Relapse Management Worksheet
1. Self-Regulation. List any examples of the person’s ability to self-regulate thinking, feelings, or behavior.
2. Integration. List any examples of the person’s ability to understand and accept situations and events which have led to past relapses (if the person has never relapsed in this behavior before, what is the understanding of relapse triggers for other behaviors).
3. Understanding. List examples of the person’s understanding of general factors that cause relapse.
4. Self-Knowledge. List examples of the person’s understanding of personal relapse warning signs.
5. Coping Skills. List examples of the person’s plan for coping with relapse warning signs.
6. Change. List examples of the person’s acceptance of recommendations for handling relapse warning signs.
7. Awareness. List examples of the person looking at relapse warning signs on a daily basis.
8. Significant Others. List examples of support for changing behavior from significant others.
9. Maintenance. When was the last time the person updated her Relapse Maintenance Plan?