May 10, 2015

By Terence T. Gorski

Here are the key points of the definition of relapse from a wide variety of internet dictionaries :

To experience a relapse means:

1. The return of a disease or illness after partial or full recovery from i

2. To suffer a deterioration in a disease after a period of improvement.

3. To fall back into illness after convalescence or apparent recovery

4. To have a deterioration in health after a temporary improvement.

5. To fall or slide back into a former state of illness or dysfunction.

6. To regress after partial recovery from illness.

7. To slip back into bad habits or self-defeating ways of living; to backslide after a period of progress.

8. To fall back into a former state, especially after apparent improvement.

Origin of the word RELAPSE: the word relapse comes from the Middle English word “relapsen,” and from Latin meaning to to “forswear” (to promise or swear in advance that a change will be made.   A combination of the words: relb or relps-, came to mean to fall back gradually; or to slide back without being able to stop ones self (as could happen when trying to move up a slippery or muddy hill.

The word relapse results from a linguistic process called “nominalization” which means to describe a process (like loving someone or relating to someone) into a thing (like love or relationship).

It is important to do a “cross-walk” between 12-Step language (i.e. dry drunk leading to a wet drunk) and the language of cognitive behavioral therapy (the process of falling back into an illness, condition, or habitual problem behaviors that ends in the act of drinking, drugging, or acting out an addiction or habitual self-defeating behavior.

Using an “addictive release” provided by an addictive drug or behavior is often seen as the start of a “relapse episode,” a single discreet episode of addictive use.

A relapse episode is usually preceded by stressful events (triggers), that raise stress and activate old self-defeating and addictive ways of thinking, feeling, acting, and relating to other people.

Marlatt distinguished between a lapse (a short term and low consequence episode of addictive use) and a relapse (a return to a previous state of out-of-control addictive acting out usually accompanied by a return of secondary problems related to the addiction.

I believe in a Twelve-Step Plus Approach that matches the needs of individual recovering people with a strong recommendation to attend 12-Strep Programs and to participate in other treatment activities (professionally supervised) and recovery activities (peer supported and community based) that meet individual needs, promotes long-term recovery, and uses appropriate relapse prevention methods. There is no wrong door into recovery. There is no wrong treatment or recovery activity if it helps people to live a sober and responsible life filled with meaning and purpose.

Language Programs The Brain,
Focuses The Mind, and
Motivates Behavior.

Think clearly to get results in recovery!

~ Terry Gorski Blog:

~ Terry Gorski, via



Relapse Prevention: The Difference Between Counseling and Therapy

May 13, 2014


The GORSKI-CENAPS® Model is designed to be used on two levels: the counseling level and the psychotherapy level. Let’s look at the distinction between those two levels.

1. The Counseling Level: Patients need to learn new ways of thinking and acting that will allow them to manage high-risk situations and other problems that occur in their lives without using alcohol or drugs. The primary focus is to teach the client how to do something different when they encounter these situations. Patients are taught to identify and more effectively manage the thoughts and feelings that get in the way of learning new and more effective ways of dealing with problem situations. This level is described in The Relapse Prevention Counseling (RPC) Workbook.

2. The Psychotherapy Level: These situations are created by repetitive self-defeating behaviors that are motivated by core personality and lifestyle problems. These basic mistaken beliefs about self, others, and the world motivate clients to become involved in and mismanage high-risk situations in spite of their conscious intent not to. This level is described in The Relapse Prevention a Therapy Workbook (RPT).

Core personality problems are self-defeating habits of thinking, feeling, acting, and relating to others.

Core lifestyle problems are the habitual ways of living and the agreements and relationships that we establish with other people at work, in the community, with friends, family, and lovers. These core lifestyle problems are a social structure that both supports and justifies the personality problems.

There are two different types of treatment designed to address these two different levels of client problems.

1. Counseling: Counseling is the process of teaching clients how to identify and manage high-risk situations and to identify and change the patterns of thinking, feeling, and acting that prevent them from effectively managing the situation. This is called Relapse Prevention Counseling.

2. Psychotherapy: Psychotherapy is the process of teaching clients how to identify and manage the core personality and lifestyle problems that cause them to keep putting themselves in high risk situations. It then teaches them how to identify and change the core belief systems and unconscious life rules that create and maintain their personality and lifestyle. This is called Relapse Prevention Therapy.

The GORSKI-CENAPS® Model has components that can address both levels of problems, but it is recommended that clinicians working at the psychotherapy level have a background in both addiction counseling and advanced clinical training in psychotherapy.

The following general decision rules are applied for determining when to work at the counseling or psychotherapy level. Before moving to the psychotherapy level:

1. Clients must be able to stay abstinent from alcohol and drugs before they can successfully work on psychotherapy issues.

2. Clients should be able to identify and manage high-risk situations at a counseling level without using alcohol or drugs before moving into Psychotherapy.

3. Clients need to have some skills at managing stress in a sober and responsible way. Focusing treatment upon core personality and lifestyle issues can defocus clients from identifying and managing high-risk situations that can cause alcohol and drug use. As a result, a premature focus upon psychotherapy can increase the risk of relapse.

4. Working on the psychotherapy issues can also increase pain and stress. This makes it even more difficult for the client to manage the high-risk situation.

5. Every high-risk situation is like the tip of an iceberg. It sits on top of a cluster of underlying personality and lifestyle problems. These underlying problems are often surfaced when the client starts learning how to identify and manage the high-risk situation.

6. It is often difficult to keep the client focused upon learning how to manage the high-risk situation when these deeper issues get activated. The client wants to focus upon the deeper issue because it is easier to look at psychotherapy issues than to focus upon learning basic abstinence skills. Since these issues are real and cause the client pain and discomfort, the counselor often feels obligated to work on these issues

7. It is inappropriate to ignore core personality and lifestyle issues or communicate to the client that these issues are not important. The client will have to resolve these issues if they are to learn how to maintain long-term abstinence. The issue is, there are other immediate situations that represent an immediate risk to abstinence. These issues must be dealt with first. Later we will review a technique called Bookmarking that will allow us to honor core personality and lifestyle issues as they come while keeping the primary focus upon identifying and managing the high-risk situations that can cause alcohol and drug use.



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