revised 1/12/98
Name: Date: Note: This worksheet is to be filled out as part of the Relapse Prevention Workbook in conjunction with your therapy
group. You should fill out one of these sheets for each addictive behavior that you have identified. You should fill them out in pencil so that you can make corrections after they have been looked at by your counselor.
1) In one sentence, write what the addictive behavior is that you will be talking about on this worksheet. In at least one more sentence, describe your addiction.
Name this addiction in one or two words (for example--Alcohol, Cocaine, sex, etc.). Now, fill in the space (____________) in each of the following questions with this word.
2) Describe in one paragraph what was going on in your life when this addiction was in its greatest control of your life. Describe the life situation that you were experiencing when you participated in this behavior--who were you living with, where were you working, who were you involved with, etc. In particular, describe any major changes that were occurring in your life at the time. Also describe anything about your living arrangements that might be considered out of the ordinary.
3) Describe your addiction using the addiction cycle: (see appendix B of this workbook to help you understand the meaning of the terms used in this section)
a) List three core beliefs that you have about (____________). A core belief should be thought of as a general life statement that allows you to carry out your addiction. 1.
2.
3.
b) Identify three ways that you specifically applied your core beliefs to your addiction (impaired thoughts).
1.
2.
3.
c) Describe in a short paragraph how you expressed your preoccupation within your addiction.
d) Identify at least five steps (ritualization) that you usually did that led up to your addictive acting out of your (____________) addiction.
1.
2.
3.
4.
5.
e) Describe in a brief paragraph what you did when you acted out on your addiction. That is, what did you do when you actually carried out your addiction.
f) Describe in a brief paragraph how you experienced shame after you carried out your addiction. Shame can be thought of as a negative self statement about your personal worth.
g) Describe in a brief paragraph how you experienced guilt after you carried out your addiction. Guilt can be thought of as a negative experience put upon you in
relationship to others and is usually experienced as a result of the consequences you experience for your behavior.
h) List at least five ways your life became unmanageable because of your (____________) addiction. 1. 2. 3. 4. 5.
4) List five feelings that you had just before you did this (____________).
For each feeling, define in one sentence what this feeling means to you. How did this feeling relate to the behavior? Why were you feeling this way?
1.
2.
3.
4.
5.
5) List five feelings that you had just after you did this (____________).
For each feeling, define in one sentence what this feeling means to you. How did this feeling relate to the behavior? Why were you feeling this way?
1.
2.
3.
4.
6) Typically, we do not just act. We usually make a series of decisions that enable us to participate in a behavior. For example, we do not just eat. We must first recognize that we are hungry, decide what we want to eat, decide how to get what we want to eat, decide to get what we want to eat, and finally decide to eat it. Abusive behavior works the same way. Below, identify 10 specific decisions that you had to make before you could participate in the (____________). A decision is defined as a cognitive process that results in action. You may find it helpful to start the statement with the phrase, “I decided to . . . ).
1. I decided to 2. I decided to 3. I decided to 4. I decided to 5. I decided to 6. I decided to 7. I decided to 8. I decided to 9. I decided to 10. I decided to
7. A rationalization is something that you tell yourself to justify or somehow make OK your decision. Rationalizations do not involve action. They just explain away our actions. Identify what you told yourself about your decisions that allowed you to make them. What did you tell yourself about the addiction that made it OK for you to do it? You may find it helpful to start the statement with the phrase “I told myself that . . . “
1. I told myself that
2. I told myself that
3. I told myself that
4. I told myself that
5. I told myself that
6. I told myself that
7. I told myself that
8. I told myself that
9. I told myself that
Relapse Prevention Worksheet
Section A (Addictive Behavior)
revised 1/12/98
Name: Date: Note: This worksheet is to be filled out as part of the Relapse Prevention Workbook in conjunction with your therapy
group. You should fill out one of these sheets for each addictive behavior that you have identified. You should fill them out in pencil so that you can make corrections after they have been looked at by your counselor.
1) In one sentence, write what the addictive behavior is that you will be talking about on this worksheet. In at least one more sentence, describe your addiction.
Name this addiction in one or two words (for example--Alcohol, Cocaine, sex, etc.). Now, fill in the space (____________) in each of the following questions with this word.
2) Describe in one paragraph what was going on in your life when this addiction was in its greatest control of your life. Describe the life situation that you were experiencing when you participated in this behavior--who were you living with, where were you working, who were you involved with, etc. In particular, describe any major changes that were occurring in your life at the time. Also describe anything about your living arrangements that might be considered out of the ordinary.
3) Describe your addiction using the addiction cycle: (see appendix B of this workbook to help you understand the meaning of the terms used in this section)
a) List three core beliefs that you have about (____________). A core belief should be thought of as a general life statement that allows you to carry out your addiction. 1.
2.
3.
b) Identify three ways that you specifically applied your core beliefs to your addiction (impaired thoughts).
1.
2.
3.
c) Describe in a short paragraph how you expressed your preoccupation within your addiction.
d) Identify at least five steps (ritualization) that you usually did that led up to your addictive acting out of your (____________) addiction.
1.
2.
3.
4.
5.
e) Describe in a brief paragraph what you did when you acted out on your addiction. That is, what did you do when you actually carried out your addiction.
f) Describe in a brief paragraph how you experienced shame after you carried out your addiction. Shame can be thought of as a negative self statement about your personal worth.
g) Describe in a brief paragraph how you experienced guilt after you carried out your addiction. Guilt can be thought of as a negative experience put upon you in
relationship to others and is usually experienced as a result of the consequences you experience for your behavior.
h) List at least five ways your life became unmanageable because of your (____________) addiction. 1. 2. 3. 4. 5.
4) List five feelings that you had just before you did this (____________).
For each feeling, define in one sentence what this feeling means to you. How did this feeling relate to the behavior? Why were you feeling this way?
1.
2.
3.
4.
5.
5) List five feelings that you had just after you did this (____________).
For each feeling, define in one sentence what this feeling means to you. How did this feeling relate to the behavior? Why were you feeling this way?
1.
2.
3.
4.
6) Typically, we do not just act. We usually make a series of decisions that enable us to participate in a behavior. For example, we do not just eat. We must first recognize that we are hungry, decide what we want to eat, decide how to get what we want to eat, decide to get what we want to eat, and finally decide to eat it. Abusive behavior works the same way. Below, identify 10 specific decisions that you had to make before you could participate in the (____________). A decision is defined as a cognitive process that results in action. You may find it helpful to start the statement with the phrase, “I decided to . . .”
1. I decided to 2. I decided to 3. I decided to 4. I decided to 5. I decided to 6. I decided to 7. I decided to 8. I decided to 9. I decided to 10. I decided to
7. A rationalization is something that you tell yourself to justify or somehow make OK your decision. Rationalizations do not involve action. They just explain away our actions. Identify what you told yourself about your decisions that allowed you to make them. What did you tell yourself about the addiction that made it OK for you to do it? You may find it helpful to start the statement with the phrase “I told myself that . . . “
1. I told myself that
2. I told myself that
3. I told myself that
4. I told myself that
5. I told myself that
6. I told myself that
7. I told myself that
8. I told myself that
9. I told myself that