Tap 19 — TAPs <<<Documents<<<Home

Exercise No. 4: Relapse Episode List

Purpose. This exercise will help you notice what happened when you tried not to use alcohol and drugs. By understanding what happened during these times, you can see what to change.

Instructions. Make three copies of this exercise. Go back to Exercise No. 3 and fill out one of the worksheets for each of the last three times you tried to stay clean and sober.

Attempt no. _________

1. I stopped using on ____________________________(month and year).

2. I stayed completely clean and sober for ________________ (days, weeks, months, and/or years).

3. When I stopped using alcohol/drugs, I used the following help:
   1. AA/NA. Meetings per week ._____

   2. Sponsor. I talked to my sponsor ______ times (fill in number of times per week).

   3. Worked on steps: 1 2 3 4 5 6 7 8 9 10 11 12 none

   4. Detox. Number of days _____.

   5. Outpatient counseling. Number of times per month _____.

   6. Inpatient program. Length of inpatient time _______.

   7. Prescribed medications ________________________________

4. How did you feel during this time? (check one)
   1. I never felt good or calm.
   2. I felt good once in a while, but it didn't last.
   3. I felt good most of the time, but sometimes I felt awful.
   4. I always felt good and thought I could do well.

5. I had problems during this period of not using.

   I had the following problems with people. Example: I fought with my wife.

   1. ---

   2. ---

   3. ---

   4. ---

   I had the following problems with situations. Example: I lived in a place where there were drug dealers.

   1. ---

   2. ---

   3. ---

   4. ---

   I had the following problems with thoughts and feelings. Example: I was angry and couldn't seem to think about anything but using alcohol or drugs.

   1. ---

   2. ---

   3. ---

   4. ---

   I had the following problems with pain and sickness. Example: My back hurt and I was tired all the time.

   1. ---

   2. ---

   3. ---

   4. ---

6. I started to use again when:
   1. I started to think

      ---

   2. I started to feel

      ---

   3. I wanted to

      ---

7. The first drug I used was (include alcohol):

   Then I used

   ---

   Then I used

   ---

8. I used for ___________ (days, weeks, months, and/or years) before stopping again.

Previous Table of Contents Next
Top of Page

 

---

Contact Us | Site Map | Privacy Policy | Accessibility
Home | Documents | Information Exchange Services
Special Topics | Resources | State Information | Online Resources

Last Updated 11-7-02