MY DRUG OR HABIT OF CHOICE (money and thrills/danger also count as a drug) __________________________________________________________
How old was I when I started using?_____________________________
How often did I use?_________________________________________
How much I did I use? _______________________________________
Other drugs I’ve used (even once) how old, how often, how much?

Describe the situation that brought you to where you are now. I want to know what YOU did, not the police, your partner, or anybody else. Take responsibility for your actions.

Legal problems your addiction has caused?

Relationship problems? How have they improved since being drug free?

Job problems? How has this improved since being drug free?

Physical problems? Eating or sleeping problems? How have they improved since being drug free?

Mental problems? Memory problems? How have they improved since being drug free?
Other ? (Motivation, getting more done, anger etc)
Triggers, Cravings, and Relapse Prevention Plan
Circle all the Excuses that you have told yourself:

Everybody does it It won’t hurt me I can control it
Friends, associates I like getting high It’s fun
bored, nothing to do I’m depressed I’m sad
I’m happy, celebrating I feel anxious My family
Hungry My mother/father Holiday/Party
Lonely My partner Celebration
Angry Stress To sleep
To eat/gain weight To relax/calm down Tired
My kids broke/money To lose weight
Women/men/sex Music Dreams
A craving Mental illness
physical illness OTHER:

1. Explain how each one is irrational and harmful to you. 2. Describe your new plan to manage these triggers. 3. What will you do if these triggers lead to a craving?

Example:
Everybody does it – 1. Most people don’t use drugs. It seemed like everybody does only because I chose friends who do drugs and avoided people who were clean/sober. I am choosing to be with people who use, but I don’t trust them. 2. My new plan is to find friends who are clean and sober, and avoid those who use. 3. If I have a craving I will call a new friend for support, deep breath, go for a walk.
Now it’s your turn. Do at least three examples. Remember, each example has three parts.

TRIGGERS, AND PLAN TO HANDLE TRIGGERS
Here are some common triggers to relapse. Write out your plan to manage each one of these that relates to you. Keep this plan where you can find it easily if you need to review it.

PHYSICAL (cravings, dreams)

SMELL/TASTE/SEE DRUGS:

THOUGHTS OF USING:

FRIENDS/FAMILY:

PLACES YOU USED:

PEOPLE YOU USED WITH:

FEELINGS (depressed, lonely, etc)

STRESSORS (bills, transportation, probation etc)

OTHER

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