Relapse Prevention Plan: A Printable Worksheet

What does relapsing mean?

Relapse means going back to drinking or drug use after a period of not using, usually to the pattern you were trying to leave. It is common. The National Institute on Drug Abuse, drawing on a 2000 JAMA review, puts relapse rates for people treated for substance use disorders at 40 to 60 percent, against 50 to 70 percent for people treated for high blood pressure or asthma, and says plainly that relapse does not mean treatment failed. It means the treatment needs to be restarted, adjusted or changed.

That is not permission. It is a reason to plan.

Some researchers split the moment of use in two. A lapse is the first drink or drug use. A relapse is a return to uncontrolled use. The step from one to the other is not inevitable. One thing that can shape it is the reaction to the lapse. Marlatt’s relapse prevention model calls it the abstinence violation effect: the person who reads one drink as proof of personal failure feels guilt, and the guilt can drive more drinking. The plan exists so a lapse gets a phone call, not a verdict.

Relapse starts before the drink

Steven Melemis, writing in the Yale Journal of Biology and Medicine in 2015, describes relapse as a gradual process that starts weeks or even months before anyone picks up a drink or drug. He breaks it into three stages:

• Emotional relapse. You are not thinking about using. You are bottling up feelings, isolating, skipping meetings or going without speaking, focusing on other people’s problems, and eating and sleeping badly. The common thread is poor self-care.
• Mental relapse. Part of you wants to use and part of you does not. Cravings, thinking about the people and places you used with, remembering the good parts and shrinking the bad ones, bargaining, lying, planning ways to use “under control,” and looking for an opening.
• Physical relapse. Using again.

The early stages are where the plan does its work. Melemis writes that the goal of treatment is to help people recognize those stages, where the chances of success are greatest, and that physical relapse is the hardest stage to stop. Section 2 of the worksheet asks you to write down what the first two stages look like in your own life, because the generic list will not match yours exactly.

How to fill it in

• Fill it in on a calm day, not in the middle of a craving.
• Do it with someone: a counselor, an IOP group, a sponsor or peer recovery specialist, or a family member you trust. Other people see your warning signs before you do.
• Write specifics. “Stress” is not a trigger you can plan around. “Sunday nights before a work week” is.
• Keep copies in three places: your wallet, a photo on your phone, and with the person you would call first.
• Review it on the date you write at the top, and again after any lapse, any medication change or any big life change: a move, a breakup, a new job, a death.

If you are in treatment now, bring the sheet to your counselor. Many programs build a version of this plan before discharge. Use this one alongside theirs. Our aftercare guide covers what the months after treatment should include, and what comes after detox covers the step before that.

Opioids: the risk after a period of not using

This fact can decide whether someone lives. After a period without opioids, tolerance falls. SAMHSA’s overdose toolkit lists using after a recent period of abstinence, which may lower the tolerance a person had, as an overdose risk, along with returning to use after jail, prison or a health care setting where medication for opioid use disorder was not provided. A dose that was routine a month ago can now be fatal.

Medication changes the math. A 2017 BMJ meta-analysis of more than 138,000 people found that staying on methadone or buprenorphine was associated with large reductions in deaths from all causes and from overdose, and that the time right after leaving treatment was a period of particularly high risk. If you are on one of these medications, section 6 is the most important part of the sheet.

The FDA approved Narcan nasal spray for over-the-counter sale in March 2023, so you can buy it without a prescription. In New Jersey, the state’s Naloxone365 program lets anyone 14 or older get naloxone free and anonymously at participating pharmacies; StopOverdoses.nj.gov lists them. Our naloxone guide covers how to use it.

When a lapse means more care

One drink after a year is a different problem from three weeks of daily use. If the lapse has turned back into the old pattern, the plan’s next step is treatment, not a better worksheet. Call your counselor or prescriber first. If you have NJ FamilyCare or no insurance, call the IME Addictions Access Center at 1-844-276-2777, which screens callers and refers them to treatment. Anyone in New Jersey can call ReachNJ at 1-844-732-2465. Both answer 24/7. Our guide to getting into detox in New Jersey covers what that call sounds like, and signs you need detox covers when withdrawal needs medical care.

If depression, anxiety, trauma or another mental health condition sits underneath the use, treat both at once. Our page on dual diagnosis treatment in New Jersey explains how to find a program that does.