Relapse Prevention: A Tribute to Terrence Gorski
Mark Sanders, LCSW, CADC
State Program Manager, IL
Great Lakes ATTC, MHTTC, and PTTC
During the holiday season from Thanksgiving to New Year’s many counselors work with clients on relapse prevention plans. One effective relapse prevention strategy comes from the late Terrance Gorski, known as a pioneer of relapse prevention.
Father Joseph Martin said that Terrence Gorski had impeccable timing (Maher,1997). Between 1986 to 1996, many inpatient substance use disorders (SUD) treatment programs closed because of managed care restrictions (White, 2014). Treatment was in disarray. At the same time of that crisis, Gorski introduced his model, Counseling for Relapse Prevention. This model was adopted worldwide and did not require inpatient hospitalization to be successful. In this post, I would like to share some of the lessons Terrence Gorski taught about relapse prevention.
Gorski identified numerous warning signs for relapse and believed that each person with a substance use disorder has unique relapse triggers that could include loneliness, isolation, anger, rage, depression, fatigue, hurt, fear, etc. However, people in early recovery may not be conscious of these triggers or of their substance use as a way of responding to triggers.
In treatment, Gorski would ask his clients to describe their five primary relapse triggers, write down each trigger in their own words on five index cards, and the read the triggers out loud. In this process, the client used three of the five senses in the first three steps of Gorski’s relapse prevention model:
1. Hearing: Clients hear their triggers when sharing them verbally.
2. Touch and sight: By writing and reading their triggers, clients touch and see them.
3. Touch, sight, and hearing: Clients use all three of these senses when holding the cards and reading their triggers out loud.
Gorski believed that building awareness of triggers could help clients prevent relapse. He encouraged clients to discuss triggers in each session and to explore on a regular basis whether or not they were discovering any new triggers in recovery.
I used Gorski's approach for years. One of my clients shared with me, “I am so aware of my triggers since we talk about them each week. I feel like I can see, touch, and feel my triggers.”
Gorski also believed that many individuals in early recovery carry a secret fantasy about what it would take for them to return to drug use. He felt that asking clients about their triggers could help bring awareness of triggers to their conscious minds. This conscious awareness could help prevent a return to drug use. Gorski believed that a relapse could be a learning experience. By asking clients in a non-shaming to trace the steps back that led to a return to drug use, they could share what they learned–because if we don't learn from history, we're likely to repeat it.
Gorski died July 2, 2020, just before the 4th of July holiday–another holiday that often requires relapse prevention planning. It is my hope that new counselors in the field study the work of pioneers like Terrence Gorski. One way to improve a profession is to study its history. We are already making improvements Gorski’s pioneering work–the term “recurrence of symptoms” rather is replacing “replace” to indicate a return to drug use. This is similar to the non-stigmatizing language used today when a cancer patient’s symptoms reappear. Changing language in this way will help increase awareness of substance use disorder as a chronic medical condition rather than a moral failure.
Gorski, T.T., & Miller, M (1982). Counseling for Relapse Prevention. Independence Press
Maher, J. One Moe Step: The life and Work of Father Joseph C. Martin. (1997). Ashley, Havre de Grace. MD.
White, W. Slaying The Dragon. (2014). Chestnut Health Systems, Bloomington, IL.