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.