal justice system.


American Psychiatric Association, Diagnostic And Statistical Manual Of Mental Disorders (Third Edition – Revised), American Psychiatric Association, Washington D.C., 1987

Beck, Aaron T. and Freeman, Arthur,  Cognitive Therapy Of Personality Disorders, The Guilford Press, New York, London, 1990

Cadoret, Remi J., Troughton, Ed, Gorman, Thomas W.,  Genetic and Environmental Factors In Alcohol Abuse and Antisocial Personality, Journal Of Studies On Alcohol, Vol 48, No 1, 1987, pp. 1 – 8

Forrest, Gary G., Chemical Dependency And Antisocial Personality Disorder, Volume 1:  Epidemiology, Etiology, And Differential Diagnosis,, The Haworth Press Inc., New York, London, Sidney, 1993

Forrest, Gary G., Chemical Dependency And Antisocial Personality Disorder, Volume 2:  Psychotherapy and Rehabilitation,, The Haworth Press Inc., New York, London, Sidney, 1993

Gillen R. and Hesselbrock V., Cognitive Functioning, ASP, and Family History Of Alcoholism In Young Men At Risk For Alcoholism, Alcohol Clin Exp Res, Vol 16 No 2, 1992, pp 206 – 214

Glen, Susan Wagner, Austin, Eririco L., Parsons, Oscar A., King, Andrea c., and Nixon, Sara Jo,  The Role of Antisocial, Affective, and Childhood Behavioral Characteristics In Alcoholics Neuropsychological Performance, Alcohol Clin Exp Res, Vol 17, No 1 1993, pp. 162-169

Gorski, T., and Miller, M. Counseling for Relapse Prevention. Independence, Missouri: Herald House – Independence Press, 1982.

Gorski, T., and Miller, M. Staying Sober – A Guide for Relapse Prevention. Independence, Missouri: Herald House – Independence Press, 1986.

Gorski, T. The Staying Sober Workbook – A Serious Solution for the Problem of Relapse. Independence, Missouri: Herald House – Independence Press, 1988.

Gorski, T. How to Start Relapse Prevention Support Groups. Independence, Missouri: Herald House – Independence Press, 1989.

Gorski, T. Passages Through Recovery – An Action Plan for Preventing Relapse. Center City, Minnesota: Hazelden, 1989.

Gorski, T. Understanding the Twelve Steps – A Guide for Counselors, Therapists, and Recovering People. Independence, Missouri: Herald House – Independence Press, 1989.

Gorski, Terence T. Relapse Prevention Therapy With Chemically Dependent Criminal Offenders, Part 1: An Executive Briefing For Policy Makers And Judges, Herald House Independence Press, Independence, MO 1993

Gorski, Terence T. and Kelley, John M.,  Relapse Prevention Therapy With Chemically Dependent Criminal Offenders, Part 2: A Guide For Counselors, Probation, And Parole Officers, Herald House Independence Press, Independence, MO 1993

Gorski, Terence T. and Kelley, John M.,  Relapse Prevention Therapy With Chemically Dependent Criminal Offenders, Part 3: The Relapse Prevention Workbook For The Criminal Offender, Herald House Independence Press, Independence, MO 1993

Miller, M.; Gorski, T.; and Miller, D. Learning To Live Again – A Guide For Recovery From Alcoholism. Independence, Missouri: Herald House – Independence Press, 1980.

Miller, M., and Gorski, T. Staying Sober Recovery Education Modules -Exercise Manual. Independence, Missouri: Herald House – Independence Press, 1989.

Millon, Theodore and Everly, George S. Jr.,  Personality and Its Disorders, John Wiley and Sons, New York, 1985

Walker, Robert, Substance Abuse and B-Cluster Disorders I:  Understanding The Dual Diagnosis Patient, Journal Of Psychoactive Drugs, Vol 24(3), Jul-Sep 1992, pp. 223 – 232

Walker, Robert, Substance Abuse and B-Cluster Disorders II:  Treatment Recommendations, Journal Of Psychoactive Drugs, Vol 24(3), Jul-Sep 1992, pp. 233 – 241

Yochelson, Samuel and Samenow, Stanton E.  The Criminal Personality, Volume 1:  A Profile For Change, Jason Aronson Inc., Northvale, New Jersey, London, 1976

Yochelson, Samuel and Samenow, Stanton E.  The Criminal Personality, Volume 2:  The Change Process, Jason Aronson Inc., Northvale, New Jersey, London, 1985

Yochelson, Samuel and Samenow, Stanton E.  The Criminal Personality, Volume 3:  The Drug User, Jason Aronson Inc., Northvale, New Jersey, London, 1986

Information Resources

1.         National Clearinghouse For Alcohol And Drug Information (NCADI) p 1-800-729-6686

2.         National Criminal Justice System Reference Service (NCJRS) – 1-800-851-3420

3.         Drugs and Crime Data Center and Clearing House – 1-800-666-3322

4.         The CENAPS Corporation, 18650 Dixie Hwy, Homewood Il 60430, 708-799-5000

5.         Herald House Independence Press, 1-800-767-8181, 816-252-5010


No Wrong Doors Into Recovery

April 27, 2012


April 13, 2012

Suicide_AddictionBy Terence T. Gorski, Author
Updated: January 9, 2014


Straight Talk About Suicide – The book by Terence T. Gorski

Over my life I have seen too many people fall into the black pit of depression and kill themselves. I have never spoken out about this problem and offered hope and helpful tools for people who are depressed and thinking of ending their lives. This book is my small attempt to save the lives of people who feel they have no out of their pain and problems except death at their own hand. The primary and powerful message I want to deliver is that suicide is a permanent solution to a temporary problem. People who are depressed and suicidal focus upon their pain and problems and develop the mistaken belief that this will never end. They lose touch with the primary principle for keep hope in recovery even during our darkest hours. This principle is captured in the slogan” This too will pass!

In a creative moment I captured my thoughts in a simple one line affirmation: Life will be new again if I have the strength to reach for beauty and the spirit to pay its price! I have found this to be true even in my darkest hours living in the black pit of depression. Somehow I always found what I found the courage, strength and hope I needed to climb out of the pit. This has always happened even though I did nt believe in the moment that I would ever feel good or get t the other side of my problems again.

People will want to read this book for one of three reasons: You are a therapist who works with people who have suicidal tendencies; you are a person who knows or loves someone who is currently thinking of suicide, has attempted in the past, or has actually committed suicide; or you yourself are considering suicide as a possible alternative to end your pain and solve your problems. The common bond between all three groups of readers is that you have been or are currently being affected by the problem of suicide and you desire to learn more about it.

I struggled when planning to write this book. Which of these three audiences should I primarily address? As I did internet and library research and talked with therapist who specialize in treating suicidal people and their families, one thing became clear. There are many books written for therapists. These tend to be clinical and are often difficult to read, especially for recovering people and their families. To be quit honest, even though many of these books contain important information and counseling approaches to restoring hope in people who are suicidal and those who love them, most of them are written is a dry professional style that makes them tedious and difficult to read.

These books often fail to give practical information that a suicidal person or the friends or families of suicidal people could use to understand what is happening and what they can do to help the suicidal person to choose life over death.
Suicide – killing yourself by your own hand – is not a pleasant subject to think or talk about. As a result most people don’t. If you know someone who is showing the warning signs of suicide, it’s difficult to believe that they might actually try to kill themselves. Even if someone tells you that they are suicidal and asks for help, most people don’t know what to say or what to do. They fear calling a mental health center or psychiatrist for fear they will be “locked up in a psycho ward,” or “zonked out on medication,” only to be sent home just to become suicidal again a few days or weeks later.

Mental health professionals, including psychiatrists, psychologists, social workers, and professional counselors know what to say and do. The problem is that they rarely get a chance to say and do what will help because the suicidal person is rarely referred to them unless they are caught in the act of attempting suicide or have tried to kill themselves and failed. Mental health professionals can be of great help to these people. But what about those people who have actually killed themselves? Here’s the sad truth – people who succeed in killing themselves are dead – end of story. There isn’t much anyone can do for them except arrange the funeral. The real task is trying to deal with the psychological and social aftermath to family, friends, and the community as a whole.

Suicide is never a private act. It always has a devastating effect on family, friends, & the community.

As I talked with professionals, family members, and people who had previously attempted suicide several things became clear.
First, most professionals already know or have access to information about how to prevent suicide and manage the people who have survived suicide attempts.
Second, most people on the brink of suicide are unlikely to pick up a book about suicide, start reading it and have a blinding flash of truth leap out at them that changes their minds. I know this happens sometimes, but it usually happens in the early stages of the suicide process.

If, however, you are suicidal, and reading this book – you owe it to yourself to read on. As the title says – I’m going to use Straight Talk About Suicide. This straight talk is written in easy-to-understand language that gives specific information, ways of thinking, and things you can do to back away from the brink of suicide and start learning to manage your pain and solve your problems. As a result, I will periodically address the readers who or considering suicide in the hope of giving them some inspiration, encouragement, or hope for the future that could change their mind and encourage them to choose life, no matter how painful it is at the moment, over a self-inflicted death.

For those of you who have attempted suicide and survived, this book can help you to understand what drove you to attempt to kill yourself and maybe even give you some insight into why you failed and why it is very bad idea to try it again.

I am also going to write to those of you who suspect that someone you know or love may be suicidal. If you know someone who is suicidal, your gut usually tells you they are seriously depressed, but your brain just can’t get believe they could be thinking about killing themselves. Even if you believe it, you probably don’t understand what is happening or know what to say or do that will be helpful. By the time you finish this book you will understand the suicidal process and have definite ideas about what you can say and do to help the person move back from the verge of suicide and get help.

So I decided to write this book primarily to those who know people who may be suicidal and to people who are suicidal and looking for a source of strength, hope, and help. I wrote as if I were talking directly to someone I knew and loved who was thinking about committing suicide or knew someone who was and wanted to help. As a result I have made this book as easy to read as possible. I’ve avoided professional jargon whenever possible and tried to explain complex ideas in easy to understand words.

I have done my best to make the book both intelligent and factual. I have not pulled any punches. I have written, to the best of my current knowledge, the honest truth about suicide that people need to know. This information can help you to empower people to move back from the brink of suicide and seek help. If you are suicidal, this book may give you the information, hope, and strength to back away from the brink of a self-imposed death.

As I said, suicide is not a pretty subject. Talking honestly about it may upset some people, but so be it! Sometimes being upset by the truth is the very thing that will keep you alive. It is better to be upset than settling for comfortable platitudes based upon wrong thinking that can kill you. I’d rather deal with someone who is upset and alive. It’s possible to help that person. There isn’t much help you can give someone who is dead.

Please get this book and learn how to be part of e solution. Spend a couple of hours, which is all it will take to read this book, having an uplifting and inspiring exploration of suicide that actual shows that there is hope. There is a way out. Remember, suicide is a permanent solution to a temporary problem. Let’s look at the problem of suicide, learn how to back away from, the brink of the abyss of self-inflicted death, and once again feel good about searching for the meaning and purpose of our lives.

Straight Talk About Suicide
By Terence T. Gorski 

TIP 50: Suicide and Substance Use Disorders

introduction to The GORSKI-CENAPS Model of Addiction, Recovery, and Relapse

August 6, 2010

This blog will give a brief and easy to understand description of addiction, recovery, and relapse prevention for addiction and related problems.

Addiction is a biopsychosocial disease with profound spiritual consequences.

  • BIO means “biological” or pertaining to the physical actions of the body.
  • PSYCHO means psychological and pertains to the actions of both the brain (the hardware of thinking, feeling, and acting) and the mind (the nonphysical software that programs the actions of the brain).
  • SOCIAL pertains to the complex interactions that we have with other people, things, and systems. The social dimension also includes culture which is the basis for deep feelings of either belonging or alienation – feelings of being a part of or apart from.

Added to this mix is the complex interaction between addiction and spirituality. For the purpose of this blog, SPIRITUALITY pertains to our search for a meaning and purpose in life that is larger than ourselves. It is, in Twelve Step language, the search for a power greater than ourselves that will give us the courage, strength, and hope to go on in spite of hardship and adversity. Spirituality is the power that gives us the ability to go on even in the face of our inevitable death.

As you can see we will be covering a lot of territory – so keep coming back.

You can review my published materials and inorfmation on training and consultation at

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