Relapse Prevention Therapy (RPT): An Evidence-based Practice

December 31, 2013


Relapse following drug treatment is quite common. “Relapse Prevention Therapy is a behavioral self-control program that teaches individuals how to anticipate and cope with the potential for relapse” (NREPP). In addition, RPT serves to normalize relapse as part of the overall recovery process, thus reducing the negative feelings and behaviors that result from a setback.

The GORSKI-CENAPS Model brings proven evidence-based practices to recovery and relapse prevention by providing proven methods for identifying and managing early relapse warning signs and high risk situations. It also presents methods for planning to stop relapse quickly should it occur. All of the key practices of evidenced-based Relapse Prevention Therapy (RPT) are made available in practical and easy to use workbooks. Training is available to teach the most effective ways to make use the workbooks in individual and group therapy and in support groups.

National Registry of Evidence-based Practices (NREPP)
North Carolina Practice Improvement Collaborative (NCPIC)


Mental Illness Hits 20% of the US Population

December 21, 2013

By Terence T. Gorski
December 21, 2013


Mental Illness Hurts!
Especially If You’re In Jail
When You Should Be In Treatment!

SAMHSA’s 2012 National Survey on Drug Use and Health brought out many new statistics that are not very encouraging.  I decided to share a recent SAMHSA Newsletter that reported the major findings.

– Nearly 20% of the population experienced a diagnosable mental illness in 2011. This is 43.7 million people. Less than half (43%) received any treatment.

– Adults who experienced mental illness in the past year were three times more likely to have met the criteria for a substance use disorder than those who had not experienced mental illness in the past year (19.2 percent versus 6.4 percent).

– Those who had serious mental illness in the past year were even more likely to have had substance dependence or abuse (27.3 percent).

– 9 million American adults (3.9 percent) had serious thoughts of suicide in the past year

– 2.7 million (1.1 percent) made suicide plans

-1.3 million (0.6 percent) attempted suicide

Our kids are not in very good shape either.

– In 2012 about 2.2 million youth aged 12 to 17 (9.1 %) experienced a major depressive episode.

– Young people suffering from depression were more than three times as likely to have a substance use disorder (16.0 percent) than their counterparts who had not experienced a major depressive episode (5.1 percent).

The White House has the answer!
Another website:  

alcohol-effects-economyI am surprised that this newsletter DID NOT MENTION:

(1) The rising rates of depression and suicide in our military troops both during active duty and after discharge. (People tend to get depressed after serving multiple combat shifts and having their retirement benefits cut.)

(2) That every year there is an increasing number of educated and licensed mental health professionals at work in the USA. The wide variety of name brands, degrees, and licenses is too mind boggling for me to describe, so I will leave that to Mental Heath America.

(3) In spite of the growing number of mental health professionals the rate of mental illness and substance use disorders is still on the rise.

Question: Is there something wrong with this picture. More professionals working on the problem – the more people who are suffering from mental illness and substance abuse. Could there be something hidden in plain view that is driving up the rates of substance abuse and mental illness?


Mental Illness On the Rise.

(4) The evidence that suggests mental health problems, substance use disorders, and other behavioral addictions such as gambling and sexual addiction all go up during economic hard times.  Hunger and homelessness is on the rise in this sluggish economy. The results of this prolonged economic turn-down is more severe than people think. Read the report for yourself.

(5) The rates of mental illness continue to rise in spite of record sales in psychiatric medications, especially antidepressants.

It has been a long-standing Federal and State Government policy to reduce costs by cutting mental health beds in long-term residential psychiatric hospitals. The government decided to return the severe and chronically mentally  ill to the community. As a result, in 2012 the USA has a shortage of psychiatric beds.
For every 20 public psychiatric beds that existed in the US in 1955, only one such bed existed in 2005.
The full story of the rise and fall of long-term psychiatric hospitals is clearly described in The Encyclopedia of New Zealand. The history closely parallels what was happening in the United States and world-wide.  When they can’t function in the community due to their mental illness, many end up in the worst possible place for a mentally ill person — prison.
According to The Human Rights Watch the prisons have become the primary psychiatric treatment facilities. The brutality to the mentally in prison is too horrible to imagine. Read the full report if your stomach is strong enough to see the truth.

“Prisons are woefully ill-equipped for their current role as the nation’s
primary mental health facilities.” said  Jamie Fellner, Director,
U.S. Program of Human Rights Watch.
There are serious consequences of cutting back on the treatment resources for the mentally ill over the past several decades:The Treatment Advocacy Center reports that because there are so few beds available, individuals with severe psychiatric disorders who need to be hospitalized are often unable to get admitted. Those who are admitted are often discharged prematurely and without a treatment plan. The consequences of the radical reduction in psychiatric hospital beds are evidenced in the following areas:

  • Homelessness.  A 2005 federal survey estimated that approximately 500,000 single men and women are homeless in the United States at any given time and multiple studies have reported that one-third have a serious mental illness. A study in Massachusetts found that 27 percent of patients discharged from a state psychiatric hospital became homeless within six months of discharge; in a similar study in Ohio, the figure was 36 percent.
  • Jails and Prisons as Psychiatric Hospitals.  Since the radical reduction in public psychiatric hospital beds there has been a massive increase in severely mentally ill persons in jails and prisons. Conservative estimates have placed the number at 7 to 10 percent of all inmates, but some studies have put the figure at 20 percent or higher. The three largest de facto psychiatric institutions in the United States are the Los Angeles County Jail, Chicago’s Cook County Jail, and New York’s Riker Island Jail.
images“On any given day, between 25-30 percent of the inmates at Cook County Jail suffer from mental illnesses. The majority of these inmates are in jail for nonviolent offenses closely associated with their mental health issues and would be far better served by treatment rather than incarceration.” ~ Thomas J. Dart, Cook County Sherrif
  • Hospital Emergency Room Overflow.  Emergency rooms are often used as waiting rooms for people in need of a psychiatric bed. This backs up the entire hospital system and compromises other medical care. In Arlington, Virginia, county officials had to call 31 hospitals before finding one that would accept a patient.
  • Violent Crime.  Studies have shown that between 5 to 10 percent of seriously mentally ill persons who are not receiving treatment will commit a violent act each year. Such individual are responsible for at least 5 percent of all homicides.
The full SAMHSA newsletter is below. I wouldn’t worry, however, The Affordable Care Act will fix all of this right up. Kathleen Sibelius, Health and Human Services Secretary who reports to the President has promised it will all be fixed. She said: “The Affordable Care Act and new parity protections are expanding mental and substance use disorder benefits for 62 million Americans. This historic expansion will help make treatment more affordable and accessible.”

How Bad Does It Have To Get
Before We Rise UP And Say ENOUGH!!!

SAMHSA News Release

Date: 12/19/2013 9:00 AM
Media Contact: SAMHSA Press Office
Telephone: 240-276-2130

43.7 Million Americans experienced mental illness in 2012

$31 Million Announced to Improve Mental Health Services for Young People
Nearly one in five American adults, or 43.7 million people, experienced a diagnosable mental illness in 2012 according to the Substance Abuse and Mental Health Services Administration (SAMHSA). These results are consistent with 2011 findings.
SAMHSA also reported that, consistent with 2011, less than half (41 percent) of these adults received any mental health services in the past year. Among those who had serious mental illness, 62.9 percent received treatment. Among adults with mental illness who reported an unmet need for treatment, the top three reasons given for not receiving help were that they could not afford the cost, thought they could handle the problem without treatment, or did not know where to go for services.
The findings also shed light on mental health issues among young people. According to the report, 2.2 million youth aged 12 to 17 (9.1 percent of this population) experienced a major depressive episode in 2012. These young people were more than three times as likely to have a substance use disorder (16.0 percent) than their counterparts who had not experienced a major depressive episode (5.1 percent).
“The President and Vice President have made clear that mental illness should no longer be treated by our society – or covered by insurance companies – differently from other illnesses,” said Health and Human Services Secretary Kathleen Sebelius. “The Affordable Care Act and new parity protections are expanding mental and substance use disorder benefits for 62 million Americans. This historic expansion will help make treatment more affordable and accessible.”
“People will only benefit from all the progress we’ve made if they aren’t afraid to get help,” said SAMHSA Administrator Pam Hyde. “That’s why President Obama called for a national conversation on mental health and proposed a budget initiative to support making it easier for young people, adults, and families struggling with mental health problems to seek help and support.” (
The Administration recently launched to help people find easy-to-understand information about basic signs of mental health problems, how to talk about mental health and mental illness, and how to locate help.
In addition, SAMHSA is announcing two grant funding opportunities to help improve mental health services for young people:
  • Planning Grants for Expansion of the Comprehensive Community Mental Health Services for Children and Their Families Program – this grant program will provide $8 million in funding to assist states, political subdivisions, tribes, or territories to develop a comprehensive strategic plan for improving, expanding, and sustaining services provided through a system of care approach for children and youth with serious emotional disturbances and their families.
  • Implementation Cooperative Agreements for Expansion of the Comprehensive Community Mental Health Services for Children and their Families Program – this grant program will provide $23 million in funding to enable states, political subdivisions, tribes, or territories to improve behavioral health outcomes for children and youth with serious emotional disturbances and their families.
The new findings from SAMHSA also found that 9 million American adults 18 and older (3.9 percent) had serious thoughts of suicide in the past year–2.7 million (1.1 percent) made suicide plans and 1.3 million (0.6 percent) attempted suicide.
Those in crisis or knowing someone they believe may be at immediate risk of attempting suicide can call the National Suicide Prevention Lifeline 1-800-273-TALK (8255) or go to The National Suicide Prevention Lifeline network, funded by SAMHSA, provides immediate free and confidential crisis round-the-clock counseling to anyone in need throughout the country, every day of the year.
According to SAMHSA, adults who experienced mental illness in the past year were three times more likely to have met the criteria for a substance use disorder than those who had not experienced mental illness in the past year (19.2 percent versus 6.4 percent). Those who had serious mental illness in the past year were even more likely to have had substance dependence or abuse (27.3 percent).
The new findings come from SAMHSA’s 2012 National Survey on Drug Use and Health. In the survey, mental illness among adults aged 18 or older is defined as having had a diagnosable mental, behavioral, or emotional disorder (excluding developmental and substance use disorders) in the past year based on criteria specified in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association.
In this survey, serious mental illness is defined as mental illness that resulted in serious functional impairment, which substantially interfered with or limited one or more major life activities. A major depressive episode is defined as a period of at least two weeks when a person experienced a depressed mood or loss of interest or pleasure in daily activities and had at least four of seven additional symptoms reflecting the criteria as described in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders.
The complete survey findings from this report are available on the SAMHSA Web site at:

The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities.



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

%d bloggers like this: