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




September 2, 2014


An Evidence-based Program and Practice

By Terence T. Gorski, author,

Find A CRPS Near You

Find a CRPS providing services in your area. Click Here. Most provide a minim of thee services on a fee for service bases:

1. RP Counseling and Therapy:

Direct RP services for recovering people and their families in developing and supervising relapse prevention plans. Some do this in individual sessions and others in groups.

2. Clinical Supervision/Case Consultation:

Clinical supervision in RP for professionals in the community working with relapse prone people. Again, some do this in individual supervision and some use group supervision.

3. Training and Presentations On Relapse Prevention and Related Area:

Many of our Professionals who have earned their CRPS do. Wide variety of training events for professionals and recovering people in the community.

I have found the members of the Association of Relapse Prevention Specialists to be dedicated and competent professionals with big hearts. They are just plain good and trustworthy people.

You can locate a certified Relapse Prevention Specialist near you by visiting the CENAPS Website: Certified Relapse Prevention Specialists (CRPS)


Supervision. Supervision.

The Relapse Prevention Certification school id conducted ever November in Fort Lauderdale FL



Using Cognitive Restructuring for Addiction (CRFA) 

June 11, 2014

CENAPS_CRFA_ArrowBy Terence T. Gorski, Author
The Cognitive Restructuring for Addiction Workbook 

There is a simple formula for applying cognitive restructuring principles to nearly any problem. Here is how it works:
Write down both a title and a description for the problem. Here’s an example:
Title: Frustrated With My Job
Description: I know that I am in trouble with my recovery when I keep getting upset by little frustrations at work that I can usually handle well.
NOTE: Don’t use the exact same words in the title as in the description. Using different words forces your brain/mind to understand the problem on different level and from  different point of view. 
Start the TFUAR Analysis by completing the following statements: 
T = Thinking: When I am experiencing this problem I tend to think …
F = Feeling: When I am experiencing this problem I tend to feel …
U = Urges (Motivations): When I am thinking and feeling this way I tend to have the self-defeating urge to …
A = Action: When I experience that self-defeating rugs what I actually do that usually fails to solve the problem is …
R = Reactions: When I take this action other people tend to react to me in ways that make the problem worse by …
Complete the TFUAR Analysis Process by answering the following questions: 
T = Thinking:  What is another way of thinking that could help me approach this problem in a more effective wash?
F = Feeling: If I were to start thinking that way how would it change what I was feeling? Would that change in feeling help me approach this problem in a more effective wash?
U = Urges (Motivations): if my feelings changed in that way, how would my urges (motivations) to act out my old self-defeating behaviors change?
A = Actions: If my urges/motivations changed in that way, what new actions could I take that would help me to deal with this problem in a  more effective way?
R = Reactions: If I used the new actions, how would the reactions of others be likely to change in a way that would help me approach the problem in a more effective way?
By using this process of TFUAR Analysis over and over again every time you experience a problem, you will begin to develop new and more effective habits for dealing with problems.
For more I information on using cognitive restructuring in your life get The Cognitive Restructuring for Addiction Workbook and use it as the basis of a discussion group with other people you know who are committed to personal growth and development.

Relapse Prevention Therapy (RPT) – The Clinical Process

May 31, 2014

20140531-010803-4083647.jpgBy Terence T. Gorski, Author

Relapse Prevention Therapy (RPT) is an in-depth clinical psychotherapy process that is designed to four outcomes – The development of a core issue list, a relapse warning sign list, warning sign management strategies, and a recovery plan.

1. Core Issue List:

Each person completing RPT develops a list of the core personality and lifestyle problems that create pain and dysfunction while attempting to maintain long-term sobriety and responsibility.

These core personality and lifestyle problems lead a person back into patterns of addictive and irresponsible thinking and behavior during times of high stress and problems. Since these patterns are automatic and unconscious and are activated by situational triggers, the individual can feel confused and powerless as they successfully avoid or cope with high risk situations only to find themselves acting out in other self-defeating ways for apparently no reason. As a result, the failure to identify and address these issues increases the risk of relapse after initial stabilization and return to normal functioning has been achieved.

The Core Issue List identifies the core or central system of irrational or mistaken beliefs about self, others, and the world that leads to feelings of deprivation and hopelessness when practicing habits of sober and responsible living.

These Core issues are based upon the general mistaken belief that “I can’t have the good life, and be sober and responsible at the same time.” The “good life” is subjectively defined by primary childhood experiences that cause the individual to perceive, think about and respond to the world using an automatic cycle of deeply habituated self-defeating behavior.

The core issue list is developed from a careful and systematic analysis of information gathered from three sources:

(1) the client’s original presenting problems,

(2) the client’s life and addiction history, and

(3) the client’s recovery and relapse history.

The goal of completing these three assessments is to guide the client in answering two basic questions:

(1) “What did you come to believe that alcohol, drugs, and irresponsibility could do for you that you could not do for yourself while being sober and responsible?”

(2) “What problems did you come to believe that alcohol, drugs, and irresponsibility could help you to cope with or escape from that you believed you couldn’t deal with while being sober and responsible?”

The client is taught:

(1) To recognize the basic core issues that increase the risk of relapse, and

(2) To write clear statements that describe the general mistaken beliefs and the automatic and unconscious patterns of thinking, managing feelings and acting that is used when that core issue is activated.

The goal is to teach the client to understand and describe the problems that lead to relapse on three levels in clear, simple, and concrete terms.

These three levels are:

(1) The mistaken beliefs or assumptions about self, others, and the world that limit choices in life planning and problem solving;

(2) The automatic and habitual self-defeating thoughts, painful unmanageable emotions, self-defeating behaviors that are activated by the structure of mistaken beliefs; and

(3) The dysfunctional professional and personal relationships that result from the habitual use of those self defeating behaviors.

This allows the client to unmask the big lie of addiction – the mistaken belief that alcohol, drugs and irresponsibility is good for me, can magically fix me and my problems, and can give me a better life.

Applications: The core issue list is designed to both prevent relapse and improve overall effectiveness by teaching the following skills:

(1) The ability to reflect upon past experiences, accurately assign meaning to those experiences, and avoid the thinking errors and self-defeating behaviors that are the logical consequences of mistaken beliefs;

(2) Mapping out the habitual patterns of thinking, feeling, and acting that are related to those mistaken beliefs; and

(3) Understanding how problems with professional and personal relationships are the logical extension of those core beliefs.

2. Relapse Warning Sign List

Each person completing RPT learns how to develop a Relapse Warning Sign List that describes the specific sequence of events and the related irrational thoughts, unmanageable feelings, self-destructive urges, and self defeating behaviors that are acted out when the core mistaken beliefs are activated.

This warning sign list allows the client to describe in concrete and specific terms the subtle changes in thinking, feeling, motivation, and behavior that set the stage for addictive thinking. It also allows significant others to recognize and assign meaning to the subtle changes in communication and behavior and to intervene appropriately before addictive thinking patterns become rigidly reestablished.

Applications: The relapse warning sign list is designed to prevent relapse and improve overall effectiveness by teaching the following skills:

(1) Developing a list of progressive personal problems and behaviors that lead back into a pattern of addictive and irresponsible thinking and behaviors;

(2) Isolating the warning signs that will interfere with performance by writing a Warning Sign List.

3. Warning Sign Management

Each person completing RPT learns how to identify key or critical warning signs and how to use specific skills or tools to manage those warning signs in a way that stops the progressive pattern of self-defeating thinking and behavior.

The coping strategies related to RPT go beyond the situational management strategies learned at the RPC level. They involve recognizing and intervening upon the more subtle patterns of thinking, emotional management and acting out that set the stage for gradually more destructive behaviors.

Applications: The relapse warning sign management strategies are designed to prevent relapse and improve overall effectiveness by teaching the following skills:

(1) Clearly identifying intervention points in the progressive pattern of irrational thinking and self-destructive behaviors that can impair performance and increase the risk of mismanaging critical situations in a way that could lead to relapse;

(2) Learning specific skills for identifying and challenging irrational and addictive thinking patterns;

(3) Learning specific skills for responsibly managing unpleasant feelings and emotions;

(4) Learning specific tools and skills for recognizing and changing subtle patterns of self-defeating behaviors that can lead to serious long-term problems and eventual relapse; and

(5) Learning how to proactively invite others to support patterns of sobriety and responsibility and to point out self-defeating behaviors or problems that clients may be unaware of.

4. Recovery Plan

Each person completing RPT develops a recovery plan consisting of regularly scheduled activities that clearly support the ability to challenge the mistaken beliefs that perpetuate a self-defeating style of living and working.



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.



The Living Carcass: Zombies, Vampires, and Addiction

May 7, 2014

imagesBy Terence T. Gorski, Author

Addiction can turn an active addict into a living carcass — the empty shell of a real human person.

A carcass is “the outside part of a vehicle, building, or other object that is left when the rest of it has been destroyed.” In terms of addiction, it is the living shell of a person who has nothing left in life but their addiction.  The addiction has stripped them of the essence of being a human being and left a arational drug seeking creature in its place.

The zombie metaphor is very appropriate for addiction. The brain is attacked by the active addiction and the addict becomes a zombie, repeating the same addictive cycle without thought or self-control. Eventually zombies die or are killed or imprisoned by those who are still alive. The consequences of their own behavior condemns zombies to dwell in then land of the living dead and function on a subhuman level.


I bite. You bleed. You may fight. I need to feed.

The vampire metaphor also applies to addiction. Vampires were once good people who were victimized by a predatory vampire. As the transformation from human to vampire progresses, need for blood grows. Even the vampires who still remember human sensibilities cannot resist the need to feed on blood, no matter what the consequence or how badly the act of feeding violates their values..

The analogy of the addict as vampire is best expressed in the book The Vampire Lestat by Anne Rice. It is a great book. Lestat is a likable vampire because he fights back against the inhuman need to feed on blood. He does not like being a vampire and goes to heroic lengths to rise above his nature and become human again. He hates himself for what he is and what he feels the compulsion to do. Yet he is what he is and cannot change his nature.

Fortunately, unlike Zombies and Vampires, people suffering from addiction can recover.

I have not seen any 12-Step for vampires. There is a book on the 12-Steps for Vampires by Michael Masden and a film entitled Vampires Anonymous.



Alcohol Facts and Statistics

May 7, 2014


On The Internet

Percentage of Drinkers:

In 2012,
– 87.6% of people aged 18 or older reported that they drank alcohol at some point in their lifetime;
– 71% reported that they drank in the past year; 56.3% reported that they drank in the past month.

Percentage of Binge Drinkers and Heavy Drinkers:

In 2012,
– 24.6 % of people aged 18 or older reported that they engaged in binge drinking in the past month (drinking 5 or more alcoholic drinks on the same occasion on at least 1 day in the past 30 days);
– 7.1% reported that they engaged in heavy drinking in the past month (drinking 5 or more drinks on the same occasion on each of 5 or more days in the past 30 days).

Alcohol Use Disorders:

An estimated 17 million Americans have an alcohol use disorder (AUD)—a medical term that includes both alcoholism and harmful drinking that does not reach the level of dependence.

Untreated AUDs:

Research shows that an estimated 15% of individuals with an AUD ever seek treatment.

Alcohol-related Deaths:

Each year in the U.S., nearly 80,000 people die from alcohol-related causes, making it the third leading preventable cause of death in our country.8

Economic Burden of Alcohol Problems:

In 2006, alcohol problems cost the U.S. $224 billion each year, primarily from lost productivity but also from health care and property damage costs. These issues affect all Americans, whether they drink or not.

Global burden of Alcohol Problems:

Globally, alcohol use is the fifth leading risk factor for premature death and disability; among people between the ages of 15 to 49, it is the first.10

Family consequences of Alcohol Problems:

More than 10% of U.S. children live with a parent with alcohol problems, according to a 2012 study.

Alcohol and College Students:

Each year —

– 1,825 college students between the ages of 18 and 24 die from alcohol-related unintentional injuries, including motor vehicle crashes.

– 696,000 students between the ages of 18 and 24 are assaulted by another student who has been drinking.

– 97,000 students between the ages of 18 and 24 are victims of alcohol-related sexual assault or date rape.

Alcohol and Adolescents:

– By age 15, more than 50 percent of teens have had at least 1 drink.
More adolescents drink alcohol than smoke cigarettes or use marijuana.

– In 2009, 10.4 million young people ages 12 to 20 reported that they drank alcohol beyond “just a few sips” in the past month.

Alcohol and Pregnancy:

– Among more than half a million pregnant women surveyed between 1991 and 2005, about 12% reported drinking and about 2% reported binge drinking.

– The prevalence of Fetal Alcohol Syndrome (FAS) in the U.S. is between 2 to 7 cases per 1,000;

– The prevalence of Fetal Alcohol Spectrum Disorders (FASD) in populations of younger school children may be as high as 2-5% in the U.S. and some Western European countries.

Alcohol and the Human Body:

– In 2009, liver cirrhosis was the 12th leading cause of death in the United States, with a total of 31,522 deaths—664 more than in 2008.

– Among all cirrhosis deaths in 2009, 48.2 percent were alcohol related. The proportion of alcohol-related cirrhosis was highest (70.6 percent) among decedents aged 35 to 44.

– In 2009, alcohol related liver disease was the primary cause of almost 1 in 3 liver transplants in the U.S.

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