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
In reviewing these statistics, it is important to
keep the following points in mind.
Fifty three percent of chemically dependent patients do recover after
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.
When compared to other chronic life style related diseases, such
as cancer and heart disease, the relapse rates to chemical dependence
are relatively low.
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%.
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.
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
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.
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