Relapse prevention is a serious concern of managed care providers who are responsible for containing the cost of chemical dependency treatment. When we look at the relapse rates following treatment, it is easy to understand why. Forty seven percent of patients treated in private treatment programs will return to chemical use within the first year following treatment. Of those who relapse, about 40% will have short-term, low consequence relapses and will rapidly return to recovery, while 60% of relapsers will have long-term, high consequence relapses that require costly treatment.

In reviewing these statistics, it is important to keep the following points in mind.

1. Fifty three percent of chemically dependent patients do recover after treatment

2. Recovery rates can be as high as 90% in clients who are socially Stable (i.e. are employed, have a stable residence and have social support in the form of family or significant friendships), supported by Employee Assistance Programs, and do not have polydrug addictions, other psychiatric disorders, or serious medical complications.

3. When compared to other chronic life style related diseases, such as cancer and heart disease, the relapse rates to chemical dependence are relatively low.

4. The recovery and relapse rates for chemical addiction have significantly improved since the introduction of abstinence-based recovery methods in 1935. Prior to the development of Alcoholics Anonymous in 1935, the 98% relapse rate led to alcoholics being declared as hopeless by most leading psychiatrists and physicians. The introduction of Alcoholics anonymous (AA) increased recovery rates to about 25% and the introduction of Minnesota Model Treatment that combines 12-Step recovery with detoxification, education, and counseling caused an increase in recovery rates to about 50%.

5. Patients who relapse are not hopeless. 40% of relapsers find their way into long-term recovery after experiencing short-term and low consequence relapses. Other relapsers significantly improve their overall health and functioning and decrease their health care utilization in spite of experiencing periodic short-term and low consequence relapses that are rapidly stabilized by appropriate intervention and treatment.

6. Relapse prevention therapy is improving the chances of recovery for relapsers. A study completed by Father Marten’s Ashley found that chronic relapsers who completed a CENAPS Model Relapse Prevention Program had the same improvement rates (approximately 65%) as did patients completing primary treatment for the first time.

Relapse Cannot be Ignored

Treatment centers and managed care providers cannot afford to ignore relapse because it is so common. Approximately 40% of all patients admitted for chemical dependency treatment in the United States are relapsers who have previously been treated for chemical dependence.

Treating these relapsers is expensive. The National Drug and Alcohol Treatment Utilization Study (NDATUS) estimated that the nation spent a total of $4.08 billion in treating chemically dependent people. Since 40% of these patients were relapsers, the nations spent $1.63 billion treating relapsers. Unfortunately, most of this money was spent on recycling patients through treatment that had already failed. Few treatment program have comprehensive relapse prevention tracts in spite of the large number of relapser that they treat.

Failed Strategies To Contain The Cost of Relapse

Managed care providers are concerned about relapse because it increases the cost of treatment. In the eyes of most managed care providers, treating relapse-prone patients in treatment programs that failed to produce sobriety the first time around is not cost effective. “If it didn’t work the first time,” they argue, “Why should it work the second?”

This has led to many managed care providers establishing cost control strategies that refuse to pay for repeat treatments with methods that have failed. These strategies limit the number treatments per lifetime to between one and three.

Unfortunately, this strategy doesn’t work because without treatment relapsers keep using alcohol and drugs until they develop serious medical and psychiatric illness that requires expensive treatment. In the long run, the policy of refusing to pay for repeat treatments increases rather than decreases treatment costs.

Since relapsers represent 30% to 40% of private treatment dollars and 50% to 70% of public treatment dollars, this policy of refusing to pay for repeat treatment places many treatment programs in serious financial trouble.

A Cost Containment Strategy That Works

What is needed is a new strategy for treating relapsers in specialty relapse prevention programs that lower relapse rates and rapidly intervene upon patients who relapse so that the duration, severity, and consequences of relapse episodes will be reduced. This significantly reduces the cost of treating relapse-prone patients.

Many managed care providers are aware that their old strategies for coping with relapse don’t work. They are beginning to institute a new strategy of paying for multiple treatments only in relapse prevention programs. This new strategy works because relapse prevention programs directly address the causes of relapse, lower relapse rates, and reduce the consequences and costs of relapse.

What is needed is the wide spread implementation of specialty treatment programs for relapse-prone people. Fortunately, such programs can be quickly and efficiently introduced in most treatment programs and cost no more to operate than other addiction treatment approaches.

Hi,
I’m Terry Gorski, and I want to welcome you to my new blog here on It’s all in the Journey’s website. Please feel free to comment or ask me any questions. I will be checking in and writing here as time permits, and I will do my best to respond to any questions in a timely fashion.
Remember, ‘It’s all in the Journey!’
Terry Gorski

“To do anything worth doing, we must act with a commitment to do what we choose to do. Nothing of value is ever accomplished by standing back, shivering with fear, and thinking only of the danger and possibility of failure. When we decide something needs to be done or something is worth doing we must put on our game face, study the situation and create a place. Then, in spite of the danger or risk of failure we need to act. WE need to move ahead with determine. We must move ahead, not without fear, but in spite of the fear. We must move ahead not because we a certain we will succeed, but because we know that if we fail we will just stand up, create a better plan, and move on. There is a saying: Try hard, fail, try again and again. Just keep failing better until you find a way to succeed. Any addict getting sober. Any sick person striving to recovery from illness but rise above the fear and doubt, figure out the next best thing we need to do, and then jump in with both feet and scramble to do what you need to do as well as we can.”
This description, which I have heard many times from successful, sober responsible people, always touches me deeply and inspires me to dig deep, and take action. As I reflect upon these ideas, as I do frequently, I begin to think about fear, anger, and transcendence.
Transcendence is the ability to rise above, move beyond, or work through the feelings and emotions that often stop us from doing what we need to do to be our best self. I love the word actualize. To recover from addiction we must dig deep and actualize the best of who we are. I love the world actualize. It means “to make real through action.!” In the context of this discussion, it means to dig deep and make real our dreams of becoming a better person, helping others, and making a better world
Transcendence means facing the two major emotional trip-wires that lead to failure – fear and anger. Fear without transcendence immobilizes us or makes us want to run away from our responsibilities. Anger, when not properly transcended and channeled through our intelligence, makes us stupid. We get angry, have a knee-jerk reaction, and then shoot ourselves in the foot. This cripples us. It limits our ability to do what is important – to do what really needs to be done.
Transcendence is a skill that can be learned and practiced.

Staying sane and sober in tough economic times can be difficult. Working a strong recovery program can provide a lot of good ideas that help.

We must be sober to transcend our economic insecurity. We need to connect in faith to higher power. The 12=Step Program says “Let go and let God.” I like the concept of transcendence, surrendering to what is and finding a place within myself that allows me to rise above and calmly endure painful reality. We need to learn how to let go and get going.
We need to let go of the anger that we feel at our difficult financial situation. We need to rise above our fear that things will keep getting worse and never get better.

Alcohol and other drugs creates the illusion of transcendence while damaging our brain and making us dependent upon the chemical effects of our drug of choice. The effect of our drugs keep us from connecting with our inner strength and tapping into the courage that we need to face adversity, ask for help, pan, act, and keep trying no matter what..

When we are dependent upon alcohol or other drugs we never learn how to dig deep and find the strength we need in the moment of crisis to do what needs to be done. It is only by digging deep, feeling the fear and letting it go, feeling the anger and releasing it, and then spiritually centering ourselves. Be quiet in the face of adversity and trust the God of your understanding. Then we can find the courage, strength, and hope that will allow us to do that many of us have never known we were capable of.
Transcendence of fear and anger is the core skill I strive to teach my son TJ Gorski and my daughter Nika Gorski. I believe it is a capacity that once learned will serve them well for the rest of their lives. There are many real-life role models that show this is possible.

Guy Lumunyon, a combat medic, is a living example of the power of this capacity to transcend anger and fear, both bin the extreme trauma of combat and the small challenges of daily life. Joe Nixon, currently serving in Iraq is another living example of this capacity.

Staying sane and sober in tough economic times can be difficult. This catalogue can provide a lot of good ideas that help.

In truth, we are all capable of transcending fear and anger and finding the strength to do the next right thing. Unfortunately, many of us have never learned we have this capacity or practiced it in a disciplined way. Many people mistaken believe that anger and fear have the power to control us, when in truth spiritual growth teaches us the absolute necessity of managing, directing, and transcending these two powerful feelings. In this way the power of anger and fear can be directed for the good instead of leading us into the chaos caused by blind overreaction.

I welcome your comments and questions.
Terry Gorski

Editor’s Note: Terence T. Gorski is Founder and President of The CENAPS Corporation (www.cenaps.com), which is a training and consultation organization with a history of over forty years of specializing in recovery and relapse prevention for addiction and related mental health problems, He is an internationally recognized author ( www.relapse.org ) and developed many popular and effective techniques for Relapse Prevention Counseling (RPC) and Relapse Prevention Therapy (RPT).
Visit both websites – you’ll be glad you did.
Charlie Griffith
Editor in Chief
It’s all in the Journey