Relapse Analysis Chart

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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
Relapse Analysis Chart
Name:
Date of Relapse:
A relapse episode does not begin when you take a drug. Often, things that happen before you use indicate the beginning of a relapse. Identifying your patterns of behavior will help you recognize and interrupt the relapse. Using the chart below, note events that occurred during the week immediately before the relapse.
Things happened
Feelings about the event
Career
Events
Personal
Treatment
Drug- Related
Behaviors
Behavioral
Patterns
Relapse
Thoughts
Health
Status