Relapse Prevention / Sobriety Maintenance Plan Template

[Full Name]

[Date of Birth: MM/DD/YYYY]

[Street Address]

[City, State/Province, ZIP/Postal Code]

[Phone Number]

[Email Address]

Date Completed: [MM/DD/YYYY]

Plan Review Date: [MM/DD/YYYY]

1. Recovery Summary

Primary Substance(s) of Concern: [Substance(s)]

Sobriety Date (or most recent clean date): [MM/DD/YYYY]

Current Recovery Supports (check or describe):

• [AA / NA / 12-step meetings]

• [Outpatient or inpatient treatment]

• [Individual counseling or therapy]

• [Medication-assisted treatment]

• [Faith-based or community support]

• [Other: [Description]]

[AA / NA / 12-step meetings]

[Outpatient or inpatient treatment]

[Individual counseling or therapy]

[Medication-assisted treatment]

[Faith-based or community support]

[Other: [Description]]

DUI-Related Case (if applicable):

Case / Docket Number: [Number]

Court / Program Name: [Name]

2. Personal Reasons for Sobriety

My main reasons for staying sober are:

• [Reason 1, e.g., “My health and safety.”]

• [Reason 2, e.g., “My children and family.”]

• [Reason 3, e.g., “Keeping my job and license.”]

• [Reason 4, e.g., “Avoiding further legal trouble.”]

[Reason 1, e.g., “My health and safety.”]

[Reason 2, e.g., “My children and family.”]

[Reason 3, e.g., “Keeping my job and license.”]

[Reason 4, e.g., “Avoiding further legal trouble.”]

Long-Term Goals Related to Sobriety:

• [Goal 1]

• [Goal 2]

• [Goal 3]

[Goal 1]

[Goal 2]

[Goal 3]

3. Triggers and High-Risk Situations

Common people, places, things, or situations that can trigger cravings or thoughts of using:

People:

• [Example: Certain friends, coworkers, or family members]

Places:

• [Example: Bars, clubs, neighborhoods, houses, or events]

Situations and Events:

• [Example: Parties, holidays, concerts, paydays, being alone, late nights]

Thoughts and Feelings:

• [Example: Stress, anger, boredom, loneliness, shame, depression, anxiety]

4. Early Warning Signs of Relapse

Physical, emotional, and behavioral warning signs that may show I am moving toward relapse include:

Physical Signs:

• [Example: Trouble sleeping, headaches, stomach problems, low energy]

Emotional Signs:

• [Example: Irritability, mood swings, hopelessness, feeling numb]

Behavioral Signs:

• [Example: Skipping meetings or appointments, isolating, lying, contacting old using friends, driving by old places, thinking “one drink won’t hurt”]

5. Coping Strategies and Healthy Alternatives

Healthy ways I can cope with cravings, stress, and difficult emotions instead of using alcohol or drugs:

Immediate Coping Tools (for cravings or urgent situations):

• [Tool 1, e.g., “Call a sponsor or trusted friend.”]

• [Tool 2, e.g., “Use grounding or breathing exercises.”]

• [Tool 3, e.g., “Go to a meeting or online group.”]

• [Tool 4, e.g., “Leave the high-risk situation immediately.”]

[Tool 1, e.g., “Call a sponsor or trusted friend.”]

[Tool 2, e.g., “Use grounding or breathing exercises.”]

[Tool 3, e.g., “Go to a meeting or online group.”]

[Tool 4, e.g., “Leave the high-risk situation immediately.”]

Ongoing Healthy Habits:

• [Habit 1, e.g., “Regular exercise or walking.”]

• [Habit 2, e.g., “Journaling, meditation, or prayer.”]

• [Habit 3, e.g., “Spending time with supportive family or friends.”]

• [Habit 4, e.g., “Hobbies, creative activities, or volunteering.”]

[Habit 1, e.g., “Regular exercise or walking.”]

[Habit 2, e.g., “Journaling, meditation, or prayer.”]

[Habit 3, e.g., “Spending time with supportive family or friends.”]

[Habit 4, e.g., “Hobbies, creative activities, or volunteering.”]

6. Daily and Weekly Sobriety Routine

Daily Routine to Support Sobriety:

• Morning: [Examples: Reading recovery literature, planning the day, brief check-in call or message, gratitude list]

• Daytime: [Examples: Work or school, scheduled breaks, healthy meals, short walk]

• Evening: [Examples: Meeting attendance, family time, self-care, reflection on the day]

Morning: [Examples: Reading recovery literature, planning the day, brief check-in call or message, gratitude list]

Daytime: [Examples: Work or school, scheduled breaks, healthy meals, short walk]

Evening: [Examples: Meeting attendance, family time, self-care, reflection on the day]

Weekly or Regular Recovery Activities:

• Meetings (AA/NA/other): [Number] times per week at [Locations / Groups]

• Counseling / Therapy Sessions: [Frequency and provider]

• Check-ins with Sponsor / Mentor: [Frequency]

• Other Support Activities: [Description]

Meetings (AA/NA/other): [Number] times per week at [Locations / Groups]

Counseling / Therapy Sessions: [Frequency and provider]

Check-ins with Sponsor / Mentor: [Frequency]

Other Support Activities: [Description]

7. Support Network and Contact Information

People I can contact when I need help, feel cravings, or notice warning signs:

Primary Support Person:

Name: [Name]

Relationship: [Relationship]

Phone: [Phone Number]

Sponsor / Mentor (if applicable):

Name: [Name]

Program / Group: [AA/NA/Other]

Phone: [Phone Number]

Additional Support Contacts:

1. Name: [Name] – Relationship: [Relationship] – Phone: [Phone Number]

2. Name: [Name] – Relationship: [Relationship] – Phone: [Phone Number]

3. Name: [Name] – Relationship: [Relationship] – Phone: [Phone Number]

Name: [Name] – Relationship: [Relationship] – Phone: [Phone Number]

8. Emergency / Crisis Plan

If I feel close to using, am in a high-risk situation, or have already slipped and used, I will:

Step 1 – Immediate Safety:

• [Example: Leave any unsafe place, stop driving, and go to a safe location.]

Step 2 – Contact Support:

• [Example: Call or text my sponsor, therapist, or trusted friend.]

Step 3 – Use Emergency Coping Skills:

• [Example: Breathing exercises, grounding techniques, cold water on hands/face, short walk.]

Step 4 – Recovery Action:

• [Example: Attend the next available meeting in person or online, or contact my treatment program.]

Step 5 – Follow-Up:

• [Example: Talk honestly with my sponsor/therapist about what happened and update this plan if needed.]

9. Driving and Legal Safety (If DUI-Related)

To prevent any future impaired driving or legal trouble, I commit to:

• Never driving after consuming alcohol or any impairing substance.

• Using taxis, rideshare, public transportation, or designated drivers when needed.

• Following all license restrictions, ignition interlock rules, and court or probation conditions.

• Discussing transportation plans with my support team when I know I will be in higher-risk situations.

Never driving after consuming alcohol or any impairing substance.

Using taxis, rideshare, public transportation, or designated drivers when needed.

Following all license restrictions, ignition interlock rules, and court or probation conditions.

Discussing transportation plans with my support team when I know I will be in higher-risk situations.

10. Personal Commitments and Affirmation

My personal promises to myself and others about my sobriety and behavior:

• [Commitment 1, e.g., “I will ask for help when I am struggling instead of hiding it.”]

• [Commitment 2, e.g., “I will keep my appointments and meetings, even when I don’t feel like going.”]

• [Commitment 3, e.g., “I will be honest with my support network about slips or close calls.”]

[Commitment 1, e.g., “I will ask for help when I am struggling instead of hiding it.”]

[Commitment 2, e.g., “I will keep my appointments and meetings, even when I don’t feel like going.”]

[Commitment 3, e.g., “I will be honest with my support network about slips or close calls.”]

Personal Sobriety Statement:

“I, [Full Name], commit to following this Relapse Prevention / Sobriety Maintenance Plan to the best of my ability. I understand that setbacks can happen, but I will use this plan and my support network to return to recovery as quickly as possible and to protect myself, my family, and the community.”

11. Signatures

Participant Signature: ___________________________

Printed Name: [Full Name]

Date: [MM/DD/YYYY]

[Optional] Therapist / Counselor / Sponsor Acknowledgment:

I have reviewed this Relapse Prevention / Sobriety Maintenance Plan with [Participant Name].

Signature: ___________________________

Name and Title/Role: [Name, Credentials or Role]

Date: [MM/DD/YYYY]