Planning for High-Risk Situations

You can already feel the night that usually goes wrong: a person, a feeling, or a small decision that makes use more likely. NIDA describes one job of cognitive behavioral therapy as recognizing, avoiding, and coping with the situations in which drug use is most likely. SAMHSA's TIP 35, written for counselors, puts the same job in maintenance: identify the situations and triggers, build a coping plan, and practice the skills. Skills inside treatment, including medication and follow-up, are on the relapse-prevention guide. The work here is naming the situations before you are standing in them.

If you or someone else has already used, open the first-steps guide. A dose the body used to tolerate can be dangerous after time away. Slow breathing, a seizure, or a person who will not wake needs 911, not a planning exercise. For a mental health crisis, call or text 988.

HALT, as one handbook uses it

SAMHSA's Matrix client handbook, written for people in intensive outpatient treatment for stimulant use disorders, includes a handout called HALT. It says the acronym is familiar in 12-step programs. It is a shorthand reminder that people in recovery can be especially vulnerable to a return when they are too hungry, angry, lonely, or tired. SMART Recovery is a separate mutual-help program. How that name differs from a 12-step meeting is on the overview guide. HALT, in the handbook, is a teaching cue. It is not a membership test.

The handbook's four notes are short, and each one already has a fuller page.

Hunger, it says, is common because people often ignore food while using. It says hunger can change body chemistry so that self-control and cravings are harder to manage, and that a person may feel anxious without tying the feeling to a missed meal. Eating regularly, in that account, supports emotional stability. That is one curriculum's explanation. It is not a meal plan. Food, without menus, is on the nutrition guide.

Anger, the same handout says, is probably the most common cause of a return to drug use. That sentence belongs to this stimulant handbook. It is not a national ranking of causes, and it is not a prediction for you. The handbook's advice is to talk about anger-producing situations rather than to act without thinking or to pretend the feeling is absent. Why that work belongs with a clinician, not a home course, is on the anger guide.

Loneliness, it says, is often part of recovery because relationships were lost and because staying abstinent may mean leaving friends who still use. The feelings are real, and they can raise vulnerability. That subject is the loneliness guide. Tiredness, the handbook says, often follows the loss of chemical sleep aids, and exhaustion can be a trigger. Habits, without sedative doses, are on the sleep guide.

The handbook then asks how often these states show up, and what a person could do differently. Those are questions for a group that already has a counselor. They are not a diary you have to finish tonight.

Who, where, and when

TIP 35 tells counselors to identify a high-risk situation as who, where, and when. External triggers are the "what." Internal triggers are thoughts, feelings, and physical cravings that came before use in the past. Clients and counselors then look at coping that has worked before and coping that might work later. The protocol says a written plan might be a few notes, or a longer change plan. It also says the work includes rehearsal. A clinician does that rehearsal. A list of categories has not done it for you.

The same chapter names a trap it calls an apparently irrelevant decision. The example is small on purpose. A person buys a bottle of wine "just in case" a friend comes over, and puts it in a cabinet that had been cleared with a sponsor's help. The decision did not look like use. It set the room up for use. The example is the protocol's, not a rule about your kitchen. The useful idea is that the risky moment is often earlier than the drink or the drug.

The Matrix handbook makes a related point in plainer words. People who maintain abstinence, it says, do it by being smart, not by being strong. If drugs might appear, or if friends are drinking and using, the chance of using is much greater than if you were not in that situation. The handbook tells readers not to count on strength. What a cue is lives on the triggers guide. The therapy that practices avoidance and coping is the CBT guide. Neither one is a dare to see how close you can stand.

Buildup, before the substance

The handbook's relapse section says a return is going back to use and to the behaviors that come with it, and that the behaviors often return first. It describes emotional buildup as feelings that do not go away and keep getting stronger, until they seem unbearable. The feelings it names include boredom, anxiety, irritability, and depression. The important step, it says, is to act when the warning shows, not after use. The actions it lists for a treatment group include calling a counselor or a friend, talking with family, or going to a mutual-help meeting. That list is group material. It is not a ranked protocol you have to complete as homework.

Specific weeks already have their own pages. Seasonal stress is on the holiday guide. Empty time is on the boredom guide. A plan that only says "avoid triggers" has not named a single real hour.

Search FindTreatment.gov if you need a counselor who will build the plan with you. Call or text (800) 653-9376 if you want help asking about that kind of counseling.

Additional Resources

Sources cited on this page:

• SAMHSA: Client's Handbook, Matrix Intensive Outpatient Treatment for People With Stimulant Use Disorders (SMA 15-4154)
• SAMHSA TIP 35, Chapter 7: From Action to Maintenance (NCBI Bookshelf)
• NIDA: Treatment and Recovery
• NIDA: Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition)
• SAMHSA FindTreatment.gov
• 988 Suicide & Crisis Lifeline

Common Questions