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.
| Subject | Career Events | Personal Events | Treatment Events | Drug Related Behaviors | Bahavioral Patterns | Relapse Thoughts | Health Status |
|---|---|---|---|---|---|---|---|
| atterns of Behavior | |||||||
| eelings About the Above Event |