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Matrix (IOP) - External Trigger Questionnaire Example
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Source: U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment. Counselor's Treatment Manual: Matrix Intensive Outpatient Treatment for People With Stimulant Use Disorders, 2007 Place a checkmark next to activities, situations, or settings in which you frequently used substances; place a zero next to activities, situations, or settings in which you never have used substances. Home alone Before a date After payday Home with friends During a date Before going out to dinner Friend’s home Before sexual activities Before breakfast Parties During sexual activities At lunch break Sporting events After sexual activities While at dinner Movies Before work After work Bars/clubs When carrying money After passing a particular street or exit Beach After going past dealer’s residence School Concerts Driving The park With friends who use drugs Liquor store In the neighborhood When gaining weight During work Weekends Vacations/holidays Talking on the phone With family members When it’s raining Recovery groups When in pain List any other activities, situations, or settings where you frequently have used. List activities, situations, or settings in which you would not use. List people you could be with and not use. External Trigger Questionnaire