Recovery Workshop Relapse Assessment Worksheet First Name and Last Initial: E-mail address: 1) Do you have a Relapse Monitoring Plan developed? Check all that apply: Yes, it is complete (or close to it) Yes, it is complete, but I do not use it I started it but never finished it I have not started a Monitoring Plan I have scheduled monitoring sessions in place, and have been completing them regularly I have scheduled monitoring sessions in place, but haven't used them in months I do not have scheduled monitoring sessions in place My relapse plan includes at least five action plans My relapse monitoring plan includes an action plan to help get me back on the right track My relapse monitoring plan includes an updated list of my prioritized values My relapse monitoring plan includes an updated list of my existing boundaries My relapse monitoring plan includes an area for motivation My relapse monitoring plan includes an area for support 2) Balance of Values If I were to assess the balance of my life right now, I would have to say that my value system is: Not Mildly Moderately Severely ...out of balance with my priorities. 3) Issues The biggest issues that I am struggling to manage are: 4) Neglected Values The most important values that I am neglecting in my life are: 5) How did you get here? Describe the mental process (as best you can) that led from your initial enthusiasm/motivation to rebuild your life to its current level of apathy, complacency, helplessness and/or hopelessness. 6) Warning Signs Looking back, what signs did you see that might have served as a warning signal that action needed to be taken before this relapse occurred? 7) What was your reaction to these signs? For instance, I ignored them intentionally. I took actions, but the actions I took were ineffectual. 8) Consequences The most significant consequence of relapse is the long-term disruption to the value system that has been under construction. From an awareness viewpoint, list the new obstacles that this relapse has created in your life. For instance, the developing trust within my marriage has been decimated. My stress level has increased dramatically. 9) Regaining Perspective The most important element of relapse is regaining healthy motivation and perspective. Without saying, "I don't know", how will you regain this healthy motivation and perspective? 10) Next Steps What will be the next immediate, active steps that you will take to get yourself back on a healthy track?
