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Addictions Worksheets, Dual Diagnosis, And Relapse Prevention

Misuse of alcohol and other drugs frequently co-occurs with other mental health conditions. For example, rates of PTSD among some groups misusing substances have been reported to be as high as 50% (Reynolds et al., 2005). Mental health professionals working with substance misuse use a variety of psychological approaches. These include cognitive behavioral techniques, relapse prevention, motivational interviewing, and solution-focused brief therapy. Read more
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36 of 36 resources
A Guide To Emotions (Psychology Tools For Living Well)

A Guide To Emotions (Psychology Tools For Living Well)

Cognitive behavioral therapy can help your clients to live happier and more fulfilling lives. Psychology Tools for Living Well is a self-help course ... https://www.psychologytools.com/resource/a-guide-to-emotions-psychology-tools-for-living-well

Books & Chapters

ABC Model

ABC Model

ABC is an acronym for Antecedents, Behavior, Consequences. It is used as a tool for the assessment and formulation of problem behaviors and is useful ... https://www.psychologytools.com/resource/abc-model

Worksheets

Audio Collection: Psychology Tools For Mindfulness

Audio Collection: Psychology Tools For Mindfulness

The Psychology Tools For Mindfulness Audio Collection is the perfect way to introduce your clients to the practice of mindfulness. Developed by a clin ... https://www.psychologytools.com/resource/psychology-tools-for-mindfulness-audio-collection

Audio

Behavioral Experiment

Behavioral Experiment

Behavioral experiments are planned experiential activities to test the validity of a belief. They are one of the most powerful techniques available to ... https://www.psychologytools.com/resource/behavioral-experiment

Worksheets

Behavioral Experiment (Portrait Format)

Behavioral Experiment (Portrait Format)

Behavioral experiments allow individuals to test the validity of their beliefs and assumptions. They are a core experiential technique for therapeutic ... https://www.psychologytools.com/resource/behavioral-experiment-portrait-format

Worksheets

Body Scan (Audio)

Body Scan (Audio)

The Body Scan is a mindfulness exercise encouraging present-moment awareness, with the sensations of the body being used as an anchor for mindful atte ... https://www.psychologytools.com/resource/body-scan-audio

Audio

Boundaries - Self-Monitoring Record

Boundaries - Self-Monitoring Record

Developing self-monitoring skills teaches clients to systematically observe and record specific targets such as their own thoughts, body feelings, emo ... https://www.psychologytools.com/resource/boundaries-self-monitoring-record

Worksheets

Classical Conditioning

Classical Conditioning

Classical conditioning is a process by which stimuli become associated with responses. This information handout describes key principles of Classical ... https://www.psychologytools.com/resource/classical-conditioning

Information handouts

Cognitive Behavioral Model Of The Relapse Process (Larimer, Palmer, Marlatt, 1999)

Cognitive Behavioral Model Of The Relapse Process (Larimer, Palmer, Marlatt, 1999)

Marlatt's (1985) cognitive behavioral model of relapse conceptualizes relapse as a “transitional process, a series of events that unfold over time ... https://www.psychologytools.com/resource/cognitive-behavioral-model-of-the-relapse-process-larimer-palmer-marlatt-1999

Information handouts

Functional Analysis

Functional Analysis

Functional analysis examines the causes and consequences of behavior. This classic A-B-C Functional Analysis worksheet can be used to collect informat ... https://www.psychologytools.com/resource/functional-analysis

Worksheets

Functional Analysis With Intervention Planning

Functional Analysis With Intervention Planning

This classic A-B-C functional analysis worksheet can be used to collect information about what came before a behavior (antecedents), the behavior itse ... https://www.psychologytools.com/resource/functional-analysis-with-intervention-planning

Worksheets

Grounding Statements (Audio)

Grounding Statements (Audio)

Grounding techniques are used to help people to reorient themselves to the present moment and to safety. Grounding Statements are a form of cognitive ... https://www.psychologytools.com/resource/grounding-statements-audio

Audio

Grounding Techniques Menu

Grounding Techniques Menu

Dissociation can be described as a shift of a person’s attention away from the present moment. When working with traumatized clients, this shift oft ... https://www.psychologytools.com/resource/grounding-techniques-menu

Information handouts

Intrusive Memory Record

Intrusive Memory Record

Intrusive (unwanted, involuntary) memories are a common feature of PTSD, but also depression and other conditions. This Intrusive Memory Record is des ... https://www.psychologytools.com/resource/intrusive-memory-record

Worksheets

Lapse And Relapse Management

Lapse And Relapse Management

Recovery has a fluctuating course and so Lapse And Relapse Management is necessary when learning any new skill. It is applicable to most CBT work, as ... https://www.psychologytools.com/resource/lapse-and-relapse-management

Worksheets

Managing Substance Use Disorder: Practitioner Guide

Managing Substance Use Disorder: Practitioner Guide

Managing Substance Use Disorder comes in two volumes. This page is for the Practitioner Guide. Click on the following link to access the Workbook.&nbs ... https://www.psychologytools.com/resource/managing-substance-use-disorder-practitioner-guide

Treatments That Work®

Managing Your Substance Use Disorder: Workbook

Managing Your Substance Use Disorder: Workbook

Managing Substance Use Disorder comes in two volumes. This page is for the Client Workbook. Click on the following link to access the Practitioner Gui ... https://www.psychologytools.com/resource/managing-your-substance-use-disorder-workbook

Treatments That Work®

Mindful Attention (Audio)

Mindful Attention (Audio)

Mindful Attention is a technique for becoming aware of one’s thoughts and experiences, and being able to observe these as transient mental events. ... https://www.psychologytools.com/resource/mindful-attention-audio

Audio

Mindfulness In Everyday Life (Audio)

Mindfulness In Everyday Life (Audio)

Mindfulness In Everyday Life is a short mindfulness exercise which guides clients how to bring present-moment awareness into everyday life. This audio ... https://www.psychologytools.com/resource/mindfulness-in-everyday-life-audio

Audio

Mindfulness Of Breath (Long Version) (Audio)

Mindfulness Of Breath (Long Version) (Audio)

Mindfulness Of Breath (Long version) is a mindfulness exercise encouraging present-moment awareness, using the breath as an anchor for the attention. ... https://www.psychologytools.com/resource/mindfulness-of-breath-long-version-audio

Audio

Mindfulness Of Breath (Short Version) (Audio)

Mindfulness Of Breath (Short Version) (Audio)

Mindfulness Of Breath (Short version) is a mindfulness exercise encouraging present-moment awareness, using the breath as an anchor for the attention. ... https://www.psychologytools.com/resource/mindfulness-of-breath-short-version-audio

Audio

Mindfulness Of Sounds And Thoughts (Audio)

Mindfulness Of Sounds And Thoughts (Audio)

Mindfulness Of Sounds And Thoughts is a mindfulness practice exercise that encourages relating to thoughts as ‘just thoughts’ that come and go in ... https://www.psychologytools.com/resource/mindfulness-of-sounds-and-thoughts-audio

Audio

Motivation and Ambivalence

Motivation and Ambivalence

Motivation is a necessary precursor to change, yet many clients are ambivalent about the process of change. The Motivation And Ambivalence worksheets ... https://www.psychologytools.com/resource/motivation-and-ambivalence

Exercises

Operant Conditioning

Operant Conditioning

Operant conditioning / instrumental learning is a mechanism by which behaviors can be strengthened or weakened over time. This information handout des ... https://www.psychologytools.com/resource/operant-conditioning

Information handouts

Raisin Exercise (Audio)

Raisin Exercise (Audio)

The Raisin Exercise is a short mindfulness exercise encouraging present-moment awareness of the senses, connecting with taste, touch and smell while y ... https://www.psychologytools.com/resource/raisin-exercise-audio

Audio

Relaxed Breathing Exercise 1 (Audio)

Relaxed Breathing Exercise 1 (Audio)

Breathing Exercise 1 guides the listener through simple instructions to make their breathing slower, deeper, and more regular. ... https://www.psychologytools.com/resource/relaxed-breathing-exercise-1-audio

Audio

Relaxed Breathing Exercise 2 (Audio)

Relaxed Breathing Exercise 2 (Audio)

Breathing Exercise 2 uses the imagery of inflating a balloon to help the listener make their breathing slower, deeper, and more regular. ... https://www.psychologytools.com/resource/relaxed-breathing-exercise-2-audio

Audio

Relaxed Breathing Exercise 3 (Audio)

Relaxed Breathing Exercise 3 (Audio)

Breathing Exercise 3 uses the imagery of breathing air of different colours to help the listener make their breathing slower, deeper, and more regular ... https://www.psychologytools.com/resource/relaxed-breathing-exercise-3-audio

Audio

Relaxed Breathing Exercise 4 (Audio)

Relaxed Breathing Exercise 4 (Audio)

Breathing Exercise 4 guides the listener through simple instructions to breathe in a more relaxed fashion. ... https://www.psychologytools.com/resource/relaxed-breathing-exercise-4-audio

Audio

Sensory Grounding Using Smells (Audio)

Sensory Grounding Using Smells (Audio)

The Sensory Grounding Using Smells exercise is an audio track from the Psychology Tools For Overcoming PTSD Audio Collection. It is designed to teach ... https://www.psychologytools.com/resource/sensory-grounding-using-smells-audio

Audio

Sensory Grounding Using Your Five Senses (Audio)

Sensory Grounding Using Your Five Senses (Audio)

The Sensory Grounding Using Your Five Senses exercise is an audio track from the Psychology Tools For Overcoming PTSD Audio Collection. It is designed ... https://www.psychologytools.com/resource/sensory-grounding-using-your-five-senses-audio

Audio

Stages Of Change

Stages Of Change

The Stages Of Change model is helpful for conceptualizing the mental states of individuals at different stages of their change journey. This informati ... https://www.psychologytools.com/resource/stages-of-change

Information handouts

Therapy Blueprint (Universal)

Therapy Blueprint (Universal)

A therapy blueprint is CBT tool which summarizes the work a therapist and patient have completed together. It represents the past (the problems, what ... https://www.psychologytools.com/resource/therapy-blueprint-universal

Worksheets

Thinking Versus Sensing (Audio)

Thinking Versus Sensing (Audio)

Thinking Versus Sensing is a short mindfulness exercise to demonstrate the difference between thinking about our experience and sensing it directly. E ... https://www.psychologytools.com/resource/thinking-versus-sensing-audio

Audio

Unhelpful Thinking Styles

Unhelpful Thinking Styles

Human thinking is subject to a number of characteristic biases. In the 1960s, Aaron Beck identified several of these biases which were common in his d ... https://www.psychologytools.com/resource/unhelpful-thinking-styles

Information handouts

Window Of Tolerance

Window Of Tolerance

The window of tolerance concept was coined by Dan Siegel in his 1999 book The Developing Mind. Siegel proposes that everyone has a range of intensitie ... https://www.psychologytools.com/resource/window-of-tolerance

Information handouts

Assessment

  • Drinking motives questionnaire | Cooper, Russell, Skinner, Windle | 1992
    • Scale  download  archived copy
    • Cooper, M. L., Russell, M., Skinner, J. B., & Windle, M. (1992). Development and validation of a three-dimensional measure of drinking motives. Psychological Assessment,4,123-132.
  • Drinking motives questionnaire – adolescent | Cooper | 1994
    • Scale  download  archived copy
    • Cooper, M.L. (1994). Motivations for alcohol use among adolescents:  Development and validation of a four-factor model.  Psychological Assessment, 6,117-128.
  • Leeds Dependence Questionnaire | Raistrick, Bradshaw, Tober, Weiner, Allison, Healey | 1994
    • Scale  download  archived copy
    • Raistrick, D.S., Bradshaw, J., Tober, G., Weiner, J., Allison, J. & Healey, C. (1994) Development of the Leeds Dependence Questionnaire, Addiction, 89, pp 563-572.
  • Maudsley Addiction Profile (MAP) | Marsden, Gossop, Stewart, Best, Farrell, Lehmann, Edwards, Strang | 1998
    • Scale  download  archived copy
    • Marsden, J. Gossop, M. Stewart, D. Best, D. Farrell, M. Lehmann, P. Edwards, C. & Strang, J. (1998) The Maudsley Addiction Profile (MAP): A brief instrument for assessing treatment outcome, Addiction 93(12): 1857-1867.
  • Readiness to Change Questionnaire (RTQ) | Heather, Rollnick | 1993
  • Severity of Dependence Scale | Gossop, Darke, Griffiths, Hando, Powis, Hall, Strang | 1995
    • Scale  download  archived copy
    • Gossop, M., Darke, S., Griffiths, P., Hando, J., Powis, B., Hall, W., Strang, J. (1995). The Severity of Dependence Scale (SDS): psychometric properties of the SDS in English and Australian samples of heroin, cocaine and amphetamine users. Addiction 90(5): 607-614.
  • Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) | Miller, Tonigan | 1996
    • Scale  download  archived copy
    • Miller, W. R., & Tonigan, J. S. (1996). Assessing drinkers’ motivation for change: the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). Psychology of Addictive Behaviors, 10(2), 81.

Intervention

Treatment manuals

  • Enhancing Motivation for Change in Substance Use Disorder Treatment | SAMHSA | 2019 download  archived copy
  • Motivational Enhancement Therapy Manual | Miller, Zweben, DiClemente, Rychtarik | 1995 download archived copy
  • Cognitive Behavioural Coping Skills Treatment Manual: A clinical research guide for therapists treating individuals with alcohol abuse and dependence | Kadden, Carroll, Donovan, Cooney, Monti, Abrams, Litt, Hester | 2003 download archived copy
  • Clinical guidelines for implementing relapse prevention therapy | Marlatt, Parks, Witkiewitz | 2002 download archived copy
  • A cognitive-behavioral approach: Treating cocaine addiction | Carroll | 1998 download archived copy
  • Addictions and trauma recovery | Janina Fischer | 2000 download archived copy
  • Patient’s workbook for cognitive behavioral therapy sessions – Intensive Treatment and rehabilitation program for residential treatment and rehabilitation centers for drug dependents (INTREPRET) | Phillipines Department of Health | 2020 download archived copy
  • Substance use / brain injury bridging project – Client workbook | Community Head Injury Resource Services of Toronto (CHIRS) and the Centre for Addiction and Mental Health (CAMH) download archived copy

Information Handouts

Information handouts

Presentations

  • Cognitive behavioral & relapse prevention strategies | UNODC | 2007 download archived copy
  • Acceptance and commitment therapy for substance abuse | Richie | 2013 download archived copy
  • The great porn experiment – TED lecture | Gary Wilson  youtube.com
  • Yourbrainonporn – contains useful information about neurobiology of addiction  link

Recommended Reading

  • Brownell, K. D., Marlatt, G. A., Lichtenstein, E., & Wilson, G. T. (1986). Understanding and preventing relapse. American Psychologist, 41(7), 765. download
  • Hendershot, C. S., Witkiewitz, K., George, W. H., & Marlatt, G. A. (2011). Relapse prevention for addictive behaviors. Substance abuse treatment, prevention, and policy, 6(1), 17. download
  • Larimer, M. E., Palmer, R. S., Marlatt, G. A. (1999). An overview of Marlatt’s Cognitive-Behavioural Model. Alcohol Research and Health, 23(2), 151-160 download archived copy
  • Volkow, N. D., Koob, G. F., & McLellan, A. T. (2016). Neurobiologic advances from the brain disease model of addiction. New England Journal of Medicine, 374(4), 363-371 download

What Is Addiction?

Signs and Symptoms of Addictions and Relapse

Behavioral and Social Signs of Addictions Include:

  • Continuing to use a substance (or engage in certain behaviors) despite the negative consequences that they cause
  • Trying but failing to reduce or stop misusing a substance
  • Secretive, furtive, or dishonest behavior

Psychological Symptoms of Addictions Include:

  • Mood swings
  • Anger or irritability
  • Paranoia
  • Defensiveness
  • Poor judgment

Psychological Models of Addictions and Relapse

There is considerable psychological theory which clinicians working in the field of addiction can draw upon.

Prochaska and DiClemente’s Transtheoretical Model (Stages of Change Model)

The transtheoretical model (Prochaska & DiClemente, 1982; Prochaska, DiClemente, Norcross, 1992) is used to conceptualize the process of intentional behavior change. It identifies important stages in the process of changing a behavior: precontemplation, contemplation, preparation, action, and maintenance. The transtheoretical model also identifies processes which need to be implemented to attain behavior change: consciousness raising (awareness of the facts), dramatic relief (paying attention to feelings), environmental re-evaluation (noticing our effects upon others), self–re-evaluation (creating a new self-image), social liberation (noticing support around us), self-liberation (making a commitment), counterconditioning (using substitutes), helping relationships (getting support), reinforcement management (using rewards), stimulus control (managing your environment).

Marlatt and Gordon’s Cognitive Behavioral Model of Relapse

Marlatt and Gordon published a cognitive behavioral model of relapse in 1985. They conceptualize relapse as a “transitional process, a series of events that unfold over time” (Marlatt & Gordon, 1985). The model identifies factors that can contribute toward episodes of relapse. These include intrapersonal factors such as self-efficacy (the degree to which an individual feels confident and capable of performing a certain behavior in a specific situational context), outcome expectancies (an individual’s anticipation of the effects of a future experience), craving, motivation, and social support.

The Cognitive Behavioral Model of Substance Abuse

The cognitive behavioral model of substance abuse (Beck, Wright, Newman, & Liese, 1993) describes psychological areas of vulnerability that predispose an individual to misusing substances including: dysfunctional beliefs about drugs, oneself, or one’s relationship with drugs; ‘permission-giving beliefs’ with which an individual may justify their drug use; and reactions to a lapse or relapse that lead to a vicious cycle of maintenance.

Evidence-Based Psychological Approaches for Working with Addictions and Relapse

Cognitive approaches to working with addictions may include:

  • identifying patterns of dysfunctional thinking such as ‘permission-giving beliefs’;
  • learning how to delay and distract in response to cravings and urges;
  • learning problem-solving techniques;
  • making positive lifestyle changes;
  • treating underlying mental health conditions which predispose an individual toward substance misuse.

Resources for Working with Addictions and Relapse

Psychology Tools resources available for working therapeutically with addictions may include:

  • psychological models of addiction and relapse
  • information handouts for addiction and relapse
  • exercises for addiction and relapse
  • CBT worksheets for addiction and relapse
  • self-help programs for addiction and relapse

References

  • Beck, A. T., Wright, F., Newman, C., & Liese, B. (1993). Cognitive therapy of substance abuse: a treatment manual. New York Guilford.
  • Larimer, M. E., & Palmer, R. S. (1999). Relapse prevention: An overview of Marlatt’s cognitive-behavioral model. Alcohol Research and Health, 23(2), 151–160.
  • Marlatt, G. A. (1985). Relapse prevention: Theoretical rationale and overview of the model. In G. A. Marlatt & J. R. Gordon (Eds.), Relapse prevention. New York: Guilford Press.
  • Prochaska, J. O., & DiClemente, C. C. (1982). Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research & Practice,19(3), 276–288.
  • Prochaska, J. O., DiClemente, C. C., & Norcross, J. C. (1992). In search of how people change: Applications to the addictive behaviors. American Psychologist, 47(9), 1102–1114.
  • Reynolds, M., Mezey, G., Chapman, M., Wheeler, M., Drummond, C., & Baldacchino, A. (2005). Co-morbid post-traumatic stress disorder in a substance misusing clinical population. Drug and Alcohol Dependence, 77(3), 251–258.

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