Chrysalis Health Relapse Prevention Plan Worksheet

Chrysalis Health
Relapse Prevention Plan
Phase I: Motivation
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Client Name
Date Created
Therapist
The Costs (Negative Impacts of Use)
What immediate or progressive damage happens to my health, family, career, and self-respect if I return to active use?
My Pillars (Reasons to Stay Sovereign)
What or who am I protecting? What dreams, opportunities, and inner peace am I building by remaining sober today?
Routine Maintenance & Structure
Sobriety thrives on structure. When our daily and weekly schedules collapse, old habits crawl back. Map out your foundational routines below.
My Daily Sobriety Essentials
Morning reflection, meditation, or prayer
Following medication/treatment plan strictly
Eating nutritional meals & tracking sleep
My Weekly Core Anchors
Therapy appointment or recovery group attendance
Honest conversation with sponsor/mentor
Weekly clean recreational activity or hobby
Chrysalis Health © 2026 • Relapse Prevention Toolkit Empowering True Personal Metamorphosis

Chrysalis Health
Warning Signs Radar
Phase II: Awareness
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My Five-Dimensional Warning Signs
Relapse is a progressive emotional and behavioral process. Check the signs below that indicate your recovery is facing vulnerability, and specify your personal warning behaviors.
Thoughts & Beliefs
Romanticizing past use Bargaining ("just once") Believing sobriety isn't worth it
My Personal Thoughts:
Attitudes & Outlook
Complacency ("fully cured") Defensiveness or finger-pointing Resentment toward guidelines
My Personal Attitudes:
Feelings & Moods (HALT)
Intense anxiety, fear, or panic Pervasive boredom or emptiness Frequent irritability or anger
My Personal Moods:
Behaviors & Habits
Isolating yourself in room/house Skipping therapeutic support sessions Hiding details / broken agreements
My Personal Behaviors:
Social Dynamics & Relating to Others
Withdrawing from safe friends/family Visiting old active risk locations Inciting fights with accountables
My Social Red Flags:
Primary Alarm Response
If I identify more than three checked warning signs above, I pledge to take the following preventative actions immediately:
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Chrysalis Health
Trigger Action Plan
Phase III: Mapping
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Understanding My Triggers
Triggers can be Internal (physical or emotional states inside you) or External (specific people, places, times, or things around you). By anticipating these triggers, you create armor.
1. Categorizing My Cues
Internal (Feelings & States)
Physical fatigue/exhaustion (Tired) Loneliness, isolation, or boredom Stressful family arguments/conflicts Celebratory mood ("I deserve to party")
External (Environments & Tools)
Passing by old drug-buying spots/bars Social media posts of people partying Seeing drug paraphernalia or cash Friday nights, holidays, or paydays
2. Coping Action Log
Write down your 4 highest-risk triggers and map out a concrete, actionable coping response for each.
| Trigger Scenario (Be Specific) | Threat Rating | Exact Coping Action Strategy |
|---|
| | |
| LOW • MED • HIGH | | |
|
|
| LOW • MED • HIGH |
|
|
| LOW • MED • HIGH |
|
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| LOW • MED • HIGH |
|
Chrysalis Health © 2026 • Relapse Prevention Toolkit Empowering True Personal Metamorphosis

Chrysalis Health
Crisis Activation Plan
Phase IV: Action
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1. My Circles of Trust
Who will you reach out to first when an urge hits? List your emergency responders in order. Be completely honest and transparent with these individuals.
Primary Recovery Mentor / Sponsor
NAME
PHONE NUMBER
Chrysalis Lead Counselor
NAME
PHONE NUMBER
Family Emergency Contact
NAME
PHONE NUMBER
Sober Peer Network Backup
NAME
PHONE NUMBER
2. Emergency Urge Protocol (Imminent Risk)
If I am experiencing active, severe, physical cravings, or feel my cognitive controls failing completely, I will execute these Three Immediate Actions:
1 Stop & Retreat
Freeze what you are doing. Physically walk away from the trigger space immediately. Go to a public, clean, or secure location.
2 Ring Your Circle
Do not sit alone with your thoughts. Place your phone call to your sponsor, partner, or therapist immediately. Explain the threat level.
3 Go to Sanctuary
Go directly to an active 12-step meeting hall, a clean relative's house, or a local emergency department/Chrysalis Detox Center.
My 2 Designated Safe Sanctuaries
LOCATION A (Address/Sober Spot)
LOCATION B (Alternative Safe Room)
Chrysalis Health © 2026 • Relapse Prevention Toolkit Empowering True Personal Metamorphosis

Chrysalis Health
The Restart Protocol
Phase V: Recovery
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What If a Slip Happens?
A lapse (a single, brief slip-up) does not mean you have to return to relapse (prolonged, active addiction cycle). Do not let shame keep you trapped. The speed of your return to clean living determines your trajectory.
Four Steps to Get Back on Track Immediately
1
Destroy & Discard: Immediately discard any remaining substance. Empty any bottles, flush any items, and break contact with the source. Do not hold onto anything.
2
Shatter the Isolation & Secrets: Within 2 hours of the slip, you must contact your sponsor, counselor, or clean loved one. Keeping the slip a secret feeds the shame cycle.
3
Evaluate the Vulnerability Gap: Sit down with your counselor to clinically review: Where did the defense plan fail? What early warning signs were ignored? This is data, not doom.
4
Reinforce Boundaries: Immediately block phone numbers, avoid those neighborhoods, reset your schedule, and check back into intensive peer recovery meetings.
Vulnerability Gap Assessment
Work with your therapist or case manager to explore these questions if a lapse occurs:
1. What specific triggers or early warning signs did I miss before the slip?
2. What boundary was compromised, and what action will I take today to lock down this loop?
"I pledge to show myself radical grace. A slip is a bend in the road, not the end of the road. I commit to being transparent, choosing vulnerability over hiding, and taking these immediate steps to restart my chrysalis transformation."
Client Re-Commitment Signature:
Clinical Witness:
Chrysalis Health © 2026 • Relapse Prevention Toolkit Empowering True Personal Metamorphosis
Chrysalis Health Recovery Resource Directory

Chrysalis Health
Recovery Resource Directory
Companion Guide
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Sobriety is built on a foundation of continuous support. Keep this directory on your wall, in your bag, or on your phone as a reminder that you are never alone on this journey. Reach out whenever you need an anchor.
1. National Crisis Hotlines
SAMHSA National Helpline 1-800-662-4357
Free, confidential, 24/7/365 treatment referral and information service in English and Spanish.
Suicide & Crisis Lifeline 988
Call or text 988 for immediate help with psychiatric emergencies, intense cravings, or emotional distress.
Crisis Text Line Text HOME to 741741
Connect with a crisis counselor 24/7 over text for quiet, immediate emotional support.
Tip: Save these numbers directly into your phone contacts under "A-Support" for instant speed dial.
2. Mutual Aid & Peer Groups
Alcoholics Anonymous (AA) aa.org
12-step mutual support community. Find local in-person and digital speaker/discussion meetings.
Narcotics Anonymous (NA) na.org
12-step support network specializing in recovering from drug addiction of all types.
SMART Recovery smartrecovery.org
Science-based, self-empowered community teaching cognitive tools for managing addiction.
Tip: Download the "Meeting Guide" mobile app (white chair on blue circle icon) to find meetings near you.
3. Digital Sobriety Apps & Local Safety Network
Recommended Mobile Apps
- • I Am Sober: Sobriety counter, daily pledge tracker, mood journal, and active peer community.
- • Connections App: Evidence-based support tool for individuals in outpatient programs or aftercare.
- • Sober Grid: Social networking for sober folks. Instantly locate clean friends nearby or access peer help.
My Local Emergency Contacts
Local Detox / Urgent Care Center
Chrysalis Health 24/7 Emergency Line
1-888-(Sample Only)
Sober Friend Ride / Transport Connection
Chrysalis Health © 2026 • Relapse Prevention Toolkit Empowering True Personal Metamorphosis