External Trigger Questionnaire

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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
During sexual activities
At lunch break
Sporting events
After sexual activities
While at dinner
Before work
After work
When carrying money
After passing a particular street or exit
After going past dealer’s residence
The park
With friends who use drugs
Liquor store
In the neighborhood
When gaining weight
During work
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

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