There are many ways to tell whether you or someone you know may be headed for a relapse - that is, start using drugs or alcohol again. This section will help you to examine the thoughts, feelings, and behaviors that appear in a person along the road to relapse. The individual may not have all the signs in the order listed but they will have some of them.

Instructions. Read the following lists of relapse warning signs. Place a check mark next to any that have happened to you. Place a question mark next to any that you do not understand. Underline any words that cause you to have strong thoughts or feelings, make you want to do something.

Phase I: Internal Warning Signs

1. Trouble thinking clearly: Sometimes I cannot understand what is going on. At times, it is hard to think, or I can only think about the same thing over and over. At times I cannot think at all, or when I do, I make mistakes that I usually would not make.
2. Trouble managing feelings and emotions: Sometimes I have mood swings. I go from feeling excited to feeling depressed within a matter of minutes. Sometimes I do not feel anything when I know I should. At times the way I feel does not match up with anything that is happening. At times I feel or act crazy and feel bad later. When these things happen, I try to forget about them.
3. Trouble remembering things: At times, I forget things I have just learned. Sometimes I can remember things from the past and other times I can't, no matter how hard I try. Sometimes when I can't remember, I make mistakes that I feel bad about later.
4. Trouble managing stress: Sometimes I do not know when I am tense until I become really uptight. When I try to relax, it gets worse. Sometimes it gets so bad that I am afraid I might collapse or go crazy.
5. Trouble sleeping: At times, I cannot sleep at night. When I do, I still feel tired the next day. Sometimes I have strange dreams and nightmares, including dreams about using that seem real. Sometimes I get very tired and sleep much longer than usual.
6. Trouble with physical coordination: Sometimes I stagger, have dizzy spells, stumble, or have accidents. At times reading and writing become more difficult.
7. Feelings of shame, guilt, and hopelessness: At times I feel guilty and ashamed. I think something is wrong with me and I am afraid I won't get better. When these things happen, I try to take care of them on my own. I do not tell anyone. No matter how hard I try, things seem to get worse and I begin to think it is hopeless to try.

   Phase II Return of Denial

8. Concern about well-being: Sometimes I worry about my recovery. This worry comes and goes and doesn't seem to last very long.
9. Denial of the concern: In order to deal with these worries, I try not to think about them. Soon I forget what I was worried about. Sometimes even when I try to remember, I can't.

   Phase III: Avoidance and Defensive Behavior

10. Believing "I'll never use again": Sometimes I believe I will never use alcohol or drugs again. Sometimes I tell others, but most of the time I keep this to myself. When I start believing this, I do not feel I have to work as hard to stay clean and sober.
11. Thinking about others instead of myself: When I stop working as hard to stay sober and clean, I find myself blaming other people for my problems. Sometimes I think others should be acting differently, and I criticize them to others or to myself.
12. Defensiveness: when I start thinking this way, I feel as if others do not like what I am doing. I get angry when people try to talk to me and I avoid them. I do not let other people talk, or I do not talk so they won't find out how I feel.
13. Compulsive behaviors: I overdo things and get wrapped up in things so I do not have time to think. I may get over-involved with work, sex, food, exercise, or AA, just so I do not have to think about or feel my problems. This doesn't make my problems go away.
14. Impulsive behavior: I become so stressed out that I do things on the spur of the moment that I feel bad about later.
15. Tendencies toward loneliness: Even though I want to be around people, I make excuses so that I do not have to. I spend more time alone, and do things to avoid thinking and feeling.

    Phase IV: Crisis Building

16. Tunnel vision: I look only at a small part of my life, and ignore everything else. When little things go wrong, I blow up and feel like life is unfair.
17. Minor depression: I start to feel down and depressed. I have less and less energy, and I oversleep. I try not to feel these things by getting busy and not talking about it, but the feelings do not go away.
18. Loss of constructive planning: I stop making plans for my day and react to whatever comes up.
19. Plans begin to fail: My plans are not well thought out or realistic. I begin to have more and more problems. I feel bad about them, but do not know how to solve them.

    Phase V: Immobilization

20. Daydreaming and wishful thinking: I daydream about something that might solve all my problems like winning the lottery or running away to another place.
21. Feeling that nothing can be solved: I begin to feel as if I have failed at recovery. Nothing I do appears to make things better.
22. Unfulfilled wish to be happy: I want things to work out and I want to be happy, but I don't know how to make them better or I'm afraid to try.

    Phase VI: Confusion and Overreaction

23. Periods of confusion: I can't figure anything out. This makes me angry with myself and I become more confused.
24. Easily angered: I become angry with people over little things. I feel angry most of the time and am afraid I might hurt someone. Sometimes I want to hurt others.
25. Irritation with friends: When other people try to talk to me about what is going on, I think they are criticizing me and we have arguments.

    Phase VII: Depression

26. Irregular eating habits: I stop eating regular meals, and eat junk food instead. I either overeat or eat little or nothing.
27. Lack of desire to take action: I feel scared and trapped. It seems impossible to start, let alone finish anything.
28. Irregular sleeping habits: I find it impossible to sleep until I am completely exhausted. When I finally get to sleep, I have bad dreams and may sleep for 12 to 20 hours at a time.
29. Loss of daily structure: I get so stressed and miserable that I cannot make decisions. I miss appointments and meetings. Sometimes I plan on going, but I am running so late that I decide not to go at all.
30. Periods of deep depression: I feel hungry, angry, lonely, and tired. I feel angry with others. They try to help, but I think that nobody really cares.

    Phase VIII Behavioral Loss of Control

31. Irregular attendance at AA/NA and treatment meetings: I stop going to my regular AA or NA meetings. I miss counseling appointments. I begin to feel that there are more important things to do and that the sessions aren't helping anyway.
32. Development of an "I don't care" attitude: I feel like everything is hopeless. I don't want other people to know this, so I act as if I don't care.
33. Open rejection of help: When people try to help me, I blow up and drive them away. I tell others that I do not need their help and avoid anyone who might see how I really feel.
34. Feelings of powerlessness and helplessness: Things appear to be so bad that it seems useless to try to do anything to make them better.

    Phase IX: Recognition of Loss of Control

35. Self-pity: I feel sorry for myself and try to get sympathy and attention from friends or AA/NA and family members.
36. Thoughts of social drinking: I start thinking that maybe I could drink or use drugs and stay in control. I think about how good it would feel to drink or use drugs for just a little while.
37. Conscious lying: I start to lie to others even when I do not need to.
38. Complete loss of self-confidence: I think I am a total failure at recovery and in life. I do not believe that I can change things for the better, no matter what I do.

    Phase X: Option Reduction

39. Deep resentments: I feel angry with the world and feel as if everyone is against me.
40. Discontinue all treatment and AA/NA: I do not attend AA/NA meetings, avoid my sponsor, and have stopped going to counseling or aftercare.
41. Overwhelming loneliness, frustration, anger, and tension: I begin to feel like I am insane and think my only choices are drinking or using drugs, suicide, or insanity.
42. Loss of behavioral control: I have problems in all areas of my life. I cannot control how I act think, or feel.

    Phase XI Return to Use, or Physical/Emotional Collapse

43. Return to "controlled" use: I try to use with control and sometimes I am able to do this for a short period.
44. Shame and guilt: I feel ashamed and guilty for using and believe that if I had done things the right way, this wouldn't have happened to me. I believe I am a bad person because I've started to use again.
45. Loss of control: I begin to use just as much or more than I did before.
46. Life problems: I begin to have severe problems with my spouse/partner, job, friends, health, or the law. I need professional help in order to get better.

    From the Relapse Prevention Workbook for Chemically Dependent Criminal Offenders