When Twelve-Step Programs Are Not Enough

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When Twelve-Step Programs Are Not Enough

Using The Relapse Warning Sign List As An Additional Recovery Tool

by Terence T. Gorski
September 10, 2001

            Many treatment professionals believe that the best way for recovering people to avoid relapse is to regularly attend Twelve Step Meetings and work the Steps.  This belief is reinforced by the slogan:  “It works if you work it!”  If this is true, it means that people relapse because they stop going to meetings or stop working the steps.  If they’d just keep going to their meetings and working the steps they wouldn’t relapse.

            Unfortunately, many people who diligently work twelve step programs do relapse.  The AA world office in New York City publishes a series of follow-up studies of their members which indicate that within the first 90 days of attendance at AA, 50% of the members drop out.  Of those who maintain sobriety beyond the first 90 days, one half of them will return to alcohol or drug use within the next nine months.  This means that AA used as a single, stand-alone intervention has about a 25% abstinence rate. 

            Follow-up studies of treatment centers that heavily use Twelve Step programs indicate that when AA is coupled with professional treatment the average sobriety rates at one year raise from 25% to between 50 and 62% in high prognosis patients.  This still means a lot of people relapse.  For these individuals, Relapse Prevention Therapy is a critical addition to their recovery program.

            At the heart of Relapse Prevention Therapy is the understanding that relapse is a process not an event.  Relapse begins long before alcohol and drug use.  In essence the relapser moves from a state of stable recovery back into alcohol and drug use.  This journey is similar for all addicts and the process has been mapped out in the form of a relapse warning sign list.  This list of warning signs can literally save your sobriety if it is used correctly.  Unfortunately, many people don’t know how to use the warning sign list as an effective relapse prevention tool.

            They make the simple mistake of believing that all they have to do is read the warning sign list, check the warning signs that apply to them, and somehow they will magically stay in recovery.  Unfortunately, for most recovering people, this isn’t true.

            The relapse warning sign list was never intended to be used as the exclusive checklist to avoid relapse.  The warning sign list is simply a starting point.  It’s a tool designed to help people to recognize and remember specific things that have happened to them on their personal journey from recovery to relapse.  Here’s some guidelines about how to use the warning sign list more effectively:

            First, review the list of warning signs.  This is best done by reading the warning sign list out loud in a recovery group, with a therapist, or a recovery sponser.  The warning sign list and the complete descriptions of each warning sign are read aloud for a period of ten to fifteen minutes.  Then the group stops reading and each person comments on how he/she is relating to the warning signs that are read.  After everyone comments, they continue reading again for another ten to fifteen minutes until the entire warning sign list is read. 

            Second, ask each member of the group to select three warning signs that they identify with and rewrite them in their own words.  Each warnig sign should have a personal title consisting of a word or short phrase that is easy to remember and a personal description that starts with the words, "I know I am in trouble with my recovery when ...".  Each member of the group reads these three personalized warning signs to the group and tells the group why they selected these warning signs. 

            Third, each group member tells the story of a past experience related to each warning sign they selected.  In the context of telling these stories, hidden warning signs become apparent.  A hidden warning sign is a problem in recovery that is related to relapse which the relapser was previously unaware of.  Just as most people do not get a traffic ticket from an officer that they see, most relapsers do not get drunk over warning signs that they are aware of.  The goal of relapse prevention therapy is to use the initial warning sign list as a projective device to help people get in touch with their own unique, personalized list of warning signs that lead them from a stable recovery back to alcohol and drug use.

            Fourth, each group member identifies a time in the near future when they nmay experience one or more of their warning signs and describe in detail how they could mismanage that warning sign in a way that could lead to using alcohol or other drugs. 

            Fifth, each member of the group listens carefully, asks clarifying questions, looks for hidden warning signs, and gives the feedback. 

            Sixth, write each hidden warning sign on a 3x5 card, arrange the cards in the sequence in which the warning signs tend to occur.  Be sure to eliminate duplication and identify any gaps in the action where vital warning signs may have been missed.  The end result is a personalized list of relapse warning signs which clearly shows the sequence of connected problems that lead from stable recovery to relapse. 

            Seven, once this list is written and arranged in proper order, the next step is to identify the three most critical warning signs.  This is done by identifying the warning signs that can recognize when they occur. 

            Eight, develop a warningn sign management strategy which describes his/her old, self-defeating way of coping with that warning sign and replaces it with a new, more effective coping strategy.  Behavioral research indicates that mental rehearsal techniques, especially when supplemented with role plays and actual practice exercises do, in fact, reduce the relapse rate. 

            Nine, backtrack to the earliest possible indicators that a person is becoming dysfunctional in recovery.  This is done by looking at the first warning sign on the list and asking the question:  “Did the process really start here?  What happened before this that caused me to experience this warning sign?

            Ten, identify the thoughts, feelings, and action urges that accompany each warning sign.  This is done by turning each warning sign over and writing down a:

     thought statement (“When I experience this warning sign I tend to think …”), 

     feeling statement (“When I experience this warning sign I tend to feel …”), 

     urge statement (“When I experience this warning sign I have an urge to …”), 

    action statement (“When I experience this warning sign what I actually do is …”), 

    social reaction statement (“When I experience this warning sign people around me tend to respond by …”).

            Eleven, sort the cards according to thoughts to identify the primary irrational thoughts that drive the relapse process.  Once you find these thoughts, you can develop ways to challenge them sober rational ways of thinking.

            Twelve, sort the cards according to feelings to identify the primary feelings and emotions related to relapse.  Research has shown that nearly 70% of all relapses are related to unmanageable emotions.  This sorting technique is very powerful in identifying the feelings and emotions that set them up to return to alcohol and drug use.  Once these feelings are identified you can then develop effective emotional management strategies.

            Thirteen, sort the cards to identify the common self-defeating urges.  By recognizing the self-defeating behaviors that you feel an urge to use, you can figure out a way to manage those urges.

            Fourteen, sort the cards by self-defeating actions and then develop more constructive things that you can do to stop the relapse process and get back into recovery. 

            Fifteen, sort the cards by social reactions.  Tjhis will allow you to see how you are inviting people react to you in a way that gives you excuses to go back to using alcohol or other drugs.  Then you can consciously develop ways of inviting people to respond to you in more helpful ways.

            The final step of relapse prevention therapy is to develop a list of high risk situations and a recovery plan to help them counteract those high risk

situations by either avoiding them or learning how to responsibly cope

with them.

About the Author

Terence T. Gorski is internationally recognized for his contributions to Relapse Prevention Therapy. The scope of his work, however, extends far beyond this. A skilled cognitive behavioral therapist with extensive training in experiential therapies, Gorski has broad-based experience and expertise in the chemical dependency, behavioral health, and criminal justice fields.

To make his ideas and methods more available, Gorski opened The CENAPS Corporation, a private training and consultation firm of founded in 1982.  CENAPS is committed to providing the most advanced training and consultation in the chemical dependency and behavioral health fields.

Gorski has also developed skills training workshops and a series of low-cost book, workbooks, pamphlets, audio and videotapes. He also works with a team of trainers and consultants who can assist individuals and programs to utilize his ideas and methods.
Terry Gorski is available for personal and program consultation, lecturing, and clinical skills training workshops. He also routinely schedules workshops, executive briefings, and personal growth experiences for clinicians, program managers, and policymakers.

Mr. Gorski holds a B.A. degree in psychology and sociology from Northeastern Illinois University and an M.A. degree from Webster's College in St. Louis, Missouri.  He is a Senior Certified Addiction Counselor In Illinois.  He is a prolific author who has published numerous books, pamphlets and articles.  Mr. Gorski routinely makes himself available for interviews, public presentations, and consultant.  He has presented lectures and conducted workshops in the U.S., Canada, and Europe.  

For books, audio, and video tapes written and recommended by Terry Gorski contact: Herald House - Independence Press, P.O. Box 390 Independence, MO 64055.  Telephone: 816-521-3015 0r 1-800-767-8181.  His publication website is www.relapse.org.

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