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Patient ID: ___Clinic: ___Date: ___ /___ /___Date of last Relapse Prevention Form: ___Since last completing the Relapse Prevention Form, my client has: (If this is a baseline form, please complete
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How to fill out what is a relapse

01
Identify triggers that may lead to a relapse such as stress, negative emotions, or exposure to substances.
02
Develop a plan to cope with triggers effectively such as seeking support from a therapist or attending support groups.
03
Monitor thoughts and feelings regularly to catch early signs of relapse and intervene before it escalates.
04
Engage in healthy activities and hobbies to distract oneself from cravings and maintain a positive mindset.
05
Stay connected with a strong support network of friends, family, or mentors who can provide encouragement and guidance.

Who needs what is a relapse?

01
Individuals who have struggled with addiction and are at risk of experiencing a relapse.
02
Family members or friends of individuals with addiction who want to better understand the warning signs of relapse and provide support.
03
Healthcare professionals such as therapists, counselors, or doctors who work with individuals battling addiction and need to address relapse prevention strategies.
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A relapse is when someone who was previously in recovery from addiction reverts back to using substances.
Typically, individuals or treatment centers involved in the recovery process are required to report a relapse.
Documentation of the relapse, including dates, substances used, and any triggers or circumstances leading to the relapse, should be provided.
The purpose of reporting a relapse is to track progress in recovery, identify contributing factors, and adjust treatment plans if necessary.
Information such as date of relapse, substances used, triggers, and any resulting consequences should be reported.
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